Introductory primer on how to get more omega-3s in your diet.

Do you know your DHA and EPA from an ALA? And, are you getting enough of these important Omega-3 fatty acids?  Not sure? You are not alone. As many as 95% of Americans do not get enough DHA and EPA. This primer outlines how to get the most benefits from Omega-3 fatty acids that may improve your brain health, reduce your risk of high blood pressure and make certain your cardiovascular system has what it needs to function at its best. It’s all about getting the right types of fats in your diet, whether through food or dietary supplements. 

Omega-3 fatty acids are considered essential fatty acids because they are necessary for human health, but your body cannot produce them. Diet is the only way to provide your brain, tissues and cells with these fats – hence the term essential. 

Though there are as many as 11 types of Omega-3 fatty acids, these three – DHA, EPA and ALA – are the most important and each one has a distinct role in the body. Most Americans get enough ALA (alpha-linolenic acid) fatty acids from nuts and seeds and cooking oils. But if you shy away from these foods, consider adding flax and borage seed oil (an omega-6, and good source of gamma-linolenic oil) to your daily intake of healthy fats or look for a dietary supplement that contains a blend of Omega-3 and Omega-6 essential fatty acids, such as Barlean’s. For the sake of this article, we will focus on DHA and EPA because in American culture, we don’t eat enough fish weekly and that should be a concern for you and your health provider. 

Why are DHA and EPA fatty acids so important?

Omega-3 fats like DHA and EPA are classified as polyunsaturated fats (PUFA). These fats can reduce inflammation, lower the risk of clogged arteries from platelet aggregation, keep cholesterol at the ideal level, slightly lower blood pressure and regulate heart rhythms. Overall, PUFAs maintain a healthy brain, eye and cardiovascular function. To the body, PUFAs are more flexible and fluid than stiff and sticky saturated fats (like those found in processed foods, dairy fats and red meats), thus allowing for better circulation of lipids in the bloodstream, effective cell signaling and improved smooth muscle-cell function in the vascular system. 

Let’s look more closely at their role in the body. Docosahexaenoic acid (DHA) is an omega-3 fatty acid that provides structure for the brain, skin and retina. DHA may lower harmful LDL levels and raise healthy HDL cholesterol levels, as well as maintain healthy blood pressure levels and play a significant role in nervous system function. Its partner fatty acid, eicosapentaenoic acid (EPA), may reduce cellular and neuroinflammation and improve joint health. 

Watch this video to learn more:

How can I get enough DHA and EPA in my diet? 

The primary food source of DHA and EPA are cold-water fatty fish, such as wild bluefin tuna, anchovies, herring, lake trout, mackerel, sardines and wild salmon. These species contain anywhere from 1,000 mg to 1,500 mg of Omega-3 fatty acids per 3-ounce portion (some farmed salmon contain as many Omega-3s as wild, while others are lower, depending on their feed, so they are not always reliable sources). Fish, such as canned tuna, oysters, bass, tilapia and cod contain about half as much DHA and EPA as those listed above (see a complete list here). 

Photo by Dana Tentis from Pexels

While the American Heart Association recommends eating 3-ounces of cold-water fatty fish at least twice per week, we seldom do. This is why many consider supplements, made from fish oil, krill oil and algal oil (a vegetarian source of DHA and EPA), as an easy option. 

Experts recommend taking 250-500mg of fish oil per day if you do not consume enough fatty fish. Your healthcare provider may recommend a higher dose but please do so on their recommendation. 

When selecting a dietary supplement, look for the following: 

  1. Serving size: Many brands differ so be sure you understand whether the dose is one or two capsules or softgels.
  2. DHA and EPA: Your practitioner may recommend a specific DHA and EPA level, so look for a breakout of milligram weight and percentages on the nutrient facts panel. 
  3. Total Omega-3s: Typically, this number will be slightly larger than the total percentage or weight of the DHA and EPA. 
  4. List of ingredients: Make sure you know all the ingredients in the product, such ingredients used to blend the oil and preservatives. You may see ingredients like rosemary and d-alpha tocopherol (Vitamin E), which are antioxidants used to preserve the supplement. 
  5. What about contaminants in fish? All wild fish contain some level of mercury, PCBs (polychlorinated biphenyls), dioxins and other environmental contaminants. Larger predatory fish, such as swordfish and tilefish typically have higher levels of contaminants than say wild salmon or sardines. Dietary supplement companies purify the oil to make sure all the contaminants are removed. If you are looking for the highest quality standards for a product, find out whether the company follows the guidelines set forth by an organization called The Global Organization for EPA and DHA Omega-3s or GOED.  

Is there a test to know if I am getting enough DHA and EPA? 

In recent years, new testing options have become available. However, this is an important question to discuss with your naturopath or healthcare provider. If your physician is not familiar with how and whether to test for DHA and EPA, you can find a list of licensed naturopathic doctors  through the Institute for Natural Medicine here who can help you. 

In summary, here is what you need to know about DHA and EPA: 

  1. 95% of Americans do not get enough DHA and EPA from their diet.
  2. These essential nutrients can be obtained only through diet, which is why eating cold-water fatty fish is important. If this is not possible, please speak with your healthcare provider about whether a dietary supplement is recommended. See a directory of licensed naturopathic doctors who focus on whole-person healthcare here. 
  3. Omega-3 fatty acids are important for maintaining healthy triglycerides and blood pressure, supporting brain health and promoting eye health. 
  4. For mothers-to-be, getting enough Omega-3 fatty acids for both you and your baby is important for brain and eye health. 

For more information, see these helpful tips and FAQs on Omega-3 fatty acids:

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  1. National Institutes of Health, Omega-3 Fatty Acids, Fact Sheet for Health Professionals
  2. The Global Organization for EPA and DHA Omega-3s (GOED). 
  3. Seafood Health Facts, Making Smart Choices
  4. Papanikolaou Y, Brooks J, Reider C, Fulgoni VL, 3rd. U.S. adults are not meeting recommended levels for fish and omega-3 fatty acid intake: results of an analysis using observational data from NHANES 2003-2008. Nutr J 2014;13:31. [PubMed abstract]
  5. Wang C, Harris WS, Chung M, Lichtenstein AH, Balk EM, Kupelnick B, et al. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr 2006;84:5-17. [PubMed abstract]
  6. Manson JE, Cook NR, Lee I-M, Christen W, Bassuk SS, Mora S, et al. Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. N Engl J Med. 2018 Nov 10. doi: 10.1056/NEJMoa1811403. [PubMed abstract]
  7. Trikalinos TA, Lee J, Moorthy D, Yu WW, Lau J, Lichtenstein AH, et al. Effects of eicosapentanoic acid and docosahexanoic acid on mortality across diverse settings: systematic review and meta-analysis of randomized trials and prospective cohorts. Nutritional Resaerch Series vol. 4. In. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012. [PubMed abstract]
  8. Wen YT, Dai JH, Gao Q. Effects of omega-3 fatty acid on major cardiovascular events and mortality in patients with coronary heart disease: a meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2014;24:470-5. [PubMed abstract]
  9. Miller PE, Van Elswyk M, Alexander DD. Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and blood pressure: a meta-analysis of randomized controlled trials. Am J Hypertens 2014;27:885-96. [PubMed abstract]
  10. Casula M, Soranna D, Catapano AL, Corrao G. Long-term effect of high dose omega-3 fatty acid supplementation for secondary prevention of cardiovascular outcomes: A meta-analysis of randomized, placebo-controlled trials [corrected]. Atheroscler Suppl 2013;14:243-51. [PubMed abstract]
  11. Kotwal S, Jun M, Sullivan D, Perkovic V, Neal B. Omega 3 fatty acids and cardiovascular outcomes: systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2012;5:808-18. [PubMed abstract]