Should you eat oily fish or take an Omega 3 supplement for pregnancy?

"About five years ago, a portion of Atlantic salmon of 130g was able to deliver three and a half grams of beneficial Omega 3.  Now, the level of Omega 3 has halved.  Therefore, instead of eating one portion of farmed salmon, we would need to eat two."

Professor Douglas Tocher, Stirling University 

Or you could just take a fish oil supplement.

I love food. I love cooking it, dishing it and serving it. And of course, I love eating it. Perhaps a little too much. But even for me, a self confessed health food junkie and believer in wholesome living for optimal health (I should probably add that I’m a natural healthcare professional too), doubling my intake of oily fish is a bit too much. Sickening in fact. “Waiter, I’ll have the grilled lemon and pepper salmon with charred vegetables, sweet potatoes and salad. Oh, and an extra fillet of salmon. Please.” That’s one way to make my date run a mile (actually not a bad idea - if he can stomach my large appetite he’s definitely the one).

I know I’m not alone. For most of us the mere thought of eating oily fish makes us gag. Never mind actually eating it. The recent National Diet and Nutrition Survey reports that our nation’s children are eating way below the recommended intake of oily fish. Adults too. We just don’t seem to like it anymore. It’s a real shame. In the vast and ever changing world of healthcare, it’s very rare for professionals to agree on one thing. Yet, without doubt, across all disciplines the view on Omega 3 benefits is unanimous. We need it. Our bodies can’t function without it. And there’s only one way to get it. We have to eat it.

Nutrition 101 for dummies   

There are many types of Omega 3. If Omega 3 were an action movie EPA and DHA would be your superheroes. Fighting inflammation, high blood pressure, depression, memory loss and fetal neural defects to restore peace and harmony in our bodies. ALA, on the other hand, found in some nuts, seeds and plant oils, is just the side kick. It doesn’t really do much. At least not until our bodies transform it into the all powerful EPA and DHA; something we don’t do very well. However, oily fish like salmon, sardines, mackerel and anchovies are brilliant at it. That’s why they’re our best sources of Omega 3 EPA and DHA. 

At least that’s what I thought before reading Professor Douglas Tocher’s study on the declining Omega 3 levels in Atlantic Salmon. Farmed salmon is the number one choice of oily fish for approximately half the UK population. Assuming you’re even eating the recommended four portions of fish per week, never mind if it’s oily, it seems likely that you’re still not eating enough Omega 3.

If you ask me, fish oil supplementation seems like the most obvious, realistic and logical solution. All the Omega 3 you need. Cheaper. Purer. Effective. And much less faff than doubling your fish consumption. Assuming it’s good quality, of course.

“Are fish pills a load of old cod?”

Yet, Dr. Michael Mosley, brainchild of the popular 5:2 diet, presenter of ‘Trust me I’m a Doctor’ and my crush of 10 years (don’t judge, we all have our guilty pleasures) has cast doubt on the efficacy of Omega 3 supplementation over eating fish in its wholesome form. In a recent article titled ‘Are fish pills a load of old cod?’ he announced that his show, ‘Trust me I’m a Doctor’, is currently searching for volunteers for a trial that’ll put his skepticism to the test. 

Of course eating plenty of wild, oily fish is king. We all know that. After all, supplementation is, well… exactly that. Something that supplements your nutrient intake, where your diet no longer supports you. But isn’t that precisely the issue with Omega 3? Our diets are not enough.

I’m a realist. Aside from my wild and overstretched fantasy that I’ll one day sing and shake my booty like Beyonce, of course. Nevertheless, my view that supplementing with good quality fish oil is the only realistic solution. These are the cold facts that face us: 

1. We don’t like eating oily fish. Period. Nowhere near the amounts we need for healthy levels of Omega 3. 
2. Good quality and wild fish is expensive. Most households just can’t afford it. 
3. For those who can afford wild fish, there are risks of heavy metal intoxication. For safety reasons, the UK government recommends we limit our intake to four portions per week (two if you’re a child or pregnant). But four portions a week may not be enough. Refer to point 4.
4. Our demands for Omega 3 are a lot higher than 10 years ago because we’re eating far too much Omega 6. In excessive amounts, Omega 6 is like kryptonite to our superheroes EPA and DHA; it prevents absorption. Processed foods, vegetable oils and too much meat has kicked our healthy Omega 3 to 6 ratio from approximately 1:4 to 1:30. We’d have to eat a truck load of fish to bring that down. Never going to happen. Refer to point 1.

My plea for fish oil supplementation

There are over 30,000 clinical trials that prove fish oils work. That’s a lot of trials to ignore and cast doubt over. Where doubt has arisen, it’s likely the result of most fish oil companies selling supplements that are too low in EPA and DHA to get results. They're likely rancid too. There’s no question on the efficacy of good quality fish oil itself. Below are some of the most recent clinically proven benefits and their strengths:

1. The European Food Safety Authority (EFSA) approves the claim that 3000mg of EPA and DHA a day lowers high blood pressure. It works so well that the British National Formulary (BNF), a database of pharmaceutical drugs for doctors, warns against the use of fish oils alongside blood pressure medication.  Otherwise, it’s a bit like taking an overdose.
2. A recent study proved that 4000mg a day of Omega 3 for 6 months reduces adverse remodeling after a heart attack by 5.8%.¹ While 1000mg supports secondary prevention of cardiovascular diseases.² Collectively, these preventative measures are estimated to save 12.9 billion Euros per year across Europe.³
3. Supplementing with 900mg of DHA a day for 24 weeks has been shown to support memory health in healthy older adults with age related cognitive decline.⁴ We need not suffer in old age.
4. The EFSA maintains a positive scientific view that there is a clear cause and effect relationship between taking DHA supplements and normal brain development.  It's essential for pregnant women. 

If, like Dr. Michael Mosley, you’ve taken fish oil tablets in the past and didn’t feel a difference, it’s worth looking at the strength of EPA and DHA you were taking. We know fish oils work. At least ours do. We receive far too many testimonials that prove, at the right strength, fish oils can change your health for the better.

It’ll be interesting to watch the outcome of Dr. Michael Mosley’s experiment on ‘Trust me I’m a Doctor.’ Of course, like with every clinical trial, there are variables to consider that may change the results:

• Will they supplement volunteers with a strength of EPA and DHA that meets the average clinically proven dose to support heart and mental health? The article quoted 450mg. That doesn't even begin to come close.

• How will they guarantee that the amount of Omega 3 in the fish they serve will always be the same? 

• Will the amount of Omega 3 in the fish eating group equal the amount for the supplemented group? It’s only fair that they’re the same.

• Will they have a control group? It’s important that the results from both the supplemented and fish eating groups are compared to the average diet of the population. 

• Will they monitor how much Omega 6 each volunteer is eating and the effects it has on their Omega 3 absorption?

These are just some of the questions I’d love to ask Dr. Mosley and his production team. If by any luck you happen to read this Dr. Mosley, please do get in touch.  We could share our views over a lovely salmon dinner for two (as long as you don’t judge my extra portion).

Disclaimer: Always seek advice from your medical practitioner before introducing any supplement into your diet. It’s important to make sure that what you take is compatible with any other medication or existing medical conditions.

References:

1. Heydari et al. “E ect of omega-3 acid ethyl esters on le ventricular remodeling a er acute myocardial infarction” Circulation. 2016;134:378– 391. DOI: 10.1161/CIRCULATIONAHA.115.019949 


2. Lavie et al. 2009 (review), “Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases“ http://www.ncbi.nlm.nih.gov/pubmed/19660687

3. http://www.foodsupplementseurope.org/value-of-supplementation

4. Yurko-Mauro et al. 2010, “Bene cial e ects of docosahexaenoic acid on cognition in age-related cognitive decline” http://www.ncbi.nlm.nih. gov/pubmed/20434961