Ultimate Omega 3-6-9

Omega-3 is one of the easier supplements to get right, and the real questions are which source and which strength. These are the questions our naturopaths ask in store, in the order they ask them.

A good fit if

• You eat oily fish less than twice a week and want to close the gap to Australia's dietary target
• You're vegan or vegetarian and want ready-made EPA and DHA rather than relying on plant ALA
• You want to compare products on the EPA and DHA line, not the milligrams on the front
• You're happy to take it with a meal, which is what the label says and how it absorbs best
• You have no seafood allergy, take no blood-thinning medicine and have no surgery coming up

Check with us first if

• You take a blood thinner (an anticoagulant or antiplatelet medicine). Concentrates must carry a "seek medical advice" warning, and INR monitoring is advised if you take warfarin.
• You have surgery or a dental procedure coming up. Tell your surgeon or dentist, because omega-3s affect how your blood clots.
• You're thinking about a dose close to 4 g a day. That's the level where a link with irregular heart rhythm (atrial fibrillation) appeared.
• You're choosing cod liver oil while pregnant or planning a pregnancy. The concern is its vitamin A, not the omega-3.
• You've been diagnosed with a heart rhythm problem, or your doctor is managing high triglycerides.
• Reflux, burping or aftertaste have put you off before. Changing the format, strength or timing usually helps.
• You take any prescription medicine. Check with your doctor, pharmacist or our naturopaths first.

• Standard fish oil capsule (natural triglyceride). Best known for: The everyday starting point. A 1,000 mg capsule usually gives about 180 mg EPA and 120 mg DHA. Absorption: Natural triglyceride form. Well absorbed, and better with a meal that has some fat in it. Typical use: Two to four capsules a day to reach a meaningful dose of EPA plus DHA.
• Concentrated fish oil (ethyl ester). Best known for: Fitting much more EPA and DHA into one or two capsules. Absorption: Absorbed somewhat less well than triglyceride forms, though it still works. Typical use: One or two capsules. It carries extra warnings that are mandatory in Australia.
• Re-esterified triglyceride (rTG) fish oil. Best known for: A concentrate turned back into triglyceride form after purifying. Absorption: Absorbed like the natural triglyceride form, at concentrate strength. Typical use: One capsule a day, in premium and practitioner ranges.
• Cod liver oil. Best known for: The traditional source, which also gives you vitamin A and vitamin D. Absorption: Natural triglyceride, but the vitamin A limit caps how much you can take. Typical use: Capsules or liquid. Its vitamin A (retinol) content sets the Australian daily limit.
• Krill oil (Euphausia superba oil). Best known for: Omega-3 bound to phospholipids, with astaxanthin, in much smaller capsules. Absorption: Carried on phospholipids. Whether that beats fish oil is mixed, not settled. Typical use: One small capsule a day. Krill is a crustacean, so it is not for you if you have a shellfish allergy.
• Calamari or squid oil. Best known for: Naturally rich in DHA, from a short-lived species low on the food chain. Absorption: A triglyceride concentrate, similar to other marine oils. Typical use: For when DHA matters more than EPA. The label must declare that it comes from molluscs.
• Algal oil (Schizochytrium microalgae). Best known for: The only vegan source of ready-made DHA and EPA. It is where fish get theirs. Absorption: Its DHA is absorbed as well as DHA from cooked salmon. Typical use: Capsules, drops or liquid for vegans and anyone avoiding seafood.
• Flaxseed, chia and walnut oils (ALA). Best known for: Plant omega-3 in its starting form, with no EPA or DHA of its own. Absorption: Easily absorbed as ALA. The hold-up is converting it, not absorbing it. Typical use: A useful fat in your diet, but not a replacement for a marine or algal oil.

Reference values. There's no recommended intake. The NHMRC sets an adequate intake for long-chain omega-3s (EPA plus DPA plus DHA) of 160 mg a day for adult men and 90 mg for adult women. It also sets a higher suggested dietary target of 610 mg for men and 430 mg for women, aimed at lowering the risk of chronic disease rather than preventing deficiency.

Typical supplemental range. Australian labels range from roughly 300 mg to 1,500 mg of combined EPA and DHA per daily dose. The number that matters is the EPA and DHA line in the ingredients panel, not the "1000 mg" on the front, which is the weight of the whole oil.

Upper level. The NHMRC hasn't set an upper limit. Australian limits apply to concentrates instead: omega-3-acid ethyl esters 90 is capped at 4,000 mg a day of the ingredient and 3,750 mg of EPA, DHA and DPA combined from all sources, and Calanus finmarchicus oil at 2.3 g a day. The European food safety authority (EFSA) considers up to about 5 g a day of combined EPA and DHA safe long term.

Worth knowing. Two or three serves of oily fish a week brings most people close to the target without a capsule. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Herring, cooked: about 1.7 g EPA plus DHA per 85 g serve
• Atlantic salmon, cooked: about 1.2-1.8 g per 85 g serve
• Sardines, canned: about 1.2 g per 85 g serve
• Mackerel, cooked: about 1.0 g per 85 g serve
• Chia seeds: about 5.1 g ALA per 28 g: no EPA or DHA
• Walnuts: about 2.6 g ALA per 28 g: no EPA or DHA

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• You are allergic to fish, shellfish or molluscs. Marine oils are not suitable. Algal oil is the plant-based alternative.
• You take blood thinners (anticoagulant or antiplatelet medicines). Australian omega-3 concentrate labels must tell you to seek medical advice, and INR monitoring is advised if you take warfarin.
• Pregnancy and breastfeeding. Omega-3-acid ethyl ester concentrates and Calanus finmarchicus oil must be labelled as not recommended.
• Children under 12. Omega-3-acid ethyl ester concentrates must be labelled as not recommended.
• Cod liver oil when you are pregnant or planning a pregnancy. Vitamin A warnings apply to natural fish oil products that make vitamin A or vitamin D claims.
• You have surgery or dental work coming up. Tell your practitioner, because these oils affect your platelets.
• High doses around 4 g a day. Two long-term trials reported a slight increase in atrial fibrillation.
• You already have a heart rhythm disorder. Talk to your doctor before you start.
• Unusual bruising, or bleeding that will not stop. Stop taking it and get medical advice.
• Palpitations or an irregular heartbeat. Stop taking it and get medical advice.
• Mild reflux, burping, a fishy aftertaste, nausea or loose stools are common, and usually come down to the dose or form.
• Concentrated omega-3 medicines must be taken with food. This is a required label direction, not a suggestion.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.