Carusos Triple Strength Fish Oil

Fish oil is easy to get wrong on strength, and easy to get right once you know where to look. These are the questions our naturopaths ask in store.

A good fit if

• You eat oily fish less than twice a week and want to top up with a capsule
• You're happy to take it with a meal, which is what the label says and how it absorbs best
• You want to compare brands properly using the EPA and DHA amounts
• The aftertaste has put you off before and you're open to a liquid or coated capsule
• 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 (anticoagulant or antiplatelet medicine). Concentrated omega-3 products must carry a 'seek medical advice' warning, and INR monitoring is advised if you take warfarin.
• You have surgery, a dental procedure or a colonoscopy coming up. Let your practitioner know, because fish oil can affect how your blood clots.
• You're considering close to 4 g a day of EPA plus DHA. Two long-term trials found a slight increase in an irregular heart rhythm (atrial fibrillation) at that level.
• You have reflux, gastritis or a hiatus hernia. Fish oil can make reflux worse, though changing the format, timing or splitting the dose usually helps.
• You're choosing a cod liver oil while pregnant or planning a pregnancy. The concern is its vitamin A, not the omega-3.
• You're buying for a child. Children's products are made and labelled separately, and adult concentrates aren't just a smaller version.
• You've been diagnosed with a heart rhythm problem, or your doctor is managing your triglycerides.
• You take any prescription medicine. Check with your doctor, pharmacist or our naturopaths first.

• Standard strength capsule (1,000 mg oil). Best known for: The most common fish oil product on Australian shelves. Absorption: Natural triglyceride form; take it with a meal that contains some fat. Typical use: Three to four capsules a day to reach about a gram of EPA plus DHA.
• High or 'double' strength capsule. Best known for: Halving the number of capsules without moving to a pharmaceutical-grade concentrate. Absorption: Usually natural or re-esterified triglyceride; the label says which. Typical use: One to two capsules a day.
• Triple strength 'one-a-day' concentrate. Best known for: A full daily dose in a single softgel, if you won't swallow three. Absorption: Often ethyl ester; check whether the panel says triglyceride, which is absorbed better. Typical use: One capsule with your main meal.
• Flavoured liquid oil. Best known for: A measured spoonful instead of capsules, and the easiest option for anyone who can't swallow softgels. Absorption: The same oil with no capsule shell, so you can judge freshness by taste. Typical use: Keep it in the fridge after opening, and finish it within the stated time.
• Enteric-coated or 'odourless' capsule. Best known for: Made to open past the stomach so you don't taste the oil again. Absorption: The coating delays release rather than reducing how much is absorbed. Typical use: If you gave up fish oil because of reflux or aftertaste.
• Children's liquid, chewable or gummy. Best known for: Small sweetened doses for kids, often with added vitamin D. Absorption: The same oil at a fraction of the dose. Typical use: Follow the age bands on the label; adult concentrates carry different warnings.

Reference values. There's no recommended intake for fish oil itself. The NHMRC sets figures for the omega-3s EPA, DPA and DHA, and you'll find them on our omega-3 page. A fish oil label shows the amount of oil, with the EPA and DHA listed separately in the panel.

Typical supplemental range. Australian fish oil labels are built around the capsule, not the dose. A standard 1,000 mg capsule has about 300 mg of EPA plus DHA, so the daily dose is usually two to four capsules. A triple-strength one-a-day has three times that in a single capsule. To compare brands, multiply the EPA and DHA amounts by the number of capsules in the daily dose and add them together. That one number is what matters.

Upper level. There's no NHMRC upper limit for fish oil. Australia's limits apply to the vitamins A and D that natural fish oil carries, not to its omega-3. The rules for natural fish oil (item 3465) cap the daily dose at 3000 micrograms of retinol equivalents (vitamin A) and 25 micrograms of vitamin D. Concentrated omega-3 oils have their own limits, covered on our omega-3 page.

Worth knowing. Fish oil is a fat from food and behaves like one, so take it with meals. If it repeats on you or causes reflux, splitting the daily amount across two meals usually helps. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Rainbow trout, wild, cooked, 85 g: about 0.84 g EPA plus DHA: about three standard capsules
• Sea bass, cooked, 85 g: about 0.65 g, most of it DHA
• Oysters, eastern, wild, cooked, 85 g: about 0.53 g EPA plus DHA
• Prawns, cooked, 85 g: about 0.24 g EPA plus DHA
• Tuna, light, canned in water, drained, 85 g: about 0.19 g: a much weaker source than people assume
• Cod, Pacific, cooked, 85 g: about 0.14 g: white fish stores oil in the liver, hence cod liver oil

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

• You have a fish or shellfish allergy. It isn't suitable; algal oil is the plant-source alternative.
• You take an anticoagulant or antiplatelet medicine. Concentrate labels must carry a 'seek medical advice' statement, and INR monitoring is advised with warfarin.
• You're pregnant or breastfeeding. Omega-3-acid ethyl ester concentrates must be labelled not recommended.
• Children under 12. Those concentrates must be labelled not recommended; use children's products instead.
• You take cod liver or another natural fish oil that claims vitamin A or D. Vitamin A warnings and a 3,000 microgram retinol equivalent limit apply.
• You have surgery, dental work or an endoscopy planned. Tell your practitioner, because of the effect on platelets.
• You'd take close to 4 g a day of EPA plus DHA. Two long-term trials found a slight increase in atrial fibrillation.
• You have a heart rhythm disorder. Talk to your treating doctor first.
• You have reflux, gastritis or a hiatus hernia. Fish oil can make reflux worse.
• You notice unusual bruising or bleeding that won't stop. Stop taking it and get medical advice.
• You notice palpitations or an irregular heartbeat. Stop taking it and get medical advice.
• It smells or tastes rancid, or a liquid has been kept past its use-by-after-opening period. Throw it out.
• Unpleasant taste, bad breath, heartburn, nausea and loose stools are common, mild and usually depend on the dose.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths first.