Ultimate Omega

Omega-3 is one of the easier supplements to get right, and the real questions are which source and which strength. So here is the triage our naturopaths run at the counter, in the order they run it.

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 are vegan or vegetarian and want ready-made EPA and DHA rather than converting plant ALA
• You want to compare products on the EPA and DHA line, not the milligrams on the front
• You are happy to take it with a meal, which is both the label direction and how it absorbs best
• No seafood allergy, no blood-thinning medicine and no surgery coming up

Check with us first if

• Taking an anticoagulant or antiplatelet medicine. Concentrates carry a mandatory 'seek medical advice' statement, and INR monitoring is advised alongside warfarin.
• Surgery or a dental procedure coming up. Tell the surgeon or dentist, because of the platelet effect.
• Considering a dose near 4 g a day. That is where the atrial fibrillation signal appeared.
• Choosing cod liver oil while pregnant or planning a pregnancy. The vitamin A content is the issue, not the omega-3.
• Diagnosed with a heart rhythm problem, or high triglycerides being managed by a doctor.
• Reflux, burping or aftertaste has put you off before. Form, strength and timing usually fix it.
• Taking any prescription medicine. Check with your doctor, pharmacist or our naturopaths first.

• Standard fish oil capsule (natural triglyceride). Best known for: The everyday baseline; a 1,000 mg capsule typically supplies about 180 mg EPA and 120 mg DHA. Absorption: Natural triglyceride; well absorbed, better with a fatty meal. Typical use: Two to four capsules daily to reach a meaningful EPA plus DHA dose.
• Concentrated fish oil (ethyl ester). Best known for: Fitting a much larger EPA and DHA load into one or two capsules. Absorption: Somewhat lower bioavailability than triglyceride forms, though still effective. Typical use: One or two capsules; carries extra mandatory Australian warnings.
• Re-esterified triglyceride (rTG) fish oil. Best known for: A concentrate converted back to triglyceride form after purification. Absorption: Triglyceride-form bioavailability at concentrate strength; hence the price. Typical use: One capsule daily in premium and practitioner ranges.
• Cod liver oil. Best known for: The traditional source, which also delivers vitamin A and vitamin D. Absorption: Natural triglyceride, but the vitamin A ceiling caps the dose. Typical use: Capsules or liquid; retinol content sets the Australian daily limit.
• Krill oil (Euphausia superba oil). Best known for: Phospholipid-bound omega-3 with astaxanthin, at much smaller volumes. Absorption: Phospholipid carrier; the advantage over fish oil is mixed, not settled. Typical use: One small capsule daily; a crustacean, so out with shellfish allergy.
• Calamari or squid oil. Best known for: Naturally DHA-dominant, from a short-lived species low on the food chain. Absorption: Triglyceride concentrate, comparable to other marine oils. Typical use: Where DHA matters more than EPA; must declare mollusc content.
• Algal oil (Schizochytrium microalgae). Best known for: The only vegan source of ready-made DHA and EPA. Where fish get theirs. Absorption: DHA bioavailability equivalent to that 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 parent form, with no EPA or DHA of its own. Absorption: Readily absorbed as ALA; conversion is the bottleneck, not absorption. Typical use: A useful dietary fat, not a substitute for a marine or algal oil.

Reference values. There is no RDI. The NHMRC sets an Adequate Intake for long-chain omega-3 (EPA plus DPA plus DHA) of 160 mg a day for adult men and 90 mg for adult women, plus a higher Suggested Dietary Target of 610 mg for men and 430 mg for women, aimed at chronic disease risk reduction rather than deficiency.

Typical supplemental range. Australian labels run 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. No NHMRC Upper Level exists. 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. EFSA regards up to about 5 g a day of combined EPA and DHA as safe long term.

Worth knowing. Two or three serves of oily fish a week puts most people near the target without a capsule. Your needs depend on your age, diet and health circumstances. 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

This list is the part of the page we will not shorten. If any of it applies to you, talk to one of our naturopaths or your doctor before starting.

• Fish, shellfish or mollusc allergy. Marine oils are not suitable; algal oil is the plant-source alternative.
• Anticoagulant or antiplatelet medicines. Australian omega-3 concentrate labels carry a mandatory 'seek medical advice' statement; INR monitoring advised with warfarin.
• Pregnancy and lactation. 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 in pregnancy or when planning pregnancy. Vitamin A warnings apply to natural fish oil products making vitamin A or vitamin D claims.
• Planned surgery or dental procedures. Tell the practitioner, because of the platelet effect.
• High doses around 4 g daily. A slight increase in atrial fibrillation was reported in two long-term trials.
• Existing heart rhythm disorders. Discuss with the treating doctor before starting.
• Unusual bruising or bleeding that will not stop. Stop and seek medical advice.
• Palpitations or an irregular heartbeat. Stop and seek medical advice.
• Mild reflux, burping, fishy aftertaste, nausea or loose stools are common and usually dose- or form-related.
• Concentrated omega-3 medicines must be taken with food. This is a mandatory label direction, not a suggestion.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before starting.