It seems each passing year adds another new chapter in the story of the fish oil phenomenon. The keen interest in the heart-healthy effects of fish oil began in earnest shortly after publication of the Italian GISSI Prevenzione Trial involving over 11,000 participants. It demonstrated that doses in the range of 1000mg of EPA and DHA provided an enormous 30% reduction in death from cardiovascular disease and a 45% reduction in sudden cardiac death. (EPA and DHA are the active ingredients in fish oil. Don't confuse the active ingredient dose with the total weight of a fish oil capsule as it generally contains fillers). The large number of participants in the GISSI study made their conclusions statistically rock solid and beyond reproach. Other follow-up studies confirmed the result and some showed even greater benefit as fish oil dose increased. Fish oil was on its way to becoming the next "wonder" supplement.
Of course, I take fish oil to fight cardiovascular disease as do many others concerned about heart health and started with a modest dose totaling 1800mg EPA/DHA per day. That changed when another landmark study, the Lugalawa Study, suggested that high-dose fish oil was also effective at reducing Lipoprotein(a) [Lp(a)] which just happens to be my most pronounced heart disease risk. The study compared the Lp(a) levels of coastal Bantu fishermen, who ingest 3000-5000mg EPA/DHA per day from fish, to an inland Bantu group who are primarily vegetarian. The fish eaters showed an almost 50% lower Lp(a) compared to the pure vegetarians. Sure enough, when I upped my fish oil dose to 5400mg EPA/DHA per day (which requires me to pound down six "horse-pill" sized, triple-strength fish oil capsules every day) I also saw an approximately 50% decrease in my Lp(a). Wow! My appreciation for fish oil grew even stronger.
But, it now appears there is even more to the story. Not surprisingly, additional studies have shed new light how to assess our intake of fish oil as part of our personal programs of Informed, Self-directed Healthcare (ISH). Like Vitamin D, it turns out that what you take might not be as important as what actually gets into your bloodstream. I need to take at least 8000IU to maintain a Vitamin D blood level of at least 60ng/dL. I know many others who need only half that amount. I started my dosing at 2000IU and increased my dose in 2000IU increments until my blood level tested at 62ng/dL at a final dose of 8000IU (note that I have to raise this to 10,000IU in the winter time to account for reduced sun exposure). For those who cannot convince their doctors to order the 25-OH Vitamin D3 test it has been available as a home blood spot test for quite some time now from numerous sources.
A new study from the Metabolism and Nutrition Research Center at the Sanford School of Medicine shows that the greatest benefits may require an omega-3 index of 8% (the omega-3 index is the proportion of total fatty acids in red blood cells occupied by omega-3s). Those wishing to review this study will also find that the omega-3 index offered the most powerful correlation for reducing sudden cardiac death among common risk factors such as cholesterol and CRP. Much like Vitamin D, the key may be to assess what your personal omega-3 blood level is as opposed to simply how much you ingest orally. Predictably, your doctor is very likely to be behind the knowledge curve and may resist ordering the test or not even know it exists. Not to worry, there are already a few outlets offering an at-home omega-3 index blood test for those who wish to personally investigate this novel marker. I already have mine ordered! I'll let you know what I find.