Omega-3 fatty acids: Frequency vs. quantity

I believe I have been observing an unexpected phenomenon: When it comes to fish oil and omega-3 fatty acids, the frequency of dosing may be as important, perhaps more important, than the actual dose.

First of all, why advocate omega-3 fatty acids from fish oil? There’s a list of lipid/lipoprotein reasons, including reduction of triglycerides and triglyceride-containing particles (VLDL, intermediate-density lipoproteins), reduction of small LDL, and increase in HDL. There’s also solid benefit in reduction of heart attack risk, reduction in death from heart attack, and reduction in stroke. There are also anti-inflammatory benefits and improvements in mood, reduction in depression.

Fish oil is a crucial ingredient in the Track Your Plaque program. I am honestly uncertain of just how much success we would give up if fish oil were NOT a part of the program, but I am unwilling to find out. The data are simply too compelling to not include omega-3 fatty acids from fish oil. Of course, supplementation of omega-3 fatty acids assumes greater importance in a modern world in which your food has become terribly depleted of the omega-3 fraction of oils. (Cultures that rely heavily on fish or wild game probably would not benefit to the same extent, since these foods contain omega-3 fatty acids.)

But I believe I have observed a curious effect over the past year or two. With the proliferation of many different preparations of fish oil that provide seemingly endless choices—low-potency fish oil, high-potency fish oil, paste forms of fish oil like Coromega, liquids such as Carlson’s, etc.¾I’ve observed that frequency of dosing may exert as much of an effect as the dose.

For example, someone might take the basic, low-potency preparation like Sam’s Club that contains 180 mg EPA and 120 mg DHA per capsule, four capsules per day. That yields a total of 1200 mg EPA and DHA per day. This is our minimum dose that provides the basic heart attack-reducing effect, though with modest effect on triglycerides and associated patterns.

Say someone switches to a high-potency preparation of 360 mg EPA and 240 mg DHA, providing a total of 600 mg omega-3 fatty acids per capsule, or twice the dose of the low-potency preparation. Would you expect double the effect?

Curiously, no. What I have observed, however, is that more frequent dosing may provide a larger effect. The least effective dosing is once per day; twice per day is far more effective. Three times per day¾though cumbersome¾provides even greater effect.

So, which is more important: dose or frequency?

I can’t say for certain, since my observations are informal and have not been obtained by a formal statistical analysis of our data. That will come with time.

For the present, suffice it to say that, if you are struggling with suppression of patterns like increased triglycerides, IDL, or low HDL, then at least twice- or three-times-per-day dosing might be worth considering, even before you increase the dose further.

Best: Greater dose, or higher-potency preparation, combined with higher frequency.

Comments (8) -

  • Anonymous

    10/20/2007 5:44:00 PM |

    Dr. Davis, what do you think of Krill Oil as opposed to fish oil as a source of EPA and DHA?

  • Dr. Davis

    10/21/2007 1:01:00 AM |

    Well, the one published study that I've seen was very promising. I have no personal experience, however.

    I'd like to see more data generated before we jump in deeper.

  • BarbaraW

    11/30/2007 3:32:00 AM |

    Dr. Davis,
    What about fish oil supplementation for people who are taking Warfarin? I see on our bottle of fish oil a notice to consult a health care professional if you are on an anticoagulant.  What can you tell us about this?  Thank you.

  • Dr. Davis

    11/30/2007 4:01:00 AM |

    Hi, Barbara-

    Because of the mild platelet-blocking, blood thinning effect of fish oil, you'll find that warning on all preparations. In our patients, we have never seen any meaningful interactions--no bleeding, no strokes, no other adverse consequences of the combination. In fact, in my view, the combination is beneficial.

    However, legal concerns force me to say that you should always consult with your doctor first.

  • Dr. Davis

    11/30/2007 4:02:00 AM |

    Let me add that taking fish oil with warfarin is no more risky than eating salmon or other oily fish every day while on the drug.

  • BarbaraW

    11/30/2007 4:25:00 PM |

    Thank you, Dr. Davis!
    I understand that you are not giving specific advice here, but it is helpful to have your professional perspective on these matters.  From your posts, it certainly sounded like you must have some patients who are on warfarin and taking fish oil, too.

    My husband had a PE (cause undetermined) last January and has been on warfarin since then.  As he was lucky enough to survive the PE, he decided to get serious about improving his health.  I had been nagging him for some time before his near-death experience, to no avail, to try the Protein Power plan. As I've mentioned in other posts, he's lost quite a bit of weight (now 50 lbs) with the low-carb way of eating and is feeling better than he has in years - younger, actually, and he looks it, too!  I've benefited, too, much to my delight.  We can still each lose a few more pounds to be at optimal weights, and we're getting there, slowly but surely. We're never going back to wheat and sugar, that's for sure.

    BTW, I just finished Dr. Malcolm Kendrick's book, The Great Cholesterol Con, and I think it's a great read (I was highly entertained - I enjoy his writing style!) and helpful in understanding heart disease.  Your comments on this book would be a great blog post, although I'm sure you have a long reading list!  

    Thanks again.

  • Dr. Davis

    11/30/2007 5:25:00 PM |

    Hi, Barbara-

    I've not read Dr. Kendrick's book but, based on your comments and those of others, I'm adding it to my list.

    A reader also brought some of his webcasts to my attention:

    Part 1: Cholesterol:
    Part 2: Familial Hypercholesterolaemia:
    Part 3: About Statins:
    Part 4: Stress and the HPA axis (Bjorntorp):
    Part 5: CVD Populations and Stress:

  • buy jeans

    11/3/2010 9:53:31 PM |

    Say someone switches to a high-potency preparation of 360 mg EPA and 240 mg DHA, providing a total of 600 mg omega-3 fatty acids per capsule, or twice the dose of the low-potency preparation. Would you expect double the effect?