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Review ArticleClinical Review

Practical Applications of Fish Oil (Ω-3 Fatty Acids) in Primary Care

Robert Oh
The Journal of the American Board of Family Practice January 2005, 18 (1) 28-36; DOI: https://doi.org/10.3122/jabfm.18.1.28
Robert Oh
MD
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    Figure 1.

    Arachidonic acid is converted to leukotrienes by the enzyme lipoxygenase (LPO) and to thromboxane A2 and prostaglandins by the enzyme cyclooxygenase (COX). Ω-3 fatty acids, in essence, reduce the breakdown of arachidonic acids.

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    Table 1.

    American Heart Association (AHA) Recommendations for Fish Oil*

    Patient PopulationRecommendations
    Patients WITHOUT documented coronary heart diseaseEat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in α-linolenic acid (flaxseed, canola, and soybean oils; flaxseed and walnuts)
    Patients WITH documented coronary heart diseaseConsume approximately 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA supplements could be considered in consultation with the physician.
    Patients who need to lower triglycerides2–4 g of EPA+DHA per day provided as capsules under a physician’s care.
    • * http://www.americanheart.org/presenter.jhtml?identifier=4632

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    Table 2.

    Clinical Uses and Recommendations

    Clinical UseDosageCommentsStrength of Recommendation
    Secondary prevention of cardiovascular disease1–2 g/dayMay encourage dietary intake, or fish oil supplementationA19,20
    HypertriglyceridemiaInitial 2–4 g; up to 12 gFor doses greater than 3 g, consider monitoring for bleeding side effects, LDL, and glycemic responseA23
    Rheumatoid arthritis2.6–6 g may initiate at 90 mg/kg; maintenance dose 45 mg/kgMay take 8–12 weeks for clinical response; consider tapering NSAIDs; compliance may be an issueA29,30
    Infants (not breast-feeding)0.35% of dietary fat as DHAConsider Ω-3 and Ω-6 enriched infant formulaB42,43
    Women (pregnant and of childbearing age)2 fatty fish meals a week (up to 12 oz)Avoid shark, tile fish, king mackerel, swordfish. Limit albacore tuna to 6 oz per week.C47,48,66
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    Table 3.

    Ω -3 Content in Fish (Cooked, Dry Heat)*

    FishEPA & DHA† (mg per 100 g of edible fish; ∼3–4 oz.)
    Herring‡1700
    Salmon§1600
    Mackerel‖1400
    Flounder500
    Halibut¶500
    Tuna**300
        Bluefin1500
        Canned white900
        Canned light300
    Cod200
    Catfish200
    Haddock200
    • * Approximated to nearest 100 mg (http://www.nal.usda.gov/fnic/foodcomp/index.html).

    • † EPA and DHA; EPA=20:5 Ω-3; DHA=22:6 Ω-3.

    • ‡ Average; Atlantic and Pacific.

    • § Average; Atlantic (wild and farmed), Chinook, pink, coho.

    • ‖ Average; Atlantic, Jack; Pacific, Spanish.

    • ¶ Greenland halibut, 1100 mg.

    • ** Skipjack/yellowfin, 300 mg.

    • View popup
    Table 4.

    Components of Selected Fish Oil Products

    BrandAmount of EPA & DHA (mg per capsule)Cost* ($)Number of capsules/dayWeb Site
    GNC Fish body oil180/1206.003–4http://www.drugstore.com
    Natrol Omega-3 complex180/1206.003–4http://www.drugstore.com
    Twinlab Omega-3234/12515.003http://www.drugstore.com
    Mega Twin EPA†600/24015.001–2http://www.drugstore.com
    OmegaRx†400/20025.002http://www.zonenetonline.com/fishoil_detail.asp?realname=
    Ultimate Omega†350/25026.952https://www.nordicnaturals.com/direct/prodsummary.asp?ID=30
    TriOmega†500 (total)20.002http://www.triomega.com
    Kirkland Fish Oil‡180/1205.003–4http://www.costco.com
    Nature Made Fish Oil‡216/1447.003–4http://www.drugstore.com
    • * 1-month supply, supplying 1 g of EPA/DHA.

    • † Pharmaceutical grade or makes claim regarding manufacturing process.

    • ‡ United States Pharmacopeia-branded.

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The Journal of the American Board of Family Practice: 18 (1)
The Journal of the American Board of Family Practice
Vol. 18, Issue 1
1 Jan 2005
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Practical Applications of Fish Oil (Ω-3 Fatty Acids) in Primary Care
Robert Oh
The Journal of the American Board of Family Practice Jan 2005, 18 (1) 28-36; DOI: 10.3122/jabfm.18.1.28

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Practical Applications of Fish Oil (Ω-3 Fatty Acids) in Primary Care
Robert Oh
The Journal of the American Board of Family Practice Jan 2005, 18 (1) 28-36; DOI: 10.3122/jabfm.18.1.28
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