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dosage appears to be highly individualized, and if the initial target dosage is not
adequately effective, a gradual titration of the omega-3 fatty acid dosage is often
required to empirically determine the optimal dosage."^55
Writing in Brown et al. II, Mischoulon and Freeman recommend against use of omega-3s
as monotherapy and counsel physician supervision for dosages of over 3g per day.^56
Given the wide disparity in these numbers and the gastrointestinal side effects,
consultation with a health care provider seems prudent before upping the dose above
one to two g. per day of combined EPA and DHA and then doing so slowly, separating
and timing doses with meals.
- FISH OIL ISSUES
High quality fish and fish oil from “wild” fish low on the food chain remains the best
source of omega-3 essential fatty acids. Look for the total amount of EPA and DHA on
the label. It may say 1,000 milligrams of fish oil concentrate per capsule, but the small
print may show only 300 milligrams of EPA and DHA (or simply “omega-3 fatty acids”),
which is the key number. That would mean you need to take three capsules to get about
a gram a day. Some fish oil capsules are more concentrated than others.
There’s no evidence that expensive over-the-counter fish oil brands are better than
store brands—or that special marine oils such as krill, or widely promoted Norwegian or
Icelandic brands, are better.^57 Claims about “molecular distillation” and other special
purification processes are unverified.
Like all over-the-counter supplements, fish oil capsules are unregulated, so you don’t
really know what you are getting. Still, recent tests of dozens of brands found that
nearly all supplements contained the amount of omega-3 fats listed on the labels—with
no significant contamination. The only regulated product is the prescription supplement,
Lovaza, approved by the FDA for treating high triglycerides.
To reduce gastrointestinal problems such as belching, take fish oil capsules with food,
divide the doses among your meals, and start at a low dose and gradually increase it.
Discard fish oil supplements that have a rancid smell or taste.
