Q:  Is there an Optimum Dose of Fish Oil?

Dr. Phelps

PLEASE,PLEASE Take the Time to Read this. I know you are selective in the Q's you answer. 

I only saw two references to Omega 3 out of all the archive Q's. I have read extensively on the subject and all the current clinical trials that are in the works. It appears you are familiar with Dr. Andrew Stolls findings and I am willing to try Omega 3 to see if it will help, however I am very afraid of who to buy from. Of course I know you can't endorse conclusively one brand over another but I noticed you had Kirkland Brand on your Web-site as well as Country-Life. I stumbled across Puritan's Pride and they have gel caps that are 1200 mg in 2 caps. You mentioned that you have recommended or told your patients it is ok to take Omega 3 and I was wondering if you personally have an opinion about what might be to little or too much? Maybe that's not something you can divulge in this forum. I have been through the ringer concerning meds. I have tried combinations of about 30 different kinds over the past 18 years and am still struggling to get stabilized so I am desperate to try something that "COULD" help even if there aren't conclusive and consistent findings related to the Omega 3's. I just am worried about over doing it with the mg's/gm's. I don't even know where to begin.  

Can you please give me any feedback? My daughter was also diagnosed with BP 2 years ago and her Med- managment Doc referred us to you and highly recommended you and said you are really good and responding. I understand that you probably get thousands of emails and Q's but I am hopeful that My email will be one that you respond to.  

Thank you for all your hard work and effort in educating and providing a way to get informed for those of us who live with this and for those who put up with us. I appreciate your valuable time.
 

Sincerely,
Giselle
 

Dear Giselle --

Thanks for your very polite approach in your letter.  Happy to respond.  In this case, that's fairly easy because I have already collected many of the relevant studies (all of the research that I know of, to date) in the table you probably saw on my website.  Obviously, the doses used in these studies vary tremendously. Indeed, the range goes from about 1 g of fish oil to about 10 g.  

Note that several studies used doses in the range of 8-10 g of fish oil.  More recently, investigators have reported concentrations of the two omega-three forms, EPA and DHA. Since most of the patients I treat have some version of bipolar disorder, the study most relevant in this respect was led by Dr. Frangou. Her team compared 1 g of EPA versus 2 g, versus placebo.  1 g was better than placebo, but 2 g was not better than 1 g.  So, I have generally recommended to my patients that when trying this approach, they shoot for 1 g of EPA. 

Unfortunately, unless you spend extra money on a very concentrated form of fish oil, getting that much EPA requires quite a handful of pills per day.  As you saw, using the cheapest version, which so far does not appear to have any disadvantages compared to more expensive versions (except in the words of those who make or can profit from the expensive pills), one must take about seven fish oil capsules per day of the Kirkland brand to reach 1 g of EPA.  "Three with breakfast, 4 with dinner", I tell my patients. 

However, at this point I think it is safe to say that the optimum dose of fish oil has yet to be determined.  Note that these studies are relatively short in duration.  So the safety of taking very large doses of fish oil, for years, has yet to be conclusively established.  Of course, that will take an extremely long time.  Like any other medication, the lowest dose that does the job is probably best.  Figuring that out with fish oil could be very difficult: in my patients, at least, it is difficult to see a clear impact from fish oil.  It may indeed have some effect in the long run, but trying to tell the difference between 1 g of EPA, and 2 g, would likely be tricky.  Good luck figuring it all out.
 

Dr. Phelps