$ 300 a month?
It really must have smoked her white starched shorts. Virtually the whole damn country used fish oil supplements, and all the drug companies could do was pout.
All the money that should have been theirs goes into the hands of the quirky supplement manufacturers. Oh the outrage, oh the injustice, oh the really nice cars they could have driven!
It must have been a doer in marketing who came to her rescue: “Why don’t we just make ‘prescription’ fish oil, charge a ton for it, and spend a portion of the obscene profits to denigrate fish oils that aren’t prescription fish oils ? “
When the pharmaceutical company realized the genius when it saw it, it likely abandoned its plans to make prescription plum juice and began making the first prescription omega-3 fatty acid product, Omacor, now known as Lovaza.
Others soon followed. Today doctors have a choice between prescription fish oils: Epanova. The Lovaza mentioned above. Vascepa. Omtryg. Ermahgerd. Okay, not Ermahgerd, but Ermahgerd is a legitimate answer to some of those wild names.
Are you worth it? Are they really that much better, or really better, than high quality over-the-counter fish oil supplements like Flameout®?
The most comprehensive paper on the benefits of prescription omega-3 fatty acids (Hilleman et al. 2020) contains a number of complaints about omega-3 fatty acid supplements. They supposedly have different inconsistencies in content and labeling. The products are of poor quality and filled with impurities except for the gills. And damn it, if the paper doesn’t make a good case.
In truth, many of the allegations described in the newspaper are spot on. There are likely many inconsistencies in the labeling of fish oil supplements, and I can imagine they often have inconsistencies in labeling. Contaminants are likely to be widespread.
It’s no wonder the supplement industry has, dare I say, many villains, almost as many villains as the pharmaceutical industry, albeit without so many regulations to curb its worst instincts.
That being said, many of the non-prescription fish oil supplements on the market are likely made by relatively rogue-free companies, but the only fish oil supplement I can speak for with complete confidence is Biotests Flameout® as I was there early and were familiar with the manufacturing standards, under which it is made.
So let’s take a look at the key arguments made by prescription fish oil advocates that prescription fish oils contain much more omega-3 fatty acids and are much purer than omega-3 supplements, even high-quality ones like Flameout®.
Testimony and Cross Examination – Purity
It is true that prescription omega-3 products contain a higher percentage of essential fatty acids than over-the-counter products.
For example, pharmaceutical grade omega-3 fatty acid products are between 80% and 96% EPA / DHA. Compare this to the 60% DHA / EPA in Flameout® or the average fish oil supplements, which generally contain around 30% EPA / DHA.
The inequality is possible because of the patented cleaning processes used by pharmaceutical companies. For example, Lovaza and Omtryg contain high levels of omega-3 acid ethyl esters, while Vascepa is made from icosapentem ethyl, which allows a product to be made that contains only one of the two hard-hitting omega-3 fatty acids EPA (EPA). what they claim is significantly better for people with high blood triglycerides).
The end result is a product with only a higher percentage of EPA / DHA or EPA, which leaves less “space” in a capsule for other fats or additives.
But this additional space is not a problem, at least when it comes to Flameout®. This extra space is taken up by 1) the addition of CLA, another fatty acid that has a variety of cardiac protective and body compensatory effects, and 2) a few milligrams of isomerized safflower oil, which is certainly not a problem. Even the presumably “pure” pharmaceutical products contain alpha-tocopherol (vitamin E), gelatin, glycerin, sorbitol and purified water.
So yes, the pharmaceutical products contain a little more omega-3 fatty acids than Flameout® and a lot more omega-3 fatty acids than conventional fish oil products. Regardless of this, by taking 4 capsules of Flameout® per day you will get roughly the same amount of omega-3 fatty acids as 4 capsules of Lovaza, as the Flameout® capsules are slightly larger at around a sixth of the price.
Let’s move on to “Purity”. First we have to define it.
Obviously, things like heavy metals and chemicals from industrial runoff would be considered major contaminants. Unlike most over-the-counter fish oil supplements, Flameout® uses a process called molecular distillation to create an amazingly clean fatty acid product.
Take dioxin, a common contaminant in fish oil, for example. The World Health Organization sets the limit for dioxin at a little less than two ppm, but the molecular distillation process used in the manufacture of Flameout® reduces the amount of dioxin to just 0.3 ppm.
Now it is possible that the pharmaceutical products contain a little less dioxin, but the difference is really, really, negligible and also insignificant as it is well below the WHO limit.
In terms of effectiveness and the possibility of contamination, Flameout® and the prescription products are nearly equivalent.
Testimony and Cross Examination – Effectiveness
Okay, this is where it gets weird. As noted nutritionist Mike Roussell a few years ago in an article by T Nation, a large study (Dyerberg, et al. 2010) compared the differences in bioavailability between fish oil supplements and prescription fish oils made as omega-3 ethyl esters such as in Lovaza and Omtryg:
“The researchers found that the bioavailability of the omega-3 ethyl esters was -27% compared to the control fish oil (which basically corresponds to squeezing EPA and DHA from a salmon fillet). However, the difference was not statistically significant omega-3. Esters consistently showed poor results in the various tests. “
Another study cited by Roussell (Neubronner et al. 2011) came to similar results. Subjects who took high quality over-the-counter dietary supplements had a much higher omega-3 blood index at months three and six than those who took ethyl ester supplements.
If that’s the case, what the hell are drug companies beating their chests on?
Maybe it will be nice when a doctor prescribes your fish oil capsules for you. I mean, having a doctor assess your health and blood chemistry while you are on a drug or supplement will probably help.
That being said, I haven’t met a doctor who knows the mechanics behind omega-3s or a supplement, or worse, any aspect of human nutrition. Except maybe scurvy. Most of them know about scurvy.
Diet just isn’t something they spend a lot of time in medical school on. However, it makes sad sense because our entire medical system is based on responding to disease rather than preventing it.
But I digress. If a doctor scripted you for fish oil and you work on a regular basis and their insurance company is willing to pay all or most of the bill, I’d say you should go for it.
However, if you 1) don’t have insurance and want to save a ton of money, 2) don’t want to trust a doctor to determine your daily fatty acid dose, and 3) like the idea that Flameout® also contains CLA – a third fatty acid that yours Has its own healthy superpowers – you should choose Flameout®.
Related: Beyond Fish Oil
Related: The Omega-3 You Missed
- Dyerberg J, Madsen P, Müller JM, Aardestrup I, Schmidt EB. “Bioavailability of Marine N-3 Fatty Acid Formulations”, Prostaglandins, Leukotrienes and Essential Fatty Acids 2010; 83: 137-141.
- Daniel Hilleman, Barbara Wiggins and Michael Bottorff. “Critical Differences Between Diet Supplements and Prescription Omega-3 Fatty Acids: A Narrative Review”, Advances in Therapy, 37, 656-670 (2020).
- Neubronner J., JP Schuchardt, G. Kressel, M. Merkel, C. von Schacky, A. Hahn Nutrition 2011; 65: 247-254.