Fatty acids: Uses, common brands, and safety info

Fatty acids have generated tremendous enthusiasm over the past 10 years due to their possible health benefits. From promoting brain development in infants to preventing heart attacks in adults, the potential health windfall from these dietary fats has garnered due attention. The result has been a plethora of fatty acid dietary supplement pills, such as fish oil, coming to market, followed by a couple of prescription options. However, the jury is still out on how helpful these supplements and treatments really are. There are several types of fatty acids—trans fat, saturated fat, unsaturated fat, and polyunsaturated fatty acids (PUFA)—however, PUFAs like omega-3s are the ones used therapeutically for medicinal purposes. Use this guide to review some available fatty acid options, how they work, their cost, and their side effects.

What are fatty acids?

Fatty acids derive from our intake of both plants and animals, and there are healthy and unhealthy varieties. Small differences in the chemical structure of fatty acids can account for a major discrepancy in healthfulness. While all of the details of these differences are still being fully elucidated, we do know some generalities.

Types of fatty acids

Trans fat

Trans fatty acids seem to contribute to elevations in bad cholesterol (low-density lipoprotein or LDL) and higher rates of heart disease. The natural trans fats in dairy and meat products do not seem to be the big troublemakers but rather partially hydrogenated fats found in industrialized foods, such as commercial baked goods.

Saturated fat

While also contributory to high LDL cholesterol levels, saturated fats are another example of how the source matters. This group of fatty acids has more adverse health effects if sourced from processed red meats but has a mix of advantages and disadvantages if we get them from unprocessed red meat and dairy products. In general, saturated fat intake is best limited to moderate amounts and replaced largely with unsaturated fats.

Unsaturated fat

Unsaturated fatty acids have gotten the most press for promoting health. There are mono- and polyunsaturated versions of these nutrients. While red meat and dairy do have monounsaturated fatty acids, these foods also have an equal amount of less healthy saturated fat. On the contrary, olive oil, avocados, tree nuts, and canola oil have higher concentrations of monounsaturated fatty acids, thereby making them a healthier choice. 

Polyunsaturated fatty acids

The stars of the unsaturated group are the polyunsaturated fatty acids (PUFA), consisting of omega-3 and omega-6 fatty acids. These fatty acids are the ones used therapeutically for medicinal value. Linoleic acid (omega-6) and alpha-linolenic acid or ALA (omega-3) are essential fatty acids, meaning that our bodies need them but cannot make them. Omega-3 and omega-6 varieties are found in vegetable oil, flaxseed oil, and plant sources like nuts, seeds, and soybeans. 

The omega-3 types of most interest are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are found in abundance in seafood and certain nuts and seeds, like walnuts, flaxseed, and soybean oil. Although both families of polyunsaturated fats are thought to reduce cardiovascular disease risk, the most abundant evidence is behind EPA and DHA. The American Heart Association recommends eating fish twice a week.

How do omega-3 fatty acids work?

The heart benefit from PUFA is thought to relate to the cholesterol changes that they induce. Greater consumption of omega-3 fatty acids from marine sources is associated with increased levels of good cholesterol (high-density lipoprotein or HDL) and LDL, and decreased triglyceride (a type of harmful fat). As a result, they may offer some protection against heart disease. Protective effects may also come from small reductions in blood pressure and heart rate.

PUFA has also been postulated to have neurologic benefits. In infants, there are investigations into their importance in the developing brain. Interest has also been generated into whether they have a protective effect against dementia. These fatty acids are incorporated into the phospholipids of nervous system cell membranes, which may lead to better function. At this time, these benefits have not been proven.

Omega-3 fish oil supplements have also been taken by individuals hoping to get relief from arthritis. This use is likely based on fatty acid effects on the inflammation pathways of the body. Studies have not consistently supported this usage thus far.

RELATED: How to lower cholesterol

What are omega-3 fatty acids used for?

• Reduction in triglycerides

• Prevention of heart disease (not an approved use by the Food and Drug Administration)

• Fortification of some varieties of infant formula

Types of omega-3 fatty acids

Omega-3 fatty acid ethyl esters (Lovaza and generic supplements)

Over-the-counter fish oil supplements contain omega-3 fatty acids but often at a variable and relatively low percent of the total capsule. A one-gram capsule may only be 60% omega-3 fatty acids (DHA and EPA). For fish oil supplements, the fatty acids are in their ethyl ester form, and for krill oil supplements, the same types of fatty acids are in their phospholipid and free fatty acid forms. There is no conclusive benefit of one over the other. Prescription Lovaza boasts a standardized, higher percentage of PUFA per capsule, with DHA and EPA comprising over 80% of the capsule.

Icosapent ester (Vascepa)

Prescription Vascepa contains EPA. This lone PUFA comprises over 80% of a Vascepa capsule.

RELATED: Vascepa vs. Lovaza

Who can take omega-3 fatty acids?

Adults can take omega-3 fatty acid supplements and prescriptions. While supplementation has been done in children, proper dosing has not been established.

Are omega-3 fatty acids safe?

Restrictions

• Avoid if allergic to omega-3 fatty acids or other pill components

• Consider avoiding if allergic to fish

• Patients with liver problems, bleeding problems, or atrial fibrillation should consult a healthcare professional

Can you take omega-3 fatty acids while pregnant or breastfeeding?

These fatty acids can be taken while pregnant or breastfeeding and may even be beneficial, but neither the evidence nor proper dosing is well-established. Women should talk to their healthcare providers about the benefits and risk factors of any supplement during pregnancy or while breastfeeding.

Are omega-3 fatty acids controlled substances?

No, omega-3 fatty acids are not controlled substances.

Common omega-3 fatty acids side effects

• Bad taste. This is primarily a problem for the over-the-counter products, which can taste fishy, but freezing the capsules can help reduce the problem.

• Belching, stomach pain, constipation, nausea, or vomiting

• Skin rash, hives, or itching

• Liver enzyme elevation

• Atrial fibrillation or flutter (heart arrhythmias)

• Increased bleeding potential, although this is more so with higher than typical dosing

How much do omega-3 fatty acids cost?

As a nutritional supplement, omega-3 fatty acids can be quite affordable. The prescription versions offer more purity, better standardization, and less fishy taste. These advantages come at a cost though, with Lovaza and Vascepa oftentimes costing over $200 for a one-month supply. To save money, pharmacy customers can ask for a generic version and use a SingleCare discount card.