Triglycerides vs Ethyl Ester for Omega-3 Supplements (4 min.)

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We lean on Cooper Clinic physicians who help formulate our products based on evidence and trends they see from the thousands of preventive exams they conduct each year, along with medical research. Combining the evidence and recommendations of Cooper Clinic physicians with those of leading omega-3 researchers, including Bill Harris, PhD, we decided to switch to fish oil in the triglyceride form from the previously used ethyl ester form.

Studies Comparing Triglycerides vs Ethyl Ester Fish Oil

The following studies are part of the body of evidence demonstrating that the triglyceride form of fish oil (omega-3 fatty acids) is better absorbed than the ethyl ester form†.

Study 1

At the prescribed dosage, the statistical ranking of the four products in terms of increase in whole blood omega-3 fatty acid levels was:

• Concentrated re-esterified triglyceride (rTG) fish oil*
• Ethyl Ester (EE) fish oil
• Triglyceride (TG) salmon oil
• Phospholipid (PL) krill oil

* (The form chosen for Cooper Complete Advanced Omega-3)

Study design included:

• Randomly assigned
• 28-day period
• Followed by a 4-week washout period
• Blood samples taken before and after supplementation were analyzed for fatty acids.

Results:

Whole blood EPA percentage increase in subjects consuming concentrated rTG fish oil was more than four times that of krill and salmon oil†. Markers associated with cardiovascular health† improved to a greater extent with concentrated rTG fish oil than with any other supplement†. Krill oil and (unconcentrated) triglyceride oil were relatively unsuccessful in this aspect of the study†.

Laidlaw, M., Cockerline, C. A., & Rowe, W. J. (2014). A randomized clinical trial to determine the efficacy of manufacturers’ recommended doses of omega-3 fatty acids from different sources in facilitating cardiovascular disease risk reduction. Lipids in health and disease, 13(1), 99.

Study 2

“The ethyl esters of EPA and DHA have a different absorption rate in the human body than triglyceride forms, but plasma lipid levels appear to be equivalent; however, the triglyceride form can be better utilized in the body†.”

Walker, R., Decker, E. A., & McClements, D. J. (2015). Development of food-grade nanoemulsions and emulsions for delivery of omega-3 fatty acids: opportunities and obstacles in the food industry. Food & Function, 6(1), 41-54.

Study 3

 “Enhanced increase of omega-3 index in response to long-term n-3 fatty acid supplementation from triacylglycerides versus ethyl esters†”

Study design included:

• Double-blinded placebo-controlled trial
• Investigated the response of the Omega-3 Index, the percentage of EPA+DHA in red blood cell membranes, to supplementation with two different omega-3 fatty acid formulations in humans
• 150 volunteers were randomly assigned to one of the three groups:
  1. Fish oil concentrate with EPA+DHA (1.01 g+0.67 g) given as re-esterified triglycerides (rTG group)
  2. Corn oil (placebo group)
  3. Fish oil concentrate with EPA+DHA (1.01 g+0.67 g) given as ethyl ester (EE group)
• Volunteers consumed four gelatin-coated soft capsules daily over a period of six months
• Omega-3 Index was determined at baseline, after three months and at the end of the intervention period

Results:

The Omega-3 Index increased significantly in both groups treated with fish oil from baseline to 3 and 6 months (P<0.001); the Omega-3 Index increased to a greater extent in the re-esterified triglycerides (rTG, also referred to as rTAG in research) group (than in the EE group: 186 versus 161% (P<0.001) after 3 months, and 197 versus 171% (P<0.01) after 6 months†. (Note: The Omega-3 Index is determined in all Cooper Clinic patients.)

Neubronner J, Schuchardt JP, Kressel G, Merkel M, von Schacky C, Hahn A. Enhanced increase of omega-3 index in response to long-term n-3 fatty acid supplementation from triacylglycerides versus ethyl esters. J Clin Nutr. 2011;65(2):247-54.

Using EPA and DHA Supplements to Raise the Omega-3 Index

Knowing an individual’s Omega-3 Index is the only way to accurately determine the level of supplementation needed†.  OmegaQuant, founded by the previously mentioned Bill Harris, PhD, is a lab that specializes in Omega-3 Index testing.  The lab’s research has led to the following advice for increasing an individual’s Omega-3 Index:

“If your Omega-3 Index is between 4 percent and 8 percent, OmegaQuant would recommend you increase your current EPA+DHA intake by 0.5 -1 gram (500-1,000 mg) per day. This can be accomplished in two ways: eating more oily fish and/or taking fish oil supplements†. On the other hand, if it is less than 4 percent, our recommendation is to raise your intake by 1-3 g (1,000 -3,000 mg) per day. Although this can be accomplished by eating more oily fish, fish oil supplements are usually necessary to achieve this level of EPA+DHA intake†.”

Raising your Omega-3 Index can be accomplished by consistently consuming the recommended level of omega-3 over time. The re-esterified triglyceride form in our Advanced Omega-3 provides customers with the ideal form for optimal absorption in comparison to ethyl ester†.

(Bonus: For more information on the omega-3 index, read What a Cardiologist Wants You to Know About Omega-3 for Heart Health.)

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Cooper Complete October 10, 2017