"I know Omega 3 EFAs are good for you and I want to include them in my regimen.  If I eat fish 2-3 times per week, do I need to take fish oil capsules, too?  Or is that just duplicating efforts?  And, is flax a better source than fish oil?"

Having proper amounts of essential fatty acids, particularly Omega 3s, in our diet can have a significant impact in cardiovascular health, cancer prevention, depression, autoimmune diseases, arthritis and inflammation, brain development, and more.

While I am a huge advocate of obtaining as many nutrients as we can through nutrient dense foods, rather than rely heavily on supplements, I do advise my clients to supplement with Omega 3s, in addition to any dietary fish consumption - for several reasons.

It's very difficult to obtain enough through diet alone

The benefits are so significant, and impact so many areas of our health, that it is one of the top items I advise my clients to include in their standard supplement regimen.  The reason being that there are only 36 foods that provide at least 9% of the daily recommended amount of Omega 3s.

Omega 3s are found in foods such as flaxseed and walnut oils, cold water fatty fish, and marine plankton.  (Grass fed organic beef contains Omega 3 as EPA and DHA as well, though most beef is fed grains, your local health food store may carry this type of beef).

Dietary sources are problematic - for 2 reasons

First, while I'm sure most people would prefer a delicious meal of fresh fish over swallowing a capsule with a glass of water, there are some things to consider. 

The challenge with eating the fish is the concern of it being contaminated with PCBs, dioxins, or heavy metals such as mercury, which is especially a concern for pregnant and lactating women.   There are actually limits placed on how much fish a pregnant woman can safely consume in a week, and it's not nearly enough to experience the incredible benefits of Omega 3s.  (Which is too bad, because Omega 3s are incredibly important to fetal brain development as well as for the mother for a variety of reasons.)

There has also been some concern about this contamination in fish oil supplements as well.  While this is a widespread sentiment, it is not actually supported by data.  In fact, Consumer Labs recently published information on fish oil supplements and of all the ones they tested, they found no detectable levels of mercury or PCBs.   Consumer Reports also found no mercury in any of the supplements that it tested, either.

The likely explanation of this is that the mercury in fish is concentrated in the meat itself, not in the oil.  The other explanation is that the distillation process used by high end manufacturers removes any possible toxins so the result is pure, clean oil.   So it goes without saying that consuming fish 2-3 times per week, while it may contain the omega 3s, it also likely contains varying levels of mercury as well.

We need to improve our ratio of Omega 3s to Omega 6s

Second, it's important to note here that there are also Omega 6 (and lesser known Omega 9) essential fatty acids.  However, we typically get plenty of those from our diet alone and it's important to keep the ratio in balance.  This is important because while Omega 3s reduce inflammation, Omega 6s promote inflammation.  And to put it simply, inflammation is bad.

The figures vary depending on who you ask, but consensus is that the ideal ratio would be anywhere from 1:1 to 1:5 of Omega 3:Omega 6.  It is not unusual for many Americans to have a 1:20 ratio or higher - meaning they are taking in 20 times as much omega 6 as they are 3.  This is why it is extremely rare that people should supplement with 6, and I personally have not suggested that to any of my clients.

This is one of the reasons I prefer fish oil as an Omega 3 source over flax.  Flax contains both Omega 3, and Omega 6.  Even though flax contains more Omega 3 than 6, in my opinion, if you can take in additional 3s without any 6s at all, why not go that route?  Plus, flax is only used by the body if ground up fresh before use, and can go rancid quickly.

Flax's Omega 3 essential fatty acid is called Alpha Linolenic Acid (ALA), which must be converted in the body to the usable forms of Omega 3, EPA and DHA, before a person can benefit.  This process can often be compromised as we age.  Fish oils already contain EPA and DHA, so you can essentially skip the conversion process altogether, and know you are already giving your body the forms of Omega 3s it can use without wondering if you are converting properly.  Plus, only 20% of ALA gets converted to EPA and DHA, so the same amount of EPA and DHA are five times as potent as the same amount of ALA in the body.

In addition to increasing the amount of Omega 3s, you can also improve your ratio by reducing your intake of Omega 6s at the same time.  One way to reduce this ratio is to avoid things rich in Omega 6, such as avoiding sunflower, canola, trans fats, safflower oil, and shortening. 

So how much to take?

Recommended daily amounts needed of Omega 3s vary, and can be much higher if you are using them therapeutically for a specific health condition.  A range I use in my practice is minimum 1.5g daily (to prevent deficiency), 3 grams daily for prevention of chronic disease, and up to 6 grams daily if using it therapeutically for specific health concerns (as with any supplementation, please consult with a qualified practitioner before self-administering any dosage above the standard recommended amount to ensure safety).

The grams I'm referring to relate to the EPA/DHA grams, not the total grams of fish oil contained in the supplement.  The one that I use with my clients contains 2 grams of oil, containing 800mgs EPA and 400 mgs DHA per serving (and people take 2 servings per day).  That means, if you add up the 800mgs and 400mgs, you get 1.2 grams of Omega 3s per serving, not the 2 grams it says of just the oil.  It also contains additional vitamin E to help prevent oxidization. 

When shopping for fish oil, it's important to look at the EPA/DHA content of the fish oil.  I have seen many well-known brands that have many grams of fish oil, but frighteningly low amounts of these nutrients so be sure to take a look. 

On a slight side note here, even high quality fish oils are not among the super expensive supplements out there, so bargain hunting in this arena is not necessary.  For example, the one that I use with my clients costs only $22 per month, and it's the best one I've seen out there.   

Some other things to note about fish oil:

Cod liver oil:

While this is also a source of omega 3s, it's high in vitamins A and D, which can be a concern for toxicity with overuse, so I personally think it's better to use other supplements for your Omega 3s.

Add vitamin E at the same time (200 IUs daily) :

When you increase your intake of Omega 3s, you also want to make sure that you increase your intake of vitamin E as well - in fact, some high quality fish oil supplements already have included extra E in the capsule as well.  This is done to prevent the oxidization of the fats, which can increase free radicals in your body and increase your chances of developing disease.  Foods high in vitamin E include wheat germ oil, sunflower seeds, almonds, red peppers, asparagus, and your dark leafy greens like dandelion, turnip, swiss chard, and beet greens.