TG Omegas (Triglyceride) vs. EE Omegas (Ethyl Ester) - Which Form of Fish Oil is Better?

TG Omegas (Triglyceride) vs. EE Omegas (Ethyl Ester) - Which Form of Fish Oil is Better?

Material from:

http://www.sciencebasedhealth.com/Fish-Oil-EE-vs-TG-omega-3s-which-is-better-W119.aspx

Background: We have been asked whether TG omega-3s are superior and safer than EE omega-3s. The following Q/A address the TG vs. EE issue.

Research suggests TG omega-3 and EE omega-3 fish oil forms are absorbed about the same when taken over several weeks or more. Claims that the TG omega form is better absorbed are highly misleading. While some research measuring absorption over just a single day or less found the TG form to be better absorbed, differences in TG vs. EE disappear in studies that compared these forms over two weeks or more. In fact, the EE omega form has been used in nearly every clinical trial showing benefit of omega-3s from fish oil and is the choice for the National Eye Institute’s AREDS 2 trial now in progress. SBH products include the EE form of fish oil omega-3s and reflect the latest scientific evidence to date.

• What are omega-3 ethyl esters (EE) and triglycerides (TG)?

  
  Triglycerides are composed of 3 fatty acids bound to a glycerol backbone. Unrefined fish oil contains TG omegas with varying amounts of EPA and DHA as the fatty acids attached to glycerol. One limitation of unrefined fish oil is that its low concentration of omega-3 can make it impractical to obtain higher doses. Both the EE and commercially available TG omega forms undergo processing and purification by various methods.
  
  The concentration of omega-3 in fish oil can be increased through ethylation. During this process, the glycerol backbone of triglycerides is removed from EPA and DHA and some of the shorter chain fatty acids are also taken out. The DHA and EPA free fatty acids are than esterified to form ethyl esters.
  
  Another way to increase omega-3 content is to first use ethylation to concentrate DHA and EPA. The resulting ethyl esters are then broken down, and the free fatty acids are reconverted to triglycerides.

• Is one form more stable than the other?

  No. Suppliers of high quality omega-3 fish oil store the oils under nitrogen to prevent light and oxygen exposure. Under these conditions, with controlled temperatures, there is no difference in stability between the EE and TG omega forms. Similarly, both forms are equally stable once the fish oil is encapsulated in hermetically sealed softgels, packaged and stored properly.

• What is the ScienceBased Health position on the EE and TG omega forms?

  
  To date, the available evidence does not indicate any compelling difference between the two forms with consistent intake of supplemental omega-3 fish oil. If this changes, SBH will ensure that the form of omega oils in our products reflect the most current science. The fish oil source of omega-3 fatty acids in ScienceBased Health products.

• SBH suggests 2 small softgels daily of OmegaAdvance for those who want to meet the American Heart Association's recommended intake of approximately 500 mg omega-3s daily. For those who wish to match the level of 1000 mg combined EPA and DHA that is being examined in AREDS-2 clinical trial, 4 softgels twice daily is the required dose.

• Has the EE omega form been shown to be clinically effective?

  Most clinical studies examining supplemental omega-3s for various health parameters have employed the EE omega-3 form, according to omega-3 researcher Dr. Jing Xuan Kang, Associate Professor at Harvard, and as reflected by a recent Mayo Clinic review (1). The well known 'GISSI' secondary prevention trial is one example. In this study of over 11,300 patients who had experienced recent heart attacks, those receiving about 850 mg daily of combined EPA and DHA (in the EE omega-3 form) for 3 ½ years had a reduced risk of death from all causes plus nonfatal heart attack and stroke, as well as significant risk reduction for cardiovascular death, especially sudden death (2,3).
  Also notable: the fish oil being administered in the AREDS-2 trial now underway contains the EE form of omega-3s (4). This trial will test the effects of 1,000 mg of combined EPA (650 mg) and DHA (350 mg) daily in age-related macular degeneration.

• Is the TG omega form better absorbed than the EE form?

  No. Results from comparative studies suggest that absorption of EPA and DHA from TG or from EE — and the biological outcomes over time — are similar when fish oil is routinely supplemented and a steady state has been achieved.
  Human studies comparing absorption of omega-3 fatty acids from the two forms have been somewhat conflicting: Several studies show no difference in absorption (5-8), while others suggest that absorption of ethyl esters may be less efficient (9-11). While these findings seem to diverge, differences in test materials, subjects, analyses and duration make comparisons difficult. In general, however, studies that found lower absorption rates for ethyl esters tended to be of short duration (8-12 hours) and provided omega-3 as a single large dose. In studies where omega-3 fish oil supplementation spanned 2 or more weeks, there were generally no significant differences in absorption.
  Why would there by a difference between short and longer term study findings regarding EE? Omega-3s in the TG form are acted upon by pancreatic lipase enzyme in the gut, while the EE form is hydrolyzed (the fatty acid separated from its ethyl carrier) only when taken up by endothelial cells of the intestinal lining, where long chain omega-3s are "repackaged" into triglycerides for transport into the blood stream. The process of EE hydrolysis may be slower than the action of pancreatic lipase for TGs, which would explain the delayed rise in levels seen in some human studies (12).

• Can the EE form lead to excess free radical formation?

  We have been asked whether fish oil omega-3s in the EE form might pose more of a risk for free radical formation than the TG form if the fatty acids from EE are not fully converted to triglycerides in endothelial cells. First, it has been demonstrated that EE is fully converted to triglycerides.6 Secondly, dosing with EE has shown clear incorporation of omega-3 fatty acids into both triglycerides and plasma phospholipids within a week (13). Finally, the results from a study using high dose omega-3 in the EE form suggest that this premise has little merit. Highly purified EPA and DHA as EE (4 grams daily) led to no significant change in the oxidative status of plasma, indicating no increase in oxidative stress in plasma at these doses (14).

References:

1. Lee JH, O'Keefe JH, Lavie CJ, Marchioli R, Harris WS. Omega-3 fatty acids for cardioprotection. Mayo Clin Proc 83(3):324-32, 2008. 
2. GISSI-Prevenzione . Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction. Lancet 354:447-55, 1999.
3. Breslow JL. N-3 fatty acids and cardiovascular disease. Am J Clin Nutr ;83(6 Suppl):1477S-1482S, 2006.
4. AREDS-2 Investigators Brochure, www.areds2.org
5. Nordoy A, et al. Absorption of the n-3 eicosapentaenoic and docosahexaenoic acids as ethyl esters and triglycerides by humans. Am J Clin Nutr 53:1185-90, 1991.
6. Krokan HE, et al. The enteral bioavailability of eicosapentaenoic acid and docosahexaenoic acid is as good from ethyl esters as from glyceryl esters in spite of lower hydrolytic rates by pancreatic lipase in vitro. Biochimica et Biophsica Aca 1168:59-67, 1993.
7. Hansen JB, Olsen JO, et al. Comparative effects of prolonged intake of highly purified fish oils as ethyl ester or triglyceride on lipids, haemostasis and platelet function in normolipaemic men. Eur J of Clin Nutr 47:497-507, 1993.
8. Reis GJ et al. Effects of two types of fish oil supplements on serum lipids and plasma phospholipid fatty acids in coronary artery disease. Am J Cardiol 66:1171-75, 1990.
9. El Boustani S, et al. Enteral absorption in man of eicosapentaenoic acid in different chemical forms. Lipids 22:711-14, 1987. 
10. Lawson LD and Hughes BG. Human absorption of fish oil fatty acids as triacylglycerols, free fatty acids, or ethyl esters. Biochem Biophys Res Comm, 156:328-35, 1988.
11. Dyerberg G, et al. Bioavailability of n-3 fatty acids. In n-3 Fatty Acids: Prevention and Treatment in Vascular Disease, SD Kristensen, EB Schmidt, R DeCaterina and S Endres, eds. Bi and Gi Publishers, Verona-Springer Verlag, London pp. 217-26, 1995.
12. Ackman RG. The absorption of fish oils and concentrates. Lipids 27:858-62, 1992.Breslow, JL. . Review: n-3 Fatty acids and cardiovascular disease. Am J Clin Nutr 83(s):1477s-82s, 2006.
13. Zuijdgeest van Leeuwen SD, et al. Incorporation and washout of orally administered n-3 fatty acid ethyl esters in different plasma lipid fractions. Br J Nutr 82:481-8, 1999.
14. Hansen JB, Berge RK, et al. Lipid peroxidation of isolated chylomicrons and oxidative status in plasma after intake of highly purified eicosapentaenoic or docosahexaenoic acids. Lipids 33:1129-9, 1998.

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