Essential fats

Cod liver oil

Description	Cod liver oil is obtained from the liver of the cod. Cod liver oil and other fish liver oils are rich sources of vitamins A & D; they are also rich sources of the omega-3 essential fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
Function/ Used for	EPA and DHA are found in every cell membrane in the body and have a wide range of functions. Their health benefits include¹: Reducing triglyceride levels in the blood Heart health Supporting brain function Reducing blood pressure Maintaining eye health EPA and DHA also inhibit the production of inflammatory chemicals in the body and have an anti-inflammatory effect in their own right. Fish body oils and fish liver oils are widely used in the management of inflammatory joint conditions². EPA may also help to discourage the formation of blood clots and help assist the blood to flow freely around the arteries, maintaining the circulation. EPA may also help maintain a healthy heart. DHA is important in infant development, particularly in prematurely born infants. It is believed to be necessary to early eye and brain development. DHA is also thought to support brain development throughout childhood. Omega 3 fatty acids also help maintain suppleness.
Intake	The European Food Safety Authority³ makes recommendations for EPA and DHA intake, substances which are found in fish oils: · 250mg of EPA/DHA per day for adults and children over the age of 2. · 100mg DHA per day for infants and young children aged 7-24 months. · 100-200mg DHA per day in addition to general adult requirements for pregnant and lactating women from fish body oils (fish liver oils should be avoided. See ‘use in pregnancy and breastfeeding’).
As a supplement	Cod liver oil and other fish oil supplements are available as capsules and liquids. Food supplements generally provide 100–1500 mg combined EPA/DHA per dose. The dose is not established but doses of 1-3g daily may be adequate.
Found in (dietary sources)	Cod liver oil is obtained from the liver of the cod.
Deficiency	N/A
Precautions and contraindications	Patients with blood clotting disorders or those taking anticoagulants such as warfarin should be monitored while taking cod liver oil or other fish oils.⁴
Use in pregnancy and breastfeeding	Cod liver oil or other fish liver oil supplements should not be taken by women who are pregnant or planning a pregnancy because high amounts of vitamin A may be present. Fish body oils do not contain vitamin A and are safe to consume up to 3 grams a day.⁴
Interactions e.g. with other medications	Taking cod liver oil or other fish oils with anticoagulants (such as warfarin), aspirin, dipyridamole (a vasodilator), ginkgo biloba or ginseng, may increase the risk of bleeding. Medical supervision in these cases is required.⁴
Adverse effects	Fish liver oils contain vitamins A and D , fat soluble vitamins that can be toxic when consumed in excessive amounts.⁴ Reflux or “burping up” of fish oil may occur in some individuals. Take with food to avoid this occurring.
References	¹EU Community Register of Nutrition and Health Claims http://ec.europa.eu/food/safety/labelling_nutrition/claims/register/public/?event=register.home ² Natural Medicines Comprehensive Database, via the National Library of Medicines National Institutes of Health ³EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Journal 2010; 8(3):1461. [online] Available at: http://www.efsa.europa.eu/en/efsajournal/pub/1461.htm [Accessed February 2017]. ⁴ Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

Page content last reviewed: March 16, 2017

Docosahexaenoic acid (DHA)

Description	Docosahexaenoic acid (DHA) is a long-chain omega-3 polyunsaturated fatty acid (PUFA); it has 22 carbons in its chain compared to the 18 carbons of alpha-linolenic acid (ALA), its precursor omega-3 fatty acid. Eicosapentaenoic acid (EPA) is the other important long-chain omega-3. Although DHA can be formed in the body through the conversion of ALA, the conversion rate is very limited meaning that we must have a source in our diet to obtain appropriate amounts.
Function/ Used for	DHA has many functions in the body including as a significant component of phospholipid cell membranes in cells found throughout the body; DHA is especially concentrated in cells in the retina, brain and sperm. DHA provides a rich source of energy and is also used to form eicosanoids – signalling molecules used within the cardiovascular, pulmonary, immune and endocrine systems. Eicosanoids formed from omega-3s such as EPA are generally more anti-inflammatory than those formed from omega-6s, meaning they could have an anti-inflammatory effect in the body if consumed in greater amounts. DHA is needed for maintaining good heart health by contributing to normal heart function and supporting normal blood pressure and blood triglycerides levels1. DHA is important in infant development, particularly in prematurely born infants1. It is believed to be necessary to early eye and brain development in the foetus and breastfed babies. DHA is also thought to support brain development throughout childhood and to support normal brain function and vision throughout life.These beneficial effects are obtained with a daily intake of1: • 3g EPA + DHA for normal blood pressure; • 2g EPA + DHA for blood triglyceride levels; • 250mg EPA + DHA for normal heart function; • 250mg DHA for brain function and vision and • 200mg DHA plus 250mg EPA + DHA for development of brain and eye in the foetus and breastfed babies.
Intake	The European Food Safety Authority makes recommendations for combined EPA and DHA intake2: • 250mg of EPA/DHA per day for adults and children over the age of 2; • 100mg DHA per day for infants and young children aged 7-24 months; • 100-200mg DHA per day in addition to general adult requirements for pregnant and lactating women from sources such as fish body oils (fish liver oils should be avoided -see ‘use in pregnancy and breastfeeding’).In the UK long-chain omega-3 fatty acid intake has been recommended to increase from 200mg per day to 450g per day; equating to one portion of white and one portion of oily fish per week3.UK average daily intake: Average intake of omega-3 fatty acids as a percentage of dietary energy increases with age from 0.8% for 4–10-year-olds up to 1% in adults (19-64 years of age)3.
As a supplement	There are currently no UK recommendations for omega-3 supplements and recommendations are to get it from food. However, common supplements providing DHA (and EPA) include cod liver oil and fish oil supplements available as capsules and liquids. It’s also possible to get vegan long-chain omega-3 supplements made from algae oil. The British Dietetic Association (BDA) advises taking a supplement providing the recommendation for EPA+DHA of 450mg/day⁴. Some supplements provide doses much greater than this. Supplements made from fish liver oils also contain other nutrients such as vitamin A so it advised to check how much it’s providing if you’re also taking a vitamin A supplement. The SACN advises that you should have no more than 1500ug of vitamin A from food and supplements combined⁵. Also see ‘use in pregnancy and breastfeeding’. People should always check the label for information about a specific product.
Found in (dietary sources)	Good sources of DHA include oily fish (e.g. salmon, mackerel, trout), fish body and fish liver oil, white fish (e.g. cod, haddock, pollock), algae oil, eggs (particularly from chickens fed an omega-3 enriched diet).
Deficiency	A deficiency of omega-3s can cause rough, scaly skin and a red, swollen, itchy rash; however obvious symptoms of deficiency such as this are rare in the UK2.
Precautions and contraindications	Patients with blood clotting disorders or those taking anticoagulants such as warfarin should be monitored while taking cod liver oil or other fish oils6.
Use in pregnancy and breastfeeding	Cod liver oil or other fish liver oil supplements should not be taken by women who are pregnant or planning a pregnancy because high amounts of vitamin A may be present. Women who are pregnant or breastfeeding, or likely to become pregnant, and girls who may become pregnant in the future, can safely have up to two portions of oily fish a week.
Interactions e.g. with other medications	Taking cod liver oil or other fish oils with anticoagulants (such as warfarin), aspirin, dipyridamole (a vasodilator), ginkgo biloba or ginseng, may increase the risk of bleeding. Medical supervision in these cases is required6.
Adverse effects	When consumed in amounts consistent with dietary intake DHA is likely very safe. Fish liver oils contain vitamins A and D, fat soluble vitamins that can be toxic when consumed in excessive amounts6. Reflux or “burping up” of fish oil may occur in some individuals. Take with food to avoid this occurring.
References	1 EU Community Register of Nutrition and Health Claims 2 EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Journal 2010; 8(3):1461. 3 SACN; Saturated fats and health (2019) 4 British Dietetic Association (BDA); Omega-3: Food Fact Sheet 5 SACN; Advice on Fish Consumption: Benefits and Risk (2004) 6 Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001.

Page content last reviewed: March 29, 2022

Eicosapentaenoic acid (EPA)

Description	Eicosapentaenoic acid (EPA) is a long-chain omega-3 polyunsaturated fatty acid (PUFA); it has 20 carbons in its chain compared to the 18 carbons of alpha-linolenic acid (ALA), its precursor omega-3 fatty acid. Docosahexaenoic acid (DHA) is the other important long-chain omega-3. Although EPA can be formed in the body through the conversion of ALA, the conversion rate is very limited meaning that we must have a source in our diet to obtain appropriate amounts.
Function/ Used for	EPA has many functions in the body including as a significant component of phospholipid cell membranes in cells throughout the body and providing a rich source of energy. It is also used to form eicosanoids – signalling molecules used within the cardiovascular, pulmonary, immune and endocrine systems. Eicosanoids formed from omega-3s such as EPA are generally more anti-inflammatory than those formed from omega-6s, meaning they could have an anti-inflammatory effect in the body if consumed in greater amounts. EPA is considered to be especially important for our heart health by contributing to the normal function of the heart and to normal blood pressure and blood triglyceride levels¹. These beneficial effects are obtained with a daily intake of¹: 3g EPA + DHA for normal blood pressure; 2g EPA + DHA for blood triglyceride levels and 250mg EPA + DHA for normal heart function.
Intake	The European Food Safety Authority makes recommendations for combined EPA and DHA intake²: 250mg of EPA/DHA per day for adults and children over the age of 2; 100mg DHA per day for infants and young children aged 7-24 months. In the UK long-chain omega-3 fatty acid intake has been recommended to increase from 200mg per day to 450g per day; equating to one portion of white and one portion of oily fish per week³. UK average daily intake: Average intake of omega-3 fatty acids as a percentage of dietary energy increases with age from 0.8% for 4–10-year-olds up to 1% in adults (19-64 years of age)³.
As a supplement	There are currently no UK recommendations for omega-3 supplements and recommendations are to get it from food. However, common supplements providing EPA (and DHA) include cod liver oil and fish oil supplements available as capsules and liquids. It’s also possible to get vegan long-chain omega-3 supplements made from algae oil. The British Dietetic Association (BDA) advises to find a supplement providing the recommendation for EPA+DHA of 450mg/day⁴. Some supplements provide doses much greater than this. Supplements made from fish liver oils also contain other nutrients such as vitamin A so it’s advised to check how much it’s providing if you’re also taking a vitamin A supplement. The SACN advises that you should have no more than 1500ug of vitamin A from food and supplements combined⁵. Also see ‘use in pregnancy and breastfeeding’. People should always check the label for information about a specific product.
Found in (dietary sources)	Good sources of EPA include oily fish (e.g. salmon, mackerel, trout), fish body and fish liver oil, white fish (e.g. cod, haddock, pollock), algae oil, eggs (particularly from chickens fed an omega-3 enriched diet).
Deficiency	A deficiency of omega-3s can cause rough, scaly skin and a red, swollen, itchy rash; however obvious symptoms of deficiency such as this are rare in the UK².
Precautions and contraindications	Patients with blood clotting disorders or those taking anticoagulants such as warfarin should be monitored while taking cod liver oil or other fish oils⁶.
Use in pregnancy and breastfeeding	Cod liver oil or other fish liver oil supplements should not be taken by women who are pregnant or planning a pregnancy because high amounts of vitamin A may be present. Fish body oils do not contain vitamin A and are therefore safe to consume during pregnancy. Women who are pregnant or breastfeeding, or likely to become pregnant, and girls who may become pregnant in the future, can safely have up to two portions of oily fish a week.
Interactions e.g. with other medications	Taking cod liver oil or other fish oils with anticoagulants (such as warfarin), aspirin, dipyridamole (a vasodilator), ginkgo biloba or ginseng, may increase the risk of bleeding. Medical supervision in these cases is required⁶.
Adverse effects	When consumed in amounts consistent with dietary intake EPA is likely very safe. Fish liver oils contain vitamins A and D, fat soluble vitamins that can be toxic when consumed in excessive amounts⁶. Reflux or “burping up” of fish oil may occur in some individuals. Take with food to avoid this occurring.
References	¹ EU Community Register of Nutrition and Health Claims ²EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Journal 2010; 8(3):1461. ³SACN; Saturated fats and health (2019). ⁴British Dietetic Association (BDA); Omega-3: Food Fact Sheet. ⁵SACN; Advice on Fish Consumption: Benefits and Risk (2004). ⁶Mason, P. Dietary Supplements. Pharmaceutical Press, London, 2001

Page content last reviewed: May 10, 2022

Omega-3 (Alpha-linolenic acid)

Description	Alpha-linolenic acid (ALA) is one of the 3 main omega-3 fatty acids, a major class of polyunsaturated fatty acids (PUFA). ALA is an essential fatty acid, meaning that the body can’t produce it so it must be obtained through the diet.
Function/ Used for	As a fatty acid, ALA contains a rich source of energy (9kcal/g) and has many functions in the heart, blood vessels, brain, lungs, immune system, and endocrine system. ALA can be converted to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the long-chain omega-3s, although the conversion rate is limited. ALA is considered to be especially important for certain processes in the body including: The maintenance of normal blood cholesterol levels; The normal growth and development of children. These beneficial effects are obtained with a daily intake of 2g ALA¹.
Intake	Adequate intake (AI) as set by EFSA: 0.5% dietary energy². The UK DRV for PUFA (combined omega-3 and omega-6 PUFAs) is 6.5% of total dietary energy³. Average intake of omega-3 fatty acids as a percentage of dietary energy increases with age from 0.8% for 4-10 year olds up to 1% in adults (19-64 years of age)⁴.
As a supplement	There are currently no UK recommendations for omega-3 supplements. Supplements are commonly available as soft gel capsules containing ALA-rich oils such as flaxseed oil. These are often available as a single supplement but also combined with other fatty acids from the omega-6 and omega-9 classes. People should always check the label for information about a specific product.
Found in (dietary sources)	ALA is found in mostly plant foods; rich sources include flaxseed and flaxseed oil, walnuts and walnut oil, rapeseed oil, chia seeds, soybeans, hemp seeds and eggs (particularly from chickens fed an omega-3 enriched diet).
Deficiency	A deficiency of omega-3 can cause rough, scaly skin and a red, swollen, itchy rash; however obvious symptoms of deficiency such as this are rare in the UK².
Precautions and contraindications	ALA should not be used to treat cardiovascular disorders without medical supervision.
Use in pregnancy and breastfeeding	There is no evidence of adverse effects in pregnancy at normal intakes.
Interactions e.g. with other medications	ALA may increase the antiplatelet activities of Ibrutinib (a cancer growth inhibitor)⁵.
Adverse effects	When consumed in amounts consistent with dietary intake ALA is considered very safe.
References	1 EU Community Register of Nutrition and Health Claims 2 EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA Journal 2010; 8(3):1461. 3 Department of Health; Dietary Reference Values A Guide (1991). 4 SACN; Saturated fats and health (2019). 5 National Institute for Health and Care Excellence (NICE); Ibrutinib Drug Interactions.

Page content last reviewed: March 29, 2022

µg	Microgram a measurement of weight equal to one millionth of a gram (or one thousandth of a milligram). Microgram (µg or mcg) is used for a number of nutrients found in food supplements.
Amino Acid	The building blocks of protein, there are eight essential amino acids which cannot be synthesised within the body and therefore must come from the diet. These are: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. In addition arginine and histidine are amino acids required by infants and young children which supports their rapid growth.
Antioxidant	A substance or nutrient which helps to protect our cells from damage caused by free radicals, damaging molecules which are found in pollution and tobacco smoke. Our bodies also produce free radicals as part of the normal biochemistry of living.
Deficiency	A lack of essential macronutrients or micronutrients which results in malnutrition and or disease. This may be the result of inadequate intakes or absorption issues associated with gastrointestinal disease. There are a number of recognised deficiency diseases including (but not exclusively): scurvy (vitamin C deficiency); rickets (vitamin D deficiency); anaemia (iron deficiency, but also deficiencies in B12 and folic acid) and Kwashiorkor (protein deficiency).
DH	The Department of Health is a UK Government department. It has responsibility for nutrition legislation and sets health policy for nutrition.
DHA	Docosahexaenoic acid; one of the key omega-3 fats that provides health benefits
Dietitian	An individual qualified in nutrition and dietetics who can assess, diagnose and treat health issues associated with nutrition and diet. Dietitians are governed by law with a statutory code of practice; they often work within the health service although increasing numbers are also working in a freelance capacity.
EFA	Essential fatty acids (omega 3 and omega 6) cannot be synthesised by the body and must be derived from the diet. EFAs do not provide fuel for energy production and are required for vital biological processes which support growth, development and health.
EFSA	European Food Safety Authority; the European Union food risk management agency which scientifically evaluates safety across all areas of food.
EPA	Eicosapentaenoic acid; one of the key omega-3 fats that provides health benefits.
Fat soluble vitamin	The fat soluble vitamins are vitamins A, D, E and K. Because they are fat soluble these substances can accumulate in the body, often being stored in fat cells, or in the liver. This can create health issues, particularly if intakes have been high for a prolonged period of time. For example, long term high intakes of vitamin D may lead to the laying down of calcium in tissues such as liver and kidneys which can cause nausea and vomiting.
Food supplement	A food supplement is a concentrated source of vitamins, minerals or other substances with a nutritional or physiological effect which is sold in small, measured unit doses.
FSA	The Food Standards Agency is a non-ministerial UK Government department responsible for food safety and food hygiene.
GLA	Gamma-linoleic acid is an omega-6 fatty acid (an essential fatty acid considered to be necessary for human health which must be derived from the diet). GLA is most commonly found in evening primrose oil (EPO), borage or starflower oil and blackcurrant seed oil.
Health claim	A health claim is any claim which states, or implies, that consumption of a specific food will have a beneficial effect on health. Claims may be written, verbal or pictorial.
Herbal medicine (herbal remedy)	A product is considered to be a herbal medicine if the main active ingredient/s are only herbal substances or preparations. Not all herbal products are medicines, some may be food supplements and some may be cosmetics. What determines if a product is, or is not a medicine is complex but generally rests with how the product is presented (i.e. does it make medicinal claims to treat, prevent or cure any disease) and what it does (i.e. does it have a physiological impact on, or alter, any body functions).
Macronutrient	Dietary constituents which are needed in significant amounts, generally protein, fat, carbohydrate, fibre and water.
Malnutrition	Malnutrition is a state in which the deficiency of nutrients such as energy, protein, vitamins or minerals results in measurable adverse effects on the body. Malnutrition may refer to insufficient intake of protein, carbohydrate and fats (macronutrients) which can result in overly low BMI. It may also be insufficient intake of vitamins, minerals and other micronutrients, which can impact on overall health and could include obese individuals with poor diets.
Mg	Milligram is a measurement of weight equal to one thousandth of a gram. Mg is used for a number of nutrients found in food supplements.
Micronutrient	A substance derived from food which is needed in extremely small amounts for the normal growth and development of living beings. Micronutrients are vitamins, minerals and essential fatty acids (omega-3 fats)
Mineral	Inorganic micronutrient essential to health and wellbeing. Minerals are absorbed from soil by plants which are in turn eaten by animals or humans. Minerals may be split into minerals which are needed in relatively high amounts (calcium, phosphorus, magnesium, sodium, chloride and potassium) and trace elements (iron, zinc, cobalt, copper, chromium, fluoride, iodine, manganese, molybdenum, boron and selenium) which are needed in very small quantities.
Multivitamin	A product which contains more than one vitamin, often multivitamins will contain all 13 vitamins although some may contain only the eight B vitamins, or a combination of some of the vitamins and some additional minerals.
NDNS	The UK National Diet and Nutrition Survey is a continuous rolling survey of the dietary habits and nutritional status of adults and children in the UK. The results are used to assess whether intakes of food and nutrients are adequate across different ages and population groups.
NRV	Nutrient Reference Value is the amount set by the European Food Safety Authority (EFSA), primarily to support food labelling, which the majority of the population requires to maintain health. Previously known as RDA
Nutrient	A substance derived from food which provides nourishment to the body and is essential for the maintenance of life and for growth and development.
Nutritionist	Nutritionists generally work for public bodies or governments, although some do work with private clients. They tend to look at large populations to determine risk factors and make dietary recommendations that are applied at population levels. For example, evidence on the incidence of type II Diabetes led public health nutritionists to determine that some populations are more at risk of developing this disease, and to make recommendations for dietary changes to either reduce the risk or manage the disease. However, public health nutritionists do not practice with individual patients.
Omega-3 fats	Essential fatty acids which cannot be synthesised by the body and must be derived from the diet. Primary sources for omega-3 fats are oily fish and fish oil supplements with some also coming from enriched eggs and fortified foods. There are a number of scientifically proven health benefits for omega-3 fats including supporting the health of the eyes, brain and heart, maintaining an appropriate balance of triglycerides in the blood and reducing blood pressure.
Omega-6 fats	Essential fatty acids which cannot be synthesised by the body and must be derived from the diet. Primary sources for omega-6 are vegetable oils such as sunflower and corn oils as well as nuts and seeds. There are a number of health benefits associated with omega-6 fatty acids; they are thought to be beneficial in the management of premenstrual syndrome and in some skin conditions including eczema and psoriasis.
PAGB	Proprietary Association of Great Britain (PAGB) is the UK trade association which represents the manufacturers of branded over-the-counter medicines, self care medical devices and food supplements.
Prebiotics	Foods which promote the growth of probiotics, the beneficial bacteria that inhabit our gut. Prebiotics are generally fibres such as inulin, which our bodies cannot digest and absorb but which provide a food source for probiotics.
Probiotics	Live bacteria (and some yeasts) which inhabit the digestive tract which are viewed as being beneficial to human health. There are thousands of different bacterial strains; some are resident in specific areas of the digestive tract whilst others are transient, simply passing through.
Public Health England (PHE)	Public Health England is an agency of the Department of Health responsible for improving public health. They work with local government, the NHS and non-governmental organisations as well as communicating public health messages to the general public.
PUFA	Polyunsaturated fatty acids (PUFA) are found in nuts, seeds, fish (and fish oil), krill and some algae, small amounts are also found in leafy greens. The omega-3 and omega 6 fats are PUFAs, which are generally associated with health.
RDA	Recommended Daily Amount; previously used terminology for the amount set, primarily to support food labelling, which the majority of the population require to maintain health. Now described using nutrient reference value (NRV)
SUL	Safe Upper Levels of vitamins and minerals were established by the Expert Group on Vitamins and Minerals who published a report in 2003 (https://cot.food.gov.uk/sites/default/files/cot/vitmin2003.pdf). The UK food supplements industry works to the levels set in this report.
Vitamin	Organic micronutrient essential to health and wellbeing. Vitamins cannot be synthesised in sufficient amounts by the animal or human body and must therefore be obtained from the diet. Plants manufacture vitamins which move up the food chain as the plants are consumed by animals or humans. Vitamins can be divided into fat soluble (vitamins A, D, E and K) and water soluble (vitamins B1, B2, B3, B5, B6, B12, biotin, folic acid and vitamin C).
Water soluble vitamin	The B vitamins and vitamin C are water soluble. They are not stored in any significant quantities within the body and are generally either utilised or excreted in the urine. As they are not stored in the body, they tend to have low toxicity and are needed on a daily basis.