Fish Oil Ethyl Ester vs Triglyceride - Revisited

fish oil ethyl ester triglyceride
There is a lot of back-and-forth about fish oil types – triglyceride (TG) versus ethyl esters (EE). OmegaVia was highly concentrated ethyl ester form of fish oil. Since 2016, it in Triglyceride (rTG) form. I get emails about this almost daily.
  • Is EE fish oil is really fish oil?
  • Is there alcohol in it?
  • Will it be absorbed?
  • I heard it is banned in several countries!
We're nutritionists. So it shouldn't come as a surprise that we believe that foods are better sources of nutrients than supplements. We’d much rather you get your Omega-3 from wild fish. However, eating salmon three times a week is neither possible nor convenient for many. Enter supplements. So supplements, at best, are stopgaps. I think debaters can find common ground thus far. Saying that ethyl ester form of Omega-3 is not 'real fish oil' because it's concentrated is like saying calcium supplement is not milk. Taking fish oil is not the goal but rather getting enough Omega-3 and balancing excess Omega-6 levels.

The Purpose of Ethyl Ester Fish Oil

The purpose of OmegaVia (and other ultra-concentrated supplements) is very simple: deliver a very high amount of Omega-3 into the body.* And they do the job very well. By extension, their purpose is NOT to condense all benefits of fish into a pill, which cannot be done. Ethyl ester oils cannot do that and neither can triglycerides, phospholipid or free fatty acid forms. Each of these four forms of Omega-3 are prepared differently and have different costs and applications. Examples:
  1. We would never make a liquid fish oil product that’s to be taken by spoon using a free fatty acid product – that would be a disaster due to the rancidity risk. Triglyceride-form is a better for that application.
  2. Phospholipid Omega-3 (from krill oil) can’t be concentrated because the phospholipid bond breaks down and that reduces absorption.
  3. Triglycerides cannot be concentrated without first converting into ethyl esters.
So for the most part, low concentration products are triglycerides. Highly concentrated products are ethyl esters or rTG-forms.

Concentrated TG Fish Oil

You can convert concentrated ethyl ester oil back into triglyceride form using lipase enzymatic conversion. Ultra-concentrated TG oils are made this way. To be blunt, all this technical hair-splitting side steps the key reason for taking Omega-3 supplements, which is to increase Omega-3 levels in the body. Both EE and TG forms of fish oil do it perfectly well. And equally well.

Pharmacokinetics vs Pharmacodynamics

The pharmacokinetics (what the body does to fish oil) of ethyl ester vs TG is very slightly different. Your body breaks down EE oils and ‘rebuilds’ it the TG form, so there is a short delay - but your body still knows exactly what to do with it. However, the pharmacodynamics (what the fish oil does to your body) of both forms of fish oil is exactly the same. There is NOT A SINGLE published health benefit of Omega-3 you get from TG form that you cannot get from EE form* Not a single one. There are over 25,000 published papers on Omega-3 and their health benefits.* It's the most studied substance after aspirin. The vast majority of this research was conducted using ethyl ester form. All the PhD scientists conducting the research don’t seem to be alarmed about ethyl ester oils. In every single case, the ones raising the alarm are those selling TG oils. Coincidence?

EE Fish Oil and Alcohol

You’ll also hear fear-mongering about alcohol generated by metabolizing ethyl ester forms – technically, this is not incorrect, but no one seems to mention how infinitesimally small the amounts are. (see Science Alert below) If the alcohol amounts we’re talking about were substantial, you’d find fish oil supplement users laughing or passed out near their medicine cabinets! You’ll find more alcohol in orange juice – many foods and all fruits and juices have naturally present alcohol. I’ve done the math: you’d have to eat several hundred OmegaVia pills in one sitting to equal the alcohol in one lite beer. This concern is not based in reality and that’s why I call it fear-mongering. Yet, calling ethyl ester oil a 'poison' is the #1 ammo of all TG fish oil marketers. 'The UGLY TRUTH,' some call it.

TG Fish Oil - Slightly Better Absorbed

To be fair, there are minor differences in absorption. TG form is slightly better absorbed, but only slightly. For this very minor improvement in absorption, you will pay a 2X premium. The concept of relative difference vs absolute difference is slightly technical. Quick explanation: 2% - 1% = 1% (this is absolute difference.) 1% divided by 2% = 50% (this is relative difference.) 50% is bigger and more impressive sounding. Which one do you think marketers and salesmen prefer? This is gratuitously exploited by marketers of TG fish oil to suit their needs. In other words, the real difference in absorption between the forms is exaggerated - 50% or 70% or even 200%, depending on who is selling the product. It’s just marketing. The truth lies in absolute difference, which no one will mention. (Cholesterol medications are marketed this way too: ‘33% less heart attacks,’ but the absolute difference between statin drugs and placebo is only a couple of percent.)

If I were to put on my weasel-hat and hawk EE fish oil on late night TV infomercials, this is what I'd say:

'Ethyl ester oils are natural - they are found in fruits and juices! We've been consuming them for millennia! But that's not all! Concentrated TG Fish Oils that passes for 'natural' well, sheesh, they have 2 to 3 fatty acids per glycerol molecule! That's unheard of in nature! But wait...there's more! EE fish oils have a natural number of fatty acids per glycerol backbone. Speaking of backbone...ask the TG guys what percent of their oil is TG. You'll never get an answer! You know why? Because if you buy one bottle of their stuff, they'll keep sending bottles every month until your grandchildren are eighty! So call now! Order one. Or a hundred. Heck, I don't care! You'll eventually pay for a hundred. Hurry! Call now! If phones are busy, it's because we're in trouble with the FTC.'
But I jest.

Empty Stomach vs Taken With a Meal

The real difference in absorption virtually vanishes if both forms are taken with a meal. The fats present in meals increases the absorption of EE oils. The difference in absorption also lessens if you take both forms of fish oil over a long period of time. If you only plan on taking fish oil for a week or two, then TG is definitely better. But otherwise, as the President of Tersus Pharmaceuticals recently put it to me, 'Saying TG fish oil is better is like judging the winner of a marathon twenty minutes into the race.' If you plan on taking fish oil for the long-term, don’t sweat the minor difference. In my opinion, this is not worth the 2X premuim. Why? Because both forms are perfectly safe and the pharmacodynamics are exactly the same. In other words, both will make you healthier if you’re suffering from Omega-3 deficiency. And ultimately, isn’t that what we all really want from supplements, to make us healthier? If Omega-3 must be consumed in the form nature intended, then only eating fish will do. Supplements – all kinds – fall far short.

'BANNED!!!'

You will also read that EE fish oil is ‘BANNED!’ in many countries. They are not banned anywhere. Nowhere! In Japan and Australia, EE fish oil is sold exclusively as drugs and supplements are in TG form. If anything, that should give you more comfort in the efficacy of EE fish oils, not less.

Bottom-line:

Since marketing verbiage is not standardized or regulated by any US government body, there is a lot of language and philosophical flexibility in how companies approach fish oil marketing. Instead of embracing quality, transparency and consumer education, many companies opt for false comparisons, gimmicks and styrofoam-cup parlor tricks. It’s sad that you, the consumer, have to wade through all this conflicting, self-serving information. The fact still remains: if someone can show me peer-reviewed published data that shows differing pharmacodynamics of EE vs TG fish oil where TG fish oil effects different health outcomes, we will change OmegaVia's formula to TG oil. Why? For selfish reasons! Because we all take EE fish oil and give it to our families. If something else is proven to be better, we want what's truly better. We don't anticipate having to make this formula change anytime soon. For a much more detailed explanation and scientific references to the claims above, please see these previous blogs here and here.   *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.