If you could take only one supplement to improve your health, what would it be? I asked this question of one of our highly respected sources, Leo Galland, MD, an internist, author and internationally recognized leader in integrated medicine, based in New York City.

His answer? Fish oil -- because of its unique ability to do everything from boosting brain power to preventing heart attacks and migraine headaches. That makes sense, I said -- but what advice do you have for people who can’t digest it easily... or who are vegans... or who hate the very idea -- not to mention the taste -- of fish oil? What about them?

Dr. Galland assured me that there are several ways to make fish oil go down easier -- and if you still can’t stomach it, he said, there are less pungent alternatives.


Before describing our options, Dr. Galland emphasizes that fish oil is packed with omega-3 essential fatty acids, which are essential nutrients that our bodies cannot manufacture. Thus, we must get them from food or supplements. These nutrients are especially important for people who suffer from an inflammation-related disease (including practically all chronic diseases, such as heart disease, cancer, diabetes and depression) or an autoimmune disorder (such as rheumatoid arthritis, lupus or ulcerative colitis), because they are likely to have an omega-3 deficiency and would benefit from supplementation.

Other signs that you may be omega-3 deficient are...
Dry skin
Chicken skin (tiny rough bumps, usually on the back of arms)
Dry hair and dandruff
Excessive earwax
In women, menstrual cramps and/or premenstrual breast tenderness.

Fish oil is the single richest source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the long-form chains of omega-3 fatty acids that are easiest for our bodies to use. But besides not tasting good (even if it comes from good-tasting fish!), fish oil can sometimes bring other unpleasant consequences -- specifically, diarrhea and fish burps. To get around these problems, Dr. Galland advises his patients to:
Experiment with fish oil. Take it at different times of the day and see how you feel. To prevent diarrhea: Don’t take all the pills at once... spread them out during the day. To avoid the fishy taste and fishy burp: Take fish oil with a full glass of water one hour before meals. This way it moves quickly out of your stomach before you introduce food. Also, freeze pills briefly before you take them. Note: Fish oil capsules don’t need refrigeration, but liquid fish oil should be kept refrigerated after opening.
Take delayed-release fish oil. Enteric-coated delayed-release fish oil is released in the intestine rather than the stomach, which lowers your risk for fishy breath, fishy burps and gastrointestinal (GI) discomfort.
Do not buy bargain brands of fish oil. There are many types manufactured by reputable companies, so don’t be penny-wise and pound-foolish -- you can’t be certain of the purity of unknown brands. One brand that Dr. Galland likes is Nordic Naturals, which is available in health-food stores and online. Some people prefer to have fish oil flavored with lemon or orange, but the flavoring won’t diminish the GI side effects.
Eat more wild fish instead. If the supplements bother you, an obvious solution is to get omega-3 from food. The most reliable food source of omega-3s is wild salmon (never farmed -- farmed fish can contain high levels of toxins). Other choices include wild mackerel, trout, herring or tuna (but don’t have tuna more than once a week). Dr. Galland says: To get the proper amount of omega-3s, you need to eat six to eight ounces of wild fatty fish three times a week.

For vegans and/or anyone who really doesn’t want to go anywhere near fish, plant sources such as walnuts and flaxseed, canola oil and soybean oil offer a partial solution, in that these contain a different, shorter-chain form of omega-3 fatty acid -- alpha-linolenic acid (ALA). ALA provides some protection against heart attacks but does not help prevent sudden cardiac arrest (the two are different) -- according to Dr. Galland, only fish oil has been shown to have that benefit. Your body can convert ALA to EPA and DHA, but the extent to which it does so varies a great deal from person to person. Dr. Galland recommends:
Flaxseed oil. Take one teaspoon to one tablespoon daily of cold-pressed flaxseed oil (about 2.3 grams of ALA). Important: Do not cook with flaxseed oil -- heat damages it.
Flaxseed. Take one tablespoon of freshly ground flaxseed daily (about 1.6 grams of ALA). Sprinkle it over your cereal or salad.
Walnuts. Eat about 12 walnuts daily.

DHA is found primarily in fish and fish oil, but Dr. Galland has another alternative for vegetarians or for those who simply don’t like fish oil -- get your DHA from sea vegetables. DHA supplements derived from natural marine algae are widely available online and at health-food stores in capsule form.

There’s a catch: Sea vegetables don’t contain EPA. Dr. Galland noted that EPA and DHA have different protective effects in the body -- DHA enhances cardiovascular and brain tissue health, but unlike EPA is not helpful for depression.


Yet another option is to decrease your need for omega-3 fatty acids by lowering your intake of omega-6 fatty acids.

Research demonstrates that the typical American diet has a high omega-6/omega-3 ratio, which promotes inflammatory and autoimmune diseases. To change your own ratio, you must severely cut back on (and ideally eliminate) red meat, egg yolks (unless the chickens laying the eggs are fed flaxseed or some other source of omega-3s), poultry and vegetable oils (except olive). While such a dietary change may be too radical for most people to stick with, any reduction is at least a step in the right direction.

In short, you have plenty of healthful omega-3 alternatives to choose from. Play around with different strategies, products and combinations, and work with your health-care provider to find the formula that works best for you -- but do be sure that you are paying attention to your body’s need for this vital nutrient.


Leo Galland, MD, internist, author and internationally recognized leader in integrated medicine based in New York City. Dr. Galland is the director of the Foundation for Integrated Medicine ( For more information about supplements and drugs and free access to Dr. Galland’s Web application visit

Sal Casano Ph.D. R.N FCN
Faith Community Nurse Coordinator
Trinity Church
1336 First Avenue
Watervliet, NY 12189