The 2012 National Health Interview Survey reports that, with the exception of vitamins and minerals, fish oil capsules are the most commonly used dietary supplement. Fish oil is an excellent source of two types of omega-3 fatty acids -- eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In combination, these oils may help reduce the risk of cardiovascular disease, arthritis and some cancers. However, according to the National Institutes of Health's Office of Dietary Supplements, approximately 7 percent of people who take omega-3 supplements experience side effects, including belching and stomach discomfort -- so if you have acid reflux, taking these supplements could aggravate your symptoms. There are steps you can take to minimize these side effects while still reaping the potential benefits of increasing your omega-3 fatty acid intake.
Take With Food
Omega-3 and fish oil supplements are available in liquid or capsule form. The outer coating of the capsules, depending on formulation, dissolves primarily in the stomach or small intestine. Fish oil that enters an empty stomach will float on the fluid in your stomach. This makes the oil more likely to travel back up into your throat and mouth if you burp or are prone to acid reflux, a condition in which your stomach contents flow backward into your esophagus. You can minimize this side effect by taking your fish oil supplement immediately before a meal, which will help the oil better mix with the food you eat. Limiting liquids when you take your supplement can also help prevent fish oil regurgitation.
Adjust Type or Dose
According to the National Institutes of Health’s Office of Dietary Supplements, a reduced dose of fish oil or omega-3 supplements can help manage any side effects that aggravate acid reflux symptoms. Starting with a relatively low dose that is increased gradually over time may help prevent the gastrointestinal side effects altogether. Enteric-coated fish oil or omega-3 capsules are another option. These capsules are coated with a material that doesn't dissolve until it passes through your stomach and reaches your small intestine -- preventing regurgitation of oil altogether. Freezing fish oil capsules before taking them may also help prevent burping and reflux.
Try Alternative Sources
An alternative to fish oil or omega-3 supplements is to regularly eat fish rich in omega-3 fats, such as salmon, mackerel, herring, sardines, lake trout and albacore tuna. In addition to marine sources, omega-3s are also found in plants in the form of alpha-linolenic acid, or ALA. So if you find that fish oil aggravates your acid reflux, or you prefer to avoid the fish sources, try increasing your ALA intake. Seeds such as flaxseed oil, ground flax seed, chia seeds and hemp seeds are the richest sources of ALA. Other relatively good plant sources of omega-3s are canola oil, soybean oil and walnuts. A drawback is that the body needs to convert ALA to the omega-3 fatty acids EPA and DHA for the desired health benefits, and since this process is not very efficient, plant sources of omega-3 fats are not as potent.
Warnings and Precautions
Omega-3 supplements and fish oil are generally considered safe. However, these oils may interact with blood thinners or diabetes drugs, so if you are on any prescription medications, talk to your doctor before taking the supplements. Also talk to your doctor if you cannot tolerate your prescribed dose of omega-3s and want to try a lower dose or food sources instead. By sharing information about all the things you do to manage your health, you will help foster coordinated, safe healthcare. Let your doctor know if you experience symptoms of severe or frequent acid reflux, recurrent ear and sinus infections, or chronic cough and hoarseness. Always seek immediate medical attention if you experience persistent chest pain, especially if it is accompanied by shortness of breath or pain in your jaw or arm, since a heart attack and the heartburn associated with acid reflux can have similar symptoms
Medical advisor: Jonathan E. Aviv, M.D., FACS