EPA vs DHA understand the difference

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EPA and DHA are both important types of omega-3, with different roles and actions in the body.
Our requirements for each fat change throughout life. Therapeutic use of omega-3 involves
specific ratios of EPA and DHA, at differing levels according to different conditions and health
concerns.

The two main omega-3s we hear most about are the long-chain fatty acids EPA (eicosapentaenoic acid) and DHA
(docosahexaenoic acid). These fats are found in oily fish and seafood, with small amounts of DHA found in algae. If
you are seeking nutritional support for a specific health concern or condition, it is important to understand the
difference between EPA and DHA and how the body absorbs and utilises them.

A tremendous body of research has been conducted on these important nutrients since it was first discovered in the
1950s that fish oil offered many health benefits and that these benefits were attributable to a type of polyunsaturated
fat called omega-3. Despite the volumes of research on omega-3s, it is only in recent years (within the last 15 years
or so) that the actions of EPA and DHA have come to be understood individually. Researchers now often investigate
the actions of EPA and DHA individually rather than together, no longer simply under the generic label omega-3 as
they are widely referred to.

We are now fortunate to understand how these fats work in combination and in isolation, how they are digested,
absorbed and utilised in the body, so we are able to tailor different blends of EPA and DHA according to the health
benefits we are seeking to achieve. At Igennus, we have long specialised in the role of the omega-3 fatty acid EPA in
clinical nutrition, as a powerful tool in the patients toolkit for helping to regulate inflammation by restoring several
biological markers, known as the omega-6 to omega-3 ratio and AA to EPA ratio. Before we discuss the therapeutic
role of EPA in nutritional medicine, heres a very brief summary of the role of both EPA and DHA in health throughout
life.

Omega-3 EPA & DHA in general health

Omega-3 EPA and DHA in clinical nutrition

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Omega-3 EPA & DHA in general health

EPA and DHA during life stages: what to take and when?

Our requirements for EPA and DHA change throughout life and so does the optimal amount of each fatty acid in our
diet.

Children require DHA for growth and development, and the brain, CNS and retina rely heavily on the adequate
supply of DHA during growth in the womb. Thus women should emphasise DHA in their diets when they become
pregnant and continue to take this until they cease breastfeeding. Children continue to need DHA up until the age
they start school, so if children under the age of five are taking an omega-3 supplement, it should contain DHA. The
exception is for children with developmental problems where pure EPA or high EPA omega-3 has been shown to
be most effective for supporting cognitive function. We would still recommend, where possible, naturally derived
sources of omega-3 such as oily fish to support a balanced EPA and DHA intake.

EPA levels are under constant demand and low EPA levels in adolescents and adults correlates
strongly with development of mental health issues, including depression, dyslexia and dyspraxia,
heart problems, joint and bone conditions, as well as neurodegenerative diseases such as MS and
Parkinsons.

After the age of five, the development of the brain and CNS starts to reduce and the bodys need for DHA reduces.
This is a good time to increase EPA in the diet, as studies show that EPA can help with childhood behaviour and
academic performance, as well as focus, attention and reducing aggression. Dry skin conditions, asthma and
allergies are also common in children and good levels of EPA at this time can help reduce the inflammation
associated with these issues.

Between the ages of five and 65, the majority of the bodys needs can be met by using EPA-rich oils and eating fish,
marine products, organic greens and pastured animal products. EPA levels are under constant demand and low
EPA levels in adolescents and adults correlates strongly with development of mental health issues, including
depression, dyslexia and dyspraxia, heart problems, joint and bone conditions, as well as neurodegenerative
diseases such as MS and Parkinsons. EPA also protects our genes and cell cycle, as well as helping to keep our
stress response regulated, so an adequate supply of EPA throughout adult life can help prevent a range of chronic
illness.

In later life, cognitive function and brain deterioration may become a concern. Once again, maintaining high levels of
EPA has been shown to lower the risk of developing and worsening cognitive decline and dementia. If, however, you
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know someone who already has a diagnosis of dementia or Alzheimers, their brain has already been damaged and
needs structural support. At this point, DHA becomes important again and taking a high-EPA product that contains
250mg of DHA also is important to prevent further loss of brain tissue.

Omega-3 EPA and DHA in clinical nutrition

Our requirements for EPA and DHA omega-3 fatty acids in clinical conditions differ significantly from when we are
looking to support general health.

Since EPA and DHA are both essential for health and appear together in nature, many studies have attempted to
treat clinical conditions with combined EPA and DHA oils, but the outcomes have been varied, contradictory and
disappointing. Consequently, researchers have started to investigate the individual actions of EPA and DHA in
isolation, in numerous health conditions where an omega-3 deficiency is related to symptoms or known to play a
causative role. The emerging evidence shows marked differences between how these two fatty acids affect us not
just at the cellular level but also the body as a whole.

Actions of EPA vs DHA

Whilst EPA and DHA are both considered to be important regulators of immunity, platelet aggregation and
inflammation, their health-influencing by-products arise from very different pathways and their effects in the body
differ. DHA is the most abundant omega-3 fatty acid in cell membranes, present in all organs and most abundant in
the brain and retina, playing an important structural role. EPA is present structurally only in minute quantities, always
being utilised and under constant demand to be replaced. Whilst DHA provides mainly a structural role, it is
becoming evident that EPA may be the dominant functional fatty acid out of the two in many areas of health and
especially in inflammatory conditions.

Competition between EPA and DHA during digestion and absorption

The chemical structures of EPA and DHA are very similar and they compete for uptake and processing resources.
During digestion, the triglyceride molecules in standard fish oil are broken down into a mono glycerol and two free
fatty acids, small enough to be absorbed into cells of the gut lining. More often than not, DHA is the fatty acid that
remains attached to the glycerol backbone, meaning in essence that DHA gets a free pass into the gut, while the
remaining free fatty acids (more often EPA) must reattach onto a glycerol molecule or risk being oxidised and used
as fuel. The implication of this is that DHA levels in our cells are often concentrated at the expense of EPA after
absorption when taking EPA and DHA in the standard ratio of 1.5 to 1.

The competition between EPA and DHA during digestion and absorption and the fact that DHA appears to block the
therapeutic actions of EPA can therefore be an issue if we are looking to optimise the benefits associated with EPA
(Martins 2009; Bloch & Qawasmi et al, 2011; Sublette et al, 2011). High dose, high concentration and high ratio EPA
supplements increase the effectiveness in depression studies, and pure EPA-only is optimal. Depression is also a
condition with an inflammatory basis, so this is likely another significant reason for EPA being the key player its
antagonistic relationship with the inflammatory omega-3 AA (arachidonic acid) is very effective at reducing
inflammation.

When a supplement contains an equal quantity of EPA and DHA the body must effectively choose
which to absorb and use, and so any therapeutic benefit can be neutralised.

The absence of DHA in many pure EPA trials, and therefore lack of competition between EPA and DHA during
digestion and consequently for uptake, is considered to be partly responsible for the positive outcomes. Simply put,

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pure EPA delivers more EPA into cells where it is needed than combined EPA & DHA blends. Consequently, oils
containing DHA may not be suitable for a variety of conditions when treatment relies on increasing levels of EPA and
its end products.

The differing actions of EPA and DHA, together with their competitive uptake, help to explain why studies that
attempt to use standard fish oil therapeutically (where DHA and EPA are combined, in a natural ratio of
approximately 1.5:1) are either less beneficial than expected, or even completely ineffective. Standard EPA/DHA
fish oils are more suitable for everyday wellbeing, to compensate for a lack of fish in the diet and to meet a
suggested intake.

Too much DHA is as bad as too little

Healthy cells require a delicate balance of EPA and DHA and the body employs clever mechanisms to support this
natural equilibrium. DHA levels are self-regulated through inhibiting the activity of the enzyme delta-6 desaturase
the very enzyme that supports the conversion of EPA into DHA to ensure levels of DHA do not become too high. It
is therefore possible to have too much preformed DHA, if our supplement intake exceeds the bodys needs.

So why is an excess of DHA detrimental and an excess of EPA useful? DHA has a larger structure with two extra
carbons and two extra double bonds, so it literally takes up more space in cell membranes than EPA. On the one
hand, this is important because DHA plays a structural role in maintaining the fluidity of cell membranes ( essential
for the normal function of proteins, channels and receptors that are also embedded in the membrane), but if a cell
membrane becomes too saturated with DHA it can become too fluid, which can have a negative effect on cell
function. EPA, on the other hand, is constantly utilised and always in demand.

Which EPA:DHA ratio is optimal?

In short, there is no single optimal EPA:DHA ratio. If we are really healthy, with an optimal omega-6 to omega-3 ratio
(from a diet rich in omega-3 fatty acids and low in grains and vegetable oils) and have an active, stress-free lifestyle,
relying on standard fish oil in the natural 1.5:1 EPA:DHA ratio or simply consuming oily fish is completely adequate.

If, however, we want to target the actions and benefits of either fat for more intensive support or clinical use, we
need to alter the natural 1.5:1 EPA:DHA ratio found in most omega-3 sources such as fish oil which is when
concentrated supplements are especially useful. Certain forms of omega-3 called ethyl-ester and re-esterified
triglyceride give nature a helping hand allowing us to achieve targeted ratios of specific fatty acids at high
concentration and physiologically active doses.

Higher EPA ratios are especially important for maintaining a healthy brain and optimal lipid profiles, for example,
best supported by an EPA:DHA ratio of approximately 3:1, while pure EPA is optimal during the initial treatment
phase in conditions where inflammation is acute.

Pure EPA & inflammation control

Inflammation plays a role in the onset of most conditions from cardiovascular disease, neurological disorders,
diabetic complications, metabolic disorders, chronic pain and mental health disorders to chronic inflammatory
disorders such as irritable bowel disease and rheumatoid arthritis.

Several recent clinical studies, especially those focusing on the benefits of omega-3 in inflammatory conditions,
have investigated the actions of pure-EPA in protecting against excess inflammation in the body. EPA works in
several different ways. Firstly, it is the precursor to a number of immune messengers, collectively called
eicosanoids (series-3 prostaglandins, series-3 thromboxanes and series-5 leukotrienes,) all of which have anti-
inflammatory roles.

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Secondly, when we consume EPA, it inhibits the production of AA from DGLA and also competes with AA for uptake
into cell membranes and can therefore lower the amount of AA in membranes by literally saturating the cell in
essence, it takes up more of the available space and displaces AA. When there is less AA present, there is a
reduced capacity for it to produce inflammatory products.

Finally, in order for AA to be converted into inflammatory products it must be released from phospholipids (part of the
cell membrane) using the enzyme phospholipase A2 and then converted by the enzyme cyclooxygenase. EPA
utilises both of these enzymes, so if EPA levels are increased in the diet, it attracts enzyme away from AA to EPA
again giving rise to anti-inflammatory products instead of inflammatory ones.

Omega-3 EPA dosages in clinical conditions

If we want to deliver the benefits associated with EPA therapeutically, it is essential to optimise digestion and
uptake. If we take EPA and DHA in their natural 1.5:1 ratio, its an uphill struggle for EPA because we know that DHA
is more effectively absorbed and assimilated into cells. Delivering the benefits of EPA (for example, for cognitive
function, mood and depression, inflammation regulation, heart health, skin health and so on), requires doses of EPA
in excess of DHA, which determines the type of benefits obtained and the degree of the beneficial outcomes. The
higher the ratio of EPA to DHA (meaning higher doses of EPA in relation to DHA), the more likely that EPA will be
digested and absorbed, ready to meet the bodys high demands for this important nutrient.

To reach the required dose of EPA for treating certain conditions such as depression, CVD or CFS/ME you would

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need to take approximately 1-2 grams of free EPA daily. Even with a concentrated omega-3 fish oil supplement,
offering 180 mg excess EPA over DHA, this would require 10-20 capsules daily significant in terms of volume and
cost, and not efficient in terms of uptake in the body as our capacity for fat absorption is limited. The most effective
and efficient way to ensure high EPA uptake in the body rapidly is to supplement with pure EPA for a minimum of 3-6
months.

For more information on the conditions that omega-3 EPA and DHA can help in term of both prevention and
management, visit our health section.

Igennus anti-inflammatory omega-3 EPA protocols

Increased EPA levels in the blood and cell membranes effectively regulates inflammatory pathways and reduces
total inflammatory load, so for any inflammatory conditions or concerns, we recommend a phase of pure EPA
supplementation for at least 3-6 months. Pre-loading the body with pure EPA (without the opposing actions of DHA
for uptake and utilisation) ensures constant replenishment of EPA supplies to support its high rate of turnover. Since
DHA levels remain fairly stable and much lower daily amounts are required, DHA levels can be supported continually
through dietary intake, or increased to 250 mg daily in later stages of treatment through supplementation.

Whilst EPA is increasingly being shown to be of most benefit when taken in isolation for a range of clinical
conditions, it is not suitable for everyone to take pure EPA throughout their life.

At Igennus we emphasise EPA concentration in our therapeutic products to maximise the dose of
free EPA that is active and unopposed key to regulation of inflammatory conditions.

A summary of omega-3s in clinical nutrition

1. Many health conditions benefit from taking pure EPA without DHA particularly during the initial treatment
phase for any inflammatory based illness and especially in depression and ADHD.
2. Taking EPA without DHA means that 100% of the capsule is free EPA not only is this optimum for
increasing EPA levels in cells rapidly because EPA absorption and utilisation is unopposed by DHA, but it
means that therapeutic EPA doses can be achieved in fewer, smaller capsules.
3. Concentrating fish oil via molecular distillation to produce high EPA concentrations requires a more thorough
purification process compared with lower EPA concentration oils so the higher the EPA concentration, the
purer the oil in terms of removing impurities such as heavy metals, PCBs and dioxins.
4. EPA is the precursor to DHA in the body and can be converted to DHA with the enzyme delta-6 desaturase,
but this process is inefficient in many people (much like the inefficiency of short-chain omega-3s to long-
chain). For those individuals taking pure EPA products as well as those taking our EPA-rich products, we still
recommend eating oily fish at least once each week to provide a natural source of DHA. Fish provides a
unique nutritional package, supplying the diet with important amino acids (the building blocks of proteins) and
antioxidants, including vitamins and minerals needed to process fats, so eating fish will also support the
natural enzyme-dependent EPA to DHA conversion.

Which omega-3 sources are suitable for what?

There are numerous omega-3 sources with varying proportions of EPA and DHA, and the balance of EPA and DHA
in a supplement influences the actions of these fats in the body. For more information about the different types of
omega-3 sources and which are most suited for your individual needs, read our page on the different types of
omega-3 supplements

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References

Bloch MH & Qawasmi A. (2011) Omega-3 fatty acid supplementation for the treatment of children with attention-
deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American
Academy of Child Adolescent Psychiatry 50:991-1000.

Martins JG. (2009) EPA but not DHA appears to be responsible for the efficacy of omega-3 long-chain
polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled
trials. Journal of the American College of Nutrition 28: 525-42. Review.

Sublette ME, Ellis SP, Geant AL, Mann JJ. (2011) Meta-analysis of the effects of eicosapentaenoic acid (EPA) in
clinical trials in depression. Journal of Clinical Psychiatry 72: 1577-84.

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