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Omega-3s: Boost Brain and Bone Health, but Heart-Health Benefits Uncertain

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Upon losing almost 10 feet of intestines, a 6-year-old girl became reliant on total parenteral (intravenous) nutrition. After five months, she experienced neurological symptoms such as numbness, weakness, and blurred vision. Analysis showed a significant deficiency in linolenic acid, a type of omega-3 fatty acid. Switching her to an emulsion with linolenic acid eventually resolved her neurological symptoms.

Doctors and dieticians have praised omega-3s for potentially reducing cardiovascular events for decades, making fish oil a popular nonvitamin, nonmineral dietary supplement in the United States.

Despite their widespread use, omega-3 supplements remain controversial; some studies tout their benefits, while others suggest they have no effect or could even be harmful.

Complicating matters is the debate over whether a deficiency in omega-3s or an excess of omega-6 fatty acids contributes to chronic disease. Both are essential but often imbalanced in modern diets. While the body requires dietary omega-3s, the critical question persists: Are omega-3 supplements beneficial or harmful?

Omega-3s are widely promoted for their potential health advantages, which range from heart health improvement to cancer prevention. Yet scrutiny of scientific research reveals a nuanced and occasionally conflicting narrative. Here, we delve into the suggested benefits of omega-3s, presenting varied scientific outcomes that indicate positive, neutral, or sometimes adverse effects.

Particularly noteworthy is the significance of dietary balance between omega-6 and omega-3 fatty acids. Studies generally seem positive when this balance is maintained, underscoring the crucial role of dietary equilibrium.

image-5680964

Omega-3 fatty acids support brain and mental health, slow age-related macular degeneration, and keep bones and joints healthy. (Illustration by The Epoch Times, Shutterstock)

1. Reduce Heart Disease Risk

Omega-3 fatty acids have gained attention for their potential cardiovascular benefits. Despite a fatty fish-rich diet, these benefits were initially observed in Greenland Inuits with low cholesterol, triglycerides, and low-density lipoprotein (LDL) levels. Subsequent studies have produced mixed results. One 2019 study found that despite having a better blood lipid profile, the Canadian Inuit population had a higher prevalence of heart attack, stroke, diabetes, obesity, and hypertension than the general Canadian population.

What Are the Benefits of Eating Fish?

A 2024 study examining nearly 200 blood samples found a 16 percent reduced risk of stroke due to DHA from fish consumption. Researchers of one 2004 meta-analysis concluded that the mortality rates from coronary heart disease might be reduced by consuming fish once or more per week. The meta-analysis showed that a 20-gram daily increase in fish consumption was associated with a 7 percent reduction in coronary heart disease mortality risk.

A 1989 trial involving 2,033 men with a history of heart attacks found that fatty fish consumption reduced the risk of two-year all-cause mortality by 29 percent. The researchers concluded that eating two to three portions of fish per week may lower mortality in men who have recovered from heart attacks. As per a 2018 review, after examining extensive evidence, the American Heart Association (AHA) Science Advisory Board recommended eating one to two seafood meals per week to decrease the risk of certain heart diseases.
However, a 1995 study with 44,895 participants with no known cardiovascular disease found no substantial benefit from increasing fish intake from one to two servings per week to five to six servings per week over six years.
The most extensive meta-analysis, encompassing 86 trials on omega-3 fatty acids and cardiovascular disease, was published in 2020. The authors concluded that consuming oily fish or omega-3 supplements only slightly reduced all-cause mortality, cardiovascular mortality, or cardiovascular events.

Arguments for and Against Supplementing

Studies both supporting and opposing supplementation have been reported.

A 2008 trial involving 6,975 participants with chronic heart failure found that consuming 1 gram of omega-3 polyunsaturated fatty acids (PUFAs) daily reduced the risk of all-cause mortality by 9 percent. Similarly, a 2020 meta-analysis of 16 trials found that administering 1 gram of omega-3 PUFAs daily for at least one year led to a 9 percent lower risk of cardiac death and a 17 percent lower risk of heart attack.
On the other hand, a 2020 trial involving 25,871 healthy American adults aged 50 and older found that omega-3 supplementation did not significantly affect the incidence of major adverse cardiovascular events or death. A 2013 trial involving 12,513 individuals at risk for cardiovascular disease reported no decrease in cardiovascular mortality or morbidity with a daily intake of 1 gram of n-3 (another name for omega-3) fatty acids.

Potential Harms From Supplementing

Atrial fibrillation (AF) is a type of arrhythmia, or abnormal heartbeat, characterized by extremely fast and irregular beats originating from the heart’s upper chambers, typically exceeding 400 beats per minute. A 2024 review concluded that larger studies on omega-3 PUFA supplementation with long-term follow-up have shown a dose-dependent increase in the incidence of AF. For instance, daily doses of 1 gram or more of omega-3 PUFA are associated with a 50 percent increased risk of developing AF.
Atherogenic dyslipidemia is an abnormal blood lipid profile characterized by elevated triglycerides and reduced high-density lipoprotein (HDL) cholesterol linked to an increased residual cardiovascular risk. A 2020 trial involving 13,078 atherogenic dyslipidemia patients assigned participants to two groups: high-dose (4-gram) omega-3 supplementation and corn oil supplementation groups. Participants received at least four weeks of statin treatment prior to the study. New cases of atrial fibrillation were observed in the omega-3 group, with an occurrence rate of 2.2 percent compared to 1.3 percent in the corn oil group. The omega-3 group also experienced a higher rate of gastrointestinal adverse events (24.7 percent) than the corn oil group (14.7 percent).
A 2024 study found that regular fish oil supplementation was linked to an increased AF risk in individuals with no known cardiovascular disease. However, for those already diagnosed with AF, the use of fish oil supplements either had a protective effect or showed no effect on transitions from AF to major adverse cardiovascular events, AF to death, and major adverse cardiovascular events to death. Specifically, regular fish oil supplementation was connected to a 5 percent increased risk of stroke in people with a healthy cardiovascular state.
In summary, the effects of omega-3s on cardiovascular health are unclear. Some observational studies suggest benefits from fish consumption, especially when the balance of omega-6 and omega-3 fatty acids is considered. This highlights the need for personalized approaches to medicine and evaluating both omega-6 and omega-3 intake to maintain a healthier balance of these essential fats in the diet.

2. Lower Cancer Risk

Research findings on the potential of omega-3s to reduce cancer risk are also mixed. Research has associated high consumption of fish or fish oil in human populations with a reduced risk of colon, prostate, and breast cancers. However, other studies have not found a significant association or a slightly increased risk.

Prostate Cancer

Regarding fish consumption, a 2021 meta-analysis of 5,607 men with an average follow-up of five years found consuming omega-3-rich fish did not affect prostate cancer risk. Although a 2010 meta-analysis noted a 63 percent reduction in death from prostate cancer among those who consumed fish, it also failed to divulge compelling evidence indicating a protective link between fish consumption and prostate cancer incidence.

When the balance of dietary omega-6 and omega-3 fatty acids was considered, a 2011 clinical trial noted that achieving a dietary omega-6:omega-3 ratio of 2:1 through fish oil and dietary adjustments reduced cancer progression among prostate cancer patients.
Regarding supplementation, a 2021 meta-analysis concluded that neither fish oil supplements nor consuming n-3 PUFA-rich fish provided discernible benefits in reducing prostate cancer risk. Similarly, a 2024 placebo-controlled clinical trial published in Communications Medicine found no impact on tumor cell proliferation.
However, harmful effects have been reported with omega-3 supplementation. A 2008 case-control analysis reported a significant risk of high-grade prostate cancer with eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA), two types of omega-3s. According to the Prostate Cancer Prevention Trial (1994–2003), docosahexaenoic acid (DHA) might increase the risk of high-grade prostate cancer, and polyunsaturated fat supplementation was associated with a 27 percent higher risk of high-grade prostate cancer, suggesting a potential role of these fatty acids in promoting tumor formation.
A 2020 meta-analysis of 47 clinical trials involving 108,194 participants concluded that long-chain omega-3 and ALA could marginally raise prostate cancer risk, and increasing total PUFA might slightly increase the risk of cancer diagnosis and cancer-related mortality. However, the doses of total PUFA were notably high in certain trials.

Breast Cancer

In several studies, increased consumption of long-chain omega-3 fatty acids is linked to a reduced risk of breast cancer. Among 35,298 women aged 45 to 74 in the Singapore Chinese Health Study (1993–1998), those with the highest three quartiles of long-chain omega-3 intake had a 26 percent reduced risk of breast cancer compared to those in the lowest quartile, following about five years of observation.

In the VITamins And Lifestyle (VITAL) cohort of 35,016 women aged 50 to 76, those using fish oil supplements experienced a 32 percent decreased breast cancer risk compared to those who did not use fish oil over an average duration of six years.
The omega-3 to omega-6 fatty acids ratio may be an important determinant of breast cancer risk. According to a 2015 review, women with higher intake ratios of omega-3s relative to omega-6s were found to have a reduced risk of breast cancer in several—though not all—case-control and cohort studies.

Colorectal Cancer

A 2007 meta-analysis of 19 cohort studies found that fish consumption only slightly reduced overall colorectal cancer risk. However, among those with the highest fish intake (eating at least seven times more fish per month than those with the lowest intake), there was a 22 percent lower risk of colorectal cancer compared to the lowest-intake group.

According to VITAL cohort data, people who took fish oil supplements at least four days a week for over three years had a 49 percent lower risk of colorectal cancer compared to nonusers. This decrease in colorectal cancer risk was more prominent in men and applied mainly to colon cancer. While the consumption of dark fish and total EPA and DHA supplementation didn’t show a direct link to colorectal cancer risk overall, the relationship varied based on genetic risk. Specifically, low-to-moderate genetic risk groups saw a decrease in colorectal cancer risk with these supplements, while high-risk groups experienced a slight increase in risk.

3. Maintain Mental Health and Cognitive Function

Low intake of marine omega-3s is linked to an increased risk of various mental health issues, including attention-deficit/hyperactivity disorder (ADHD), autism, bipolar disorder, depression, and suicidal thoughts. Omega-3s, in general, play a crucial role in promoting brain development and regulating behavioral and neurochemical aspects related to mood disorders, including stress responses, depression, and aggression, as well as dopamine-related content and function.

  • Depression: Multiple studies demonstrate the effectiveness of omega-3s in treating major depressive disorder and various psychiatric conditions. For instance, a 2023 study showed that combining an omega-3 fatty acid supplement with an antidepressant led to a significantly greater improvement in depressive symptoms compared to either the supplement or antidepressant alone.
  • ADHD: Children require omega-3 fatty acids for proper brain development. A 2014 review of two meta-analyses concluded that children with ADHD tend to have lower levels of omega-3s, and supplementing their diet with them can lead to modest improvements in ADHD symptoms. Given the evidence, omega-3 fatty acids may be considered as an additional supplement to traditional ADHD treatments.
  • Schizophrenia: While specific clinical interventions have demonstrated the efficacy of omega-3 PUFA supplementation in relieving symptoms and enhancing cognitive functions in schizophrenia patients, not all studies have shown the same results.
  • Bipolar disorder: Bipolar disorder leads to extreme mood swings, characterized by mania or hypomania (emotional highs and lows) and depression. A 2014 study suggested that omega-3s appeared to be an effective supplementary treatment for both unipolar and bipolar depression.
  • Alzheimer’s and age-related cognitive decline: A 2023 meta-analysis of 1,135 participants showed that long-term users of omega-3 supplements had a 64 percent lower risk of developing Alzheimer’s disease.

4. Improve Hyperlipidemia

Hyperlipidemia is characterized by high levels of lipids, such as cholesterol and triglycerides, in the blood. It is associated with atherosclerosis (artery hardening) and can lead to severe health issues, such as heart attacks and strokes. Omega-3s reduce plasma triglyceride levels, especially in individuals with hypertriglyceridemia.

A 2011 study revealed that omega-3 PUFA consumption has several cardiovascular benefits, including reducing triglycerides and potentially reducing blot clots. Specifically, each 1-gram daily increase of EPA and DHA reduced triglycerides by 5.9 milligrams per deciliter. Omega-3 PUFA supplementation may also increase HDL (“good”) cholesterol levels.

5. Manage Autoimmune Diseases

Omega-3s, especially EPA and DHA, have strong immunomodulatory effects. Research suggests that omega-3s possess anti-inflammatory properties, making them potentially beneficial for managing inflammatory and autoimmune diseases such as arthritis, Crohn’s disease, ulcerative colitis, and lupus.

6. Support Healthy Bones and Joints

Evidence indicates that omega-3s are beneficial for bone health. A 2007 study found a positive association between omega-3s and higher bone mineral density in healthy young men. Research also suggests that omega-3s could be a promising treatment for osteoarthritis.

7. Enhance Sleep Quality

A 2021 study found that DHA-rich oil supplementation in healthy adults who didn’t regularly eat oily fish significantly improved sleep efficiency and reduced the time it took to fall asleep compared to a placebo. Additionally, a 2022 study showed that DHA/EPA enhances sleep quality for individuals aged 45 and older, pointing out that these effects had already been observed in children and young adults.

8. Promote Infant and Child Development

DHA is essential for infants’ growth and development of the central nervous system and visual function.

9. Reduce Menstrual Pain

A 2012 study found that omega-3 fatty acid supplementation effectively reduced the severity of primary dysmenorrhea (painful menstruation) symptoms, reducing the need for ibuprofen as a rescue medication. Older research has also suggested that dietary supplements containing fish or seal oil, enriched with or combined with vitamin B12, could significantly alleviate menstrual discomfort.

10. Alleviate Diabetes Symptoms

A 2015 meta-analysis reported that omega-3s had no significant effect on glucose control. However, when the omega-6:omega-3 ratio was lowered, a 2019 meta-analysis reported decreased insulin and insulin resistance in diabetic patients when supplementation was implemented for more than eight weeks.

Additionally, ALA’s antioxidant properties are considered beneficial for nerve damage. Although widely used in Germany for peripheral neuropathy, most supportive studies have involved intravenous administration of alpha-lipoic acid.

11. Lower High Blood Pressure

Some studies have determined that omega-3s can lower hypertension. A 2012 review suggested that high doses of omega-3s (at least 3 grams per day) can lower blood pressure, particularly systolic pressure, in older and hypertensive individuals. However, study results regarding dosage vary. One 2022 dose-response meta-analysis concluded that consuming around 2 to 3 grams of omega-3s daily is optimal for lowering blood pressure.

12. Significantly Improve Rheumatoid Arthritis

An older clinical trial showed that daily fish oil supplements reduced morning stiffness and the number of tender, swollen joints in rheumatoid arthritis patients. These benefits were more pronounced with higher doses.

A 2000 study suggested that fish oil supplementation providing omega-3s at 40 milligrams per kilogram of body weight per day, combined with a background diet of less than 10 grams a day of omega-6 fatty acids, improved the symptoms of patients with rheumatoid arthritis.

13. Reduce Macular Degeneration Risk

Age-related macular degeneration (AMD) is a leading factor contributing to vision impairment in older people. Researchers believe that DHA, found in the membranes of retinal cells, and EPA, which produces beneficial compounds for the retina, could protect the retina and potentially prevent or slow AMD progression.

In a 2008 study involving 2,275 participants aged 65 years or older, those who ate fatty fish at least once a week had a 53 percent lower risk of neovascular AMD than those who consumed fatty fish less frequently.

14. Decrease Blood Clot Risk

Long-chain omega-3 fatty acids such as EPA and DHA can help prevent blood cells (platelets) from sticking together too much, which is good for heart health. Taking these fatty acids might lower the risk of bleeding during surgery, according to a 2018 study.

The effectiveness of omega-3 fatty acids can vary based on several factors, including the disease it’s intended to combat and its stage of progression. In addition, conflicting study results may stem from the following:

  • Dose-dependent effect: According to a 2023 review in Cardiovascular Research, most evidence shows that low-dose (1 gram per day or less) omega-3 supplementation does not significantly decrease the risk of cardiovascular events. Overall, higher doses of supplements may or may not provide health benefits and could lead to adverse effects, such as atrial fibrillation.
  • Composition: Some studies use fish-sourced omega-3s, while others use fish oil containing both EPA and DHA. Others use only EPA or a highly purified form, while some studies do not provide a supplement. Instead, these studies rely on participants consuming an omega-3 supplement of their choice. This variation fuels ongoing debate about which form is most effective.
  • Purity: According to a 2020 article, omega-3 supplements from U.S. stores had about a 50 percent chance of containing less omega-3 than stated on the label. If products have lower omega-3 fatty acid content than advertised, the dosage might be inadequate for achieving the desired outcomes in studies where supplement content wasn’t clearly labeled.
  • Rancidity: Omega-3 supplements are highly susceptible to oxidation, which can change the structure of the fat, potentially reducing its effectiveness and leading to adverse health impacts. Eating rancid fat can lead to inflammation, organ damage, carcinogenesis, and advanced heart disease in animal studies, according to a 2013 review. The Guardian reported that independent tests by Labdoor found over 10 percent of fish oil supplements from 60 major retail brands were rancid, and nearly half were close to the maximum recommended limit. Two studies (1, 2) from 2015 mentioned in the 2020 article above revealed that oxidation was common, with 50 percent to 92 percent of store-bought supplements exceeding recommended cutoffs for markers of rancidity.
  • Omega balance: Studies generally report benefits when the balance between omega-6 and omega-3 fatty acids is restored, highlighting the importance of a proper dietary ratio.

Omega-3s are polyunsaturated fats and essential fats, which means our bodies cannot produce them. We must obtain them from our diet or supplements.

These fatty acids are vital for cell function, forming part of cell membranes to provide structure and support interactions. They are especially concentrated in the eyes and brain and crucial for eye, neurological, and psychological health. In addition, they provide energy and support the cardiovascular and endocrine systems.

The main types of omega-3s are:

  • Eicosapentaenoic acid (EPA): Your body can utilize EPA directly in its original form. It is typically found in cold-water oily fish (e.g., salmon), algae oil, krill oil, and fish oil supplements.
  • Docosahexaenoic acid (DHA): DHA is found in oily fish, seaweed, krill oil, algae oil, and omega-3 supplements. It is crucial for a healthy brain. Infants need DHA during their first six months for proper brain, eye, and nervous system development. Both EPA and DHA primarily originate from cold-water fish, earning them the name marine omega-3s. When consumed, the body converts some of the DHA back into EPA to maintain balanced levels of these essential fatty acids.
  • Alpha-linolenic acid (ALA): ALA is considered a short-chain omega-3. ALA is found in certain plants, including green leafy vegetables, walnuts, flaxseeds, chia seeds, and industrial oils such as canola and soybean.

After consumption, ALA converts into EPA and, subsequently, DHA. Nevertheless, this conversion process is notably inefficient, particularly among men. Men convert approximately 8 percent of ALA into EPA (and consequently DHA), whereas women of reproductive age convert about 30 percent of ALA into EPA, according to the 2023 Cardiovascular Research review. The review also suggested that given the limited conversion rates, relying on dietary sources of EPA and DHA is crucial to ensure adequate intake of omega-3 fatty acids.

Supplements

Scientists agree that the best way to acquire omega-3 fats is from food. There is also general agreement on the importance of balancing omega-6 and omega-3 fatty acids. The ideal ratio of omega-6 to omega-3 fatty acids is approximately 2:1, according to a 2021 article. However, many Americans exceed a ratio of 20:1, which can contribute to cardiovascular and other diseases. This is because most people consume too many omega-6 fatty acids, mainly from refined vegetable oils, processed foods, and grain-fed meats. Omega-3 fatty acids, more prevalent in marine animals like fish and shrimp and plants like flaxseed and walnuts, are consumed in much lower quantities.

Omega-3 supplements include marine- or plant-based oils and capsules. Synthetic and natural forms are also available, including dietary supplements of fish, krill, cod liver, and algal (vegetarian) oils.

These formulations can contain different omega-3 forms.

Natural forms include:

  • Triglycerides: found in fish and other marine sources.
  • Phospholipids: found in krill oil and some algal oils.
  • Free fatty acids: These are individual fatty acids that are not attached to other molecules. They are released when triglycerides are broken down by an enzyme called lipoprotein lipase in fat tissue.

Synthetic forms include:

  • Re-esterified triglycerides: These are generally more easily absorbed by the body than those in ethyl ester form.
  • Ethyl esters: These have lower bioavailability than other natural forms of omega-3s.

If you decide to use omega-3 supplements, here are some tips:

  • Not all omega-3 supplements are created equal. Choose a supplement that has been tested for heavy metals, rancidity, and purity.
  • If you cannot eat fish or shellfish, consider kelp- or seaweed-based supplements with EPA and DHA.
  • To avoid a fishy aftertaste from fish oil supplements, try freezing them before consumption, look for enteric-coated options, or take them with meals.
  • Be cautious with supplements containing fish liver oil, such as cod liver oil. These can contain high levels of vitamins A and D that may be harmful if consumed excessively, especially during pregnancy.
  • Ensure the supplement is stored in a dark container to protect the omega-3 fatty acids from exposure to sunlight, as they are prone to oxidation.

Although, according to the National Institutes of Health (NIH), omega-3 deficiency is rare in the United States, many people are thought to have inadequate intake of omega-3 fatty acids. In a 2009 review by the Harvard School of Public Health on risk factors for death, low omega-3 intake was ranked as the eighth most significant risk factor, with up to 96,000 deaths in the United States attributed to insufficient omega-3 intake each year.
Data collected from the 2003–2014 National Health and Nutrition Examination Survey (NHANES) show notable variations in omega-3 intake among different age groups over the surveyed years. The data further suggested that younger individuals might be vulnerable to low omega-3 consumption, and women might face a higher risk of low omega-3 intake than men.

Current daily recommendations for omega-3 intake differ significantly, with no set allowances for DHA and EPA across age groups. Various organizations have recommended adequate omega-3 intake based on age, health, and other factors. The NHANES analysis revealed that all age and gender groups fell short of meeting these recommended intakes for EPA, DHA, and EPA+DHA. Therefore, omega-3 deficiency could be widespread in the United States.

Western diets lack sufficient omega-3s despite containing excess omega-6s compared to our ancestors’ diets. This imbalance of high omega-6/omega-3 ratios contributes to the development of various diseases, such as cardiovascular disease, cancer, inflammation, and autoimmune diseases. Conversely, achieving a low omega-6/omega-3 ratio can protect against these conditions. Therefore, we may not be deficient in omega-3s in some cases but are overeating omega-6s.
Omega-3 deficiency, or an imbalance of omega-6 to omega-3, can lead to:

  • Dermatitis, or inflammation of the skin, which can cause symptoms such as redness, itching, swelling, and sometimes blistering or peeling
  • Rough, scaly skin
  • Dry eyes
  • Inflammation
  • Dry, brittle hair and hair loss
  • Cognitive decline
  • Joint pain and stiffness
  • Muscle pain
  • Depressive symptoms
  • Digestive issues
  • Allergies
  • Poor brain development
  • High triglycerides

Wild-caught, fatty fish that live in cold water are generally a rich source of omega-3s.

ALA is the predominant omega-3 fatty acid in many Western diets. It is present in chia and flax seeds, nuts (especially walnuts), leafy vegetables, some animal fats, especially from 100 percent grass-fed animals, and plant oils such as canola, soybean, and flaxseed oils.

Foods rich in omega-3 essential fatty acids include:

  • Herring
  • Mackerel
  • Salmon
  • Cod
  • Tuna
  • Whitefish
  • Sardines
  • Anchovies
  • Oysters
  • Halibut
  • Striped bass
  • Rainbow trout
  • Algae
  • Chia seeds
  • Hemp seeds
  • Flaxseeds
  • Walnuts (also high in omega-6)
  • Fortified foods (e.g., certain eggs, yogurt, soy beverages, and infant formula)

Other foods containing omega-3 fatty acids include egg yolks from pasture-raised chicken, as well as pasture-raised chicken and grass-fed, grass-finished beef.

Plant-based omega-3 fatty acids mainly come in the form of ALA, while fish provide both DHA and EPA. However, individuals following vegan diets are not necessarily deficient in these longer-chain omega-3s. In fact, women on vegan diets had higher levels of long-chain omega-3 fats in their blood compared to fish eaters, meat eaters, and ovo-lacto-vegetarians, according to the EPIC-Norfolk Study. Despite not consuming long-chain omega-3s and having lower ALA intake, it is possible that the ratio of product to precursor was higher in non-fish-eaters than in fish-eaters, suggesting a potentially greater conversion of ALA.

Mercury in Fish

Certain fish have higher mercury levels than others. Species that primarily consume other fish—typically large, deep-sea fish—tend to accumulate mercury more quickly in their bodies. Here are some varieties that can contain elevated mercury levels:

  • King mackerel
  • Marlin
  • Orange roughy
  • Shark
  • Swordfish
  • Tilefish
  • Bigeye tuna

If you enjoy fishing for your own catch, you must check with local authorities to confirm the safety of eating fish from nearby waters.

There are several dietary and lifestyle practices you can use to optimize omega-3 intake and absorption, including the following:

  • Pair omega-3s with a high-fat meal: Since omega-3s are fat-soluble, consuming them with dietary fat can enhance absorption. Pair omega-3-rich foods or supplements with a meal that includes healthy fats such as olive oil, avocados, or nuts.
  • Limit omega-6 intake: High levels of omega-6s can potentially interfere with the body’s absorption and utilization of omega-3s, as both omega-3 and omega-6 fatty acids compete for the same enzymes in the body for metabolism. This is why maintaining a balanced ratio of omega-6 to omega-3 fatty acids is vital for optimal health. Limit omega-6-rich food intake by avoiding vegetable oils (e.g., corn, soybean, sunflower), processed foods, and livestock raised on grain.
  • Avoid smoking and alcohol: Both smoking and alcohol consumption can contribute to oxidative stress in the body, which can impair omega-3 metabolism and change omega-3 concentrations.
  • Choose the right cooking method: Generally speaking, boiling or baking fish can better preserve their omega-3s than frying or microwaving.

Several nutrients that boost the effects of omega-3s include:

  • Vitamin E: As an antioxidant, vitamin E protects omega-3s from oxidation, thus ensuring they remain effective in the body.
  • Vitamin C: Vitamin C’s antioxidant effects safeguard omega-3s, leading to the belief that higher consumption of fatty acids should be paired with increased vitamin C intake.
  • Zinc: Adding zinc supplements has been shown to boost the impact of omega-3 in lowering triglycerides and LDL levels in the bloodstream in diabetic patients. Additionally, consuming omega-3 in conjunction with zinc supplements can aid in decreasing inflammation.

Many organizations have issued recommendations for the adequate intake (AI) of omega-3s.

The recommendations are for ALA omega-3s only for children aged 1 year and up, as the National Academy of Medicine has only established AIs for ALA and not the other types of omega-3s.

  • Birth to 6 months: 0.5 gram
  • 1 to 12 months: 0.5 gram
  • 1 to 3 years: 0.7 gram
  • 4 to 8 years: 0.9 gram
  • 9 to 13 years: 1.2 grams (males); 1.0 gram (females)
  • 14 to 18 years: 1.6 grams (males); 1.1 grams (females)
  • 14+ years (pregnancy): 1.4 grams
  • 14+ years (lactation): 1.3 grams
  • Over 19 years: 1.6 grams (males); 1.1 grams (females)

The American Heart Association (AHA) recommends consuming at least 8 ounces of fish per week, equivalent to two servings weekly. This means consuming 0.5 to 1.8 grams daily of both EPA and DHA is recommended, either through fatty fish or supplements.

Routine health care evaluations typically don’t include checking omega-3 levels, and there’s no standardized test for diagnosing a deficiency.

Still, blood tests can measure omega-3 levels, typically expressed as a percentage of total phospholipid fatty acids by weight. For accuracy, this measurement requires fasting overnight.
Another method involves analyzing the fatty acid composition of red blood cells, offering insight into long-term omega-3 consumption over several months.

A 2024 review published in Diagnosis (mentioned earlier regarding atrial fibrillation risk) cautioned against supplementation of omega-3 fatty acids for older people or those with cardiovascular disease, diabetes, or hypertriglyceridemia. According to the authors, existing data argue against supplementation for preventative purposes because of the lack of cardiovascular benefits and increased risk of atrial fibrillation that rises with age and in a dose-dependent manner.

Supplementing with a very high dose of 8 grams of omega-3s daily for eight weeks increased blood sugar levels by 22 percent in people with Type 2 diabetes, which is associated with a higher risk for cardiovascular disease, according to a small 1989 study. Moreover, animal studies have shown an increased risk of stroke due to decreased clotting ability following high omega-3 intake.
Side effects can occur from omega-3 supplementation—especially in high doses (over 3 grams)—including:

  • Bad breath
  • Gastrointestinal upset, including diarrhea
  • Indigestion
  • Stomach pain, nausea, or heartburn
  • Potential for excess bleeding, such as nosebleeds
  • Increased risk of atrial fibrillation
  • Immune system slowdown
  • Allergic reaction
  • Hypomania, a mildly manic state that may occur in people with bipolar disorder
  • Changes in blood sugar level
  • Rash
  • Severe dizziness
  • Exhaustion of the body’s supply of antioxidants

People with a fish or shellfish allergy should not consume fish oil.

Omega-3s interact with the following medications:

  • Chemotherapy medications: ALA has the potential to interact with certain chemotherapy drugs.
  • Thyroid medications: ALA may decrease thyroid hormone levels.
  • Diabetes medications: Someone who is diabetic, bruises easily, or is taking medication should speak with their doctor before consuming an omega-3 supplement.
  • Blood-thinning medications: Warfarin may increase the anticoagulant effect of blood thinners, so people taking it should consult their doctor before taking omega-3 supplements.

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