Fish Oil Quick Reference
Fish Oil Quick Reference
• Overall context for this topic
• General information
• Program target
• Supplement considerations
• Product suggestions
• Testing considerations
Page edition: 2018-08-08
Omega 3 DHA and EPA, almost always from fish oil, is a core program supplement.
Unless you consume ancestral amounts and forms of wild-caught seafood and/or game
organ meats, your Omega 3 levels, of these particular fatty acids,
are very likely suboptimal.
There are at least 11 Omega
3 (ω3) fatty acids found in nature. Of these, only
three are significant food-source Omega 3s:
DHA: Docosahexaenoic acid
EPA: Eicosapentaenoic acid
ALA: alpha-Linolenic acid Return to ToC
The need for DHA and EPA from fish oil has been part of the program, going back
at least a decade, and is extensively discussed in all the books and
Book: Undoctored: starting page 287 of the print edition
you consuming enough omega-3 fatty acids? (public)
Benefits of Omega-3s (members)
If You Don’t Like Fish Oil? (members)
The "fish oil" nomenclature is no accident. The principal (economic) source of
DHA and EPA is from fish. Ancestrally, eating enough seafood to meet ω3 needs
was fine. Modern ocean toxins make that unwise. Ancestrally, humans would also have
gotten these ω3s from
game organ meats (and game brains), but modern humans, eschew those sources.
ALA is widely available from plant sources, and humans do convert a small
percentage of it to DHA and EPA, but not enough, and consuming excess ALA
reportedly drives conversion down (and may have independent health risks).
There is generally no need to supplement ALA. Return to ToC
Program Fish Oil Targets
Generally: 3000 to 3600 mg/day of DHA+EPA
With elevated Lp(a): 6000 mg/day
High seafood intake: adjust supplementation per
Divide the daily amount into 2 or 3 doses.
This is milligrams of DHA plus EPA, and not the total amount of fish
oil (which will be higher). The ratio of DHA:EPA may be anywhere
between 1:2 and 2:1, or put another way, make sure you get the total,
and at least 1000 mg of each. For comparison, this is about how
much fish oil is present in 3 small cans of sardines.
The actual DHA+EPA goal is for blood levels of Omega 3
to be 10% of fatty acids, and for Omega 6 levels to be no
more than twice that. See Testing considerations below for further information.
Non-coincidentally, the program’s standard dose of DHA+EPA is in the same
range as for the preposterous
prescription forms of fish oil (Lovaza®, Omacor®, Omtryg™ and Vascepa®).
For anyone avoiding fish for any reason, DHA and EPA are available from
processing of marine algae (the same place the fish get it), and, from
time to time, via industrial fermentation. These sources, although
often costly, and obviously not ancestral, can meet program requirements.
Split the daily fish oil does into two or three portions, taken across the
day. If taking part of that as a fish oil+D3, take the D3 variant in the
Take fish oil while fasting?
That depends on the reason for the fast. Fish oil is 3.6 grams
of fat, or 32 calories. Being a fat, however, it would be no threat to ketosis. Return to ToC
On a statin?
There is an interference between statin drugs and fish oil benefits.
Dr. Davis wrote about this in a 2013 (then TYP) Blog post:
statins and omega-3s incompatible?
In addition to the paper linked there, here’s a later one:
of polyunsaturated fat in relation to mortality among statin users
and non-users in the Southern Community Cohort Study
Anyone with an unresolved fish allergy, or anaphylactic reaction to fish or
shellfish, needs to approach fish oil carefully.
In that situation, using a vegetarian source of DHA+EPA might be the interim
solution, but it could actually be more costly than the co-pay for using one
of the highly-processed prescription fish oils. The prescription oils are still fish-sourced,
so being hypo-allergenic reaction is not assured. Getting that prescription is another matter. Return to ToC
Blood thinning speculations
Site members are directed to this
remark by Dr. Davis from 2008.
The prescription forms of fish oil these days merely suggest monitoring,
where anticoagulant agents are in use. Such papers as exist cautioning
about fish oil tend to be confounded by statin use (perhaps unrecorded),
adverse wider diet, and med interactions.
Mega-dose fish oil?
Nothing in the program today suggests consuming more than 6 grams
per day. Much higher doses are being used experimentally in certain
situations, such as TBI,
but chronic uses of mega-doses is basically unexplored territory.
Gelcaps or bottled liquid oil are suggested.
With capsules, seek the highest potency per capsule (not necessarily per “serving”),
to keep the capsule count manageable. Favor the triglyceride form of fish oil over
the ethyl ester form, depending on other priorities.
Be cautious about products containing
anything other than fish oil and seek grain-free encapsulation. Added vitamin D can
be valuable, but mind the IUs. Return to ToC
This is not an exhaustive list. Other available products
are satisfactory. Typical price for 3.6g/day is shown parenthetically.
500 mL Liquid
Naturals Ultimate Omega
(650 mg/cap ω3, US$1.83/day)
Naturals Omega 3 (liquid)
(14.4 mL for 3600 mg ω3, US$1.19/day)
(1000 mg/cap ω3, US$1.07/day)
(14.4 mL for 3600 mg ω3, US$1.10/day)
Ethyl ester (or unstated) forms
Factors Ultra Strength RxOmega-3
(900 mg/cap ω3, US$1.06/day)
Joe’s Omega-3 Fatty Acids
(600 mg/cap ω3, US89¢/day)
Mark Triple Strength
(900 mg/cap ω3, US53¢/day)
Mark Double Strength w/D3
(650 mg/cap ω3, note)
the MM Double Strength product provides 2000 IU D3 per capsule, and typically
can’t be used as the sole source of fish oil, as that would be 11,000 IU
of D3 per day. 1-3 of these in the AM, and the balance as the Triple Strength
product can work. Run these numbers for any fish oil with/D, as other brands
can present the same issue.
Beyond those products, you may want to rely on third party product evaluations.
Subscription site ConsumerLab tests fish oil periodically.
Industry site IFOS
has open-access test data available, but doesn’t really rate products,
and only reports on member products.
Avoid krill-based products on economy grounds (just run the numbers some time).
Avoid cod liver oil due to excess vitamin A and marine toxins.
Fish oil incidentally includes fatty acids other than DHA and EPA, but avoid
anything that is mostly ALA (such as added flaxseed oil).
Avoid anything with added Omega 6 (adverse).
Avoid anything with added Omega 9 (needless).
Store fish oil in a cool location out
of direct sun exposure. Refrigeration is fine. Return to ToC
If in doubt about fatty acid status, or needing to dial-in supplementation
due to high seafood intake, two tests can be useful. These are the most accurate
when weight has been stable for 30 days or more. If you are losing weight, that includes
a lot of stored fat — fat which may represent prior diet (and is apt to be low in
ω3 and high in ω6).
CPT Code 82542 (suite)
||10 to 12%
||This is percentage of serum fatty acids that are Omega 3.
"Complete" or "plus" tests may also report details on DHA and EPA
as line items, which can be useful.
|Omega 6:3 Ratio, aka
CPT Code 82542 (suite)
|2:1 or lower
||"Complete" or "plus" tests may also report details on specific
ω6 fatty acids as line items, which can be useful.
If these tests aren’t routinely covered by your carrier (and they
it’s often cheaper to obtain them on your own, nanny state permitting,
from a mail-order or walk-in lab, perhaps via a Life
Extension Omega-3 Index Plus (LC100065, US$79-105) or Life
Extension Omega-3 Index Plus (LC100066, US$79-105).
Test day considerations
Fasting status: Avoid fish oil 12 hours before test.
Other supplements/meds: may be taken before or after draw
Time of day for test: anytime
Re-Test timing: wait 3-4 months Return to ToC