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⇩ Overall context for this topic ⇩ General information ⇩ Program target ⇩ Cautions ⇩ Supplement considerations ⇩ Product suggestions ⇩ Testing considerations
Page edition: 2025-01-26
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 organs, 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-sources of 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 two decades, and is extensively discussed in all the books and program materials: 🖵🗏 The RBC Omega-3 Index (members) 🖵🗏 Physiological Benefits of Omega-3s (members) 🖵🗏 What If You Don’t Like Fish Oil? (members) 📖 Super Gut: starting page 188 of the U.S. print edition 📖 Wheat Belly R&E (2019): starting page 252 of the U.S. print edition 📖 Undoctored: starting page 287 of the U.S. print edition 📖 Wheat Belly 10-Day Grain Detox: starting page 73 of the U.S. print edition 🖵🗏 Omega-3 Fatty Acids: Facts and Controversies (members) 🅑 IHB: Omega-3 fatty acids: Facts and controversies (public) 🅑 WBB: Some unexpected benefits of omega-3 fatty acids (public) 🅑 WBB: Are you consuming enough omega-3 fatty acids? (public)
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 sufficed. Modern ocean toxins make that unwise. Ancestrally, humans could also have gotten these ω3s from game organ meats (and game brains), but modern humans, eschew those sources, some of which are now risky as well.
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
⟲ Intake targets: Generally: 3000 to 3600 mg/day of DHA+EPA With elevated Lp(a): 6000 mg/day High seafood intake: adjust supplementation per ⇩test results Divide the daily amount into 2 or 3 doses.
This is milligrams of DHA plus EPA (combined, not each, and also 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.
⟲ Titer targets: 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. Because an Omega 3 titer is the real goal, it can be achieved by some combination of food and fish oil supplementation. The challenge is the hazards in modern food sources.
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.
⟲ Dose timing Split the daily fish oil dose into two or three portions, taken across the day. If taking part of that as a fish oil+Vitamin D, take the +D₃ variant in the morning. “Fish oil is best taken before breakfast and before dinner to take advantage of its postprandial lipoprotein-clearing effect.”
Store fish oil in a cool location out of direct sun exposure. Fish oil can be refrigerated or frozen to extend shelf life. Capsules may be consumed while still frozen.
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, if that’s the intent.⇱ 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: 🅑Are statins and omega-3s incompatible? In addition to the paper linked there, here’s a later one: NMCD: Intake of polyunsaturated fat in relation to mortality among statin users and non-users in the Southern Community Cohort Study
⟲ Fish Allergy? 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 current vegetarian sources of DHA+EPA tend to be at least twice the price of fish oil, and many of them have disqualifying ingredients.⇱ Return to ToC
⟲ Blood thinning speculations Site members are directed to this remark by Dr. Davis from 2022: “ The omega-3 fatty acids in fish oil normalize blood thinning, a big difference. For instance, it reduces high levels of fibrinogen that promote blood clotting: normalization of clotting, not blood thinning. The only contribution omega-3s make towards blood thinning is to reduce excessive platelet activation that may slightly prolong bleeding time, rarely a clinically meaningful effect.”
⟲ 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 are basically unexplored territory.
⟲ Supplement form Gelcaps or bottled liquid oil are suggested. With capsules, generally 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 may be satisfactory. Typical price for ~3300 mg/day is shown for rough price comparisons, using brand MSRP. Lower prices may be found at credible resellers, and via subscription purchase. Some general selection principles are discussed below the list. Buy only from credible sources, which today often ⚠excludes on-line ‘marketplace’ sites.
Carlson® Maximum Omega 2000 (soft gels) DHA+EPA 875 mg/cap, 4/day = 3500 mg, US$2.07/day The Very Finest Fish Oil (soft gels) DHA+EPA 300 mg/cap, 11/day = 3300 mg, US$2.45/day The Very Finest Fish Oil™ (500mL liquid) DHA+EPA 260 mg per mL, 13 mL/day = 3380 mg, US$1.43/day
Nature’s Way {formerly Ascenta} NutraSea® Omega-3 (500 mL liquid) DHA+EPA 250 mg per mL, 13 ml day = 3250 mg/day, US$1.56/day
Nordic Naturals® Ultimate Omega (soft gels) DHA+EPA 550 mg/cap, 6/day = 3300 mg, US$2.32/day Ultimate Omega (237mL liquid) DHA+EPA 494 mg per mL, 7 mL/day = 3458 mg, US$2.30/day
OmegaVia® Ultra Concentrated Omega-3 (soft gels) DHA+EPA 1040 mg/cap, 3/day = 3120 mg, US$2.00/day
Barleen’s Ideal Omega® 3 Softgels - Orange Flavor DHA+EPA 1000 mg per capsule, 3/day = 3000 mg, US$2.50/day
innovixlabs: Triple Strength Omega-3 (soft gels) DHA+EPA 840 mg/cap, 4/day = 3360 mg, US$1.00/day
Kirkland Signature (Costco) Kirkland Signature Fish Oil 1000 mg., 400 Softgels DHA+EPA: 250 mg per cap, 13 caps/day = 3250 mg, US72¢/day
Natural Factors RxOmega-3 Ultra Strength 2,150 mg DHA+EPA 1015 mg per cap, 3 caps/day = 3045 mg, US$3.40/day
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.
When checking product economy, be sure to assess only the DHA+EPA content, and how many capsules (or mL) are required to deliver the label ‘portion’ amount (as it is often 2 or more capsules, and often only 5mL for liquid). Program amounts will be much higher.
Avoid krill-based products on economy grounds (just run the numbers some time). Avoid cod liver oil due to marine toxins (Hg, PCBs), and excess vitamin A at program intake levels. 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). If the package touts Omega 6, that’s a warning label. Avoid anything with added Omega 9 (needless).
Several brands of fish oil are available with Vitamin D. This can be a way to take most, or even all of the day’s Vitamin D₃.
These product can’t typically be used as the sole source of fish oil, as that would be excess D₃ per day. Perhaps a few of these in the AM, and the balance as pure fish oil product could work. Run the numbers for any fish oil with/D₃.⇱ 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).
If these tests aren’t routinely covered by your carrier (and they often aren’t), it’s often cheaper to obtain them on your own, nanny state permitting, from a mail-order or walk-in lab, perhaps via a home finger-stick test from: ∞omegaquant Omega-3 Index Plus Test ($79.95, basic test less) ⌬Omega-3 Index Plus Finger Stick Test (LC100065, US$79-105) ⌬Omega-3 Index Complete Finger Stick Test (LC100066, US$79-105).
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