Fish oil supplements are a controversial topic.
As we touch on in our fish oil buying guide, many fish oil supplements contain rancid and damaged fats and the content of EPA and DHA (the two most important types of omega-3 fatty acids) is often overstated.
In some cases, low quality fish oil supplements contain more saturated fat than they do omega-3 fats.
For this reason, the first step before deciding on a fish oil dose is to identify a good brand.
Does fish oil have proven benefits?
In the scientific literature, the long term benefits of fish oil supplements are contradictory.
But then you have the recent Vascepa trial, which looked at the impact of taking 2 grams of medical grade EPA twice a day on the incidence of stroke and death from heart disease. The death rate and heart attack rate was lower in the group taking the EPA medication.
The Vascepa trial was published in the New England Journal of Medicine, however, despite the promise of this one study, fish oil supplements have been associated with bad outcomes in other studies. 3 4
Fish oil is an important source of omega-3 fatty acids
The dilemma for those looking to eat well is how do you get adequate amounts of omega-3 fatty acids, especially if you follow a more plant based diet?
Supplementing with fish oil remains controversial, but the benefits of adequate omega-3 fatty acids in the diet are not.
For example, this study, appearing in the Australian and New Zealand Journal of Psychiatry, which found that EPA supplementation was just as effective at treating depressive disorder as was a commonly prescribed prescription drug. Or this study which found that balancing the fatty acid intakes of elderly women (by giving them 2.5 grams a day of EPA) improved symptoms of depression.
So, what I hear you saying at this point is, wait a minute, all the beneficial studies you’re citing administered heavy doses of omega-3, and you’re micro-dosing?
Yes, luckily I am not sick with heart disease and I am not depressed.
At this point, that level of intervention isn’t necessary for me. Instead, I want to be vigilant about keeping my omega-6 to omega-3 intake in balance. Too much omega-6 hinders the ability of the body to get and use EPA, so as my intake of omega-6 relative to omega-3 goes up, my levels of healthy fat metabolism overall goes down.
Fish oil is a tool I use to keep things in balance and more aggressively target my omega-6 to omega-3 ratio, not something I choose to mega-dose under the philosophy “more is better.”
For example, even inside of a single day of eating, the benefits of a small dose (around a tsp) of Rosita Cod Liver Oil (View on Amazon) are obvious when you start to track your macro and micronutrient ratios.
Using an app like Cronometer, you can see the change in omega-3 to omega-6 ratio when direct EPA and DHA is added to the diet. In the visual below, a dose of cod liver oil, as well as some algal oil, bumped my omega-3 intake up to a ratio of about 2.5:1 omega-6 to omega-3.
Side note: Cronometer adds in the trans fat whenever you use oil, and in this case I cooked eggs in a combo of ghee and avocado oil. That gave me the fractional uptick in trans fat.
Why does balancing omega-3 to omega-6 fats matter?
The meat and eggs many of us eat on a daily basis are already higher in omega-6 fatty acids as a result of the industrial farming system feeding corn, soy and other low quality GMO grain to these animals.
Next, factor in all the vegetable oils found in everything from gluten free bread to your favorite salad dressing, to your morning omelette at the local diner, and you’re in an omega-3 deficit relative to the omega-6 rich diet most consume.
Testing EPA / DHA to determine fish oil dose
Ok, so let’s say you’re a little low on omega-3 and want to shift to a better omega-6 to omega-3 balance.
You can compensate by eating wild salmon and other fatty fish, and probably should, but even the best of these fish carry a toxic burden. It’s likely not wise to eat fish every day of the week, no matter how pristine. And here’s the thing: eating fatty fish is no guarantee that your omega-3 fatty acid levels will be where you want them at your next blood draw.
The fish oil regimen any of us take should be tailored to our lab results.
If we’re low on EPA and DHA, or if we want to better balance the ratio of arachidonic acid to EPA, take the amount of supplemental EPA and DHA you need to get the ratios in check.
Don’t take more.
There is a well documented, proven benefit to balancing omega-3 to omega-6 consumption in favor of omega-3. 7
There is not a proven benefit in taking mega-doses of over the counter fish oil.
Finding the right fish oil dose
If you opt out of the fish oil path and testing confirms you have adequate levels of omega 3, great. According to long time nutrition commentators like Dr. Barry Sears, the ratio of ARA to EPA that is optimal is somewhere between 1.5 – 4.
In these cases, there is no need to go any further, especially if you are feeling sharp and healthy.
However, if you test low, fish oil, as a bioavailable form of EPA and DHA, can start to look like an attractive option, but how much to take?
Many advocate for mega dosing fish oil, and it’s true that of the therapeutic applications for EPA and DHA have been discovered in higher dose pharmaceuticals.
Does it follow that the average Joe should go out and take large doses of fish oil everyday?
As with anything, I’m sure it depends on the individual. Fish oil is a blood thinner and some people develop side effects when taking high doses.
In the Vascepa trial, the group given the EPA drug had higher incidents of “serious bleeding events.” Not everyone will tolerate a lot of fish oil.
I find benefit from taking 2-3 days consecutive of about 600mg and 425mg of DHA:EPA.
I notice a calming effect and increased cognitive function, however, if I up the dose, I develop side effects reliably, the primary one feeling a little light headed. I also find that more than a few days at this dose is sub optimal for me as well. Taking too much fish oil, especially cod liver oil which is rich in Vitamin A, K and D can cause unwanted side effects, dizziness being a common one.
Taking small doses and skipping multiple days a week is the best bet for me.
This is essentially the regimen outlined by longevity researcher Valter Longo in his book The Longevity Diet (View on Amazon). Longo recommends a fish oil capsule, but only a couple times a week.
One of the benefits of buying bottled fish oil, as opposed to fish oil capsules, is it’s easier to create a custom dose based on what works best for you.