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You know you should take omega-3s. Your doctor may have even mentioned fish oil. But the supplement aisle has 47 options: fish oil, krill oil, algae oil, cod liver oil. Different doses. Different forms (triglyceride, ethyl ester, phospholipid). Different prices. Most people grab something, take one capsule, and call it good. That's usually 300-500 mg of combined EPA and DHA. Therapeutic doses for reducing inflammation and cardiovascular risk start at 2,000 mg. You're probably underdosing by 75%. Harris and von Schacky published the Omega-3 Index concept in Preventive Medicine (2004), showing that measuring red blood cell EPA+DHA levels predicts cardiovascular risk better than cholesterol. An index above 8% is cardioprotective. The average American is at 4-5%. That's a risk zone. Let's fix it.
The modern Western diet has an omega-6 to omega-3 ratio of approximately 15-20:1. Our ancestors ate 1-2:1. This imbalance drives chronic inflammation.
Omega-6 fatty acids (linoleic acid, arachidonic acid) are precursors to pro-inflammatory eicosanoids. Omega-3s (EPA and DHA) are precursors to anti-inflammatory eicosanoids and specialized pro-resolving mediators (SPMs) that actively resolve inflammation.
When omega-6 overwhelms omega-3, your body stays in a pro-inflammatory state. This contributes to cardiovascular disease, autoimmune conditions, depression, cognitive decline, joint pain, and virtually every chronic inflammatory condition.
Simopoulos published the definitive review in Biomedicine & Pharmacotherapy (2002): a ratio below 4:1 is associated with reduced risk of cardiovascular disease (70% decrease in total mortality), breast cancer, colon cancer, rheumatoid arthritis, and asthma.
You can't supplement your way out of a terrible omega-6/omega-3 ratio, but reducing seed oil consumption and increasing omega-3 intake together shift the balance dramatically.
Two forms of omega-3 matter clinically: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). ALA (alpha-linolenic acid) from flax and chia converts to EPA and DHA at less than 5% efficiency, making plant-based ALA sources inadequate for therapeutic needs.
EPA and DHA serve different functions, though both are essential.
EPA is primarily anti-inflammatory. It competes with arachidonic acid (omega-6) for the same enzymes, reducing pro-inflammatory prostaglandin and leukotriene production. EPA is the dominant omega-3 in studies showing mood improvement and depression reduction.
Sublette and colleagues published in the Journal of Clinical Psychiatry (2011) that EPA-predominant formulations were more effective for depression than DHA-predominant formulations. For mood support, choose a supplement with higher EPA than DHA.
DHA is primarily structural. It makes up 40% of the polyunsaturated fatty acids in your brain and 60% in the retina of your eyes. DHA is essential for brain development (critical during pregnancy and early childhood), cognitive function throughout life, and visual acuity.
DHA also has anti-inflammatory properties and supports cardiovascular health, but its primary role is maintaining the structural integrity of cell membranes, particularly in the brain.
For general health: equal EPA and DHA or slightly higher EPA. For depression and mood: higher EPA (at least 1,000 mg EPA daily). For brain health and cognitive support: higher DHA. For pregnancy: at least 300 mg DHA daily (most prenatal formulas are inadequate). For cardiovascular protection: 2,000+ mg combined EPA/DHA.
Fish oil is the most studied omega-3 supplement. The vast majority of clinical trials used fish oil, giving it the strongest evidence base.
Pros: Cost-effective ($0.05-0.15 per gram of EPA/DHA). High EPA/DHA content per capsule (500-1,000 mg per serving in quality products). Extensive research backing. Widely available.
Cons: Oxidation. Fish oil oxidizes easily, and rancid fish oil is not just ineffective but potentially harmful. Albert and colleagues published in Scientific Reports (2015) that a significant percentage of commercial fish oil supplements exceeded acceptable oxidation levels. Buy from brands that publish third-party testing for oxidation markers (peroxide value, anisidine, TOTOX).
Fishy burps. Taking fish oil with meals reduces this. Enteric-coated capsules also help.
Form matters: Triglyceride form fish oil has 50% better absorption than ethyl ester form. Dyerberg and colleagues published this comparison in Prostaglandins, Leukotrienes and Essential Fatty Acids (2010). Many cheap fish oils use ethyl ester (labeled as "fish oil concentrate"). Look for "triglyceride form" or "rTG" on the label. Nordic Naturals, Carlson Labs, and Life Extension use triglyceride form.
Heavy metal contamination is a concern with lower-quality products. Look for IFOS (International Fish Oil Standards) 5-star certification or Labdoor testing.
Dose: 2,000-3,000 mg combined EPA/DHA daily with food. This typically means 2-4 softgels per day, depending on concentration. One standard 1,000 mg fish oil capsule contains only 300 mg EPA/DHA. You need the actual EPA/DHA amount, not the fish oil amount.
Krill oil comes from tiny Antarctic shrimp-like crustaceans. It has some distinct advantages over fish oil.
Phospholipid-bound omega-3s: In krill oil, EPA and DHA are bound to phospholipids rather than triglycerides. Cell membranes are made of phospholipids, so phospholipid-bound omega-3s may be incorporated more efficiently. Ulven and colleagues published in Lipids (2011) showing that krill oil raised the omega-3 index comparably to fish oil despite lower total EPA/DHA content, suggesting better bioavailability.
Astaxanthin: Krill oil naturally contains astaxanthin, a potent carotenoid antioxidant that gives krill their red color. Astaxanthin protects the omega-3s from oxidation (no fishy burps) and has its own anti-inflammatory and antioxidant benefits.
No fishy aftertaste: The phospholipid form and astaxanthin content mean krill oil rarely causes burping or fishy taste.
Cons: Lower EPA/DHA per capsule (typically 100-300 mg per serving vs 500-1,000 in fish oil). You need more capsules to reach therapeutic doses. More expensive per gram of omega-3. Sustainability concerns (though most brands use MSC-certified sustainable harvesting).
Allergy note: Krill is shellfish. People with shellfish allergies should avoid krill oil.
Krill oil makes sense for people who want moderate omega-3 supplementation with added astaxanthin benefit and can't tolerate fish oil. For therapeutic dosing (2,000+ mg EPA/DHA), fish oil is more practical and cost-effective.
Algae oil is derived from microalgae, the original source of omega-3s in the marine food chain. Fish get their omega-3s from eating algae (or eating fish that ate algae). Algae oil cuts out the middleman.
Pros: Vegan and vegetarian friendly. No heavy metal concerns (algae are cultivated in controlled environments). Sustainable (no ocean fish depletion). No fishy taste.
Cons: DHA-dominant. Most algae oil supplements are high in DHA but low in EPA. Some newer products (like Nordic Naturals Algae Omega) include both, but the EPA content is typically lower than fish oil.
Conversion from DHA to EPA is possible but limited (about 10% in humans). If you need high EPA for mood or anti-inflammatory purposes, algae oil alone may not be sufficient.
More expensive than fish oil. Typically $0.15-0.30 per gram of DHA.
Dose: Aim for at least 500 mg DHA daily from algae oil. For combined EPA/DHA, you may need to take multiple capsules or use a high-potency product.
Algae oil is the best option for vegans, vegetarians, people with fish allergies, or those concerned about environmental sustainability. For therapeutic anti-inflammatory dosing, combining algae oil with dietary sources of EPA (like some mushroom-derived products) may be necessary.
The Omega-3 Index measures the percentage of your red blood cell membranes composed of EPA and DHA. It's the most accurate way to assess your omega-3 status.
Harris and von Schacky first proposed this test in Preventive Medicine (2004) as a cardiovascular risk factor.
Below 4%: High risk zone. Associated with 10x higher risk of sudden cardiac death compared to above 8%. 4-8%: Moderate risk. Most Americans fall here. Above 8%: Cardioprotective. This is the target. Above 12%: Common in Japanese populations with high fish intake. Associated with lowest cardiovascular mortality.
RBC membranes turn over every 120 days, so the Omega-3 Index reflects 3-4 months of intake. Test at baseline, supplement for 3-4 months, then retest to see if you've reached 8%+.
OmegaQuant offers at-home finger-prick testing for about $50. Some functional medicine practitioners include it in comprehensive panels.
Why test? Because individual response to supplementation varies dramatically. Some people reach 8% on 2,000 mg daily. Others need 4,000 mg. Genetics, absorption, and dietary omega-6 intake all influence your response. Testing removes the guesswork.
Take omega-3 supplements with a fat-containing meal for optimal absorption. Consuming them on an empty stomach reduces absorption by approximately 50%.
You need more omega-3s than you're getting. The modern diet provides far too many omega-6 fatty acids and far too few omega-3s. This imbalance drives chronic inflammation behind virtually every modern disease. For most people, fish oil in triglyceride form is the most practical and cost-effective option. Take 2,000-3,000 mg combined EPA/DHA daily with food. Choose brands with third-party testing for oxidation and purity. For those who prefer krill, you get better bioavailability and astaxanthin but at higher cost and lower EPA/DHA per capsule. For vegans and vegetarians, algae oil provides DHA effectively. Seek products that also include EPA. Test your Omega-3 Index. Target above 8%. Retest after 3-4 months of supplementation. This is one of the simplest, most evidence-backed interventions in preventive medicine. Reduce inflammation. Protect your heart. Support your brain. Take your omega-3s.
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