Omega-3 (EPA/DHA)
The most evidence-backed nutritional supplement on the market. Anti-inflammatory, cardioprotective, neuroprotective — and almost everyone is under-eating it.
Triglyceride reduction (proven), cardiovascular event reduction (especially at higher doses — REDUCE-IT trial used 4g/day prescription EPA), depression (EPA-dominant blends), rheumatoid arthritis joint pain, dry eye, and infant neurodevelopment have strong RCT support. Anti-inflammatory effects appear in 2–4 weeks; mood and joint effects in 4–8 weeks; cardiovascular markers in 8–12 weeks.
Omega-3 fatty acids are essential — the body can't make them, you have to eat them. The two that matter most are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), found in fatty fish. EPA drives the anti-inflammatory and mood-related effects through its conversion to specialised pro-resolving mediators that actively switch off inflammation. DHA is structural — a major component of brain cell membranes and the retina. Modern diets are heavy in pro-inflammatory omega-6 (seed oils, processed food) and light in omega-3. Bringing the ratio back in balance is one of the highest-leverage dietary interventions, and supplementation is the simplest way to do it.
- Form
- Triglyceride (TG) form is most bioavailable — reads as 'Triglyceride' or 'Natural' or 're-esterified TG' on the label. Ethyl ester (EE) is cheaper and slightly less bioavailable but fine if taken with a meal. Krill oil (phospholipid form) absorbs well and includes astaxanthin, but is expensive per gram of EPA/DHA. Algae oil for vegans (DHA-rich, lower EPA). Look for third-party tested products (IFOS or NSF) to avoid heavy metals and rancidity.
- Dose
- 1 g combined EPA+DHA per day for general maintenance. 2–4 g per day for therapeutic effect (depression, inflammation, autoimmune support, triglyceride lowering). Read the label carefully — '1000 mg fish oil' often means only 300 mg actual EPA+DHA.
- Timing
- With the largest fat-containing meal of the day. Morning typically. Refrigerating capsules and taking with food reduces 'fishy burps'.
- Schedule
- Daily, ongoing. Stable replacement, not cycled.
- Side effects
- Fishy burps or aftertaste (mitigated by freezing capsules, taking with meal, or switching to enteric-coated). Mild loose stools at higher doses. Rarely, mild fish allergy reactions.
- Interactions
- Anticoagulants and antiplatelets (warfarin, aspirin, clopidogrel, DOACs) — omega-3 mildly thins the blood. At moderate doses (1–2 g/day) the effect is small; at high doses (>3 g/day) it can become clinically meaningful. Discuss with prescriber. Reduces blood pressure modestly — additive with antihypertensives.
- Contraindications
- Active bleeding disorders. Planned surgery — stop 7–14 days before. True fish allergy (krill oil is also shellfish-derived — use algae instead).
- Lab markers
- Omega-3 Index — RBC membrane EPA+DHA as percentage of total fatty acids. The single most useful marker. Target: 8–12%. Below 4% is a documented cardiovascular risk factor. Easily testable through OmegaQuant and similar labs. Triglycerides (general lipid panel) also drop measurably with adequate omega-3.
- Food sources
- Fatty cold-water fish 2–3 servings per week: salmon (especially wild Alaskan), sardines, mackerel, herring, anchovies, trout. Cod liver oil (also high in A and D). Caviar. ALA from flax, chia, walnuts, hemp — but conversion to EPA/DHA in the body is poor (~5–10% to EPA, <0.5% to DHA), so don't rely on plant sources for the EPA/DHA your body actually uses.
Pairs with
Vitamin E (protects unsaturated fats from oxidation — present in most quality fish oils). Vitamin D3 (often deficient together; both support immune regulation). Curcumin (synergistic anti-inflammatory). CoQ10 (cardiovascular synergy).
within Fatty acids