EPA and DHA from fish lower triglycerides, inflammation and at high doses cardiac events. Why the omega-3 index is the value that counts, how much fish or oil is needed, what algae oil means for vegetarians and how to recognize good fish oil.
In short
- An omega-3 index above 8 percent is the target; most Western Europeans and Americans sit at 4 to 5.
- Two to three portions of oily fish a week or 1 to 2 grams of EPA and DHA daily from fish oil or algae oil.
- Proven: triglycerides, inflammation markers, blood pressure, cardiac death at high doses; not proven: miracles in healthy people with a good index.
- Quality: triglyceride form, fresh, no rancid smell, sourced from small fish or algae.
What omega-3 are
Omega-3 fatty acids are polyunsaturated fats the body cannot make itself. The effective forms are EPA and DHA from oily fish and algae; the plant form ALA from flaxseed, walnuts and rapeseed oil is converted only to a few percent. EPA and DHA are building blocks of cell membranes, especially in brain and retina, and precursors of messengers that resolve inflammation.
The omega-3 index
It measures the share of EPA and DHA in the fatty acids of red blood cells and reflects supply over the last months. Under 4 percent counts as low with elevated cardiac risk, 4 to 8 as medium, above 8 as optimal. Japanese sit at 9 to 10, Americans and Central Europeans on average at 4 to 5. The test costs about 50 euros or dollars and says more than any question about fish quantity, because utilization is individual.
What is proven
Omega-3 lowers triglycerides by 20 to 30 percent, reduces inflammation markers, lowers blood pressure slightly and improves stiffness and pain in joint complaints. The cardiac effect is dose-dependent: at 1 gram daily large studies were inconsistent, at 2 to 4 grams of EPA the rate of cardiac events fell by 25 percent in risk patients in one large study. For brain and dementia there are hints, no proof; for depression a slight additional effect. In people who already have a high index, more brings little.
Fish or capsule
Two to three portions of oily fish a week, salmon, mackerel, herring, sardines, trout, deliver 1 to 2 grams of EPA and DHA a day on average and raise the index into the target range. Small fish have less mercury than tuna. Whoever eats less fish supplements with 1 to 2 grams of EPA and DHA from fish oil or algae oil daily, with a meal containing fat. Algae oil delivers mainly DHA and some EPA and is the source for vegetarians and vegans, equivalent for the index.
Recognizing good oil
The triglyceride form is absorbed better than the ethyl ester form, which the label often does not mention; ask the manufacturer when in doubt. The oil must be fresh: a rancid smell when biting a capsule means oxidized and harmful. The EPA and DHA content per capsule is on the label; 1,000 milligrams of fish oil often contain only 300 milligrams of EPA and DHA, so you need three to six capsules or a highly concentrated product. Store cool and dark.
Try it
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Does omega-3 thin the blood?
It slightly lowers the clumping tendency of platelets. At normal doses that is unproblematic; whoever takes anticoagulants or faces surgery talks to the doctor.
Is flaxseed oil enough?
No. Flaxseed oil delivers ALA, of which only 5 to 10 percent become EPA and almost nothing DHA. It is a good oil but no fish substitute. Algae oil is the plant alternative.
Krill oil or fish oil?
Krill oil is absorbed slightly better but contains less EPA and DHA per capsule and costs more. Fish oil in triglyceride form is the better value.
This article is general information and not medical advice. If you have symptoms or existing conditions, or before changing any medication, talk to your doctor.
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