Omega-3 Supplements: Do You Really Need Them?

Omega-3 fatty acids are important polyunsaturated fats that your body can’t make by itself. They play a key role in building cell membranes, lowering inflammation, and keeping your heart, brain, and eyes healthy. Since you have to get them from food, it’s worth knowing when your diet might fall short and when adding Omega-3 supplements could help.

There is no government recommendation in the UK on how much omega-3 we need. But UK government dietary advice recommends we eat two 140g (cooked weight) portions of fish a week, with one of these being an oily fish.

Oily fish (macarel, salmon, sardines) are the best source of EPA and DHA omega-3 fats, but there are also small amounts in white fish and shellfish. It’s worth remembering that white and oily fish are also healthy choices, as they are good sources of protein, vitamins, and minerals.

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Omega-3 Supplements: The Latest Research Results

Research indicates that regular use of Omega-3 supplements from fish oil has a dual, contrasting effect on cardiovascular health depending on an individual’s baseline condition. In generally healthy individuals, it may increase the risk of atrial fibrillation and stroke. Conversely, in those with existing heart conditions, it may slow disease progression.

A large-scale prospective study, the findings of which are accessible on BMJ Medicine, tracked over 400,000 adults over an average of 12 years and highlights two distinctly different roles for these supplements:

1. In Healthy Individuals
For those starting with a healthy cardiovascular profile, regular use of fish oil is linked to a higher risk of developing primary conditions
Atrial Fibrillation: Healthy individuals were 13% more likely to develop this abnormal heart rhythm.
Stroke: Daily users faced a mildly elevated relative risk of stroke.

2. In Individuals with Existing Heart Disease
For patients who already had diagnosed cardiovascular disease, the supplements showed a protective, secondary-prevention effect:
Lowered Event Rates: Regular use helped reduce the transition from atrial fibrillation to major adverse cardiovascular events (like a heart attack).
Reduced Mortality: Supplementation was associated with a decreased risk of heart failure progressing to death.

While observational studies and patient forums often tout the broad benefits of omega-3 fatty acids, authoritative bodies like the National Center for Complementary and Integrative Health note that the scientific evidence on broad heart disease prevention remains inconclusive.

It is always advised to consult with a doctor before starting a new supplement, particularly if you take medications that affect blood clotting or are managing a pre-existing condition. Read more about the Omega-3 and drug interactions.

Who Needs Omega-3 Supplements?

Most healthy adults do not need to take omega-3 supplements if they have a balanced diet. However, you might benefit from one if you fall into these categories:

• You don’t eat oily fish: UK guidelines advise eating two 140g portions of fish per week, with at least one being an oily fish (like salmon, mackerel, or sardines). If you do not consume fish, a supplement can help you meet your needs.

• You are vegan or vegetarian: Plant-based foods (like flaxseeds and walnuts) contain a type of omega-3 called ALA, which the body converts poorly into the active EPA and DHA forms. Vegan microalgae oil supplements are an excellent direct source of EPA and DHA.

• You are managing specific health conditions: While supplements are generally not prescribed to prevent heart disease in the general population, they are sometimes used under medical supervision to treat specific issues like high triglycerides.

How Much Omega-3 Do You Need?

If you opt for an over-the-counter supplement, UK guidance suggests aiming for a daily dose of roughly 450-500 mg of combined EPA and DHA. Always check the label carefully, as potency varies widely between products.

Important Precautions

• High doses can have risks: Taking excessively high amounts of omega-3 supplements (more than you would get from a normal diet) can increase the risk of bleeding or atrial fibrillation (an irregular heartbeat).
• Medication interactions: Fish oil can slightly thin the blood. If you take blood-thinning medications (e.g., warfarin, heparin, or aspirin), you must consult your GP before taking them.
• Avoid fish liver oils: Supplements like cod liver oil provide less omega-3 and can contain excessively high levels of Vitamin A, which should be avoided, especially if pregnant

Omega-3 Supplements for Vegans and Vegetarians

If you’re not getting enough Omega-3s from your diet, consider a supplement. Fish oil is the most common form, but plant-based options, like algal oil, are also available for plant-based diets.

Vegans and vegetarians can get essential Omega-3 fatty acids through algae oil supplements (for preformed EPA and DHA) and plant foods (for ALA). Since the human body converts plant-based ALA to EPA and DHA very inefficiently, algal oil is the most direct and reliable supplement for meeting your daily needs.

The Best Direct Supplement: Algae Oil

Fish do not naturally produce Omega-3s; they get EPA and DHA by consuming microalgae. Algal oil bypasses the middleman, providing a pure, 100% plant-based, and highly sustainable source of body-ready EPA and DHA.

How to Choose Omega-3 Supplements?

The most bioavailable form of Omega-3 supplements generally depends on how well the body absorbs and uses EPA and DHA. Research suggests that triglyceride-based Omega-3 supplements are the most bioavailable. These include fish oil supplements that retain the natural triglyceride form found in fish.

The most bioavailable Omega-3 supplements

So, carefully check the supplement label for specific terms that indicate the form of Omega-3 fatty acids. Here’s what you should look for:

1. Triglyceride form (TG) – This is the natural form found in fish and is highly bioavailable. Look for labels that say “fish oil in triglyceride form” or “natural triglyceride.”
2. Re-esterified triglyceride (rTG) – Some high-quality fish oils are reprocessed into this highly bioavailable form. If the supplement has undergone re-esterification, the label might state “re-esterified triglycerides.”
3. Phospholipid form – Found in krill oil supplements, this form may be labeled as “phospholipid-bound Omega-3s.” Due to its different structure, it’s another well-absorbed option.
4. Ethyl ester (EE) – Less bioavailable than triglycerides, so if you see “ethyl ester” on the label, you might opt for another product if absorption is your priority.

Choose Omega-3 supplements labeled as triglyceride or re-esterified triglyceride for optimal absorption.

The Omega-3 cod liver oil brands that I trust and use are the following:

Lysi Cod Liver Oil – An Icelandic traditional family brand. Comes in natural triglyceride form. I tried this at the Icelandic breakfast buffet during one of my travels to this fascinating country. Ever since, I’ve been taking their oils in rotation with:

Möller’s Cod Liver Oil – A Norwegian brand with 166 years of experience. This cod liver oil comes again in the natural triglyceride form, as stated on their website.

References:

• Regular use of fish oil supplements and course of cardiovascular diseases: prospective cohort study
• What are omega-3 fats?