As a practicing physician, my patients keep me on my toes with a steady stream of questions. One of the most common involves supplement recommendations, especially when it comes to which nutrients are most important. When I reply that fish oil is at the top of my list — even for healthy individuals — patients often ask why. After all, fish oil is a fat; and until recently, fat was a forbidden food. How times have changed!

The one thing that hasn’t changed is the confusion over good and bad fats. It occurred to me that my readers might be wondering the same thing, so here is my short and sweet guide to the omega-3 essential fatty acids (EFAs), also known as the good fats.

What Are Omega-3s

The good fats that make up the omega-3 family are called essential fatty acids (EFAs) because our bodies can’t produce them — we must obtain them from foods or supplements. An omega-3 deficiency is a serious threat to health for these reasons:

• EFAs provide the body (especially the heart) with energy.
• All EFAs (omega-3s and their relatives, the omega-6s) play a role in the creation of healthy cell membranes, nerve cells, and hormone-like substances called prostaglandins.
• Together, EFAs and prostaglandins play a role in a long list of important processes.

Here’s a quick guide to what EFAs can do:

Minimize and Prevent:

• Minimize pain, inflammation, and swelling
• Prevent blood cells from sticking together

Maintain and Regulate:

• Maintain the fluidity and rigidity of cell membranes
• Maintain proper kidney function and fluid balance
• Regulate circulation
• Regulate smooth muscle and autonomic reflexes
• Regulate pressure in the eyes, joints, and blood vessels

Manage and Supervise:

• Manage the immune system
• Dilate or constrict blood vessels
• Supervise the rate of cell division

Produce and Release:

• Produce hormones and related substances
• Oversee the release of proinflammatory substances from cells involved in allergic reactions

Transport and Guide:

• Transport oxygen from red blood cells to the tissues
• Guide hormones to their target cells
• Keep saturated fats moving in the bloodstream

By contrast, let’s look at what happens when we consume too few omega-3s. This sets the stage for a wide range of health conditions, including:

• Asthma
• Kidney disease
• Certain types of cancer
• Mental malfunctions
• Digestive disorders
• Obesity
• Emotional imbalances
• Osteoarthritis
• Heart disease
• Rheumatoid arthritis
• High blood pressure
• Type 2 diabetes
• Inflammation

As you can see, good fats are intimately involved with nearly all our bodily functions, from creating healthy cells to ensuring proper brain functions, nutrient absorption, and healthy skin and hair. As my patient Patty found, increasing her intake of good fats to remedy one problem fixed several others at the same time.

The Case of the Disappearing Omega-3s

The majority of Americans — a whopping 80 percent — consume too few omega-3s in their diet. Although this wasn’t always the case, today it’s difficult to get sufficient quantities of these nutrients from diet alone for several reasons.

First, eating a great deal of fish these days is a risky proposition. Seafood is now contaminated with assorted chemicals and toxins, including mercury, PCBs (polychlorinated biphenyl), and arsenic, to name just a few. These substances are poisons that wreak havoc in the body, so clearly we don’t want to consume these on a daily basis.

In addition, much of today’s fish is raised on fish farms, which results in far less-healthful products. Not only are the fish confined to pollution- and chemical-filled water but they are fed differently from wild fish, again making them less healthful as a food source.

Furthermore, back in the day, pasture-grazed livestock and barnyard-raised chickens gobbled up seeds and insects, which naturally added omega-3s to their meat and eggs. Today, nearly all meat comes from factory farms. Animals and fowl are now fed grain laced with antibiotics and various chemicals, most of them designed to pack on weight as fast as possible. The foods they eat no longer convert to omega-3s, so we’ve lost one major source of these nutrients. It is possible to search out grass-fed meat and free-range chickens raised the old-fashioned way, but these foods are fairly expensive and not always easy to find.

The Fat Balancing Act

In addition to a dietary shortage, there’s another problem with our omega-3 supplies. The Standard American Diet (SAD) is filled with far too many fats from common vegetable oils (e.g., corn, safflower, sunflower, soybean) known as the omega-6s.

Omega-6s themselves are not bad. In fact, they’re considered essential for good health. The problem is that our intake of omega-6s far exceeds our consumption of omega-3s. Today, the typical American consumes roughly a 20:1 ratio of omega-6s to 3s. Ideally, that ratio should be 1:1, an amount similar to the diet of our early ancestors.

Overconsumption of omega-6s creates an environment in the body where serious inflammation-related ailments can flourish. The way to solve that problem is by eating fewer foods made with omega-6-laden vegetable oils, while increasing your intake of omega-3s from either food or supplements.

Just correcting the omega-3/omega-6 imbalance can make a tremendous difference in your health. Here’s how it works: As I mentioned earlier, omega-3s and omega-6s are the raw materials our bodies use to produce prostaglandins. These powerful hormone-like substances regulate a wide range of functions, including blood pressure, the gastrointestinal system, blood platelet stickiness, and inflammation.

Prostaglandins made from omega-3s tend to reduce inflammation, thin the blood, and discourage cell production, while those that originate from omega-6s do the opposite — increase cell production, stimulate inflammation, and increase blood platelet stickiness and clotting. So clearly, when your body has more omega-6-based prostaglandins to work with, there’s a greater likelihood of developing conditions such as osteoarthritis, heart attack, stroke, or ailments involving uncontrolled cell growth, like cancer.

The Bottom Line on Omega-3s

Research shows there are two real movers and shakers in the omega-3 family — DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). Both have different roles in the body, so if you are supplement shopping, I recommend looking for a product containing at least twice as much DHA as EPA for best results.

Research shows that the greatest health benefits from fish oils come from DHA, which has strong ties to a healthy brain, vision, and nervous system functions, as well as children’s growth and development. (Not surprisingly, DHA is abundant in mother’s milk.) When fish oil is credited with improving conditions like attention deficit disorder (ADD), Alzheimer’s, macular degeneration, and depression, that’s the DHA at work.

DHA also appears to benefit individuals with insulin resistance, according to one recent study. After just three months of DHA supplements (1.8 grams every morning), 70 percent of the study participants, all of whom began the study with insulin resistance, had significantly improved insulin function.

Meanwhile, EPA is best for reducing inflammation and increasing circulation, so it supports heart and joint health. EPA also minimizes symptoms of such common disorders as arthritis, asthma, and inflammatory bowel disease.

Of course, there is some overlap in EPA’s and DHA’s duties. Earlier clinical trials, for example, have shown that DHA is effective for lowering triglycerides, as well as elevating good cholesterol, minimizing arrhythmia, and reducing blood pressure. The bottom line: Both EPA and DHA are necessary for good health, but I’ve seen the best results from formulas favoring DHA.

For those who have fish allergies, flaxseed oil may be an option. Flaxseeds contain a different EFA, which must be converted to DHA and EPA, and there is some controversy over how well our bodies do this. But research is showing that flaxseed oil may be similar to fish oil in term of benefits. I recommend 1 to 2 tablespoons of flaxseed oil daily.

If you decide to give fish oil a try, I recommend starting with a dose of at least two grams per day taken in divided doses morning and evening. Be sure to choose a product that has been purified or molecularly distilled to remove dangerous toxins. If you are already taking prescription medication, please talk with your physician about fish oil. This is especially true if you are taking blood thinners, such as Coumadin (warfarin) or aspirin, since fish oil thins the blood. Also, anyone who has a seizure disorder or hemophilia, or who may be having surgery soon, should talk with a doctor before adding fish oil to the daily regimen.

Last Updated: June 21, 2021
Originally Published: May 3, 2012