Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
This supplement has been used in connection with the following health conditions:
Congestive Heart Failure
850 to 882 mg per day
In a double-blind study of patients with chronic heart failure, supplementation with the fatty acids present in fish oil for an average of four years resulted in a small but statistically significant decrease in the number of patients who died or were hospitalized for cardiovascular reasons. The treatment consisted of 850 to 882 mg per day of a mixture of eicosapentaenoic acid and docosahexaenoic acid (as their ethyl esters).1 In another double-blind trial, supplementation with eicosapentaenoic acid and docosahexaenoic acid improved heart function and decreased the number of hospitalizations in patients with heart failure due to dilated cardiomyopathy.2
3,000 mg daily omega-3 fatty acids
Many double-blind trials have demonstrated that fish oils (also called fish-oil concentrates) containing EPA and DHA (mentioned above) lower TG levels.3 The amount of fish oil used in much of the research was an amount that provided 3,000 mg per day of omega-3 fatty acids. To calculate how much omega-3 fatty acid is contained in a fish oil supplement, add together the amounts of EPA and DHA. For example, a typical 1,000-mg capsule of fish oil provides 180 mg of EPA and 120 mg of DHA (total omega-3 fatty acids equals 300 mg). Ten of these capsules would contain 3,000 mg of omega-3 fatty acids. Other sources of omega-3 fatty acids, such as flaxseed oil, do not lower TGs. While flaxseed oil has other benefits, it should not be used for the purpose of reducing TGs.
Cod liver oil, another source of omega-3 fatty acids, has also been found to lower TGs.4 Cod liver oil is less expensive than the fish oil concentrates discussed previously. However, cod liver oil also contains relatively large amounts of vitamin A and vitamin D; too much of either can cause side effects. In contrast, fish oil concentrates have little or none of these vitamins. Individuals wishing to use cod liver oil as a substitute for a fish-oil concentrate should consult a doctor.
Omega-3 fatty acids from fish oil and cod liver oil have been reported to affect blood in many other ways that might lower the risk of heart disease.5 However, these supplements sometimes increase LDL cholesterol—the bad form of cholesterol. A doctor can check to see if fish oil has this effect on an individual. Research shows that when 900 mg of garlic extract is added to fish oil, the combination still dramatically lowers TG levels but no longer increases LDL cholesterol.6 Therefore, it appears that taking garlic supplements may be a way to avoid the increase in LDL cholesterol sometimes associated with taking fish oil. People who take fish oil may also need to take vitamin E to prevent the oil from undergoing potentially damaging oxidation in the body.7 It is not known how much vitamin E is needed to prevent such oxidation. The amount required would presumably depend on the amount of fish oil used. In one clinical trial, 300 IU of vitamin E per day prevented oxidation damage in individuals taking 6 grams of fish oil per day.8
3 to 15 grams daily omega-3 fatty acids
EPA and DHA, the omega-3 fatty acids found in fish oil, lower blood pressure, according to an analysis of 31 trials.9 The effect was dependent on the amount of omega-3 fatty acids used, with the best results occurring in trials using unsustainably high levels: 15 grams per day—the amount often found in 50 grams of fish oil. Although results with lower intakes were not as impressive, trials using over 3 grams per day of omega-3 (as typically found in ten 1,000 mg pills of fish oil) also reported significant reductions in blood pressure. One double-blind trial reported that DHA had greater effects on blood pressure than EPA or mixed fish oil supplements.10 DHA is now available as a supplement separate from EPA.
Up to 20 grams fish oil per day after consultation with a doctor
The omega-3 fatty acids in fish oil—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—decrease inflammation. Supplementation with EPA and DHA has prevented autoimmune lupus in animal research.11 In a double-blind trial, 20 grams of fish oil daily combined with a low-fat diet led to improvement in 14 of 17 people with SLE in 12 weeks.12 Other studies also found that supplementing with 10 to 15 grams of fish oil per day,13 or with the amount of EPA and DHA provided by 10 grams per day of fish oil,14 is beneficial for people with SLE. People wishing to take such a large amount of fish oil should first consult with a doctor.
3 grams daily of EPA plus DHA
Many double-blind trials have proven that omega-3 fatty acids in fish oil, called EPA and DHA, partially relieve symptoms of RA.15, 16, 17, 18, 19, 20, 21 The effect results from the anti-inflammatory activity of fish oil.22 Many doctors recommend 3 grams per day of EPA and DHA, an amount commonly found in 10 grams of fish oil. Positive results can take three months to become evident. In contrast, a double-blind trial found flaxseed oil (source of another form of omega-3 fatty acid) not to be effective for RA patients.23
Consult a doctor
Fish oil, which contains the fatty acids known as EPA and DHA, has been studied in the treatment of angina. In some studies, enough fish oil to provide a total of about 3 grams of EPA and 2 grams of DHA has reduced chest pain as well as the need for nitroglycerin;24 other investigators could not confirm these findings.25 People who take fish oil may also need to take vitamin E to protect the oil from undergoing potentially damaging oxidation in the body.26 It is not known how much vitamin E is needed to prevent such oxidation; the amount required would presumably depend on the amount of fish oil used. In one study, 300 IU of vitamin E per day prevented oxidation damage in individuals taking 6 grams of fish oil per day.27
3 grams per day
In a double-blind trial, fish oil was significantly more effective than a placebo in improving anxiety levels in a group of substance abusers (alcohol, cocaine, and/or heroin).28 The fish oil used in this study provided 3 grams per day of omega-3 fatty acids and was given for three months.
Consult a doctor
Double-blind research shows that fish oil partially reduces reactions to allergens that can trigger attacks in some asthmatics.29 Another double-blind study showed that fish oil supplements prevented exercise-induced asthma attacks in people with asthma.30 A few other researchers have reported small but significant improvements when asthmatics supplement with fish oil,31, 32 but reviews of the research concluded that most fish oil studies showed little or no benefit.33, 34 It is possible that some of these trials failed to show an improvement because they did not last long enough to demonstrate an effect. There is evidence that children who eat oily fish may have a much lower risk of getting asthma.35 Moreover, in a double-blind trial, children who received 300 mg per day of fish oil (providing 84 mg of EPA and 36 mg of DHA) experienced significant improvement of asthma symptoms.36 It should be noted that these benefits were obtained under circumstances in which exposure to food allergens and environmental allergens was strictly controlled. Though the evidence supporting the use of fish oil remains somewhat conflicting, eating more fish and supplementing with fish oil may still be worth considering, especially among children with asthma.
3 to 6 grams fish oil daily, containing at least 30% omega-3 fatty acids
Supplementation with fish oil, rich in omega-3 fatty acids, has been associated with favorable changes in various risk factors for atherosclerosis and heart disease in some,37, 38, 39, 40, 41, 42 but not all, studies.43, 44, 45 A double-blind trial showed that people with atherosclerosis who took fish oil (6 grams per day for 3 months and then 3 grams a day for 21 months) had significant slowing of progression of atherosclerotic plaques and a decrease in cardiovascular events (for example, heart attack and stroke) compared with those who did not take fish oil.46 These results contradict the findings of an earlier controlled trial in which fish oil supplementation for two years (6 grams per day) did not promote major favorable changes in the diameter of atherosclerotic coronary arteries.47
Daily omega-3 fatty acids: 9.6 grams for adults, 1,290 to 4,300 mg for children
People diagnosed with depression may have lower blood levels of omega-3 fatty acids.48, 49 A double-blind trial found that bipolar patients taking 9.6 grams of omega-3 fatty acids from fish oil per day in addition to their conventional medications had significant improvements compared with those taking placebo.50 Similar benefits were reported in a preliminary trial that used 1.5 to 2 grams per day of pure eicosapentaenoic acid, a component of fish oil.51 In a preliminary trial, children with bipolar disorder saw benefits from omega-3 fatty acids (1,290 to 4,300 mg per day) from fish oil given for eight weeks.52
Consult a qualified healthcare practitioner
[2 stars] Learn More
Docosahexaenoic acid (DHA), an omega-3 fatty acid present in cod liver oil and other fish oils, is important for normal development of the brain and eyes. Studies have shown that higher concentrations of DHA in mothers’ milk are associated with better visual acuity in the infants.53 Other studies have suggested that DHA improves the development of infants, although not all research agrees.54 Because DHA in the mother’s diet passes into the breast milk,55 some doctors advise nursing mothers to supplement their diet with cod liver oil or another fish-oil supplement. Women wishing to use this or any supplement while breast-feeding should consult their doctors and use only under the supervision of a qualified healthcare practitioner.
Do not take, or take only with a doctor's supervision, if there is a history of sustained ventricular tachycardia or ventricular fibrillation
In a double-blind trial, people with a type of arrhythmia known as ventricular premature complexes were supplemented for 16 weeks with either 15 ml (1 tbsp) per day of fish oil or a similar amount of safflower oil as placebo. Patients taking the fish oil had a significantly reduced frequency of abnormal heartbeats compared with those receiving placebo, and 44% of those receiving fish oil experienced at least a 70% reduction in the frequency of abnormal beats.56 In a separate study, however, men given 20 ml (4 tsp) of cod liver oil per day for six weeks, beginning one week after a heart attack, had the same frequency of irregular heart beats as did men given no supplemental oil.57 In a double-blind study, people who had a history of certain potentially life-threatening arrhythmias—sustained ventricular tachycardia or ventricular fibrillation—had an increase in the recurrence rate of these arrhythmias when they took fish oil.58 A similar study found no adverse effect of fish oil supplements in people with these serious arrhythmias.59 Because of these conflicting findings, people with a history of either of these arrhythmias should consult a doctor before taking fish oil.
2.7 grams daily omega-3 fatty acids in enteric-coated capsules
Inflammation within the gut occurs in people suffering from Crohn’s disease. EPA and DHA, the omega-3 fatty acids found in fish oil, have anti-inflammatory activity. Though research is conflicting, there is some evidence that fish oil improves Crohn's disease symptoms. A two-year trial compared the effects of having people with Crohn’s disease eat 3.5 to 7 ounces of fish high in EPA and DHA per day or having them eat a diet low in fish.60 In that trial, the fish-eating group had a 20% relapse rate compared with 58% among those not eating fish. Salmon, herring, mackerel, albacore tuna, and sardines are all high in EPA and DHA.
In a double-blind trial, people with Crohn’s disease who took supplements providing 2.7 g of EPA/DHA per day had a recurrence rate of 26% after one year, compared to a 59% recurrence rate among those taking placebo.61
2.7 grams of EPA daily
The impaired digestion of fats in people with CF often leads to a deficiency of essential fatty acids. This deficiency may in turn lead to lowered immune function, which makes people with CF more susceptible to respiratory infection.62 This deficiency may be reversed by supplementation with corn oil (1 gram per 2.2 pounds body weight per day),63safflower oil (1 gram per 2.2 pounds body weight per day),64 linoleic acid (7.7 grams per day),65 and eicosapentaenoic acid (EPA from fish oil) (2.7 grams per day).66 EPA supplementation was particularly effective. In a double-blind trial, six weeks of supplementation with 2.7 grams of EPA per day led to a reduction in sputum and improvement in lung function in children with chronic respiratory infection due to CF.67
9.6 grams omega-3 fatty acids per day
Omega-3 fatty acids found in fish oil, particularly DHA, are needed for normal nervous system function. Depressed people have been reported to have lower omega-3 fatty acid levels (for example, DHA) than people who are not depressed.68, 69, 70, 71 Low levels of the other omega-3 fatty acid from fish, EPA, have correlated with increased severity of depression.72 In some double-blind trials, supplementation with various amounts of fish oil was beneficial for the treatment of depression in both children and adults,73, 74 but fish oil was ineffective in other double blind trials.75, 76
EPA alone has also been reported to be beneficial. There is one case report of a man with a long history of severe depression who showed clear improvement within one month of starting a purified EPA supplement (4 grams per day of the ethyl ester of eicosapentaenoic acid [E-EPA]).77 In a double-blind study, supplementation with E-EPA for 12 weeks was significantly more effective than a placebo at relieving symptoms of depression.78 E-EPA was beneficial, even though the participants in the study had failed to respond adequately to conventional antidepressant drugs. The conventional medications were continued during treatment with E-EPA or placebo. An effective level of intake was 1 gram per day, whereas larger amounts of E-EPA resulted in little or no benefit. The authors of the study suggested that taking too much E-EPA might cause an imbalance with other essential fatty acids, which could reduce the effectiveness of the treatment.
Refer to label instructions
Diets low in omega-3 fatty acids (EPA and DHA) have been associated with menstrual pain.79 In one double-blind trial, supplementation with fish oil, a good source of omega-3 fatty acids, led to a statistically significant 37% drop in menstrual symptoms. In that report, adolescent girls with dysmenorrhea took an unspecified amount of fish oil that provided 1,080 mg of EPA and 720 mg of DHA per day for two months to achieve this result.80 A double-blind trial found that the same amount of EPA and DHA plus 7.5 mcg per day of vitamin B12 led to a greater than 50% decrease in menstrual symptoms, but a group taking only fish oil did not obtain as much relief.81 Six grams of fish oil per day provides the approximate levels of EPA and DHA used in these trials. In another double-blind trial, 1 gram per day of fish oil significantly decreased pain intensity, compared with a placebo, in women with dysmennorhea.[REF]
Adults: 1,800 mg a day of EPA; children: proportionately less, according to body weight
Ten grams of fish oil providing 1.8 grams of EPA (eicosapentaenoic acid) per day were given to a group of eczema sufferers in a double-blind trial. After 12 weeks, those using the fish oil experienced significant improvement.82, 83 According to the researchers, fish oil may be effective because it reduces levels of leukotriene B4, a substance that has been linked to eczema.84 The eczema-relieving effects of fish oil may require taking ten pills per day for at least 12 weeks. Smaller amounts of fish oil have been shown to lack efficacy.85
One trial using vegetable oil as the placebo reported that fish oil was barely more effective than the placebo (30% vs. 24% improvement).86 As vegetable oil had previously been reported to have potential therapeutic activity, the apparent negative outcome of this trial should not dissuade people with eczema from considering fish oil.
3.25 grams daily of omega-3 fatty acids
In a preliminary study, supplementation with 3.25 grams per day of a mixture of omega-3 fatty acids (primarily eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) for six months markedly reduced the frequency of seizures in five severely retarded epileptic patients.87 Additional research is needed to confirm this report and to identify which people with epilepsy are most likely to benefit.
850 to, 1700 mg omega-3 fatty acids
Fish oil contains the beneficial omega-3 fatty acids EPA and DHA, which have led to partial reversal of atherosclerosis in a double-blind trial.88 In another double-blind trial, individuals were given either fish oil (containing about 1 gram of EPA and 2/3 gram of DHA) or mustard oil (containing about 3 grams alpha linolenic acid, another omega-3 fatty acid) 18 hours after a heart attack. Both groups experienced fewer nonfatal heart attacks compared to a placebo group, while the fish oil group also experienced fewer fatal heart attacks.89 The largest published study on omega-3 fatty acids for heart attack prevention was the preliminary GISSI Prevenzione Trial,90 which reported that 850 mg of omega-3 fatty acids from fish oil per day for 3.5 years resulted in a 20% reduction in total mortality and a 45% decrease in sudden death. Other investigators suggest that fish oil reduces the amount of heart muscle damage from a heart attack and enhances the effect of blood-thinning medication.91 People wishing to supplement with fish oil should take fish oil supplements that include at least small amounts of vitamin E, which may protect this fragile oil against free radical damage.92
Immune Function and Critically Ill Patients
Consult a qualified healthcare practitioner
Research on the effect of the omega-3 fatty acids that are abundant in some fish, fish oils, and flaxseed oil is conflicting. Liquid diets containing omega-3 fatty acids used in hospitals for critically ill people have been shown to improve immune function and reduce infections.9495 However, in one controlled study in healthy people, a low-fat diet improved or maintained immune function, but when fish was added to increase omega-3 fatty acid intake, immune function was significantly inhibited.96
Supplementation with DHA (an omega-3 fatty acid found in fish oil) in healthy young men has been shown to decrease the activity of immune cells, such as natural killer (NK) cells, and to inhibit certain measures of inflammation in the test tube.97 The anti-inflammatory effects of DHA may be useful in the management of autoimmune disorders; however, such benefits need to be balanced with the potential for increased risk of infections. Other studies suggest that increased oxidative damage might be the reason for the negative effects on the immune system sometimes caused by fish oil, and that increased intake of antioxidants, such as vitamin E, could correct the problem.98
200 mg of EPA and 130 mg of DHA daily, plus small amounts of vitamin B6, folic acid, vitamin E, oleic acid, and alpha-linolenic acid
Men with intermittent claudication consumed a fortified milk product or regular milk daily for one year. The fortified product provided daily 130 mg of eicosapentaenoic acid and 200 mg of docosahexaenoic acid (EPA and DHA, two fatty acids in fish oil), small amounts of supplemental vitamin E, folic acid, and vitamin B6, and additional amounts of oleic acid and alpha-linolenic acid. Compared with regular milk, the fortified milk product significantly increased the distance the participants could walk before the onset of pain.99
In a double-blind study, supplementation with a proprietary blend of acetyl-L-carnitine, omega-3 fatty acids from fish oil, and coenzyme Q10 for 12 months resulted in an improvement in both visual function and in objective findings on eye examination (a decrease in the drusen-covered area on the retina).100
6 to 20 grams daily
Although some doctors recommend fish oil capsules for people with MS, few investigations have explored the effects of this supplement. In one small trial, people with MS were given approximately 20 grams of fish oil in capsules per day.101 After one to four months, 42% of these people received slight but significant benefits, including reduced urinary incontinence and improved eyesight. However, a longer double-blind trial involving over 300 people with MS found that half this amount of fish oil given per day did not help.102A preliminary, two-year intervention trial tested the effects of fish oil supplements (5 ml of fish oil per day, providing 400 mg of EPA and 500 mg of DHA) combined with other dietary supplements and dietary changes in people with newly diagnosed, relapsing-remitting MS.103 The other supplements included 3,333 IU of vitamin A per day, 400 IU of vitamin D per day, and approximately 5.5 IU of vitamin E per day. The dietary recommendations included reducing intake of sugar, coffee, tea, saturated fat from meat and dairy products, and alcohol, while increasing intake of fish, fruit, vegetables, and whole-grain bread. Sixty-nine percent of those following the regimen improved, 25% remained the same, and 6% (one person) deteriorated. The many interventions used in this trial make it impossible to determine what was responsible for the positive outcomes. Given the lack of other effective treatments for MS, though, this approach is worth trying while awaiting further evidence. In another trial, combining fish oil supplementation (6 grams per day) with a low-fat diet (15% of total calories) appeared to reduce the relapse rate in people with the relapsing-remitting form of MS.104
In a small preliminary trial, people with MS were given 20 grams of cod liver oil, as well as approximately 680 mg of magnesium and 1,100 mg of calcium per day in the form of dolomite tablets.105 After one year, the average number of MS attacks decreased significantly for each person. Unlike fish oil capsules, the cod liver oil in this trial contained not only eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), but 5,000 IU of vitamin D. Therefore, it is not known whether the vitamin D or fatty acids were responsible for the cod liver oil’s effects. (One preliminary study found that giving vitamin D-like drugs to animals with MS was helpful.)106 It is also possible that the magnesium and/or calcium given to these people reduced MS attacks. Magnesium107 and calcium108 levels have been reported to be lower in the nerve tissue of people with MS compared with healthy people.
Osteoporosis (Evening Primrose Oil)
6 grams daily
A preliminary trial found that elderly women with osteoporosis who were given 4 grams of fish oil per day for four months had improved calcium absorption and evidence of new bone formation.109 Fish oil combined with evening primrose oil (EPO) may confer added benefits. In a controlled trial, women received 6 grams of a combination of EPO and fish oil, or a matching placebo, plus 600 mg of calcium per day for three years.110 The EPO/fish oil group experienced no spinal bone loss in the first 18 months and a significant 3.1% increase in spinal bone mineral density during the last 18 months.
125 mg of oil or 15 mg of docosahexaenoic acid per 2.2 lbs (1 kg) of body weight daily
The PKU diet is low in fatty acids, some of which are essential for proper brain development.111 In one controlled study of children with PKU who were deficient in fatty acids, supplementation with fish oil (but not with black currant seed oil) for six months improved the deficiency. The children received 500 mg of oil per 8.8 pounds of body weight each day for 6 months. The amount varied from 5–8 capsules (each containing 500 mg) per day for each child.112 In another study, fish oil supplementation (providing 15 mg of docosahexaenoic acid per 2.2 pounds of body weight per day) improved body coordination and fine motor skills in children with PKU.113
Pre- and Post-Surgery Health
3.3 to 5 grams daily omega-3 fatty acids before and after surgery
Omega-3 fatty acids have anti-inflammatory properties,114 and animal studies suggest that supplementation with omega-3 fatty acids may improve recovery and prevent infection after surgery.115, 116 A controlled human trial found that intravenous nutritional formulas containing omega-3 fatty acids given post-operatively lowered the production of inflammatory chemicals compared with standard nutritional formulas.117 Other human studies of omega-3 fatty acid-supplemented nutritional formulas used in surgery patients have included other supplemental nutrients as well and are discussed below.118
Pregnancy and Postpartum Support
2.7 to 6.1 mg daily of omega-3 fatty acids (EPA plus DHA)
Supplementation with fish oil (providing either 2.7 g or 6.1 g per day of the omega-3 fatty acids EPA and DHA) significantly reduced recurrence of premature delivery, according to data culled from six clinical trials involving women with a high risk for such complications.119 Fish oil supplementation did not prevent premature delivery of twin pregnancies, nor did it have any preventive effect against intrauterine growth retardation or pregnancy-induced hypertension. Fish oils should be free of contaminants, such as mercury and organochlorine pesticides. Women who eat substantial amounts of certain types of seafood (e.g., swordfish, tuna) may be consuming contaminants that can increase the risk of brain and nervous system abnormalities in their offspring. Exposure to mercury and polychlorinated biphenyls (PCBs) was found to be increased in relation to maternal intake of seafood. Higher exposure to these toxic contaminants has been linked to an increased risk of deficits in the developing brains and nervous systems of the children.120
Pregnancy and Prenatal Growth
Refer to label instructions
The DHA found in fish oil is essential for the development of the visual system in infants.121 In one double-blind study, 103 term infants were randomly assigned to receive either formula with no docosahexaenoic acid (DHA) or arachidonic acid (ARA) or formula supplemented with DHA and ARA at concentrations similar to those found in human milk, starting when they were six days old. Visual maturation was assessed by measuring sweep visual evoked potential at ages 6, 17, 26, and 52 weeks. At each age, the supplemented group measured better, which led researchers to conclude that long-term supplementation of infant formula with DHA and ARA in amounts typical in human milk may help enhance visual development during the first year of life.
Take orally 10 grams daily oil or 3.6 grams daily EPA, or apply a 10% topical solution twice per day
In a double-blind trial, fish oil (10 grams per day) was found to improve the skin lesions of psoriasis.122 In another trial, supplementing with 3.6 grams per day of purified eicosapentaenoic acid (EPA, one of the fatty acids found in fish oil) reduced the severity of psoriasis after two to three months.123, 124 That amount of EPA is usually contained in 20 grams of fish oil, a level that generally requires 20 pills to achieve. However, when purified EPA was used in combination with purified docosahexaenoic acid (DHA, another fatty acid contained in fish oil), no improvement was observed.125
Additional research is needed to determine whether fish oil itself or some of its components are more effective for people with psoriasis. One trial showed that applying a preparation containing 10% fish oil directly to psoriatic lesions twice daily resulted in improvement after seven weeks.126 In addition, promising results were reported from a double-blind trial in which people with chronic plaque-type psoriasis received 4.2 g of EPA and 4.2 g of DHA or placebo intravenously each day for two weeks. Thirty-seven percent of those receiving the essential fatty acid infusions experienced greater than 50% reduction in the severity of their symptoms.127
Supplementing with fish oil also may help prevent the increase in blood levels of triglycerides that occurs as a side effect of certain drugs used to treat psoriasis (e.g., etretinate and acitretin).128
4 grams of EPA per day
In a double-blind trial, supplementation with 12 large capsules of fish oil per day (providing 4 grams of eicosapentaenoic acid [EPA] per day) for 6 or 12 weeks reduced the severity of blood-vessel spasm in 5 of 11 people with Raynaud’s phenomenon.129 Fish oil was effective in people with primary Raynaud’s disease, but not in those whose symptoms were secondary to another disorder.
2,000 to 3,000 mg daily of EPA
There are two different classes of essential fatty acids: omega-6 fatty acids and omega-3 fatty acids. There is considerable evidence these fatty acids are deficient, or are not used properly, in people with schizophrenia.130, 131, 132, 133, 134, 135 Some investigators suggest this altered fatty acid metabolism may be involved in the increased need for niacin seen in some schizophrenic patients.136 A case has been reported in which a man with schizophrenia had dramatic and sustained improvement while being supplemented with 2 grams daily of omega-3 fatty acids.137 In a preliminary trial, schizophrenic patients receiving omega-3 fatty acids showed improvement in symptoms, as well as a reduction in adverse effects from their anti-psychotic medications.138 Another study found that people with schizophrenia had lower blood levels of both omega-3 and omega-6 fatty acids, compared with non-schizophrenic people, even though both groups were consuming similar amounts of these fatty acids.139 In a separate preliminary study, higher intake of omega-3 fatty acids was associated with less severe disease, and supplementation with 10 grams of concentrated fish oil, a source of omega-3 fatty acids, led to significant improvement in symptoms over a six-week period.140 In addition, a double-blind trial found that supplementing with 1.2 g per day of omega-3 fatty acids from fish oil prevented the development of psychosis in adolescents and young adults who were at very high risk of developing a psychotic disorder.141
In a double-blind trial that included 87 patients with chronic schizophrenia or a related illness (schizoaffective disorder), supplementation with 3 grams per day of eicosapentaenoic acid (one of the omega-3 fatty acids found in fish oil) was ineffective.142 The patients in this negative study were older and had been ill for longer, compared with patients in earlier studies who improved with omega-3 fatty acid supplementation.
Several clinical trials have examined the effects of supplementation with essential fatty acids in people with schizophrenia, with inconsistent results.143, 144, 145, 146 While the results of trials using omega-3 fatty acids are promising, further double-blind trials are needed to establish whether fatty acid supplementation is an effective therapy for schizophrenia. Trials of omega-6 fatty acids (like GLA from borage oil) have yielded predominantly negative results.147
Sickle Cell Anemia
250 mg of oil per 2.2 lbs (1 kg) of body weight daily
In a preliminary trial, 13 patients with sickle cell anemia were given two supplement combinations for seven to eight months each. The first combination included 109 mg zinc, 153 IU vitamin E, 600 mg vitamin C, and 400 ml (about 14 ounces) of soybean oil containing 11 grams of linoleic acid and 1.5 grams of alpha linolenic acid. The second combination included 140 IU vitamin E, 600 mg vitamin C, and 20 grams of fish oil containing 6 grams of omega-3 fatty acids. Reduction in diseased cells was observed only during the administration of the first protocol. The authors concluded that zinc was the important difference between the two combinations and may be a protector of red blood cell membranes.148
Fish oil alone has also been studied. In a double-blind trial, supplementation with menhaden oil, in the amount of 250 mg per 2.2 pounds of body weight per day for one year, reduced the frequency of severe pain episodes by approximately 45%, compared with placebo.149 This treatment may work by correcting an imbalance between omega-3 and omega-6 fatty acids that occurs in people with sickle cell anemia.150 The beneficial effect of the omega-3 fatty acids present in fish oil was confirmed in another double-blind study.151
3 tsp per day of cod liver oil
One older controlled trial found that children given 3 teaspoons of cod liver oil per day (containing roughly 800 IU of vitamin D) for an entire school year had over 50% fewer new cavities.152 These promising results have not been followed up with modern placebo-controlled trials.
5.4 grams daily of omega-3 fatty acids
Preliminary153 and double-blind trials154, 155, 156 have found that fish oil supplementation reduces inflammation, decreases the need for anti-inflammatory drugs, and promotes normal weight gain in people with UC. However, fish oil has not always been effective in clinical trials for UC.157 Amounts used in successful clinical trials provided 3.2 grams of EPA and 2.2 grams of DHA per day—the two important fatty acids found in fish oil.
In a preliminary trial, people with UC significantly improved on a sugar-free, low-allergen diet with additional nutritional supplementation that included a multivitamin-mineral supplement (2–6 tablets per day); a fish oil supplement (400 mg per day); borage oil (400 mg per day); flaxseed oil (400 mg per day); and a probiotic formula containing Lactobacillus acidophilus and other species of beneficial bacteria.158 Some participants received slight variations of this regimen. Since so many different supplements were given and since the trial was not controlled, it is not possible to say which, if any, of the nutrients was responsible for the improvement observed by the researchers.
Refer to label instructions
In a double-blind trial, supplementing with the fatty acids present in fish oil (0.6 grams per day of EPA and 1.7 grams per day of DHA) for six months was not beneficial in people with Alzheimer's disease. However, in the subgroup of people with very mild cognitive impairment, supplementation with these fatty acids slowed the rate of cognitive decline compared with a placebo.159
Chronic Fatigue Syndrome
Refer to label instructions
In a preliminary study, four patients with chronic fatigue syndrome reported an improvement in their symptoms after taking an essential fatty acid supplement daily for at least 12 weeks.160 The amount used was 10 to 18 capsules per day, and each capsule contained 93 mg of eicosapentaenoic acid (EPA), 29 mg of docosahexaenoic acid (DHA), and 10 mg of gamma-linolenic acid. Because there was no placebo group in this study and, because fatigue often improves after treatment with a placebo, additional research is needed to confirm this report.
Chronic Obstructive Pulmonary Disease
Refer to label instructions
A greater intake of the omega-3 fatty acids found in fish oils has been linked to reduced risk of COPD,161 though research has yet to investigate whether fish oil supplements would help people with COPD. In a double-blind trial, people with COPD received a fatty acid supplement (providing daily 760 mg of gamma-linolenic acid, 1,200 mg of alpha-linolenic acid, 700 mg of eicosapentaenoic acid, and 340 mg of docosahexaenoic acid) or a placebo (80% palm oil and 20% sunflower oil) during an eight-week rehabilitation program. Compared with the placebo, the fatty acid supplement significantly improved exercise capacity.162 While two of the fatty acids supplied in this supplement (eicosapentaenoic acid [EPA] and docosahexaenoic [DHA] acid) are found in fish oil, is not known which components of the supplement were most responsible for the improvement. Gamma-linolenic acid is found in evening primrose oil, black currant seed oil, and borage oil; alpha-linolenic acid is found in flaxseed oil and other oils.
Refer to label instructions
Several human studies have found that supplementation with omega-3 fatty acids from fish oil leads to a reduction in markers for the risk of colon cancer.163, 164, 165 In each case, enough fish oil was supplemented to supply several grams of omega-3 fatty acids per day, though the optimal amount remains unknown.
Refer to label instructions
Animal research suggests that fish oils may reduce the severity of endometriosis,166, 167 and fish oils have been shown to improve symptoms of dysmenorrhea (painful menstruation),168 which may be caused by endometriosis. Therefore, while no specific research has been done on the effects of fish oils in women with endometriosis, some health practitioners recommend several grams of fish oil per day for this condition.
Refer to label instructions
Surveys have shown that Inuit people, who consume large amounts of omega-3 fatty acids, have a much lower incidence of some types of glaucoma than do Caucasians. Although there have been no studies on the use of omega-3 fatty acids to treat glaucoma, one study found that cod liver oil (a rich source of omega-3 fatty acids) reduced intraocular pressure in animals.169
Refer to label instructions
An assessment of 3,654 Australians aged 49 years or older found an association between a diet high in omega-3 fatty acids from fish and a lower risk of age-related macular degeneration.170
Refer to label instructions
Fish oil containing EPA and DHA has been reported to reduce the symptoms of migraine headache in a double-blind trial using 1 gram of fish oil per 10 pounds of body weight.171, 172 Fish oil may help because of its effects in modifying prostaglandins (hormone-like substances made by the body).
Refer to label instructions
The omega-3 fatty acids present in fish oil, EPA and DHA, have anti-inflammatory effects and have been studied primarily for rheumatoid arthritis, which involves significant inflammation. However, osteoarthritis also includes some inflammation.173 In a 24-week controlled but preliminary trial studying people with osteoarthritis, people taking EPA had “strikingly lower” pain scores than people who took placebo.174 However, in a double-blind trial by the same research group, supplementation with 10 ml of cod liver oil per day was no more effective than a placebo.175
Refer to label instructions
A preliminary trial found that elderly women with osteoporosis who were given 4 grams of fish oil per day for four months had improved calcium absorption and evidence of new bone formation.176 Fish oil combined with evening primrose oil (EPO) may confer added benefits. In a controlled trial, women received 6 grams of a combination of EPO and fish oil, or a matching placebo, plus 600 mg of calcium per day for three years.177 The EPO/fish oil group experienced no spinal bone loss in the first 18 months and a significant 3.1% increase in spinal bone mineral density during the last 18 months.
In a small preliminary trial, supplementation with fish oil (10 grams per day for three months) reduced photosensitivity in 90% of people suffering from polymorphous light eruptions.178
Refer to label instructions
Fish oil supplementation has been proposed to lower the incidence of preeclampsia.179, 180 However, controlled clinical trials suggest that fish oil does not reduce symptoms181 or protect against preeclampsia.182, 183
Type 1 Diabetes
Refer to label instructions
Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements.184 And in one trial, people with diabetic nerve damage (neuropathy) and diabetic nephropathy experienced significant improvement when given 600 mg three times per day of purified eicosapentaenoic acid (EPA)—one of the two major omega-3 fatty acids found in fish oil supplements—for 48 weeks.185 However, controlled studies have found that fish oil supplementation increases cholesterol in people with type 1 diabetes.186, 187 Until the risk–benefit ratio of using fish oil is clarified, people with diabetes should feel free to increase their fish intake, but they should consult a doctor before taking fish oil supplements.
Type 2 Diabetes
Refer to label instructions
Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements,188 and some studies have found that fish oil supplementation also improves glucose tolerance,189 high triglycerides,190 and cholesterol levels in people with type 2 diabetes.191 And in one trial, people with diabetic neuropathy and diabetic nephropathy experienced significant improvement when given 600 mg three times per day of purified eicosapentaenoic acid (EPA)—one of the two major omega-3 fatty acids found in fish oil supplements—for 48 weeks.192 However, other studies have found that type 2 diabetes worsens with fish oil supplementation.193, 194, 195, 196 Until this issue is resolved, people with diabetes should feel free to eat fish, but they should consult a doctor before taking fish oil supplements.
How It Works
How to Use It
Presumably, healthy people who frequently eat fatty fish (several times per week) have no need to supplement with fish oil. How much EPA and DHA, if any, should be supplemented by healthy people who do not eat much fatty fish, remains unclear.
Most researchers studying the effects of EPA and DHA in humans who have a variety of health conditions have given those people at least 3 grams of the total of EPA plus DHA—an amount that may require 10 grams of fish oil, because most fish oil contains only 18% EPA and 12% DHA.
The health benefits for people with Crohn’s disease have been reported with a special, enteric-coated preparation of purified EPA/DHA manufactured from fish oil. This preparation of purified fatty acids does not cause the gastrointestinal symptoms that often result from taking regular fish oil supplements, which makes it a peferable source of EPA/DHA for people with gastrointestinal illnesses.197
In one trial, the maximum amount of fish oil tolerated by people being treated for cancer-related weight loss was reported to be approximately 21 grams per day.198 However, in people who do not have cancer, the maximum tolerated amount may be different.
Where to Find It
EPA and DHA are found in mackerel, salmon, herring, sardines, sablefish (black cod), anchovies, albacore tuna, and wild game. Cod liver oil contains large amounts of EPA and DHA. Fish oil supplements typically contain 18% EPA and 12% DHA, though more purified (i.e., higher in EPA and DHA) fish oil supplements are sometimes available. In addition, DHA is available in a supplement that does not contain significant amounts of EPA.
So-called “primitive” diets have much higher levels of EPA and DHA than modern diets. As a result, some researchers and doctors believe that most people who eat a typical western diet are likely to be consuming less-than-optimal amounts of EPA and DHA. To a very limited extent, omega-3 fatty acids from vegetable sources, such as flaxseed oil, can be converted in the body to EPA.
At least four studies have reported a reduced blood level of omega-3 fatty acids in people with depression.199, 200, 201, 202
People with rheumatoid arthritis have been found to have decreased levels of omega-3 fatty acids, such as are found in fish oil, in their joint fluid and blood.203
Interactions with Supplements, Foods, & Other Compounds
Some evidence suggests that adding vitamin E to fish oil may prevent fish oil-induced increase in blood sugar levels.204
People who took fish oil and who also took 15 grams of pectin per day were reported to have reductions in LDL cholesterol.205 This suggests that pectin may overcome the occasional problem of increased LDL cholesterol reported in people who supplement with fish oil. The LDL-cholesterol raising effect of EPA and DHA has also been reported to be prevented by taking garlic supplements (or presumably including garlic in the diet) along with EPA and DHA.206
In a double-blind study, supplementing with the omega-3 fatty acids present in fish oil decreased the incidence of drug-induced nerve damage (peripheral neuropathy) in women receiving paclitaxel for breast cancer. The amounts used were 540 mg of DHA (docosahexaenoic acid) and 100 mg of EPA (eicosapentaenoic acid), each three times per day.211
The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Anemia is one of the side effects of ribavirin therapy. In a preliminary trial, supplementing with EPA partially prevented the decline in hemoglobin levels in patients with hepatitis C who were being treated with the combination of ribavirin and pegylated interferon alpha-2b.213
In a preliminary trial, taking an HMG-CoA reductase inhibitor (“statin”) for about three years significantly lowered triglyceride levels and raised levels of HDL (“good”) cholesterol in people with high cholesterol who had also been supplementing with either 900 mg or 1,800 mg of EPA for three months.207 The authors of the study concluded that the combination of the statin and EPA may prevent coronary heart disease better than the drug alone. Since drugs in the statin family have similar mechanisms of action, people taking any statin drug may benefit from fish oil.
In patients with major depression, the addition of the omega-3 fatty acids present in fish oil (1.8 g per day of eicosapentaenoic acid and 0.4 g per day of docosahexaenoic acid, in 2 divided amounts per day for 8 weeks) enhanced the antidepressant effect of citalopram.208
The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
In a preliminary trial, taking an HMG-CoA reductase inhibitor (“statin”) for about three years significantly lowered triglyceride levels and raised levels of HDL (“good”) cholesterol in people with high cholesterol who had also been supplementing with either 900 mg or 1,800 mg of EPA for three months.209 The authors of the study concluded that the combination of the statin and EPA may prevent coronary heart disease better than the drug alone. Since drugs in the statin family have similar mechanisms of action, people taking any statin drug may benefit from fish oil.
In a preliminary trial, taking an HMG-CoA reductase inhibitor (“statin”) for about three years significantly lowered triglyceride levels and raised levels of HDL (“good”) cholesterol in people with high cholesterol who had also been supplementing with either 900 mg or 1,800 mg of EPA for three months.210 The authors of the study concluded that the combination of the statin and EPA may prevent coronary heart disease better than the drug alone. Since drugs in the statin family have similar mechanisms of action, people taking any statin drug may benefit from fish oil.
In a preliminary trial, taking an HMG-CoA reductase inhibitor (“statin”) for about three years significantly lowered triglyceride levels and raised levels of HDL (“good”) cholesterol in people with high cholesterol who had also been supplementing with either 900 mg or 1,800 mg of EPA for three months.212 The authors of the study concluded that the combination of the statin and EPA may prevent coronary heart disease better than the drug alone. Since drugs in the statin family have similar mechanisms of action, people taking any statin drug may benefit from fish oil.
In a preliminary trial, taking an HMG-CoA reductase inhibitor (“statin”) for about three years significantly lowered triglyceride levels and raised levels of HDL (“good”) cholesterol in people with high cholesterol who had also been supplementing with either 900 mg or 1,800 mg of EPA for three months.214 The authors of the study concluded that the combination of the statin and EPA may prevent coronary heart disease better than the drug alone. Since drugs in the statin family have similar mechanisms of action, people taking any statin drug may benefit from fish oil.
The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The omega-3 fatty acid EPA, present in fish oil, may improve the cholesterol- and triglyceride-lowering effect of simvastatin. In a preliminary trial, people with high cholesterol who had been taking simvastatin for about three years were able to significantly lower their triglyceride levels and raise their levels of HDL (“good”) cholesterol by supplementing with either 900 mg or 1800 mg of EPA for three months in addition to simvastatin.215 The authors of the study concluded that the combination of simvastatin and EPA may prevent coronary heart disease better than simvastatin alone.
Potential Negative Interaction
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.
While those with heart disease and diabetes have often been reported to benefit from supplementation with fish oil,216, 217 both groups should check with their doctor before taking more than 3 grams of fish oil per day for several months. Elevations in blood sugar and cholesterol levels may occur in some people who take fish oil.218
The increase in blood sugar appears to be related in part to the amount of fish oil used.219 The impairment of sugar metabolism sometimes caused by supplementation with fish oil has been prevented by the addition of half an hour of moderate exercise three times a week.220
While supplementation with fish oil consistently lowers triglycerides, the effect of fish oil on LDL (“bad”) cholesterol varies, and in some people, fish oil supplementation has been reported to increase LDL levels.221
There has been one case report in which a woman with a known allergy to crabs developed a severe allergic reaction after ingesting fish oil.222
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