All about Omega 3 Fatty Acids and Fish Oil

All about Omega 3 Fatty Acids and Fish Oil
Brittany Schmidt, DC

Fish oil is a very popular supplement; in fact, this supplement has had huge commercial success, Americans actually spend about 1 billion dollars a year on over the counter fish oil supplements. You probably know of someone who takes fish oil, maybe you take it yourself on your own or because maybe your doctor has recommended it to you. The research on fish oil is extensive and abundant—which is great, but unfortunately, the results of all of this research are quite frankly all over the place. Some research shows that fish oil reduces the risk of cancer while others weakly suggest that it increases the risk of cancer. Some research shows that the heart health can be improved with fish oils, while the next study indicates that we are unsure if fish oil does anything to reduce your risk of heart attack of stroke. On top of all of this, fish oil is one of the supplements that can have VERY poor quality so finding the right fish oil can be tricky. So what is a consumer who wants to be healthier and do all the right things supposed to do when it comes to fish oil?

Personally, I think Americans do not consume enough Omega 3 fatty acids (found in fish oil) and consume too many Omega 6 fatty acids. Omega 3 fatty acids reduce inflammation in the body, while some Omega 6 fatty acids do the opposite. To confuse you further, some Omega 6s also reduce inflammation; the metabolism of fatty acids is incredibly complex. It isn’t as simple as calling omega 3 fatty acids good and omega 6 fatty acids bad, but ideally the ratio for optimum health should be roughly 4:1 (Omega 6: Omega 3). I do not think it is too much of an exaggeration to say that with the Standard American Diet the ratio is closer to 25:1 or even in some cases 40:1, SADly. Inflammation is at the root of many health conditions I find this fascinating. So even with inconsistent research and many questions still unanswered, I elect take a fish oil supplement to bring my ratio closer to 4:1.

I have endometriosis, a chronic condition where the lining of the uterus (the endometrium) grows ectopically. Because endometriosis does seem to be affected by inflammation I have more of a reason to take fish oil. One study found that endometriosis adhesions were reduced in mice that were provided with dietary fish oil compared with control animals; the researchers concluded that targeting excessive inflammation with fish oil may be an effective adjuvant therapy for reducing postsurgical endometriosis adhesions (Herington, et al 2014).

Omega 3 fatty acids are also helpful when it comes to immune health, joint health, and brain health. All expectant mothers should be taking a source of omega 3 fatty acids along with their pre-natal vitamin as omega 3s are necessary for fetal brain and eye development! I also feel many of my elderly patients would benefit from fish oil as it may be neuroprotective against dementia and memory loss.

Most individuals are familiar with fish oil and heart health. Most research suggests that fish oil plays an important role in heart health although there are a few outliers. A longitudinal study published in 2017 found that Omega 3 polyunsaturated fatty acid (PUFA) supplementation was associated with a lower hazard of coronary artery disease (Lentjes et al, 2017); a promising study with a clear result. Another 2017 randomized controlled trial looked at participants that were taking omega 3 fatty acid (EPA) and a statin drug as opposed to taking a statin drug alone to see the effect on coronary plaque (statins are medications that lower cholesterol) . The researchers found that those taking EPA with pitavastain had significantly reduced coronary plaque volume compared to those just taking pitavastatin (Wantanabe, et al 2017). Conversely, a different 2017 study reviewing 21 randomized controlled trials that looked at Omega 3 PUFAs showed that they do not show a consistent benefit to cardiovascular protection and that it is unclear if Omega 3s help with cardiovascular disease (Rizos, et al 2017).

As mentioned above, the research on fish oil is up and down. Don’t let this concern you; is actually not uncommon for research to have varying results, which is why the last statement of most research articles goes something like this: “further studies are warranted on this subject…”. What most need to realize is that research isn’t everything, it is an important and critical piece of the puzzle but it isn’t everything. Research should be considered but it is also necessary to keep in mind clinical expertise, anecdotal evidence, and patient preference, this approach is called Evidence Informed Practice, and it is what I use when guiding my patients. When it comes to fish oil, much of the research regarding inflammation and reducing risk of cardiac disease is strong, which is why I still take fish oil and also recommend it. However, I still think it is best to get nutrients from whole foods, so every morning I shoot flaxseeds and chia seeds (another great source of omega 3s) and I try to eat fatty fish at least once a week.

Here is a list of foods that are high in Omega 3 fatty acids:

  • Mackerel
  • Salmon
  • Cod Liver Oil
  • Sardines
  • Anchovies
  • Flaxseed
  • Chia Seeds
  • Walnuts
  • Spinach

Tinned fish like anchovies have recently come into style and for good reason, they are so nutrient dense! I had it in my mind that tinned anchovies were gross and couldn’t bring myself to eat them. I realized that that notion came from when I was a child and that now I enjoy many foods that I disliked as a child so maybe it was worth giving them another try. I actually didn’t mind them! If you struggle eating them whole there are lots of ways to add them into your diet. Try cutting them up small and adding them to pasta sauces for a salty tang, mash them into a salad dressing or throw them in with your salad, add them to your sandwich at lunch, mash them and spread it on crackers or toast, throw them into homemade hummus, and of course they are a classic on top of pizza. If you’re just not on board with the whole tinned fish trend there are some fantastic chia seed pudding recipes out there!

When it comes to discussing supplements one thing I will say over and over again is that quality matters. This is especially true when it comes to fish oil; many over the counter fish oil supplements are a bit fishy when it comes to quality. It is important to know what type of fish is being used, where those fish came from, is the fish from a clean and sustainable source, is it third party tested for heavy metals and dangerous cancer promoting polychlorinated biphenyls (PCBs), is it concentrated, and so on. We only offer high quality fish oil supplements! 

It is truly hard to know what is safe, efficacious, and beneficial when it comes to supplementation. What’s the bottom line when it comes to omega 3s? Do what you can nutritionally and when you can’t supplement. Ask your Doctor of Chiropractic if fish oil is something you should add to your routine!

*Not intended as medical advice*


A randomized controlled trial of eicosapentaenoic acid in patients with coronary heart disease on statins. T Watanabe-K Ando-H Daidoji-Y Otaki-S Sugawara-M Matsui-E Ikeno-O Hirono-H Miyawaki-Y Yashiro-S Nishiyama-T Arimoto-H Takahashi-T Shishido-T Miyashita-T Miyamoto-I Kubota-i CHERRY –

Dietary fish oil supplementation inhibits formation of endometriosis-associated adhesions in a chimeric mouse model. Jennifer Herington-Dana Glore-John Lucas-Kevin Osteen-Kaylon Bruner-Tran – Fertility and Sterility – 2013

Does Supplementation with Omega-3 PUFAs Add to the Prevention of Cardiovascular Disease?
E Rizos-M Elisaf –

Fish oil: friend or foe?Howard LeWine- M.d. –

Longitudinal associations between marine omega-3 supplement users and coronary heart disease in a UK population-based cohort.

M Lentjes-R Keogh-A Welch-A Mulligan-R Luben-N Wareham-K Khaw –

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