Making an omega-3 dosage recommendation can be complicated

Decades of research studies converge on the findings that omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) provide important benefits for cellular and metabolic health throughout the lifespan.^1,2 Upon learning of these benefits, one of the first things people want to know is, how much EPA and DHA should I take to meet my daily needs? While this may seem like a simple question, because several factors contribute to an individual’s omega-3 status, the answer can be quite complicated. 

To help inform this question of dosage, several health organizations have released their own dosing recommendations based on available research and various other criteria.^3,4 These organizations typically recommend that adults consume a minimum of 500 mg of EPA and DHA each day, but recognize that higher amounts are often needed for individuals with metabolic risk factors and during specific periods of development, such as gestation and infancy.⁵

Many generalized dosage recommendations fail to account for certain variables

While these generalized recommendations are helpful, they fail to account for a number of known genetic and environmental variables that affect how efficiently the body metabolizes omega-3s, and often lead to considerable variation between individuals.⁶ Coupled with the evidence that larger doses of EPA and DHA are safe, well-tolerated, and more effective for increasing omega-3 blood levels than modest doses, it stands to reason that many individuals would benefit from consuming a considerably higher dose than those recommended.⁷

Virtually all our cells depend on omega-3 fatty acids EPA and DHA

The average human body is composed of approximately 37 trillion cells and virtually all of them depend on EPA and DHA for maintaining daily cellular activities.^8,9 Although humans are able to synthesize EPA and DHA from alpha-linoleic acid (ALA)—a fatty acid precursor found in flaxseed, walnuts, and canola oil—because ALA’s conversion into EPA and DHA is very low, it is generally recommended that EPA and DHA be consumed directly through dietary sources including cold-water fatty fish and/or fish oil supplements.^10,11

After EPA and DHA are ingested, they are placed within the phospholipids of cell membranes, where they directly and indirectly affect cellular function by promoting the fluidity, flexibility, and permeability of cell membranes.⁸ These features are vital to numerous daily cell operations, including receiving, processing, and responding to information from nearby cells and messages coming from the surrounding environment.^8,12 

Importantly, because organs are made up of cells, consuming sufficient EPA and DHA allows organs to function more optimally, which is associated with greater general health. (For more information about omega-3 benefits, refer to “An Introduction to Omega-3 Fats”.)

In sum, the intake of fatty acids influences many aspects of health and disease because of their diverse roles as structural lipids in every cell and as signaling precursors throughout the body.¹³

Evidence demonstrates larger doses of EPA and DHA are safe and potentially more effective

Despite the body’s significant need for EPA and DHA, most of the clinical trials evaluating the effects of EPA+DHA have used smaller doses ranging between 250 mg to 1000 mg per day. However, accumulating evidence suggests that larger doses are safe and effective, and that doses less than 2000 mg of EPA+DHA per day may not be enough to experience the full benefits of omega-3s. ^14–16 

Omega-3 requirements vary from person to person

Many variables factor into the amount of omega-3s a person’s body requires for normal cellular and metabolic activities. More specifically, variables including age, sex, diet, body mass, genetics, medication use, health status, and exposure to pollutants and toxins all affect how well someone metabolizes dietary fatty acids, and thus, their omega-3 status.^17,18 This variability in omega-3 status also helps explain why we tend to see mixed results at the outcome of omega-3 research trials.⁶

For example, giving someone who is very deficient in omega-3s a fixed dose of 1000 mg of EPA+DHA per day may barely move the needle in terms of increasing omega-3 blood levels, while giving the same fixed dose to someone who eats fish and has no trouble metabolizing dietary fats may be perfectly sufficient for achieving therapeutic omeha-3 blood levels. Considering all this variability, EPA+DHA recommendations should be based on individual omega-3 needs and requirements whenever possible.¹⁹

Omega-3 blood testing: Important numbers to know  

The fastest and most efficient way to determine your omega-3 requirements is by taking a blood test to determine your omega-3 index and working with your doctor to determine a dosing regimen that best suits your needs. The omega-3 index is a measure of the relative amount of EPA and DHA in red blood cells, expressed as the percentage of the total amount of fatty acids present. If an individual has an omega-3 index of 3.6%, this means that 3.6% of all fatty acids present in their red cell membranes is EPA+DHA.

Importantly, this result would also suggest that the individual is omega-3 deficient, which is associated with a vast array of negative health implications.²⁰ For example, an omega-3 index less than 4% fulfills the criteria for a cardiovascular risk factor.²¹ Conversely, an index value larger than 8% is considered cardioprotective, and associated with reduced risks of cardiac events, cardiac death, and problems related to coronary health.²² 

Previous research found the average non-supplementing American had an omega-3 index value between 4 to 5 %, which is well below cardioprotective levels. Given that experts typically recommend targeting an omega-3 index between 8% and 12%, these results suggest that the average American would benefit from increasing their omega-3 index through supplementation.^19,23,24

But this begs a similar question—how much EPA and DHA does a person need to take to increase their omega-3 index? Although this can only be definitively answered through testing, supplementing, and retesting, observational and intervention studies find a dose-dependent relationship between omega-3 supplementation and the omega-3 index.^6,25 In other words: the higher the dose of supplemental EPA+DHA, the greater the increase in omega-3 index.  

Safety concerns: Is there such a thing as too much omega-3s? 

Another frequently asked question concerning omega-3 dosage is the maximum amount of omega-3s a person can safely consume. Based on their assessment of the available research, the European Food Safety Authority (EFSA) contends supplemental intakes of up to 5000 mg per day are generally well-tolerated and do not increase the risks of adverse health complications, such as prolonged bleeding or cardiovascular disease (CVD).⁷

With respect to the safety of omega-3 fish oil, a more important consideration than dosage is the oxidative stability of the product. Oxidative rancidity occurs when the double bonds of a fatty acid molecule react with oxygen and break down, forming a free radical and a chemical group that contribute to the ‘fishy smell’ often associated with less fresh fish oil.

The consumption of oxidized fatty acids has been shown to contribute to negative health outcomes—such as free radical formation and increased susceptibility to oxidative damage to tissues. Thus, selecting a high-quality, third party tested fish oil to help ensure the freshness and safety of fish oil is widely encouraged.²⁶

Omega-3 dosage recommendations: 

All individuals, regardless of age or health status, are encouraged to undergo blood testing and work with a physician who can make personalized recommendations based on their unique dietary needs. However, in the absence of personalized testing, we have provided general daily recommendations for guidance.

These recommendations are informed by careful review of the: 1) omega-3 and human physiology literatures, 2) many factors impeding omega-3 synthesis and absorption, 3) clinical evidence demonstrating that higher doses of omega-3s result in higher omega-3 levels,^6,22 and 4) research indicating that daily doses as large as 5000 mg per day are safe for adults.⁷

• Healthy Children (ages 4-12): 2000 mg EPA+DHA per day
• Healthy Adolescents (ages 13-18): 2000-3000 mg EPA+DHA per day
• Healthy Adults (ages 18+): 3000-4000 mg EPA+DHA per day

Notably, these intake recommendations are substantially higher than other health organizations, who generally recommend healthy adults consume a minimum of 500 mg of EPA+DHA daily.⁵ It is important to recognize that these more modest intake recommendations are suggested minimums, rather than recommendations for optimal cellular health and functioning. Moreover, these modest intake recommendations are informed by research using smaller doses, when we now have sufficient evidence that omega-3 doses as large as 5000 mg are safe for daily consumption and more effective for raising the omega-3 index towards cardioprotective levels than smaller doses.^6,19,22,27

3000-4000 mg of EPA and DHA per day is supportive for most healthy adults

In summary, several factors contribute to an individual’s omega-3 status, and how much omega-3s they require for optimal cellular health. Although the only conclusive way to ensure you are meeting your daily needs is through blood testing, supplementing with 3000 to 4000 mg of EPA+DHA daily should provide sufficient support for most healthy adults, and importantly, buffer against the competitive effects of factors impeding omega-3 metabolism.