Fish oil contains two active ingredients; EPA and DHA. Commercial fish oils vary in their content of EPA and DHA. The discussion of dosage below outlines the amounts of combined EPA and DHA used in human clinical studies of fish oil for various health targets. For certain health targets research suggests that an oil higher in EPA or DHA may be appropriate. These situations are highlighted when appropriate. For a description of the research from which the table below was constructed please review the discussion below.
HEALTH TARGET |
DOSAGE USED IN HUMAN CLINICAL STUDIES |
Cardiovascular Health |
600-4000mg per day of combined EPA and DHA. Low doses (600-900mg per day) deliver highly significant benefit. Larger dosages (2000-4000mg per day) provide some further benefit. See discussion below. |
Improved Mood |
No less than 1000mg of EPA per day. The oil should contain significantly more EPA than DHA. |
Attention and Concentration |
In children ages 5 and up, 500-1000mg of EPA per day. The oil should contain significantly more EPA than DHA. |
Joint Health |
2000-4000mg of combined EPA and DHA. |
Pregnancy and Breastfeeding |
No less than 300mg of DHA per day. The oil should contain more DHA than EPA, unless otherwise recommended by a healthcare practitioner. |
Bowel Health |
2000-4000mg of combined EPA and DHA per day. |
Respiratory Health |
2000-4000mg of combined EPA and DHA per day. |
Cardiovascular Health
Low doses of EPA and DHA (900mg of EPA and DHA combined per day or less) have been shown to dramatically reduce heart disease risk (Daviglus 1997, Jacobson 2007, Kris- Etherton 2003, Marchioli 2002, Yokoyama 2007). This has been shown both in otherwise healthy individuals, as well as in individuals who have existing heart disease. Most of the benefit appears to come from reduced risk of sudden cardiovascular death (a sudden, fatal heart attack).
Larger dosages deliver benefits above and beyond those achieved with smaller ones (Jacobson 2007, Yokoyama 2007). Larger dosages (2000-4000mg of EPA and DHA combined per day) do not appear to further reduce the risk of sudden cardiovascular death. They do, however, appear to reduce the risk of non fatal cardiovascular events (non- fatal heart attack, for example).
Low dosages (900mg of EPA and DHA combined per day) reduce the risk of sudden cardiovascular death by 50% or more. Larger dosages (2000-4000mg of EPA and DHA combined per day) reduce the risk of non- fatal cardiovascular complications by approximately 20- 30% (Daviglus 1997, Jacobson 2007, Kris- Etherton 2003, Marchioli 2002, Yokoyama 2007).
Larger dosages (2000-4000mg of EPA and DHA combined per day) benefit cholesterol levels. At this dosage fish oil reduces levels of harmful triglycerides by 20-40%, and raises beneficial HDL- cholesterol by approximately 10%(Jacobson 2007, Kris- Etherton 2003).
Improved Mood
The following has been taken from a position statement of the American Psychiatric Association (Freeman 2006). “All adults should eat fish >/= 2 times per week. Patients with mood, impulse- control, or psychotic disorders should consume 1g EPA + DHA per day. A supplement may be useful in patients with mood disorders (1-9g per day). Use of > 3g per day should be monitored by a physician”.
1000mg of EPA per day appears to help contribute to a balanced mood. At this dosage EPA appears to elevate a depressed mood (Fontani 2005, Zanarini 2003, Su 2003, Peet 2002, Nemets 2002, Stoll 1999, Lin 2007, Freeman 2006), and also stabilize a manic or excessively positive mood (Wozniak 2007, Frangou 2006, Sagduyu 2005, Osher 2005, Stoll 1999). The oil should contain significantly more EPA than DHA.
Many of the human studies which have examined fish oil for improving/ stabilizing mood have used 100% EPA concentrates (Frangou 2006, Osher 2005, Fontani 2005, Zanarini 2003, Peet 2002, Nemets 2002). Studies which have used oils high in EPA but containing some DHA have also been shown to be very beneficial. All of the human studies which have used high DHA oils have failed to produce benefit to mood (Grenyer 2007, Marangell 2006, Silvers 2005, Marangell 2003, Llorente 2003).
Dosages of up to 4000mg per day of combined EPA and DHA appear to be safe for adult use. Most adults obtain maximal mood benefit from 1000mg of EPA per day.
Childhood Attention Mood Concentration
As little as 500-600mg of EPA per day has been shown to benefit concentration, attention, and academic performance in children ages 5 and up, as well as improve mood (Nemets 2006, Richardson 2005, Sinn 2007). Larger dosages have been shown to successfully improve/ stabilize mood in children (Wozniak 2007).
One study benefited concentration and attention in children using very large dosages (Sorgi 2007). Although no adverse effects were observed, such dosages are not required, nor advisable unless directly directed to do so by your healthcare practitioner.
The oil should contain significantly more EPA than DHA. Of 5 studies which used high DHA oils to benefit attention, mood, and/ or concentration in children, 4 failed to produce any benefit (Hirayama 2004, Itomura 2005, Stevens 2003, Voigt 2001). The fifth achieved benefit to only 7 of 14 parameters studied (Richardson 2002).
500-1000mg of EPA per day appears to be a reasonable dosage in children ages 5 and up. Combined dosage of EPA and DHA should be kept below 1500mg per day, unless directed otherwise by your healthcare provider.
Joint Health
2000-4000mg per day of combined EPA and DHA has been shown to provide significant relief from joint pain. This has been shown for pain from arthritis (Adam 2003, Kremer 1995, Geusens 1994), spine pain from the neck or back (Maroon 2006, Sundstrom 2006), joint pain from inflammatory bowel disease (Goldberg 2007), chronic fatigue syndrome (Puri 2004), fibromyalgia (Ozgocmen 2000), Lupus (Wright 2007), and other painful situations.
Pregnancy and Breastfeeding
No less than 300mg per day of DHA is recommended for pregnant women (Simopoulos 1999). DHA supplementation in human studies of pregnant women has been shown to have a number of benefits for both the mother and the developing fetus (Denburg 2005, Jensen 2005, Judge 2007). For a discussion of these benefits, please visit fishoil and your health.
Under most circumstances the oil used in pregnancy should contain more DHA than EPA. If mood improvement benefits are required during pregnancy, an oil high in EPA may be considered.
Bowel Health
2000-4000mg per day of combined EPA and DHA has been shown to benefit bowel health in human studies of individuals who have inflammatory bowel disease (Romano 2005, Seidner 2005, Trebble 2004).
Respiratory Health
2000-4000mg per day of combined EPA and DHA has been shown to improve respiratory function in human studies of individuals who have asthma or other respiratory issues (Matsuyama 2005, Mickleborough 2006).
References
Adam O, Beringer C, Kless T, Lemmen C, Adam A, Wiseman M, Adam P, Klimmek R, Forth W. Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int. 2003 Jan;23(1):27-36.
Daviglus ML, Stamler J, Orencia AJ, Dyer AR, Liu K, Greenland P, Walsh MK, Morris D, Shekelle RB. Fish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med. 1997; 336(15):1046-53.
Denburg JA, Hatfield HM, Cyr MM, Hayes L, Holt PG, Sehmi R, Dunstan JA, Prescott SL. Fish oil supplementation in pregnancy modifies neonatal progenitors at birth in infants at risk of atopy. Pediatr Res. 2005; 57(2): 276-81.
Fontani G, Corradeschi F, Felici A, Alfatti F, Bugarini R, Fiaschi AI, Cerretani D, Montorfano G, Rizzo AM, Berra B. Blood profiles, body fat and mood state in healthy subjects on different diets supplemented with Omega-3 polyunsaturated fatty acids. Eur J Clin Invest. 2005 Aug;35(8):499-507.
Frangou S, Lewis M, McCrone P. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomized double-blind placebo-controlled study. Br J Psychiatry. 2006; 188:46-50.
Freeman MP, Hibbeln JR, Wisner KL, Davis JM, Mischoulon D, Peet M, Keck PE Jr, Marangell LB, Richardson AJ, Lake J, Stoll AL. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry. 2006;67(12):1954-67.
Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007 May;129(1-2):210-23.
Grenyer BF, Crowe T, Meyer B, Owen AJ, Grigonis-Deane EM, Caputi P, Howe PR. Fish oil supplementation in the treatment of major depression: A randomised double-blind placebo-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31(7):1393-6.
Hirayama S, Hamazaki T, Terasawa K. Effect of docosahexaenoic acid-containing food administration on symptoms of Attention deficit/ hyperactivity disorder - a placebo-controlled double-blind study. Eur J Clin Nutr. 2004 Mar;58(3):467-73.
Itomura M, Hamazaki K, Sawazaki S, Kobayashi M, Terasawa K, Watanabe S, Hamazaki T. The effect of fish oil on physical aggression in schoolchildren--a randomized, double-blind, placebo-controlled trial. J Nutr Biochem. 2005 Mar;16(3):163-71.
Jacobson TA. Beyond lipids: the role of omega-3 fatty acids from fish oil in the prevention of coronary heart disease. Curr Atheroscler Rep. 2007 Aug;9(2):145-53.
Jensen CL, Voigt RG, Prager TC, Zou YL, Fraley JK, Rozelle JC, Turcich MR, Llorente AM, Anderson RE, Heird WC. Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants. Am J Clin Nutr. 2005 Jul;82(1):125-32.
Judge MP, Harel O, Lammi-Keefe CJ. Maternal consumption of a docosahexaenoic acid-containing functional food during pregnancy: benefit for infant performance on problem-solving but not on recognition memory tasks at age 9 mo. Am J Clin Nutr. 2007;85(6):1572-7.
Kremer JM, Lawrence DA, Petrillo GF, Litts LL, Mullaly PM, Rynes RI, Stocker RP, Parhami N, Greenstein NS, Fuchs BR, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995 Aug;38(8):1107-14.
Kris-Etherton PM, Harris WS, Appel LJ; AHA Nutrition Committee. American Heart Association. Omega-3 fatty acids and cardiovascular disease: new recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol. 2003 Feb 1;23(2):151-2.
Lin PY, Su KP. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry. 2007 Jul;68(7):1056-61.
Llorente AM, Jensen CL, Voigt RG, Fraley JK, Berretta MC, Heird WC. Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Am J Obstet Gynecol. 2003; 188(5):1348-53.
Marangell LB, Martinez JM, Zboyan HA, Kertz B, Kim HF, Puryear LJ. A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Am J Psychiatry. 2003;160(5):996-8.
Marangell LB, Suppes T, Ketter TA, Dennehy EB, Zboyan H, Kertz B, Nierenberg A, Calabrese J, Wisniewski SR, Sachs G. Omega-3 fatty acids in bipolar disorder: clinical and research considerations. Prostaglandins Leukot Essent Fatty Acids. 2006 Oct-Nov;75(4-5):315-21.
Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, Franzosi MG, Geraci E, Levantesi G, Maggioni AP, Mantini L, Marfisi RM, Mastrogiuseppe G, Mininni N, Nicolosi GL, Santini M, Schweiger C, Tavazzi L, Tognoni G, Tucci C, Valagussa F; GISSI-Prevenzione Investigators. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002 Apr 23;105(16):1897-903.
Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr; 65(4):326-31.
Nemets H, Nemets B, Apter A, Bracha Z, Belmaker RH. Omega-3 treatment of childhood depression: a controlled, double-blind pilot study. Am J Psychiatry. 2006 Jun;163(6): 1098-100.
Matsuyama W, Mitsuyama H, Watanabe M, Oonakahara K, Higashimoto I, Osame M, Arimura K. Effects of omega-3 polyunsaturated fatty acids on inflammatory markers in COPD. Chest. 2005 Dec;128(6):3817-27.
Mickleborough TD, Lindley MR, Ionescu AA, Fly AD. Protective effect of fish oil supplementation on exercise-induced bronchoconstriction in asthma. Chest. 2006 Jan; 129(1):39-49.
Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry. 2002 Mar;159(3):477-9.
Ozgocmen S, Catal SA, Ardicoglu O, Kamanli A. Effect of omega-3 fatty acids in the management of fibromyalgia syndrome. Int J Clin Pharmacol Ther. 2000 Jul;38(7):362-3.
Puri BK, Holmes J, Hamilton G. Eicosapentaenoic acid-rich essential fatty acid supplementation in chronic fatigue syndrome associated with symptom remission and structural brain changes. Int J Clin Pract. 2004 Mar;58(3):297-9.
Richardson AJ, Montgomery P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics. 2005 May;115(5):1360-6.
Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Feb;26(2):233-9.
Romano C, Cucchiara S, Barabino A, Annese V, Sferlazzas C. Usefulness of omega-3 fatty acid supplementation in addition to mesalazine in maintaining remission in pediatric Crohn's disease: a double-blind, randomized, placebo-controlled study. World J Gastroenterol. 2005 Dec 7;11(45):7118-21.
Seidner DL, Lashner BA, Brzezinski A, Banks PL, Goldblum J, Fiocchi C, Katz J, Lichtenstein GR, Anton PA, Kam LY, Garleb KA, Demichele SJ. An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: a randomized, controlled trial. Clin Gastroenterol Hepatol. 2005 Apr;3(4):358-69.
Osher Y, Bersudsky Y, Belmaker RH. Omega-3 eicosapentaenoic acid in bipolar depression: report of a small open-label study. J Clin Psychiatry. 2005; 66(6):726-9.
Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002 Oct;59(10):913-9.
Sagduyu K, Dokucu ME, Eddy BA, Craigen G, Baldassano CF, Yildiz A. Omega-3 fatty acids decreased irritability of patients with bipolar disorder in an add-on, open label study. Nutr J. 2005;4:6.
Simopoulos AP, Leaf A, Salem N Jr. Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids. J Am Coll Nutr. 1999;18(5):487-9.
Sinn N, Bryan J. Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems Associated with Child ADHD. J Dev Behav Pediatr. 2007 Apr;28(2):82-91.
Sorgi PJ, Hallowell EM, Hutchins HL, Sears B. Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder. Nutr J. 2007 Jul 13;6(1):16.
Stevens L, Zhang W, Peck L, Kuczek T, Grevstad N, Mahon A, Zentall SS, Arnold LE, Burgess JR. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Lipids. 2003 Oct;38(10):1007-21.
Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LB. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry. 1999 May;56(5):407-12.
Su KP, Huang SY, Chiu CC, Shen WW. Omega-3 fatty acids in major depressive disorder. A preliminary double- blind, placebo-controlled trial. Eur Neuropsychopharmacol. 2003;13(4):267-71.
Sundstrom B, Stalnacke K, Hagfors L, Johansson G. Supplementation of omega-3 fatty acids in patients with ankylosing spondylitis. Scand J Rheumatol. 2006 Sep-Oct;35(5):359-62.
Trebble TM, Arden NK, Wootton SA, Calder PC, Mullee MA, Fine DR, Stroud MA. Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn disease. Am J Clin Nutr.2004 Nov;80(5): 1137-44.
Voigt RG, Llorente AM, Jensen CL, Fraley JK, Berretta MC, Heird WC. A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention deficit/hyperactivity disorder. J Pediatr. 2001 Aug;139(2) :189-96.
Wozniak J, Biederman J, Mick E, Waxmonsky J, Hantsoo L, Best C, Cluette-Brown JE, Laposata M. Omega-3 fatty acid monotherapy for pediatric bipolar disorder: a prospective open-label trial. Eur Neuropsychopharmacol. 2007 May-Jun;17(6-7):440-7.
Wright SA, O'prey FM, McHenry MT, Leahey WJ, Devine AB, Duffy EM, Johnston DG, Finch MB, Bell AL, McVeigh GE. A randomised placebo-controlled interventional trial of omega-3-polyunsaturated fatty acids on endothelial function and disease activity in systemic lupus
erythematosus. Ann Rheum Dis. 2007.
Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; Japan EPA lipid intervention study (JELIS) Investigators. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369(9567):1090-8.
Zanarini MC, Frankenburg FR. omega-3 Fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry. 2003 Jan;160(1):167-9.