do you really need fish oil supplements?

When I prescribe fish oil supplements to my patients — for inflammation, skin, mood, joints, heart health and more — I often get pushback. It’s spendy. It’s more pills to take. And people invariably ask, “Do I really need fish oil supplements? Can’t I just get this from my food?”

As a naturopathic herbalist with a vitalist bent, I want the answer to be yes. And if folks are just trying to stay healthy, maintaining the good health they already have, then optimizing their diet by upping intake of omega-3 foods is a good idea and likely sufficient.

maintenance vs. therapeutic dosing

But the patients coming to my clinic are often either substantially depleted or frankly sick. In these cases I’m recommending fish oil as a prescription, not just a healthy addition to their lifestyle. If they were already getting enough from their food I wouldn’t need to prescribe it.

In these cases, I’m often aiming for 3 or more grams daily of EPA and DHA (the active forms of omega-3s). That’s just three capsules of my go-to fish oil product.

If you don’t want to read further, here’s the bottom line: You may not need fish oil supplements if your diet 1) contains sufficient levels of active omega-3 fatty acids 2) that are not outweighed by your intake of omega-6 and omega-9 fatty acids (basically cereal grains and grain-fed animals). But it may take more omega-3 rich foods to get there than you’d expect.

So how much of which foods does a person need to achieve a therapeutic omega-3 dose from their diet? Let me share some research and some math.

portion sizes

When you dig into the nutrition data, most things are listed based on a standard portion size. For omega-3 fatty acids, most sources consider 3 ounces to be one portion.

For comparison, the coho salmon thawing on my counter as I first drafted this post (and pictured cooked in the header photo above) was 10 ounces raw. That turned out to be one meal, although others might have stretched it.

The can of sardines in my cupboard (which I’m really going to try someday) is 4.4 ounces.

the numbers

So I stayed up past my bedtime looking up numbers. Here are some of what I found. Note that there plants do not make the active forms of omega-3 fatty acids, EPA and DHA. And since people vary wildly in their ability to convert plant omega-3s to ones our bodies can use, I rarely consider them, even for vegans. (There are plankton-based supplements that are manufactured to contain EPA and DHA. These are expensive, but useful for vegans.)

Here’s a list in grams per 3-ounce serving of food sources of EPA and DHA:

  • Pacific herring: 1.8g EPA/DHA
  • European anchovies: 1.75g EPA/DHA
  • Herring, Atlantic, cooked: 1.71g (0.94g DHA, 0.77g EPA)
  • Sablefish/black cod: 1.52g EPA/DHA
  • Wild chinook salmon: 1.48g EPA/DHA
  • Sockeye salmon, Native Alaska canned and smoked: 1.34g EPA/DHA
  • Bluefin tuna, fresh: 1.28g EPA/DHA
  • Sardines, canned in tomato sauce and drained: 1.19g (0.74g DHA, o.45g EPA)
  • Sockeye salmon, canned and drained: 1.08g EPA/DHA
  • Atlantic mackerel, cooked: 1.02g (0.59g DHA, 0.43g EPA)
  • Pink salmon, canned and drained: 0.91g (0.63g DHA, 0.28g EPA)
  • Wild coho salmon: 0.9g EPA/DHA
  • Wild rainbow trout, cooked: 0.84g (0.44g DHA, 0.40g EPA)
  • Atlantic sardines, canned and drained: 0.83g EPA/DHA
  • Wild sockeye salmon: 0.73g EPA/DHA
  • White albacore tuna, canned and drained: 0.73g EPA/DHA
  • Wild chum salmon: 0.68g EPA/DHA
  • Mussels, cooked with moist heat: 0.66g EPA/DHA
  • Sea bass, cooked: 0.65g (0.47g DHA, 0.18g EPA)
  • Pacific oysters, raw: 0.58g EPA/DHA
  • Wild eastern oysters, cooked: 0.53g (0.23g DHA, 0.30g EPA)
  • Eastern oysters, raw: 0.33g EPA/DHA
  • Wild pink salmon: 0.52g EPA/DHA
  • Shrimp, cooked: 0.24g (0.12g DHA, 0.12g EPA)
  • Light tuna, canned and drained: 0.19g EPA/DHA
  • Farmed Atlantic salmon, cooked: 1.83 g (1.24g DHA, 0.59g EPA)

(I got these numbers from here and here. I plan to go back through the official USDA reports to double check, but all seem within range for the moment.)

other sources

You may notice that farmed Atlantic salmon has the highest EPA/DHA levels, but I’ve put it at the bottom of the list. Why? Because I can’t in good conscience recommend it as a clean food, either for your health or for the environment. I took a detour while writing this post to explain it all here.

Seafood isn’t the only source of omega-3 fatty acids. Some land animals, especially if they eat their traditional diet (e.g. grass for ruminants) can achieve significant levels. Lamb brains apparently are a good source of omega 3s, but probably aren’t a regular option for most people. This study runs the numbers for beef, but I ran out of steam to do all the conversions. Short version: grass-feed beef has a significantly better fatty acid profile than grain-fed, but seafood is still your best source of omega-3s.

let’s do the math

So what does this look like in practice? Consider my plate here, with the 10 ounces of now-cooked wild coho salmon:

Broiled wild coho salmon on a bed of steamed artichoke hearts on an orange plate on a gray porch.

This 10-ounce wild coho filet offers the omega-3 fatty equivalent of three concentrated fish-oil capsules.

As we saw above, one serving (3 ounces) of wild coho provides just under 1 gram of EPA and DHA. So we’d need just over three servings to get the therapeutic dose I regularly prescribe. That’s almost exactly what was on my plate.

Or consider the sardine can in my cupboard. One serving (3 ounces) has 0.83 grams of EPA and DHA. That’s 0.28 grams per ounce, and we’d need almost 11 ounces of the sardines to get to the 3-gram goal.  So that’s about two and a half cans daily to reach the therapeutic dose.

Let’s keep going. To get 3 grams daily of EPA and DHA you would need to eat:

  • Just under 6 ounces of European anchovies
  • 6 ounces of black cod (a.k.a. sablefish — and yum)
  • 6 ounces of cooked herring
  • 6 ounces of wild chinook salmon
  • 7 ounces of fresh bluefin tuna (higher in mercury)
  • 9+ ounces of cooked Atlantic mackerel
  • 9+ ounces of canned pink salmon
  • 18 ounces of Pacific oysters
  • 36 ounces of shrimp

And if you’re depleted, inflamed or taking fish oil for another therapeutic purpose, you’ll have to do this daily.

can you get enough omega 3s from food?

Of course you can get all your omega 3s from food. Humans traditionally have — from wild fish and game. But as our access to these foods has changed due to environmental disruptions, mass production, emphasis on cereal grains, and more, ready access to food sources has diminished. And so has our health.

The question is what you’re actually able to do. If you’re not already eating optimally, how much bandwidth do you have to overhaul your diet? Improving food choices is almost always the best way to go, as it addresses root causes of many health issues. But it’s reasonable to start with supplements as you move toward other, achievable changes.


Header photo from my front porch this morning.