How much omega-3 is enough? That depends on omega-6.

May 11, 2010 in Food & Nutrition | 59 comments


sardinesIn the first article of this series, we discussed the problems humans have converting omega-3 (n-3) fats from plant sources, such as flax seeds and walnuts, to the longer chain derivatives EPA and DHA. In the second article, we discussed how excess omega-6 (n-6) in the diet can block absorption of omega-3, and showed that the modern, Western diet contains between 10 and 25 times the optimal level of n-6.

In this article we’ll discuss strategies for bringing the n-6 to n-3 ratio back into balance. There are two obvious ways to to do this: increase intake of n-3, and decrease intake of n-6.

Many recommendations have been made for increasing n-3 intake. The important thing to remember is that any recommendation for n-3 intake that does not take the background n-6 intake into account is completely inadequate.

It’s likely that the success and failure of different clinical trials using similar doses of EPA and DHA were influenced by differing background intakes of the n-6 fatty acids. In the case of the Lyon Diet Heart Study, for example, positive outcomes attributed to ALA may be related in part to a lower n-6 intake (which would enhance conversion of ALA to EPA and DHA).

This explains why simply increasing intake of n-3 without simultaneously decreasing intake of n-6 is not enough.

Bringing n-3 and n-6 back into balance: easier said than done!

Let’s examine what would happen if we followed the proposed recommendation of increasing EPA & DHA intake from 0.1 to 0.65g/d. This represents going from eating virtually no fish to eating a 4-oz. serving of oily fish like salmon or mackerel three times a week.

The average intake of fatty acids (not including EPA & DHA) in the U.S. has been estimated as follows:

  • N-6 linoleic acid (LA): 8.91%
  • N-6 arachidonic acid (AA): 0.08%
  • N-3 alpha-linolenic acid (ALA): 1.06%

Keep in mind from the last article that the optimal ratio of omega-6 to omega-3 is estimated to be between 1:1 and 2.3:1. Assuming a median intake of n-6 (ALA + LA) at 8.99% of total calories in a 2,000 calorie diet, that would mean a daily intake of 19.9g of n-6. If we also assume the recommended intake of 0.65g/d of EPA and DHA, plus an average of 2.35g/d of ALA (1.06% of calories), that’s a total of 3g/d of n-3 fatty acid intake.

This yields an n-6:n-3 ratio of 6.6:1, which although improved, is still more than six times higher than the historical ratio (i.e. 1:1), and three times higher than the ratio recently recommended as optimal (i.e. 2.3:1).

On the other hand, if we increased our intake of EPA and DHA to the recommended 0.65g/d (0.3% of total calories) and maintained ALA intake at 2.35g/d, but reduced our intake of LA to roughly 7g/d (3.2% of total calories), the ratio would be 2.3:1 – identical to the optimal ratio.

Further reducing intake of n-6 to less than 2% of calories would in turn further reduce the requirement for n-3. But limiting n-6 to less than 2% of calories is difficult to do even when vegetable oils are eliminated entirely. Poultry, pork, nuts, avocados and eggs are all significant sources of n-6. I’ve listed the n-6 content per 100g of these foods below:

  • Walnuts: 38.1g
  • Chicken, with skin: 2.9g
  • Avocado: 1.7g
  • Pork, with fat: 1.3g
  • Eggs: 1.3g

It’s not too hard to imagine a day where you eat 200g of chicken (5.8g n-6), half an avocado (1.1g n-6) and a handful of walnuts (10g of n-6). Without a drop of industrial seed oils (like safflower, sunflower, cottonseed, soybean, corn, etc.) you’ve consumed 16.9g of n-6, which is 7.6% of calories and far above the limit needed to maintain an optimal n:6 to n:3 ratio.

Check the chart below for a listing of the n-6 and n-3 content of several common foods.

Click the thumbnail for a larger version

Ditch the processed foods and cut back on eating out

Of course, if you’re eating any industrial seed oils you’ll be way, way over the optimal ratio in no time at all. Check out these n-6 numbers (again, per 100g):

  • Sunflower oil: 65.7g
  • Cottonseed oil: 51.5g
  • Soybean oil: 51g
  • Sesame oil: 41.3g
  • Canola oil: 20.3g

Holy moly! The good news is that few people these days still cook with corn, cottonseed or soybean oil at home. The bad news is that nearly all processed and packaged foods contain these oils. And you can bet that most restaurant foods are cooked in them as well, because they’re so cheap.

So chances are, if you’re eating foods that come out of a package or box on a regular basis, and you eat out at restaurants a few times a week, you are most likely significantly exceeding the recommended intake of n-6.

Two other methods of determining healthy n-3 intakes

Tissue concentration of EPA & DHA

Hibbeln et al have proposed another method of determining healthy intakes of n-6 and n-3. Studies show that the risk of coronary heart disease (CHD) is 87% lower in Japan than it is in the U.S, despite much higher rates of smoking and high blood pressure.

When researchers examined the concentration of n-3 fatty acids in the tissues of Japanese subjects, they found n-3 tissue compositions of approximately 60%. Further modeling of available data suggests that a 60% tissue concentration of n-3 fatty acid would protect 98.6% of the worldwide risk of cardiovascular mortality potentially attributable to n-3 deficiency.

Of course, as I’ve described above, the amount of n-3 needed to attain 60% tissue concentration is dependent upon the amount of n-6 in the diet. In the Phillipines, where n-6 intake is less than 1% of total calories, only 278mg/d of EPA & DHA (0.125% of calories) is needed to achieve 60% tissue concentration.

In the U.S., where n-6 intake is 9% of calories, a whopping 3.67g/d of EPA & DHA would be needed to achieve 60% tissue concentration. To put that in perspective, you’d have to eat 11 ounces of salmon or take 1 tablespoon (yuk!) of a high-potency fish oil every day to get that much EPA & DHA.

This amount could be reduced 10 times if intake of n-6 were limited to 2% of calories. At n-6 intake of 4% of calories, roughly 2g/d of EPA and DHA would be needed to achieve 60% tissue concentration.

The Omega-3 Index

Finally, Harris and von Schacky have proposed a method of determining healthy intakes called the omega-3 index. The omega-3 index measures red blood cell EPA and DHA as a percentage of total red blood cell fatty acids.

Values of >8% are associated with greater decreases in cardiovascular disease risk. (Note that n-6 intake was not considered in Harris and von Shacky’s analysis.) However, 60% tissue concentration of EPA & DHA in tissue is associated with an omega-3 index of between 12-15% in Japan, so that is the number we should likely be shooting for to achieve the greatest reduction in CVD mortality.

The omega-3 index is a relatively new test and is not commonly ordered by doctors. But if you want to get this test, you can order a finger stick testing kit from Dr. William Davis’ Track Your Plaque website here. It’ll cost you $150 bucks, though.

What does it all mean to you?

These targets for reducing n-6 and increasing n-3 may seem excessive to you, given current dietary intakes in the U.S.. Consider, however, that these targets may not be high enough. Morbidity and mortality rates for nearly all diseases are even lower for Iceland and Greenland, populations with greater intakes of EPA & DHA than in Japan.

All three methods of calculating healthy n-3 and n-6 intakes (targeting an n-6:n-3 ratio of 2.3:1, 60% EPA & DHA tissue concentration, or 12-15% omega-3 index) lead to the same conclusion: for most people, reducing n-6 intake and increasing EPA & DHA intake is necessary to achieved the desired result.

To summarize, for someone who eats approximately 2,000 calories a day, the proper n-6 to n-3 ratio could be achieved by:

  1. Making no changes to n-6 intake and increasing intake of EPA & DHA to 3.67g/d (11-oz. of oily fish every day!)
  2. Reducing n-6 intake to approximately 3% of calories, and following the current recommendation of consuming 0.65g/d (three 4-oz. portions of oily fish per week) of EPA & DHA.
  3. Limiting n-6 intake to less than 2% of calories, and consuming approximately 0.35g/d of EPA & DHA (two 4-oz. portions of oily fish per week).

Although option #1 yields 60% tissue concentration of EPA & DHA, I don’t recommend it as a strategy. All polyunsaturated fat, whether n-6 or n-3, is susceptible to oxidative damage. Oxidative damage is a risk factor for several modern diseases, including heart disease. Increasing n-3 intake while making no reduction in n-6 intake raises the total amount of polyunsaturated fat in the diet, thus increasing the risk of oxidative damage.

This is why the best approach is to limit n-6 intake as much as possible, ideally to less than 2% of calories, and moderately increase n-3 intake. 0.35g/d of DHA and EPA can easily be obtained by eating a 4 oz. portion of salmon twice a week.

{ 59 comments… read them below or add one }

tod May 11, 2010 at 9:17 am

hi baba,
what about mercury in the fish?  do you have any concerns?
i just saw “the cove”…  yikes!
thanks for doing all the math here.
 

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Chris Kresser May 11, 2010 at 9:45 am

Hey Tod,

I’ll be addressing the safety of fish consumption in a future post – possibly the next one. In short, the concern has been way overblown and doesn’t take the protective effects of selenium in ocean fish into account. More to come.

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Isaac May 11, 2010 at 9:45 am

Fish oils and other food sources that have omega 3 are very important for heart health.  The title How much omega 3 is enough does depend on omega 6, but how do you really know if your omega 3 levels are optimal in your blood.  I would suggest getting an at home omega 3 blood test at http://www.omega3test.com.  The report will tell you if you are really taking enough omega 3 and where your omega 3 and 6 levels are at.

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Chris Kresser May 11, 2010 at 9:50 am

I mentioned the omega-3 test in the article.

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enliteneer May 11, 2010 at 12:08 pm

It’s a shame that even when you *think* you’re eating healthy (walnuts, almonds, eggs, white meat), your omega-6 to 3 ration will get out of whack!

I know nutrients in food form are always better than supplementing single nutrients, but  it seems like taking an omega-3 supplement is the most plausible solution.   Is there a reason why that isn’t mentioned as an alternative to eating 11oz fish every day?
Anyone have any mercury-free omega-3 supplement recommendations? ( Health From The Sun’s Total EFA?  Nordic Naturals?  Life Extension Omega-3s? Equateq Maxomega-90? )

 
 

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Chris Kresser May 11, 2010 at 1:13 pm

Please read the first article in the series if you haven’t already.  It clearly explains why plant-based omega-3 oils are not acceptable substitutes for EPA & DHA in seafood.  Less than 0.5% of the omega-3 oils in those supplements will be converted into EPA & DHA.  You’d have to take an obscene amount of flax oil each day to get the dose of EPA & DHA you need, but then you’d be taking in way too much polyunsaturated fat which is highly susceptible to oxidative damage.

Fish oil and DHA oil from algae are alternatives to fish consumption.  I will discuss these in more detail in subsequent posts.

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enliteneer May 11, 2010 at 1:25 pm

Doh.. I should have stated Omega-3 supplements derived from fish oil.   For example, Life Extension,  Nordic Naturals and Health from the Sun all contain 1.3g of EPA/DHA Omega-3 from fish oil per serving.

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Chris Kresser May 11, 2010 at 1:32 pm

Got it.  I’ll talk more about the relative benefits of fish and fish oil soon.  There is evidence that the EPA &  DHA is better absorbed in whole fish than in purified fish oil.  Still, fish oil is a viable option if it’s a good product (especially if the oil is in the natural triglyceride form).

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Moss Bliss May 11, 2010 at 3:02 pm

Once again, we’re only comparing two groups of fats.  Dr. Stoll clearly stated that the optimum fat ratios included Omega-9s.  As I recall the stats (and my memory is far from perfect), the typical American diet (at the time of publication) was 1:9:6 (n-3:n-6:n-9) and that optimum was 1:1:1.
 
Question:  If 1000 mg of fish oil contains 360 mg of EPA and 240 mg of DHA (standard fish oil, not special concentrates), what is the composition of the remaining 400 mg of oil?

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Robert Jacobs May 11, 2010 at 4:12 pm

Seems that fish oil would have to be refined to have over 60% PUFA’s.  Not all PUFA in fish oil is EPA and DHA.  Additionally, even COLD water fish have over 20% of fat stored as MFA’s and another 20% plus stored as SFA’s.  With fish oil, you are also going to get some BAD PUFA’s, whose rapid oxidization and damage to your body is likely to interfere with any benefits from the EPA and DHA (were they even to get to your tissues without  oxidizing first!).
I can’t believe that there are “proper ratios” of these fats.  This just does not make sense for a hunter gatherer environment in a feast/starve/feast/starve cycle or for human survival beyond the ocean.  Omega-3′s are now being promoted by the same health professionals who brought you Omega-6′s, in part, to counteract the damage of the Omega-6′s!
Since all PUFA’s oxidize rapidly upon entering a mammal, where the body temperature is close to 100 degrees, you need lots of Vitamin E to handle these oils.  Our body temps are not those of fish and we developed in warm climates, where SFA’s and MFA’s are far more beneficial.
Chris has made his case for DHA.  Even if he is right, he has concluded that REAL food (fish) is the best possible source of this PUFA.  And after you cook the fish, subjecting the PUFA’s to 200 degrees or more, what do you think you get from those oils which can possibly be healthy?
If only a piece of fish per week and avoiding all possible sources of vegetable oils is what you take away from this discussion, Chris will have done a great job helping you to improve your health.

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Moss Bliss May 11, 2010 at 6:06 pm

I hate to sound like an idiot, so I will ask this question only once:
What is a “PUFA”?

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Pieter May 12, 2010 at 5:08 am

@Moss Bliss
PUFA = Polyunsaturated fatty acid (like n-6, n-3, …)

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nicole May 13, 2010 at 11:09 am

I have recently changed my diet to include oily fish for the fatty acids, but I too am very concerned about toxicity. Looking forward to your post on the toxicity of fish.  I agree 100% on most supplement omega oils being a waste of money.

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Moss Bliss May 13, 2010 at 3:54 pm

@nicole I totally disagree that fish oil supplements are a waste of money. I’m taking 4 grams of fish oil per day, and they do more for me than any of the psych drugs ever did, with no “side” effects. And I’m taking the cheapest fish oil available (from Puritan’s Pride).
As for mercury, all of the major sources of fish oil have been tested, and no mercury or other toxins have been found even in parts per billion.

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alfredo May 14, 2010 at 9:37 am

Hi All. Very interesting information but complicated to be practical in the day to day living. There is a practical blood test that will give an indirect idea of your omega 6/omega 3 ratio: HDL cholesterol/triglycerides.

Since the consumption of all omega 6 increase triglycerides and decrease hdl cholesterol and omega 3 works in the opposite direction, this ratio gives good information. The ideal ratio HDL cholesterol/triglycerides is close to 1/1.

Eating fish has no problems, if you don’t do it too often. But if you want to supplement your diet with the proper amounts of omega 3 by just eating fish, it could be a health risk. You would have to eat fish almost every day and that could mean dangerous amounts of mercury in your nervous system.

It is important to have in mind that there are certain conditions to get the benefits fish oil can bring.

You need to take a good quality fish oil, free from mercury and other contaminants. That is a molecularly distilled fish oil.

Then, you need to take a minimum amount of fish oil, krill oil or cod liver oil at a certain frequency.

There is not an establish amount of omega 3 for any health benefit but I recommend to take at least 900 mg per day of omega 3 fats (close to 3.000 mg of fish oil), EPA plus DHA, per day. You should increase these amounts if you are overweight or you have degenerative disorders, like hypertension or high triglycerides.

Also, you should lower your intake of omega 6 fats (mostly grains and grain oils) since omega 3 and omega 6 counteract each other in the body. The best way to reduce omega 6 fats is to eliminate all starches from your diet, that is all grains and grain oil.

Please read more at http://www.omega-3-fish-oil-wonders.com/essential-fatty-acids-eicosinoids.html
Best wishes,
Alfredoe

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Moss Bliss May 14, 2010 at 3:26 pm

@ Alfredo – Recent studies are showing that the oversimplification is in what constitutes “good” and “bad” cholesterol.  It is not so simple that HDL=”good” and LDL=”bad”.  The pharmaceutical industry has us believing whatever they want us to, just to sell more anti-cholesterol drugs, all of which have many more effects than they are prescribed to treat.

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Rick May 19, 2010 at 6:27 am

I love the picture of the sardines….chocolate sardines!  Not much of an omega 3 boost there, I would imagine.
Take home for me  is that the most effective way to get your balance of fats in order is to do a big reduction in intake of omega 6′s.   That seems the most effective way to get the ratios aligned.

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Chris Kresser May 19, 2010 at 7:49 am

Rick,

It’s still important to get some omega-3 even if you reduce omega-6 significantly, but yes, I think overall it’s more important for most people to focus on reducing n-6.

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brauh May 21, 2010 at 3:55 pm

Have you seen a diet built around low carbs & low omega-6s.  I eat a low carb diet with nuts as snacks.  It is tough to eat LC and give up nuts.  Any thoughts?

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Chris Kresser May 21, 2010 at 6:38 pm

That’s a great question, and a controversial one. There are prospective studies that suggest nut consumption is beneficial. On the other hand, we know that an elevated n-6:n-3 ratio is a risk factor for many diseases. One possibility that has been pointed out, which I tend to agree with, is that the n-6 in whole foods like nuts has a different effect on our bodies than the n-6 found in industrial seed oils and processed food. Whole foods like nuts contain antioxidants and n-3 in addition to n-6, which arguably mitigate the pro-inflammatory effects of n-6. Also, if you eat the nuts soaked/raw, rather than roasted, they haven’t been cooked and there’s less of a chance that the n-6 is oxidized, which exacerbates its inflammatory effect.

I tend to think that nuts in moderation (i.e. a small handful a day, or every other day) are beneficial. However, to play it safe, it may be wise to favor nuts low in n-6 like macadamia and filberts and avoid or limit nuts high in n-6 like walnuts and brazil nuts.

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ben May 21, 2010 at 9:34 pm

So avoiding any polyunsaturated vegetable oils, it’s best to stick with saturated oils for cooking (coconut, animal fats, etc)..
BUT why is mono-unsaturated Extra Virgin Olive Oil often touted for salad dressings?
Seems every Mediterranean study concludes that olive oil is the key, yet  the Omega-6 to Omega-3 ratio is horibble, so what is it that  makes it so healthy?
 

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Chris Kresser May 22, 2010 at 8:20 am

Good question. Olive oil is best consumed in moderation, and I don’t recommend cooking with it.

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Moss Bliss May 22, 2010 at 10:26 am

Ben,
 
The answer is, it’s not a simple 3-6-9-7 issue, and the ratios are theoretical.  Nobody yet knows what ALA is good for, other than to be converted to EPA and DHA (7% conversion according to this string).  On the other hand, GLA is an n-6, but is thought to be quite useful (I mostly deal with mental health issues, and GLA is a definite mood enhancer if nothing else).
Olive oil contains triacylglycerols and small quantities of free fatty acids, glycerol, pigments, aroma compounds, sterols, tocopherols, phenols, unidentified resinous components and other (Kiritsakis, 1998).  I’m not sure about triacyglycerols, but if I remember right they are n-7s, which takes them clean out of the 3-6-9 thing.

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ben nguyen May 25, 2010 at 6:47 pm

Is there a reason why ALA isn’t listed in the chart? https://thehealthyskeptic.org/wp-content/uploads/efainfoods.png
Shouldn’t ALA, like the kind found in Flaxseed, be listed under Omega-3 with the others (LNA / EPA / DPA / DHA ).   Omega 6 shows (LA / AA).
Does it go by another acronym?

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Chris Kresser May 25, 2010 at 8:07 pm

Hi Ben,

LNA = alpha-linolenic acid = ALA. Different acronyms, same fatty acid.

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Moss Bliss May 25, 2010 at 8:24 pm

Glad to see they came up with LNA… there is another ALA, Alpha Lipoic Acid, which is often found useful in treating adult-onset diabetes… not even in the same class of acids.

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Alan Beall August 11, 2010 at 10:00 am

Chris, you are doing a great service.  Thank you.
I am taking 2 capsules per day of Daily DHA from Wellness Resources. In the product’s description it says: Daily DHA™ contains 582mg of mercury-free marine lipid oil per capsule. This provides 250mg of the highly desirable DHA omega-3 oil and 35mg of EPA per capsule! Daily DHA™ (the same compound used in Leptinal®), is molecularly distilled, ensuring no heavy metals or mercury are in the supplement. It is also a modified fish oil that is very high in DHA and low in EPA. Too much EPA may thin blood too much or actually get in the way of DHA doing its job.*
I am also following the Paleo Diet and following the 5 rules outlined in the Leptin Diet, but have not switched to grass-fed meats, which I plan to do soon.  I’ve lost 38 pounds since March, my BP is about 120/80 and have stopped taking medication. I have also stopped taking statins for cholesterol.  I take no other meds, including aspirin.  I eat almost no sugar, grains, oils, alcohol, sugar substitutes, or dairy other than pasteurized organic butter.  I do eat a lot of smoked meats.  Any recommendations?  Thanks.

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Chris Kresser August 11, 2010 at 10:02 am

Alan: certainly sounds like you’re on the right track. Keep it up!

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Janet September 29, 2010 at 11:37 am

Chris, I’m new to all this information. I was referred to your website because i was taking statins for “high” cholesterol. After reading your articles I told my doctor that I’m throwing away those pills, and now i’m trying to educate myself about these fatty acids. I have been using Smart Balance, which says it’s an “excellent source of omega-3″. It doesn’t list how much omega 6 there is. So i think you’d say throw it away and stick with butter?  Also, i take Fish Oil from SAMs, which has EPA to DHA 3:1. So i guess i’d better check out the other fish oil brands you mentioned, correct? thanks for educating us.

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Moss Bliss October 1, 2010 at 4:41 pm

Janet,
 
You might also investigate CoQ10 — I used it to get my doctor off my back on cholesterol levels.  I have been taking fish oil for many years, but it was not enough; it took about 9 months to get my cholesterol down, but the doctor finally stopped ordering tests.  I was taking 2-100 mg capsules per day.
 
Moss

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Lisa January 29, 2011 at 6:48 am

Chris – Any thoughts on Weston Price Foundation’s recommendation of fermented cod liver oil and the debate running between them and Dr. Mercola’s recommendation of krill oil?

Also, I’m supplementing vitamin D as my levels were just tested to be at 35. Any danger in over supplementing D with the addition of cod liver oil to the D? Should I be worried abou the D/A ratios?

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Chris Kresser January 29, 2011 at 10:38 am

I agree with the WAPF. Vitamin A is not toxic when D and K2 levels are adequate. I’ll be writing more about this at some point.

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Moss Bliss January 29, 2011 at 1:29 pm

Lisa, I think the answer is, follow the money. I have not heard any of the arguments on fermented cod liver oil, but fish liver oils are very high in vitamins A and D, both oil-based vitamins which are not easily eliminated. You can very quickly overdose on these vitamins using regular dosages of fish liver oil.

As for Dr. Mercola, he owns all or most of the stock in Neptune, the major producer of krill oil. And I believe the disadvantages of krill oil have been stated already in this discussion.

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Chris Kresser January 29, 2011 at 1:36 pm

I disagree with Moss on the issue of toxicity of A & D in cod liver oil. A normal dose of FCLO (1/2 tsp/d) would yield approximately 5,000 IU of A and 1,500 – 2,000 IU of D – far below the toxic doses of each. The idea that A is toxic at doses of 20,000 IU per day is incorrect. It’s based on a poorly performed study with results that have been questioned by at least three other groups of researchers. There are many more studies showing that doses as high as 50,000 IU of A are not toxic, especially when D & K2 levels are sufficient (they often are not, which probably explains the toxic effects some experience). Fermented cod liver oil has A, D & K2 which makes it superior to other fish oils in this respect.

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Moss Bliss January 29, 2011 at 1:52 pm

I am commenting on behalf of a fairly large group of people I represent, including myself, who take 4-6 grams of fish oil per day. I am not a researcher, just a peer trying to help peers make good decisions. We have experienced toxicity from cod liver oil in our group, perhaps it was a sensitive individual but then most of us taking fish oil for mental health concerns ARE sensitive.

(There are currently over 400 members of the ALT-therapies 4bipolar Yahoogroup, and perhaps as many as 1,000 or more have passed through the group since our founding in 2002.)

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Chris Kresser January 29, 2011 at 2:18 pm

Moss: what do you mean by “toxicity”? And why do you attribute that to A & D in the FCLO? I respect your experience – I’m the last person to think you need to be an M.D. or licensed practitioner to have an educated opinion. I just think we need to be cautious about drawing conclusions from subjective experience without isolating the variables. That’s the value of clinical research, of course.

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Moss Bliss January 30, 2011 at 10:41 pm

We’ve seen a lot of compromised immune systems from the drugs doctors give to mental patients, and A and D can increase that; also the fact that large amounts of A can advance bone loss, already a hazard in women as they age. While there is also a large amount of nausea and vomiting, sometimes attributed to A and/or D overdosage, it’s always difficult to pin down exactly what causes it. Further, a lot of the psychiatric drugs cause diabetes or pre-diabetic symptoms, and excesses of cod liver oil exacerbates these symptoms or makes treatment more difficult.

We also prefer fish oil over cod liver oil, as the liver is the major detoxifying organ and there seems to be no standard method of detoxifying cod liver oil; most fish oil is from dark muscle meat, less likely to harbor toxins.

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Chris Kresser January 30, 2011 at 10:48 pm

1. A does not promote bone loss when D & K2 levels are sufficient. Read this: http://www.westonaprice.org/abcs-of-nutrition/172-vitamin-a-on-trial.html

2. Vitamin A is one of the most important fat-soluble vitamins for immune health, along with D. So I do not understand your claim that A & D “increase” compromised immune system. That doesn’t make any sense.

3. The liver processes toxins – it does not store them. That’s a common misconception. Toxins are stored in the fat tissue. If you’re worried about toxins, you should avoid eating the fat of conventionally raised animals and farmed fish – not liver, which is the most nutrient-dense foods on the planet.

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Lisa January 31, 2011 at 10:12 am

Thank you, Chris for the great information. I was taking Blue Ice fermented cod liver oil but as of today have to stop. I had food sensitivity blood testing done and today received the results: cod fish is on my list of foods to avoid, so I’m assuming that includes cod liver oil.

Now I’m searching for an alternative – any recommendations? I’ve already cut out all fried foods, etc. and am eating just meat (grass fed or pastured), vegetables and non-industrial oils/fats.

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Chris Kresser January 31, 2011 at 10:55 am

Lisa: most food sensitivity testing is bogus. There’s no support for it in the scientific literature, and I have colleagues that have drawn their own blood twice on the same day, labeled each container with a different name, sent them in to the same lab, and received completely different results for each sample. It’s not at all reliable in my opinion, and I’d think twice about not eating a superfood like CLO based on food allergy testing results.

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Moss Bliss January 31, 2011 at 4:10 pm

Lisa, I would dispute what Chris says — the standard prick-test allergy tests are pretty rough, give about as many false positives as false negatives (as well as good information), but other testing can be much more accurate. In my own life this has made a great deal of difference, avoiding foods which made me break out into eczema or made me dizzy-ish (anhd other symptoms) instead of taking drugs to “ameliorate” the symptoms. (Any time a doctor prescribes you corticosteroids, he is admitting he doesn’t have a clue.)

Regular fish oil has a lot less (if any) cod in it, so you might be fine with that.

Sorry to be “against” you again, Chris, but this is experience for me.

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Chris Kresser January 31, 2011 at 4:39 pm

I’m fine with you “disputing” me, but it would hold more water if there was some scientific evidence that supported what you’re saying. The problem with relying only on experience is that it’s subjective and not reliable. Read this for more on why: http://www.paleonu.com/panu-weblog/2011/1/27/n-1.html

Don’t get me wrong – I value experience as one piece of the puzzle. But I would never advise others on dietary choices based on my experience or even the experience of a group without more evidence to support my recommendations.

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Lisa January 31, 2011 at 4:44 pm

An interesting topic – food sensitivity testing. I have to think there’s some gray area between your two opinions. There were some areas on my test results that were questionable to me. For example, I scored high on cow and goat’s milk and low on casein….huh?

I’ve learned just recently that there are many different types of testing available. The bood testing I had done, I believe is called Cytotoxic food testing….then there’s ACT, Serial End Point Titration & Proactive Neutralization and Electrodermal Titration (VOLS) which is based on orthomolecular medicine.

I have a good friend who was battling Lyme’s disease and found a treatment approach based on VOLS testing and has been on an amazing road to recovery. This technique is really interesting…it determines your reaction to foods by measuring the electrostatic charge between energy meridians (as in Chinese medicine).

Anyway, each time I’m sure I’ve found an “answer” I read conflicting sources of information. Makes for an interesting journey for sure, and it’s all good.

Thanks for your input.

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Moss Bliss January 31, 2011 at 4:44 pm

Ya know, most of the “science” on a lot of these issues is so sketchy I’d rather listen to experience. With my ALT-therapies4bipolar group, I get the experience of a lot of people (over 400 right now, maybe 1000 in and out of the group over the years), and when it lines up (as it seems to have on the topics of fish oil, magnesium, and lithium orotate to date), I’d trust that a lot more than a doctor who listens to his pharmaceutical rep.

No, I don’t want to be contentious. But when you find a good doctor, as I did once and as Lisa maybe has, they SHOW you the evidence and let you try it out. I don’t know what tests her doctor ran, so I can’t comment on the science behind them — but a lot of the “science” in allergy testing is about on the level of The Amazing Randi, a person whose job it is to debunk or cast aspersions, with the benefit going to the drug companies and their own debunkable magic. I will also admit that a lot of the “science” that is pro-allergy is nothing more than pet theories.

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McHarris February 20, 2011 at 2:40 am

I work with a trained dietician on FAILSAFE method of food chemical sensitivities. I did a huge elimination diet, and under dietician care reintroduced foods one at a time. It works if it is done properly. I am salicylate sensitive, soy and msg intolerant, legumes are a no no for me…. even if soaked and prepared WAP way. Gluten intolerant and casein intolerant…… Makes eating out tricky I tell you, but I now know what I can and cannot eat… at what cost etc…… too much broccoil and I pay the price…. milk and products keep me tied to the house and the loo for days after consuming, and gluten causes me immense pain…. not just in the bowel either. I did undergo some skin prick tests years ago, but they were inconclusive, where as using the R.P.A.H – Failsafe diet has worked for me.

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Moss Bliss February 20, 2011 at 2:55 am

McHarris, I share a lot of your sensitivities, not all. Milk and I are good buddies. But the legumes, ah yes. Not many vegetables with any protein in them that I should be eating. And sugars are way up my list too. Sugar plus wheat (aka donuts, cookies, etc.) means eczema, sure as the day is long.

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McHarris February 20, 2011 at 8:21 pm

I am really interested in finding out – on a restricted diet if I am consuming sufficient? the correct balance of 3-6′s. Considering I do not eat processed foods, foods from fast food outlets, packaged and prepared foods from supermarkets etc….. I would consider I was somewhat deficient in the 6′s (grin) according to modern food eating standards.

What fats are in my diet? hummmmmm If I cook with oil I use Rice Bran Oil in a 50/50 ratio with butter.
Any other fats come from meats and fish that I buy fresh and cook at home. Nuts….. well yes, a handful once a week maybe of cashews.

No Milk No cheese No yoghurt, which has my poor dietician tearing her hair out! I refuse soy milk, wont use rice or oat milk etc…… the shop bought pre packaged milk substitues are frankenfoods as far as I am concerned.

So am I deficient in the reverse? maybe too much 3′s and insufficient 6′s????

Maybe maybe not. When I cook with chicken all visibly fat and skin is removed. I am NOT misled by the you must eat low fat rubbish, but I don’t over do it either as I have non alcoholic fatty liver, NO gallstones evident on ultrasound, but do get pain in that area sometimes. Only very recently have I read (here I believe maybe) that tyroid problems can interfere with the liver. I have a multi nodular (growing) goitre and seem to fluctualte tween hypo and hyper……. iodine/kelp supplementation did not agree with me.

So apart from taking a krill oil capsule once a day, all other fats consumed are natural mostly 3′s I believe…… THOUGHTS appreciated.

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Moss Bliss February 20, 2011 at 8:31 pm

I’ve heard a lot of negative stuff about krill oil… the only positive info comes from Dr. Mercola, who owns most of the company. How much fish are you eating? Three servings per week of dark muscle meat fish are said to be sufficient. But nothing else you are eating has any Omega-3s in it. The nuts are mostly 6 and 9.

You don’t talk about medications you may be taking… there are a lot of things you can do for the thyroid issues, but the best (and least known) may be lithium orotate. The low levels of lithium in this product appear to be ideal for thyroid issues. Most people see lithium as being damaging to the thyroid, but that is in the light of the toxic levels of lithium carbonate given to many people. Lithium orotate is available over the counter if you can find it, and over the Internet.

And now we are officially off topic. LOL Hope it helps anyhow.

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McHarris February 20, 2011 at 11:13 pm

ahhhhh the other oil I forgot to mention that I consume daily is CLO. Doc said my D levels were fine, so I decided to take a daily CLO capsule to keep them that way. I am photosensitive, so do not spend much time out in the sun, it causes me that wretched butterfly rash on my face.

NO I have not been prescribed any prescription thyroid meds….. only suggested I take selinium which I had to find without brewers yeast (not suitable for my diet) and aswaganda (?sp) to perhaps help my thyroid and won’t hurt my other autoimmune issues. I am diagnosed SLE with vasculitis.

Doc is considering a partial thyroidectomy….. I want more information first and a closer look at what my alternatives may well be. I have found this site very informative and helpful. Gut issues do so much damage to the entire body and yet I have not found a GP yet who appreciates that fact.

Cheer’s

It is important to me that I provide the right balance of ‘ingredients’ for my system. I work hard at that.

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Moss Bliss February 21, 2011 at 12:45 am

OK, I assume you mean Cod Liver Oil, which is rich in Omega-3s (also A and D).

It is hard to find doctors who listen to their patients, or listen to anything other than what they remembered from medical school. Harder still to find good doctors who take insurance, especially things like Medicare and Medicaid. If you find a good doctor, you will also be dealing with his (or her) pet theories. None of the “alternative medicine” concepts have been rigorously tested (except with the intent to discredit them), and so you will always have trouble getting the right balance for you. Western medicine has never been interested in the individual, only in general treatments (and promoting those treatments as much more universal than they are).

OK, now that I’ve dug myself into that hole, I hope you will reject the partial thyroidectomy — that makes as much sense as “curing” mental illness with a lobotomy (or electro-convulsive “therapy”). I would suggest you consider lithium orotate — it’s cheap, readily available, and safe. (The only research showing it to be unsafe used thousands of times per body weight over suggested amounts, proving only that minerals are toxic when taken at toxic levels.) I can’t show you any research on lithium (at proper levels) and thyroid, but have several members of my ALT-therpaies4bipolar group who have greatly reduced or eliminated their thyroid meds, often with concurrence from their doctor.

But this is Chris’ group, and I have no intention of taking over either the group or the conversation. Feel free to contact me off-list, or just think about what I’ve said and accept or reject it as you will.

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白約立 March 31, 2011 at 6:56 pm

I avoid all seed oils and nuts except macadamia nuts, and I usually eat canned sardines or wild caught salmon four to five times a week, is this going to be too much EPA in light of what Chris Masterjohn has said: “Providing high doses of EPA that interfere with arachidonic acid metabolism, however, is a pharmacological approach, and it is likely to have many adverse consequences.”

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Amanda June 5, 2011 at 9:37 am

Hi Chris,

I heard you briefly mention borage oil once on your podcast. My integrative doctor has me take 1,000 mg twice a day. She did a functional test which tested all of my levels. My omega 3s were great, but I have low levels of DGLA and GLA. Is that something to be concerned about? Isn’t it better to have more omega 3?

What are your thoughts on borage oil? My omega 6 level overall is pretty low. (no seed oils, nuts etc)
Amanda

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Max Trynyn June 6, 2011 at 5:00 pm

Hello and thanks for al the great information!

I was wondering if you would have different recommendations for a competitive endurance athlete (x-c skiing) training multiple times per day. Does this change anything concerning limits on omega-6 consumption? I eat very close to your recommendations except that it is hard to get enough energy so I like to eat a lot of nuts. I am 22 and generally fit and healthy though I have some trouble with eczema.

Thanks!
Max

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Max Trynyn June 6, 2011 at 9:17 pm

…And one follow up question: I feel like I have seen a lot of claims that scientific studies found many health benefits of nut-consumption. Sorry I’m so obsessed with nuts.

Thanks!
Max

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Tania Vera July 7, 2011 at 4:45 pm

Thanks for the informative series. I’ve been working on changes to reflect the info here. I have a question. If it has already been answered, please forgive me and point me to the right place.

I was wondering about ALA. In the example you provided, you say,”if we increased our intake of EPA and DHA to the recommended 0.65g/d (0.3% of total calories) and maintained ALA intake at 2.35g/d, but reduced our intake of LA to roughly 7g/d (3.2% of total calories), the ratio would be 2.3:1 – identical to the optimal ratio.”

How do you maintain ALA at about 2.35g/d, especially if you reduce LA sources likes nuts and seeds? I tend to eat mostly meats, eggs, raw dairy, veggies (including roots/tubers), some fruit, and limited amounts of nuts/grains/legumes. I have recently started to add 2-3 servings of fish a week (mostly salmon, halibut, and ecofish tuna).

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Chris Kresser July 7, 2011 at 4:56 pm

You don’t have to worry too much about ALA. Just increase fish intake to 3 servings per week (6-7 oz. each) and reduce LA and that will do it.

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Tania Vera July 7, 2011 at 5:41 pm

Thanks. That makes total sense. I’m still wrapping my head around eating fish 3x/week (4oz each), so I think I was worried about bumping it up even more (I cut fish from my diet 5 years ago when I was pregnant due to mercury concerns. Ack.) My family is from coastal Ecuador, so fish was a huge part of my diet when I was younger. Nice to know about selenium’s affinity for mercury.

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JustMEinT July 7, 2011 at 5:32 pm

at a GP visit yeaterday she told me she had recently attended a conference where it was told that certain patients should limit their intake of fish oil capsules to 1000mg per day. the reason this came up – I have a bleed behind one eye….. she asked how much supplemental fish oil I was taking, and the told me to reduce it to 1000mg per day because I maybe a sussceptible (?sp) bleeder.

I have stents in and refuse statins. I take the fish oil as an anti inflam medication inseat of the statins….

Would appreciate your thoughts and any links for me to follow please

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Chris Kresser July 7, 2011 at 5:50 pm

Most studies I’ve seen suggest that fish oil doesn’t cause or worsen bleeding even at fairly high doses.

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