Recommended Dose of Omega-3 Fatty Acids
For general health and wellness, consume 500 mg of combined EPA+DHA daily through diet or supplementation, which can be achieved by eating fatty fish at least twice weekly. 1
General Population Recommendations
Baseline intake for healthy adults should be 500 mg EPA+DHA daily, as recommended by the International Society for the Study of Fatty Acids and Lipids. 1 This foundational dose supports cardiovascular health and can be obtained through:
- Two servings per week of fatty fish (salmon, mackerel, herring, sardines, albacore tuna) 1
- Plant-based ALA sources (tofu, soybeans, walnuts, flaxseeds, canola oil) providing 1.5-3 grams daily, though ALA is less potent than EPA+DHA 1
Condition-Specific Dosing
Cardiovascular Disease Prevention
For patients with documented coronary heart disease, take 1 gram (1,000 mg) of combined EPA+DHA daily. 1 This recommendation is based on the GISSI-Prevenzione trial showing 45% reduction in sudden death with 850 mg EPA+DHA daily in post-MI patients. 1
Hypertriglyceridemia
For elevated triglycerides (≥200 mg/dL), use 2-4 grams of EPA+DHA daily under physician supervision. 2
- Moderate hypertriglyceridemia (200-499 mg/dL): Start with 2-3 grams daily 3, 2
- Very high triglycerides (≥500 mg/dL): Use 4 grams daily, which reduces triglycerides by 30-45% 4, 2
- Prescription omega-3 products (like Lovaza) contain 840 mg EPA+DHA per 1-gram capsule; typical dosing is 4 capsules daily (4 grams total) 5
Mental Health
For major depressive disorder, start with 1-2 grams of EPA daily (or EPA+DHA with EPA:DHA ratio >2:1), titrating up to 2 grams over 2-4 weeks if tolerated. 6 The EPA-predominant formulation is crucial—DHA as the main component shows no detectable antidepressant effects. 6
Preconception and Fertility
Women attempting conception should take 1,000-2,000 mg combined EPA+DHA daily with an EPA:DHA ratio of at least 2:1. 7 Purified supplements are safer than high fish consumption during this period due to mercury concerns. 7
Formulation and Bioavailability Considerations
Triglyceride-based omega-3 supplements are more bioavailable than ethyl ester formulations. 8 When selecting supplements:
- Minimum effective dose: 1,000-1,500 mg/day EPA+DHA as triglycerides for at least 12 weeks to achieve omega-3 index ≥8% 8
- Take with food to enhance absorption and minimize gastrointestinal side effects 5
- Swallow capsules whole—do not break, crush, or chew 5
Safety Thresholds and Monitoring
Doses up to 3 grams daily are generally safe without physician supervision; doses above 3 grams require medical oversight. 1, 4
- No increased bleeding risk with doses up to 4 grams daily, even with concurrent antiplatelet or anticoagulant therapy 6
- Common side effects include mild gastrointestinal symptoms (fishy taste, belching, nausea) but serious adverse effects are rare 6
- Monitor liver function (ALT) and lipid panels (LDL-C) in patients on higher doses 5
Critical Caveat: Atrial Fibrillation Risk
High-dose omega-3 supplementation (≥4 grams daily) increases atrial fibrillation risk by 25%. 6 This dose-dependent relationship was demonstrated in multiple trials, with most increased risk occurring at doses >1 gram daily. 6 Weigh cardiovascular benefits against this arrhythmia risk, particularly in patients with existing cardiac conduction abnormalities.
Practical Algorithm
- Start with dietary sources: Aim for two fatty fish servings weekly (provides ~500 mg EPA+DHA daily) 1
- Add supplementation if indicated:
- Choose triglyceride formulation over ethyl esters when possible 8
- Monitor for atrial fibrillation if using ≥4 grams daily 6
- Reassess at 8-12 weeks and adjust based on response 6, 8