Daily Omega-3 Intake Recommendations
For a healthy adult, consume 500 mg of EPA+DHA daily—achievable through two servings of fatty fish per week—to reduce cardiovascular mortality by approximately 37%. 1, 2
General Population Baseline Intake
The American Heart Association recommends at least two portions of fatty fish weekly, providing approximately 400–500 mg/day of EPA+DHA combined, for general cardiovascular health. 1, 2, 3
For adults who do not consume fish regularly, 500 mg EPA+DHA daily from supplements is recommended for baseline cardiovascular protection. 1, 3
This dose reduces fatal coronary heart disease risk by 37% based on meta-analysis of U.S. epidemiologic studies. 4
Plant-Based Omega-3 (ALA) Requirements
Plant sources of alpha-linolenic acid (ALA)—including flaxseed, walnuts, and canola oil—require 1.5–3 grams daily but are far less potent than marine-sourced EPA+DHA. 1, 2, 3
Conversion of ALA to EPA is only approximately 6%, and conversion to DHA is severely restricted at 3.8%, making direct EPA+DHA intake far more reliable. 5
The Institute of Medicine allows up to 10% of the ALA requirement to be met by EPA or DHA, but current U.S. mean intake of EPA+DHA is only ~100 mg/day—well below recommended levels. 6
Condition-Specific Dosing Algorithm
Documented Coronary Heart Disease (Secondary Prevention)
Prescribe 1 gram (850–1,000 mg) EPA+DHA daily for patients with established coronary disease. 1, 2, 3
This dose reduces sudden cardiac death by 45% and total mortality, nonfatal MI, and stroke by 15%, with Grade A evidence from large randomized trials including GISSI-Prevenzione. 1, 2
Hypertriglyceridemia
For moderate elevation (200–499 mg/dL), prescribe 2–4 grams EPA+DHA daily under physician supervision, lowering triglycerides by 20–40%. 1, 2, 3
For severe elevation (≥500 mg/dL), prescribe 4 grams EPA+DHA daily under physician supervision, reducing triglycerides by approximately 45% and VLDL cholesterol by more than 50%. 1, 2
Cognitive Health in At-Risk Populations
For individuals with APOE e4/e4 genotype, consider 1,500–2,000 mg EPA+DHA daily with a higher EPA:DHA ratio (approximately 2:1) for cognitive protection, though evidence strength is low to moderate. 1, 2
Higher EPA+DHA intake achieving an omega-3 index ≥4% showed significant cognitive improvements at 12 and 30 months in older adults. 2
Safety Thresholds and Monitoring
Up to 5 grams EPA+DHA daily is safe for long-term use without increased bleeding risk, even with concurrent antiplatelet or anticoagulant therapy. 1, 2, 3
EPA alone up to 1.8 grams daily has been specifically validated as safe. 1, 2
Doses ≥4 grams daily increase atrial fibrillation risk by 25%, with most excess risk occurring above 1 gram daily. 1, 2, 3
Doses above 3 grams require physician supervision due to theoretical bleeding concerns, though actual bleeding risk has not been demonstrated. 1, 2, 3
Special Populations
Elderly with Cardiovascular Disease
For older patients with established cardiovascular disease, prescribe 850–1,000 mg EPA+DHA daily. 1, 2, 3
The GISSI-HF trial in elderly patients (mean age 67 years) showed reduced total mortality with this dose. 1, 2
Pregnancy and Mercury Concerns
Pregnant and nursing women should follow general population recommendations (two fish servings weekly) while avoiding high-mercury species (shark, swordfish, king mackerel, tilefish). 2, 3
Safe consumption is up to 12 oz (340 g) per week of low-mercury fish such as canned light tuna, salmon, pollock, or catfish. 2
For middle-aged and older adults, cardiovascular benefits of fish consumption outweigh potential mercury risks. 2
Vegetarians and Vegans
Algal oil provides the only direct source of EPA and DHA without animal products, offering a safe alternative for those with fish allergies or dietary restrictions. 2
Algal oil is free from methylmercury, PCBs, dioxins, and other environmental contaminants found in fish. 2
Critical Clinical Pitfalls
Omega-3 supplements provide no benefit for blood sugar control or primary cardiovascular prevention in diabetes—the American Diabetes Association states evidence is insufficient. 1, 3
Low-dose EPA+DHA mixtures (~1 gram daily) showed no significant benefit in modern trials (ASCEND, VITAL, OMEMI) with contemporary statin therapy. 1
Omega-3 can increase LDL cholesterol by 5–10% in some patients, especially at high doses, while modestly increasing HDL by 1–3%. 1
The European Society for Clinical Nutrition and Metabolism recommends against omega-3 supplementation for dementia or cognitive impairment, citing high-grade evidence showing no benefit. 3
The Surviving Sepsis Campaign advises against omega-3 as an immune supplement in critically ill patients. 3
Practical Implementation
Start with 500 mg EPA+DHA daily for healthy adults, increase to 1 gram for coronary heart disease, and escalate to 2–4 grams for hypertriglyceridemia under medical supervision. 1, 2, 3
Take omega-3 supplements with a fatty meal (10–15 g dietary fat) to optimize absorption of ethyl-ester formulations. 1
Maintain consistent daily timing (same meal each day) to improve adherence. 1
Consuming a variety of fish species minimizes potential adverse effects from environmental pollutants. 2
Removing skin and surface fat before cooking further reduces mercury and contaminant intake. 2