Fish Oil and Omega-3s: What the Research Actually Shows About EPA and DHA

Fish oil is one of those supplements that almost everybody has an opinion about and almost nobody has actually looked at the data for. Your doctor might have mentioned it. Your gym buddy swears by it. Your aunt takes it because Oprah said something about inflammation in 2014. And somewhere in between all of that, there is a genuinely interesting body of clinical trial data that most people have never seen.

We have spent a lot of time reading through the primary literature on omega-3 fatty acids, and here is what strikes us: the research is both more impressive and more nuanced than most supplement articles make it sound. There are large, well-designed cardiovascular trials showing meaningful risk reductions. There are also negative trials that found almost nothing. The difference between those outcomes usually comes down to dose, form, and the population being studied. And those details are exactly what gets lost when someone slaps "heart healthy!" on a bottle of bargain fish oil capsules.

So we are going to walk through the actual evidence. What EPA and DHA do in your body at a mechanistic level. What the landmark trials found. How to pick a product that is not rancid, poorly absorbed, or contaminated. And who actually stands to benefit the most from supplementation. If you are going to spend money on fish oil, you should know what you are buying and why.

What Omega-3s Actually Are (EPA, DHA, and ALA)

Omega-3 fatty acids are a family of polyunsaturated fats defined by a double bond at the third carbon position from the end of their carbon chain. Three of them matter for this conversation:

EPA (eicosapentaenoic acid) is a 20-carbon omega-3 primarily found in fatty fish and marine sources. It is the omega-3 most directly involved in anti-inflammatory signaling and the one with the strongest cardiovascular trial data. EPA is the precursor to a class of signaling molecules called resolvins and protectins that actively resolve inflammation -- they do not just block it, they help clean it up.

DHA (docosahexaenoic acid) is a 22-carbon omega-3, also found in marine sources. It is the predominant structural omega-3 in brain tissue and the retina. DHA makes up roughly 40% of the polyunsaturated fatty acids in the brain and about 60% of those in the retina. While EPA gets most of the anti-inflammatory credit, DHA plays a critical role in neuronal membrane fluidity, neurotransmitter signaling, and neurological development. It is the omega-3 that matters most during pregnancy and early childhood brain development.

ALA (alpha-linolenic acid) is an 18-carbon omega-3 found in plant sources like flaxseed, chia seeds, walnuts, and hemp seeds. ALA is technically an essential fatty acid because your body cannot produce it. However, and this is a big caveat, ALA is not EPA or DHA. Your body can convert ALA to EPA and then to DHA, but the conversion rate is terrible. We will cover the specifics in the plant-based section, but the short version is that relying on ALA alone for your omega-3 needs is like trying to heat your house by rubbing sticks together when there is a furnace available.

When we talk about fish oil supplementation throughout this article, we are primarily talking about EPA and DHA. Those are the omega-3s with direct clinical trial evidence. ALA has its own, smaller body of evidence, and it is not interchangeable.

The Anti-Inflammatory Mechanism

The anti-inflammatory effects of EPA are the mechanistic foundation for most of the clinical benefits attributed to fish oil. Understanding how this works helps explain why dose matters so much.

Your body uses a family of enzymes called cyclooxygenases (COX-1 and COX-2) to convert fatty acids into signaling molecules called prostaglandins and thromboxanes. These molecules regulate inflammation, pain, blood clotting, and vascular function. The specific prostaglandins your body produces depend on which fatty acids are available as raw material.

When the omega-6 fatty acid arachidonic acid (AA) is the dominant substrate, COX enzymes produce prostaglandin E2 (PGE2) and thromboxane A2 (TXA2). PGE2 is a potent pro-inflammatory mediator. TXA2 promotes platelet aggregation and vasoconstriction. These molecules have important physiological roles, but chronic overproduction of them contributes to systemic inflammation, increased cardiovascular risk, and joint pain.

When EPA is available in higher concentrations (because you are consuming more of it through diet or supplementation), it competes with arachidonic acid for access to those same COX enzymes. EPA gets converted into prostaglandin E3 (PGE3) and thromboxane A3 (TXA3), which are significantly less inflammatory and less pro-thrombotic than their AA-derived counterparts. EPA also serves as the precursor for specialized pro-resolving mediators (SPMs) -- molecules like resolvins and protectins that actively promote the resolution of inflammation and tissue repair.

The practical implication: increasing your EPA intake shifts the balance of these signaling molecules away from pro-inflammatory PGE2 and toward less inflammatory PGE3 and actively resolving SPMs. This is not a theoretical model. It has been measured directly in human supplementation studies. Calder (2015) published an extensive review in the British Journal of Clinical Pharmacology documenting these shifts in inflammatory mediator profiles with omega-3 supplementation.

Cardiovascular Data: VITAL, REDUCE-IT, and What They Mean

The cardiovascular evidence for omega-3s is where the research gets genuinely interesting, because two of the largest trials in this space arrived at very different conclusions. Understanding why tells you a lot about how fish oil supplementation actually works.

The VITAL Trial (Manson et al., 2019)

The VITAL trial (Vitamin D and Omega-3 Trial) enrolled 25,871 adults in the United States, including men aged 50 and older and women aged 55 and older. Participants were randomized to receive either 1 gram per day of fish oil (containing 840mg of combined EPA and DHA in an ethyl ester form) or placebo, and followed for a median of 5.3 years.

The primary endpoint was major cardiovascular events (a composite of heart attack, stroke, and cardiovascular death). The results: the fish oil group did not show a statistically significant reduction in the primary composite endpoint compared to placebo (HR 0.92, 95% CI 0.80-1.06). However, there was a significant reduction in total myocardial infarction (heart attack) risk, with a 28% relative risk reduction (HR 0.72, 95% CI 0.59-0.90). The heart attack reduction was particularly pronounced in African American participants and in those with low baseline fish consumption.

VITAL is often cited as a "negative" trial for fish oil, but that oversimplifies the findings. The primary composite endpoint did not reach significance, true. But a 28% reduction in heart attacks is a real finding, and the subgroup analyses suggest that the people who benefit most are those who are not already getting omega-3s from their diet.

The REDUCE-IT Trial (Bhatt et al., 2019)

REDUCE-IT is the trial that changed the conversation about omega-3s and cardiovascular risk. This was a randomized, double-blind, placebo-controlled trial that enrolled 8,179 adults with established cardiovascular disease or diabetes plus additional risk factors, all of whom had elevated triglycerides (135-499 mg/dL) despite statin therapy.

The intervention was 4 grams per day of icosapent ethyl (a highly purified EPA-only preparation, brand name Vascepa) vs. mineral oil placebo. The dose was much higher than VITAL. And the results were dramatic.

The primary composite endpoint (cardiovascular death, nonfatal heart attack, nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) was reduced by 25% in the EPA group (HR 0.75, 95% CI 0.68-0.83, p < 0.001). That is a number-needed-to-treat of 21 over 4.9 years of follow-up. For context, that is a very strong effect size for a cardiovascular intervention. It is in the same ballpark as statin therapy for secondary prevention.

Key secondary endpoints showed similarly impressive reductions: cardiovascular death, heart attack, or stroke was reduced by 26%. Total mortality events (cardiovascular death, nonfatal heart attack, nonfatal stroke) were reduced by 26%.

What Explains the Difference?

Why did REDUCE-IT show such dramatic results while VITAL was more modest? Three main factors:

1. Dose. REDUCE-IT used 4g of pure EPA per day. VITAL used 840mg of combined EPA + DHA per day. That is roughly a 5x difference in EPA exposure. As we discussed in the anti-inflammatory section, the substrate competition with arachidonic acid is concentration-dependent. More EPA, bigger shift in inflammatory mediator balance.
2. Population. REDUCE-IT enrolled people with established cardiovascular disease or high cardiovascular risk. VITAL enrolled a general population, most of whom were at relatively low baseline risk. Interventions generally show larger absolute benefits in higher-risk populations because there is more room for improvement.
3. EPA vs. EPA + DHA. REDUCE-IT used pure EPA only. Some researchers have hypothesized that DHA may partially counteract EPA's triglyceride-lowering and anti-inflammatory effects at high doses, though this is still debated. The STRENGTH trial, which used a combination of EPA + DHA at 4g/day in a similar high-risk population, did not show the same benefit as REDUCE-IT. This has led to significant discussion about whether EPA alone is the key to cardiovascular benefit, or whether other trial design differences explain the gap.

Other Evidence-Backed Benefits

Triglyceride Reduction

This is one of the most well-established effects of omega-3 supplementation. EPA and DHA reduce serum triglycerides in a dose-dependent manner. At doses of 2-4g of combined EPA/DHA per day, triglyceride reductions of 15-30% are consistently observed in clinical trials. The American Heart Association specifically endorses omega-3 supplementation for triglyceride management in people with hypertriglyceridemia (above 500 mg/dL). This is a prescription-level application, and the doses used are higher than what most over-the-counter supplements provide.

Joint Health and Inflammation

Multiple meta-analyses have found that omega-3 supplementation reduces joint pain, morning stiffness, and NSAID use in people with rheumatoid arthritis. Goldberg and Katz (2007) published a meta-analysis in the journal Pain covering 17 randomized controlled trials and concluded that omega-3 supplementation significantly reduced patient-reported joint pain intensity, morning stiffness, and number of painful joints. The doses used in these studies typically ranged from 2.7g to 4g of combined EPA/DHA per day.

For gym-related joint discomfort (the creaky knees and sore shoulders that come with years of lifting), the evidence is less robust than for diagnosed inflammatory arthritis. But the anti-inflammatory mechanism applies regardless of the source of inflammation, and many lifters report subjective improvements in joint comfort with consistent supplementation at adequate doses.

Mood and Depression

The data on omega-3s and depression is moderate but encouraging. Liao et al. (2019) published a meta-analysis of 26 randomized controlled trials in Translational Psychiatry and found that omega-3 supplementation produced a statistically significant, small-to-moderate improvement in depressive symptoms compared to placebo. Formulations with higher EPA content (at least 60% EPA relative to DHA) showed the strongest effects. Omega-3s are not a replacement for clinical treatment of major depression, but they appear to be a useful adjunct, particularly in formulations emphasizing EPA.

Muscle Protein Synthesis

This one is newer and particularly relevant for the lifting crowd. Smith et al. (2011) published a study in Clinical Science showing that omega-3 supplementation (4g/day of EPA + DHA) increased the muscle protein synthesis response to amino acid and insulin infusion in healthy adults. A follow-up study by the same group found similar results in older adults. The proposed mechanism involves omega-3s being incorporated into muscle cell membranes, improving membrane fluidity and enhancing the signaling pathways that drive anabolic responses.

We want to be measured here: the muscle protein synthesis data is interesting and mechanistically sound, but we have a small number of studies, and the practical magnitude of the effect for someone already training and eating adequate protein is probably modest. Consider it a plausible benefit, not a proven one.

Dose Recommendations: What the AHA and Research Say

Dose is where most people go wrong with fish oil. A standard drugstore fish oil capsule contains 1,000mg of fish oil but only about 300mg of combined EPA and DHA. If you are taking one capsule a day, you are getting a fraction of the doses used in the studies that actually showed benefits.

Here is what the major guidelines and research support:

For most readers of this site -- people who lift, are generally healthy, and want the anti-inflammatory, joint, and potential cardiovascular benefits -- we think 1-2g of combined EPA + DHA per day is the practical sweet spot. That is enough to meaningfully shift your tissue fatty acid profile and see real anti-inflammatory effects without requiring a fistful of capsules.

To put that in context, getting 1g of combined EPA + DHA from a standard grocery store fish oil typically means taking 3-4 capsules. A higher-concentration product (like a concentrated triglyceride-form supplement providing 500-700mg of EPA + DHA per capsule) gets you there with 2 capsules.

Fish Oil Forms Compared: Triglyceride vs. Ethyl Ester vs. Phospholipid

This is where most fish oil articles drop the ball, and it is arguably the most important section for anyone about to buy a product. The form of omega-3 you take significantly affects how well your body absorbs it.

Dyerberg et al. (2010) published a landmark bioavailability study in Prostaglandins, Leukotrienes and Essential Fatty Acids that directly compared the three major forms of omega-3 delivery. Here is what they found:

The Dyerberg et al. findings are worth emphasizing: re-esterified triglyceride (rTG) form fish oil was absorbed approximately 70% better than ethyl ester form. That means if you take 1,000mg of EPA + DHA in ethyl ester form, you might absorb the equivalent of roughly 600mg. The same dose in rTG form would deliver around 1,000mg effectively. Over months of supplementation, that absorption difference compounds significantly.

Ethyl esters are the cheapest to manufacture because the esterification process is a necessary intermediate step in concentrating fish oil. Many manufacturers stop there and sell the ethyl ester product. Higher-quality manufacturers take the additional step of re-esterifying back to triglyceride form (creating rTG), which adds cost but produces a much better-absorbed product.

How to tell what you are getting: check the label for language like "triglyceride form," "rTG," or "re-esterified triglycerides." If the label does not specify the form, it is almost certainly ethyl ester. Some brands will say "natural triglyceride form" which is different from rTG -- natural TG is unconcentrated fish oil that has not been processed to increase EPA/DHA concentration. It is well-absorbed but low-potency. The ideal is rTG: concentrated and well-absorbed.

Rancidity: The Problem Nobody Talks About

Here is something that does not get enough attention in supplement discussions: a significant percentage of fish oil products on the market are already oxidized (rancid) before you even open the bottle. This matters because oxidized omega-3s lose their beneficial effects and may actually have pro-inflammatory properties -- literally the opposite of what you are paying for.

Albert et al. (2015) published a study in Scientific Reports analyzing 32 fish oil supplements from the New Zealand market and found that the majority exceeded recommended levels for at least one oxidation marker. Similar findings have been reported in analyses of products from North American, South American, and European markets. This is not a fringe issue. It is widespread.

How Rancidity Is Measured: TOTOX Values

Oxidation in fish oil is measured using three main markers:

• Peroxide Value (PV): Measures primary oxidation products. GOED (Global Organization for EPA and DHA Omega-3s) voluntary standard: ≤ 5 meq/kg.
• Anisidine Value (AV): Measures secondary oxidation products (aldehydes). GOED standard: ≤ 20.
• TOTOX Value: Total oxidation. Calculated as (2 x PV) + AV. GOED standard: ≤ 26.

The TOTOX value is the single most useful number for evaluating fish oil freshness. A TOTOX of 10 or below indicates a very fresh product. A TOTOX between 10 and 20 is acceptable. Above 26 and you are taking rancid oil.

The challenge for consumers is that most brands do not print their TOTOX values on the label. The better brands will publish certificates of analysis (COAs) on their websites or provide them upon request. If a company will not share their oxidation data, that tells you something.

How to Protect Against Rancidity

• Buy from brands that publish third-party tested TOTOX values or COAs
• Store fish oil in the refrigerator after opening (or even before)
• Buy smaller bottles and use them within 2-3 months rather than buying bulk and letting them sit for a year
• Smell and taste your fish oil. Fresh fish oil should have a mild, slightly oceanic taste. If it tastes or smells strongly fishy, sour, or acrid, it is oxidized. Throw it out.
• Liquid fish oil in dark glass bottles can actually be fresher than capsules because you can assess the taste and smell directly, and some manufacturers ship it cold

Contaminants: Mercury, PCBs, and Heavy Metals

Fish accumulate environmental contaminants, and this is a legitimate concern for any marine-derived supplement. The main contaminants of interest are mercury (methylmercury), polychlorinated biphenyls (PCBs), dioxins, and other heavy metals like lead and cadmium.

The good news: the molecular distillation process used to produce concentrated fish oil is very effective at removing these contaminants. Multiple independent analyses of commercial fish oil supplements have found that contaminant levels are well below regulatory limits, and significantly lower than what you would get from eating whole fish. Researchers at ConsumerLab and IFOS (International Fish Oil Standards) have tested hundreds of products over the years, and outright contamination failures are rare in products from established manufacturers.

That said, here are some practical guidelines:

• Look for third-party certifications: IFOS (International Fish Oil Standards) five-star rating is the gold standard. NSF International and USP verification are also meaningful certifications. These programs test for contaminant levels, oxidation, and label accuracy.
• Source matters: Fish oils derived from small, short-lived fish (anchovies, sardines, mackerel) tend to have lower contaminant loads than oils from large, long-lived predator fish (shark, swordfish, tuna). Most quality supplement-grade fish oils are anchovy- and sardine-derived.
• Cod liver oil is different: Cod liver oil contains vitamins A and D in addition to EPA and DHA. This can be a benefit or a risk depending on your overall intake. Vitamin A toxicity is possible if you are taking cod liver oil alongside a multivitamin or other vitamin A sources. Standard fish oil (body oil, not liver oil) does not contain significant amounts of fat-soluble vitamins.

Plant-Based Alternatives: ALA and Algal Oil

If you do not eat fish or prefer to avoid marine-derived supplements, you have two plant-based pathways to omega-3s. One of them works well. The other barely works at all.

ALA (from Flaxseed, Chia, Walnuts)

ALA is an essential omega-3, and it is abundant in several plant foods. Flaxseed oil is about 55% ALA by weight. Chia seeds, walnuts, and hemp seeds are also good sources. ALA has its own modest evidence base for cardiovascular benefit.

The problem is conversion efficiency. Your body can convert ALA to EPA and then EPA to DHA, but the conversion rates are low. Burdge and Calder (2005) published a thorough review of ALA conversion in Reproduction Nutrition Development and reported the following approximate conversion rates in healthy adults:

• ALA to EPA: approximately 5-10% in men, possibly slightly higher in women (due to estrogen's upregulating effect on the conversion enzymes)
• ALA to DHA: less than 1-5%, with some studies showing conversion below 0.5% in men

To put that in perspective: if you take 10 grams of flaxseed oil (about 5.5g of ALA), you might convert roughly 275-550mg to EPA and 25-275mg to DHA. That is a lot of flaxseed oil for a modest yield. The conversion is also inhibited by high dietary omega-6 intake, which is common in modern Western diets, because omega-6 and omega-3 fatty acids compete for the same conversion enzymes (delta-6 desaturase).

ALA is worth including in your diet for its own benefits, but it is not a reliable replacement for direct EPA and DHA intake if you are trying to reach therapeutic doses.

Algal Oil (Microalgae-Derived DHA and EPA)

Algal oil is the genuinely effective plant-based alternative to fish oil, and it has a satisfying logic to it: fish get their EPA and DHA from eating algae (directly or through the food chain). Algal oil supplements cut out the fish entirely and extract DHA and EPA directly from cultivated microalgae.

Algal oil supplements typically provide 200-500mg of DHA per capsule, with some newer products also offering meaningful amounts of EPA. The bioavailability of algal oil DHA has been shown to be comparable to DHA from cooked fish in head-to-head studies (Arterburn et al., 2008).

Algal oil is the right choice for vegans and vegetarians who want the proven benefits of DHA and EPA without marine animal sources. The main limitations are cost (algal oil supplements are typically more expensive per gram of omega-3 than fish oil) and the fact that most algal products are DHA-dominant with less EPA, though this is improving as production technology advances.

Who Needs Fish Oil Most

Not everyone benefits equally from omega-3 supplementation. The evidence is strongest for certain populations:

• People who rarely or never eat fatty fish: If you are not eating salmon, mackerel, sardines, or herring at least twice a week, your tissue EPA and DHA levels are probably suboptimal. The average American consumes far less omega-3 than the 250-500mg/day minimum recommended by international guidelines. Supplementation fills this dietary gap directly.
• People with elevated triglycerides: The dose-dependent triglyceride-lowering effect of omega-3s is one of the most consistently replicated findings in the literature. If your triglycerides are above 150 mg/dL and especially above 500 mg/dL, omega-3 supplementation is a well-supported intervention (in consultation with your doctor at higher doses).
• People with established cardiovascular disease or high cardiovascular risk: The REDUCE-IT data showed a 25% reduction in major cardiovascular events in this population with high-dose EPA. The AHA recommends omega-3 supplementation for secondary prevention of coronary heart disease.
• People with inflammatory joint conditions: Rheumatoid arthritis patients have the strongest evidence, but anyone dealing with chronic joint inflammation may benefit from the anti-inflammatory effects at doses of 2-3g EPA + DHA per day.
• Lifters and athletes concerned about recovery and joint health: The combination of anti-inflammatory effects and the emerging evidence for enhanced muscle protein synthesis makes fish oil a reasonable addition to a training-focused supplement stack. It is not as directly performance-enhancing as creatine, but it supports the recovery and joint health infrastructure that allows you to train consistently over years.
• Pregnant and breastfeeding women: DHA is critical for fetal brain and retinal development. Most prenatal guidelines recommend at least 200-300mg of DHA per day during pregnancy. Many prenatal vitamins include DHA, but check the actual amount.
• Vegans and vegetarians: Without fish in the diet and with poor ALA conversion rates, tissue EPA and DHA levels in this group tend to be significantly lower than in omnivores. Algal oil supplementation is particularly valuable here.

Practical Buying Guide

After going through all the evidence, here is how we would approach buying fish oil if we were starting from scratch.

Step 1: Decide Your Target Dose

For general health and training support, aim for 1-2g of combined EPA and DHA per day. This means you need to look at products that deliver at least 500mg of EPA + DHA per capsule/serving to keep the pill count reasonable.

Step 2: Choose the Right Form

Look for re-esterified triglyceride (rTG) form. The label should say "triglyceride form," "rTG," or "re-esterified." If it does not specify, assume ethyl ester. If cost is a major constraint and ethyl ester is what you can afford, that is better than nothing, but you will need higher doses to compensate for the lower absorption.

Step 3: Check for Third-Party Testing

Look for IFOS certification, USP verification, or NSF International certification. These programs independently verify EPA/DHA content, contaminant levels, and oxidation markers. At minimum, the brand should publish certificates of analysis on their website.

Step 4: Evaluate Freshness

If the brand publishes TOTOX values, look for products under 15 (under 10 is excellent). If they do not publish TOTOX data, ask customer service. When you receive the product, do the smell and taste check. If you are using capsules, bite into one. It should taste mildly fishy at most, not harsh or acrid.

Step 5: Look at the EPA-to-DHA Ratio

For anti-inflammatory and cardiovascular benefits, you want a product that is EPA-dominant or at least balanced. Standard fish oils tend to have roughly a 3:2 EPA-to-DHA ratio, which is fine. Some products are specifically concentrated for higher EPA content, which may be preferable if your primary goal is inflammation management. If your primary concern is cognitive or neurological support, a higher DHA ratio may be more appropriate.

Step 6: Consider Your Budget and Consistency

A premium rTG fish oil might cost $0.50-1.00 per day at therapeutic doses. A budget ethyl ester might cost $0.15-0.30 per day. The premium product is a better choice if you can afford it, but an affordable fish oil that you actually take every day beats an expensive one that sits in your cabinet because you are rationing capsules. Consistency is the multiplier for every supplement. The best pre-workout is the one you actually use, and the same principle applies here.

The Bottom Line

Fish oil is a supplement with genuinely strong evidence behind it, but only when you get the details right. The wrong dose, the wrong form, and the wrong product can easily land you in a position where you are spending money on rancid, poorly absorbed oil that is not doing much for your body.

Here is the executive summary:

• EPA and DHA are the omega-3s that matter. ALA from plant sources converts poorly. If you are not eating fatty fish regularly, supplementation is a practical and well-supported choice.
• Dose is critical. One generic fish oil capsule per day is probably not enough to produce measurable benefits. Aim for 1-2g of combined EPA + DHA daily for general health, higher for specific therapeutic goals.
• Form affects absorption dramatically. Triglyceride-form (rTG) fish oil is absorbed about 70% better than ethyl ester. Spend the extra money if you can.
• Rancidity is a real and underappreciated problem. Buy from brands that test and publish their oxidation values. Store your fish oil properly. Use the smell and taste test.
• The cardiovascular data is strong at high doses. REDUCE-IT showed a 25% reduction in major cardiovascular events with 4g/day of EPA in high-risk patients. Even at lower doses, VITAL showed a 28% reduction in heart attacks. If you have cardiovascular risk factors, talk to your doctor about therapeutic dosing.
• Anti-inflammatory benefits require adequate dosing. The competition between EPA and arachidonic acid for COX enzymes is concentration-dependent. Low doses produce minimal shifts in inflammatory mediator profiles.

Fish oil is not going to produce the kind of obvious, immediate results you get from something like creatine monohydrate. You are not going to feel a difference during your next workout. What you are doing is shifting the underlying inflammatory and cardiovascular landscape of your body in a direction that, over months and years, supports better recovery, healthier joints, and reduced cardiovascular risk. It is a long-game supplement. The evidence says the long game is worth playing, as long as you are playing it with a quality product at an adequate dose.

References

1. Manson, J.E., Cook, N.R., Lee, I.M., et al. (2019). Marine n-3 fatty acids and prevention of cardiovascular disease and cancer. New England Journal of Medicine, 380(1), 23-32.
2. Bhatt, D.L., Steg, P.G., Miller, M., et al. (2019). Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. New England Journal of Medicine, 380(1), 11-22.
3. Dyerberg, J., Madsen, P., Moller, J.M., et al. (2010). Bioavailability of marine n-3 fatty acid formulations. Prostaglandins, Leukotrienes and Essential Fatty Acids, 83(3), 137-141.
4. Calder, P.C. (2015). Marine omega-3 fatty acids and inflammatory processes: effects, mechanisms and clinical relevance. Biochimica et Biophysica Acta, 1851(4), 469-484.
5. Goldberg, R.J. & Katz, J. (2007). A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain, 129(1-2), 210-223.
6. Liao, Y., Xie, B., Zhang, H., et al. (2019). Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational Psychiatry, 9(1), 190.
7. Smith, G.I., Atherton, P., Reeds, D.N., et al. (2011). Omega-3 polyunsaturated fatty acids augment the muscle protein synthetic response to hyperinsulinaemia-hyperaminoacidaemia in healthy young and middle-aged men and women. Clinical Science, 121(6), 267-278.
8. Albert, B.B., Cameron-Smith, D., Hofman, P.L., & Cutfield, W.S. (2015). Oxidation of marine omega-3 supplements and human health. BioMed Research International, 2015, 143109.
9. Burdge, G.C. & Calder, P.C. (2005). Conversion of alpha-linolenic acid to longer-chain polyunsaturated fatty acids in human adults. Reproduction Nutrition Development, 45(5), 581-597.
10. Arterburn, L.M., Oken, H.A., Hoffman, J.P., et al. (2007). Bioequivalence of docosahexaenoic acid from different algal oils in capsules and in a DHA-fortified food. Lipids, 42(11), 1011-1024.