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New Omega-3 study changes everything
The verdict is final
Kos Zharoid
April 23, 2025
Fish oil vs. fatty fish: new evidence for vascular health and thrombosis prevention.
For a long time, experts believed that regularly eating fatty fish, such as salmon, mackerel, and sardines, would meet our omega-3 needs and protect against cardiovascular disease.
However, recent research challenges this approach and answers the question: Can fatty fish replace fish oil capsules for reducing inflammation and blood clotting if you don't eat fatty fish at least 3-4 times a day?
Short answer: No.
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A study that will change cardiologists' practice.
High-dose fish oil supplements work better than fatty fish in changing the quantity and function of extracellular vesicles in healthy people: a randomized, double-blind, placebo-controlled, parallel study.
Researchers from British universities, including the University of Reading, Liverpool John Moores University, and the University of Southampton, conducted a randomized, double-blind, placebo-controlled study involving 42 healthy volunteers.
Participants were divided into three groups for 12 weeks:
Fish oil capsules: 2 g/day omega-3 (about 1.5 g EPA and 0.5 g DHA) + 2 servings of white fish weekly
Fatty fish: 2 servings of fatty fish (salmon and mackerel, equal to 1 g/day omega-3, about 0.6 g EPA and 0.4 g DHA) + placebo capsules
Control group: placebo capsules + 2 servings of white fish
The goal: determine how different forms of omega-3 affect extracellular vesicles (EVs).
Why extracellular vesicles (EVs) matter.
EVs are microscopic particles released by cells into the bloodstream. They actively participate in:
Regulating inflammation and immunity
Forming blood clots
Cell-to-cell communication
Higher amounts and activity of EVs are closely linked to risks of blood clots, strokes, heart attacks, and chronic inflammation (which also triggers metabolic syndrome, type 2 diabetes, Alzheimer's, dementia, and more).
Reducing their concentration and activity plays an important role in preventing cardiovascular diseases and controlling inflammation.
Main study results.
Only the fish oil capsule group showed a significant decrease in EVs in the blood.
Only fish oil capsules reduced the ability of EVs to stimulate clot formation (a critical indicator of blood's ability to form clots).
Despite providing a similar total amount of omega-3, fatty fish did not produce these effects.
The additional intake of EPA (eicosapentaenoic acid) proved crucial.
The capsule group received an extra +1 g EPA/day compared to the fatty fish group.
EPA is specifically associated with reducing the amount and activity of EVs.
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Why is EPA more important than DHA?
The study found that the amount of EPA in EV and red blood cell membranes most closely correlated with reducing their pro-clotting activity.
EPA incorporates faster and more effectively into cell membranes, positively affecting inflammation and platelet aggregation.
Previous studies proved that high doses of pure EPA effectively reduce cardiovascular risk (REDUCE-IT and JELIS studies). Now, this is confirmed at the EV level.
What does this mean for practice?
If your goal is:
Preventing blood clots and heart attacks
Reducing inflammation and endothelial dysfunction
Fighting chronic inflammatory processes (autoimmune diseases, metabolic syndrome, COVID recovery, etc.)
Then, the current recommendations of "two servings of fatty fish a week" won't be enough.
To achieve clinical effects, you need to consume additional EPA from high-quality fish oil (1-1.5 g/day of EPA).
How to apply this knowledge correctly:
Dose: minimum 1-1.5 g EPA daily
Form: preferably fish oil as re-esterified triglycerides (re-TG) or phospholipids for better absorption
Treatment duration: minimum 12 weeks
Monitoring:
Omega-3 index in blood (target ≥8%)
Triglyceride levels, C-reactive protein and blood clotting indicators
Don't stop eating fish. However, we must recognize that most people need additional support for true cardiometabolic prevention - proven fish oil dosages and forms with high EPA content.
Consult with a specialist before taking supplements to check for any contraindications.
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Choosing an effective and safe Omega-3 supplement.
Check the EPA/DHA content.
Always examine the ingredient label! Don't just buy something labeled "fish oil" or "Omega-3." Look for the specific amounts of EPA and DHA per serving. A product might say "1000 mg fish oil" but only contain 300 mg of actual omega-3s - that's just 30% concentration. Choose products with at least 50% concentration (500+ mg of EPA+DHA per 1000 mg capsule). Higher concentration means you'll take fewer pills.
The EPA ratio isn't critical for general health, but specific health goals require different ratios as stated above. As long as the total amount is sufficient, any balance works well.
Look for purity testing.
Quality supplements must be purified of toxins. Marine fish can contain mercury, heavy metals, and other contaminants. Good manufacturers purify their products and often display certification logos from IFOS, GOED, USP, or NSF. These independent organizations verify the accuracy and safety of ingredients.
Top tip: Choose brands that openly share their purity analysis results. Reputable manufacturers like Solgar, Nordic Naturals, and Carlson typically monitor this carefully.
Ensure freshness.
Omega-3 fats oxidize easily and become rancid when exposed to air and light. Always check the expiration date and avoid using supplements that have a bad smell. Store bottles in a cool, dark place, preferably in the refrigerator. Some products include antioxidants like vitamin E to protect the oil - that's a plus!
After opening, try to use the bottle within 2-3 months. Quality fish oil may have a light fishy smell but should never smell rancid.
Buy from trusted sources.
Since supplements are less regulated than medications, choose established brands that have been around for many years and hold international GMP (Good Manufacturing Practice) certificates. Avoid suspiciously cheap products from unknown sources - they are likely to have poor purity or incorrect doses. When possible, choose products that independent laboratories have tested.
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