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I hope this fish oil guide becomes one of the most consequential articles on this site.
I say this because, over the years, I have experienced some fantastic health benefits from taking quality fish oil supplements, benefits which I will discuss later.
Omega 3s, the most beneficial nutrients in fish oil, have been linked to eye, heart, and metabolic health, among other benefits. I want you to experience these benefits.
These benefits led me to conclude that if a law were passed stating that each person could only take one dietary supplement, I would choose fish oil. [15% off with this discount code – CURBSUGAR]
Omega 3s are essential fatty acids, meaning our bodies cannot make them. We must get them in our diets, and we should if we are serious about optimizing our health.
Yet, many people in America and other Western societies have suboptimal intakes of omega-3s. Why is this? 1 2
I will answer this question and impress upon you throughout this fish oil guide why omega 3s are vital for health. I will also detail what to look for in a high-quality fish oil supplement. [15% off with this discount code – CURBSUGAR]
Health Benefits
Fish oil is truly mother nature’s miracle supplement. Its health benefits extend from head to toe, making it a vital addition to our diets.
As you explore the health benefits, you will hopefully realize its huge part in our overall health.
Heart Health
One of the most well-known benefits of fish oil is its positive impact on heart health. Omega-3 fatty acids have been shown to:
Decrease Risk of Heart Disease: Studies indicate that populations with high fish consumption have lower rates of heart disease. Omega-3s help reduce inflammation and improve endothelial function (the lining of blood vessels), which is critical for cardiovascular health.
Lower Triglycerides: Fish oil can significantly reduce triglyceride levels in the blood, a significant risk factor for heart disease.
Reduce Blood Pressure: Regular consumption of fish oil may help lower blood pressure in people with hypertension.
Improve Cholesterol Levels: Fish oil can increase HDL (good) cholesterol while lowering LDL (bad) cholesterol levels.
Metabolic Health
Fish oil may also play a role in metabolic health by:
Improving Insulin Sensitivity: Omega-3 fatty acids can enhance insulin sensitivity, which helps regulate blood sugar levels and may reduce the risk of type 2 diabetes.
Supporting Weight Management: Some research suggests that fish oil can aid in weight loss by promoting fat oxidation and reducing appetite.
Brain Health
The brain is composed mainly of fat, making omega-3 fatty acids essential for brain health. Fish oil benefits include:
Cognitive Function: DHA is a vital brain tissue component linked to improved memory and learning abilities. Studies show that higher DHA levels are associated with better cognitive performance.
Neurodegenerative Disease Prevention: Regular fish oil intake may lower the risk of neurodegenerative diseases like Alzheimer’s by protecting brain cells from damage and supporting overall brain function.
Eye Health:
Omega-3 fatty acids are crucial for maintaining eye health. They help:
Prevent Age-Related Macular Degeneration (AMD): Fish oil can reduce the risk of AMD, a leading cause of vision loss in older adults.
Support Retinal Health: DHA is a major structural component of the retina, and adequate intake is essential for optimal eye function.
Skin Health
Fish oil can also benefit skin health by reducing Inflammation. Omega-3s help decrease inflammation associated with skin conditions like eczema and psoriasis.
Fish oil supports skin barrier function, helping to keep skin moisturized and reducing the appearance of wrinkles.
Pregnancy and Child Development
During pregnancy, omega-3 fatty acids are vital for fetal development. The benefits include:
Brain Development
DHA is essential for developing the fetal brain and retina. Pregnant women who consume adequate omega-3s may have children with better cognitive outcomes.
Reduced Risk of Allergies
Maternal intake of fish oil during pregnancy has been linked to a lower risk of allergies in children.
Inflammation-Related Diseases
Omega-3 fatty acids have powerful anti-inflammatory properties that can help manage:
Chronic Inflammation: Regular consumption of fish oil may reduce chronic inflammation associated with diseases such as arthritis and inflammatory bowel disease.
Depression
Fish oil has been studied for its effects on mental health, particularly:
Alleviating Symptoms of Depression: Research indicates that omega-3s can help improve mood and reduce symptoms in individuals with depression. EPA is particularly effective in this regard.
Weight Loss
Promoting Fat Loss: Some studies suggest that omega-3 fatty acids enhance fat burning during exercise and help reduce body fat overall.
What’s Stopping You From Taking Fish Oil
One of the main reasons so many people are deficient in omega 3 is their refusal to take supplementation due to the “fish oil burps” (aka “repeating”) that often occur when doing so.
These burps occur when the fish oil releases gases into the digestive system, producing an unpleasant taste and odor that can linger in the mouth.
As a child, I often had fishy burps and fishy breath when I ingested cod liver oil, which was very unpleasant. People who have had that experience do not find it pleasant either.
No wonder some people refrain from taking a cod liver or fish oil supplement.
Fortunately, the fish burp issue, which is more common in low-quality fish oil supplements, can be severely minimized but not 100% avoided over a lifetime.
One way to seriously minimize the fishy burps is to consume enteric-coated fish oil, provided it is processed under strict conditions.
Non-enteric coated fish oil soft gel capsules may dissolve too early in the digestive tract, especially in the stomach’s acidic environment. The early digestion causes the oil to be released prematurely and results in fishy burps.
Fish oil supplements with enteric coatings are designed to dissolve later in the non-acidic environment of small intestines, reducing the potential for fishy burps.
In this non-acidic environment, the plausible damage to omega-3 by stomach acids (which science has not yet proven whether it is significant or not) is reduced.
Nevertheless, some people have very few burps with top-quality fish oil supplements like this one, which does not have an enteric coating. [15% off with this discount code – CURBSUGAR]
Plus, the enteric coating has potential drawbacks.
The enteric coating could chip and thus fail to prevent burping.
Unscrupulous manufacturers could use the enteric coating to hide the poor quality of their fish oil.
The coating could also negatively affect the bioavailability of the fish oil.
Although rare, some people pass enteric-coated fish oils right through their digestive system into the toilet bowl, rendering the capsules ineffective.
The coating may prevent a small amount of gastric lipase, which plays a role in the emulsifying and digestion of dietary fats, including fish oils. Gastric lipase in the stomach could enhance the bioavailability of omega-3 fatty acids. 3
However, research indicates that the uptake of EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid – the primary beneficial nutrients of fish oil) from enteric-coated fish oil capsules is not significantly affected compared to uncoated capsules.4
Put another way, there is no meaningful difference in absorption between enteric-coated and non-enteric-coated capsules.
The most crucial factor to consider when consuming fish oil is the quality of the oil within the capsule. Quality is affected by rancidity (as well as contaminants, which I will discuss later).
Fishy burps are primarily caused by consuming rancid or old fish oils. When the oils are close to expiration or expired, they are more likely to be rancid and thus harmful to your health.
Fish oils that are not produced under strict conditions, typically to cut costs, will likely go rancid more quickly.
Production must happen in an environment without oxygen to keep the oil as fresh as possible. This environment is essential because oxygen can react negatively with the oil (oxidation).
When fish oil is stored in large barrels, any oxygen left in the top is removed with nitrogen, an inert gas. This method, known as “nitrogen flushing,” offers a natural alternative to using chemical additives to prevent rancidity.
However, “nitrogen flushing” can be challenging to implement, and since the FDA does not require it, many manufacturers skip this step.
The Global Organization for EPA and DHA Omega-3s (GOED) prefers the “nitrogen flushing” technique for producing quality fish oil supplements.
This high-quality omega-3 fish oil supplement producer is a member of GOED. It uses what it refers to as “nitrogen blanketing,” from fish oil extraction to encapsulation. [15% off with this discount code – CURBSUGAR]
Another way to significantly reduce fishy burps is to consume fish oil capsules with a meal. When I do this, I rarely get these burps.
To minimize fishy burps, you may also want to avoid consuming fish oil capsules with a hot beverage or with a large, fat-laden meal.
To summarize this section, consuming a high-quality fish oil supplement will provide health benefits with minimal fishy burps.
Not All Fats Are Bad
Another possible reason for omega-3 deficiencies is that the low-fat diet message often painted all fats with the same brush for decades.
This anti-fat messaging possibly led to distrusting even beneficial fats like omega-3 fish oil. But this “all fats are bad” approach isn’t true or healthy.
Yes, there are “bad fats” like saturated and trans fats, which can contribute to serious health issues like heart disease, stroke, and cancer.
However, there are also “good fats” like unsaturated fats, found in almonds, olive oil, and fatty fish (mackerel, sardines, salmon, and tuna), which can help your heart, fight disease, and even support healthy brain function.
Omega-3s, more accurately described as polyunsaturated fat, are considered good fats. You can see the difference between people who consume more of these kinds of fat and those who eat a lot of unhealthy fats.
For example, those on a traditional Mediterranean diet (rich in fatty fish, beans, nuts, and olive oil) live longer, healthier lives than those on a modern Western diet, which is typically high in omega-6s (processed foods, refined sugars, and fried meats).
Research indicates that people who adhere to this diet experience lower levels of inflammation and improved biomarkers for health, contributing to a lower risk of diseases such as cardiovascular disease and cognitive decline. Not surprisingly, they live longer than their Western counterparts. 5 6 7
More About Essential Fatty Acids EFAs
Essential fatty acids are particular fats the body needs but can’t make. They consist of tiny building blocks called molecules.
These molecules have particular parts called double bonds. Because of these double bonds, these fats are usually liquid at room temperature.
There are two main types of essential fatty acids:
Omega-3 Fatty Acids are crucial for various bodily functions and include alpha-linolenic acid (ALA) and EPA/DHA.
ALA is plant-based and is found in foods like algae (some species), fish, flaxseeds, chia seeds, and walnuts.
EPA and DHA, found primarily in fish, have excellent anti-inflammatory properties and are primarily found in fish. They are also in blue algae and particular egg and plant-based milk brands fortified with EPA and DHA.
Omega-6 Fatty acids: These fats are also essential for health and include linoleic acid (LA) and arachidonic acid (AA). They are commonly found in nuts, processed foods, meats, seeds, and vegetable oils.
Small amounts of naturally occurring LA are also in fish and fish oil.
While these EFAs play essential roles in the body, an excess of omega-6 relative to omega-3 can lead to inflammation.
The ideal is to consume about the same amount of omega-6 and omega-3 fats in our bodies. However, in Western societies, in particular, most people eat plenty of foods with omega-6 fats but not enough omega-3 fats.
The ratio of omega-6:3 consumption in the U.S. is more like 16:1.8
Excessive omega-6 consumption can cause inflammation in the body, leading to all sorts of diseases, such as diabetes, high blood pressure, and heart issues.
To maintain health, you should minimize your intake of omega-6 fats and increase your consumption of omega-3 fats, primarily EPA and DHA.
Consuming too many omega 6s in processed foods overwhelms your circulating DHA and EPA, even if you add a little fish oil or fatty fish to your diet. This consumption pattern is another significant reason so many people are deficient in omega-3s and why fish oil supplementation is such a good idea.
Many may not realize the vital roles the long-chain fatty acids EPA and DHA play in the body.
For instance, EPA is found in significant amounts in the membranes of immune cells, such as macrophages and lymphocytes. It plays a role in modulating inflammatory responses.
DHA is mainly concentrated in the retina, making up about 50% of the total fatty acids in the phospholipid membranes of retinal cells. This high concentration is crucial for maintaining the structure and function of retinal photoreceptors.
DHA also plays a significant role in the brain, constituting approximately 30-40% of the total fatty acids in neuronal membranes. EPA is present as well but in lower amounts than DHA.
What Are Vegetarians Supposed To Do?
If you are a vegan, you would not consume fish or fish oil to get EPA and DHA into your body.
Your option is usually limited to consuming ALA, the plant-based form of omega-3s, to solve this problem. ALA has a significant drawback, which I will discuss shortly.
There are now vegan EPA/DHA supplements derived from algae oil. This development avoids the big drawback of consuming ALA sources of omega 3s—the “conversion problem.”
The body’s ability to convert ALA to EPA and DHA is limited. Estimates suggest that only 1-10% of ALA is converted to EPA and 0.5-5% to DHA in healthy adults. 9 10
Changing ALA into EPA and DHA is even more challenging because ALA competes with LA (omega 6) for the same enzyme – delta six desaturase – in their metabolic pathway.
This enzyme is crucial for the body to create various types of fatty acids, including the long-chain omega-3 fatty acids EPA and DHA from shorter-chain precursors like ALA.
This means that if there is a lot of LA in your body, it can take up the enzyme first, making it harder for ALA to convert into EPA and DHA. Therefore, the conversion process of ALA into EPA and DHA can be limited when there are higher amounts of omega-6 fatty acids.
Since challenges exist in converting ALA to EPA/DHA, what is the best option for vegans?
Now, vegans can go here and search for vegan omega-3 supplements that contain both EPA and DHA.
How Much Fish Oil To Take? – The Nuances
Couldn’t we solve our omega-3 deficiency by consuming more fish? Frankly, this would neither be realistic nor the healthiest option.
I supplement with 6 grams of omega 3s daily. This dosage is moderately high.
I take this amount partly because two health professionals I hold in high regard, one of whom is the famous biochemist, Dr. Barry Sears, recommended this dosage here.
Another reason I take this dosage is that I eat a lot of peanuts, a rich source of omega-6 fats. My fish oil intake will help counter these fats.
I have long seen the American Heart Association’s recommendation (AHA) that people eat two servings of fish (particularly fatty fish) weekly. As you will see, my omega-3 intake exceeds this.
In 2019, the AHA issued a separate advisory that said taking 4 grams daily of prescription fish oil was a safe and effective way to lower triglycerides, the most common fat in the body, in people with elevated levels.
A 2022 analysis published in the Journal of the American Heart Association (JAHA) found that consuming 3 grams of EPA and DHA daily, in food or supplement form, maybe the ideal dose to help lower blood pressure.
I credit my higher dose of omega-3 supplementation with helping me get my blood pressure back within the normal range. When I was taking 3 grams of omega-3s daily, which is more in sync with the dosage recommended on fish oil supplements, my blood pressure did not improve.
Another analysis published in the June 2023 JAHA found that taking more than 2 grams per day of EPA and DHA combined in supplement form may lower triglycerides and non-HDL cholesterol but not LDL cholesterol. Non-HDL level is someone’s total cholesterol minus their HDL, the “good” cholesterol that assists the body in eliminating some of the harmful LDL.
According to the AHA, 4 to 5 ounces of Atlantic salmon provide 3 grams of omega-3 fatty acids. So, if I followed the 2022 JAHA analysis for blood pressure, I would need to consume 4-5 ounces of fish daily.
That intake is approximately 1.5 servings of fish daily, conservatively, much more than the AHA’s longstanding recommendation of 2 servings of fish weekly. Most fish lovers, let alone casual eaters, do not consume that much fish daily all year round.
Similarly, if you have high triglycerides, the recommended fish oil dosage of 2 grams daily for this issue exceeds the general recommendation of two servings of fish weekly. Two weekly servings are about 4 grams weekly or a little yes.
The existence of these various dosages impresses upon me two main points
First, if you have a health condition, your omega-3 fish oil intake would likely need to be higher than the omega-3s gained from the longstanding AHA recommendation for fish intake.
Second, it is a good idea to test your omega-3 levels to determine whether your levels are low.
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When you get the kit, you will use it to give yourself a simple finger prick at home and then post the sample to them.
Your results will fall within a scientifically based index the company formulated. Where you fall determines whether your omega-3 levels need improvement.
A calculator on their website will tell you your recommended omega-3 dosage based on your test results.
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Why Not Just Eat Fish Instead Of Taking Fish Oil?
Many people lack the “taste buds” to consume the quantity of fish necessary to overcome certain conditions, such as high cholesterol and high blood pressure.
Some people like me hardly eat fish because we do not like it very much.
The cost of fish and the desire to cook it could also prevent people from consuming enough fish to significantly impact their omega-3 levels.
Often overlooked is that fish, depending on their type and diet, have varying degrees of omega-3 fatty acid levels. So, even if your level of fish consumption is higher than average, your omega-3 levels could still be low. This is another reason why testing your omega-3 fatty acid levels is a good move.
The level of contaminants in fish is a significant reason why some people minimize their fish oil consumption. A study found that over 27% of fish from various streams in the United States contained mercury levels exceeding recommended limits. 11
Human consumption of contaminated fish can lead to serious health issues, such as cancer and immune system disruption.
Recent investigations have highlighted the significant contamination of freshwater fish with PFAS, known as “forever chemicals.”
A study revealed that the median levels of total PFAS in freshwater fish were 278 times higher than those in commercially sold fish. These chemicals have been linked to numerous health issues, raising concerns over the safety of consuming freshwater fish caught in U.S. waters.
Numerous fish consumption advisories have been issued in the U.S. Most advisories focus on mercury and PCB contamination, indicating that these fish are often unsafe for human consumption. Approximately 37 states have issued advisories specifically warning against high levels of these contaminants in local fish populations, which reflect public health concerns related to consumption. 12
Since fish contain toxins, it is essential to consume purified fish oil. [15% off with this discount code – CURBSUGAR]
Making Fish Oil Pure
Due to the high levels of toxins in waters and, by extension, in fish, consuming fish oil without purification would mean ingesting a significant amount of these harmful substances.
Therefore, it is essential to purify fish oil before consumption.
Here is a discussion of various purification methods that fish oil manufacturers may use to ensure the safety of their products.
Enzymatic Hydrolysis
Enzymatic hydrolysis is a technique where specific enzymes break down complex molecules into simpler ones.
In fish oil purification, enzymes help break down proteins and fats in fish by-products to extract the oil easily. This method is gentle compared to heat-based processes, which can damage the oil’s quality.
One significant advantage of this process is that it can produce a higher fish oil yield than traditional methods. Studies have shown that this method can achieve oil recovery rates of up to 72%, especially when processing salmon by-products.
Additionally, enzymatic methods create less waste and are more environmentally friendly than chemical extraction methods.
Oil extracted through enzymatic hydrolysis is often of higher quality due to the preservation of omega-3 fatty acids.
This process also minimizes the formation of harmful compounds, ensuring the oil remains safe for consumption.
This high-quality fish oil manufacturer uses this advanced process to produce fish oil.
Molecular Distillation: A Better Way to Clean Fish Oil
Molecular distillation is one of the most thorough methods for purifying fish oil. It uses low temperatures and vacuum pressure, which prevents the creation of unhealthy trans fats.
The process creates an ultra-pure, refined oil with virtually no contaminants and less odor. It’s so clean that modern testing methods struggle to detect impurities.
Molecular distillation effectively removes harmful substances such as heavy metals, dioxins, PCBs, and other toxins to undetectable levels for safe human consumption.
The process is also fast, which is excellent because it prevents the delicate oil from breaking down and going rancid.
However, there are some drawbacks.
Molecular distillation changes the oil’s chemical structure from the more short-term bioavailable triglyceride form to the ethyl ester form.
Some manufacturers change the oil back into its original triglyceride form, a process called re-esterification, to highlight their oil’s improved bioavailability. You might see these fish oil capsules branded as rTG.
This top-quality fish oil is in triglyceride form. [15% off with this discount code – CURBSUGAR]
However, as discussed here, the advantage in bioavailability of triglyceride fish oil is slight and may not be worth the higher price that some manufacturers charge.
The most significant disadvantage of molecular distillation is heat. To create a higher concentration of fish oil as this process does, the more times the oil is subjected to high-temperature distillation.
Overall, molecular distillation works very well in producing clean and safe fish oil.
This top-quality fish oil uses molecular distillation and enzymatic action. This combination avoids extreme heat and retains the oil’s essential components for health.
Oil Refining
Oil refining is a basic method of purifying fish oil by applying heat to eliminate contaminants.
While this process ensures the oil meets federal safety standards, it is less effective at removing toxins than other purification methods.
The high temperatures can cause oxidation, degrading the oil’s nutritional value. Although refining does not reduce the amount of omega-3 fatty acids, it significantly impacts their overall quality.
One advantage is that it preserves the oil in its natural triglyceride form instead of ethyl esters, making it more bioavailable in the short term. However, the heating process can also create unhealthy trans fats.
Supercritical CO2
Supercritical CO2 extraction is a new method for purifying and concentrating fish oil. This technology allows manufacturers to create highly concentrated and pure fish oils without heat. While traditional methods require heating fish oil to over 350 degrees Fahrenheit for high potency, CO2 extraction works at just above room temperature.
In this process, low-concentration or crude fish oil is mixed with liquid CO2. The Omega-3 fatty acids dissolve into the liquid CO2, making it easy to separate and concentrate them from other fats and cholesterol. Plus, the CO2 can be recycled, which makes this method environmentally friendly.
Supercritical chromatography is a process frequently used in conjunction with Supercritical CO2 extraction. It is environmentally friendly because it uses carbon dioxide as a solvent, which can be recycled and does not produce harmful waste.
It also removes additional contaminants and further reduces cholesterol, even when the cholesterol in some brands is virtually non-existent.
Steam purification
This method involves heating the fish oil with steam. The heat causes impurities, such as unwanted fats, toxins, and other contaminants, to evaporate or separate from the oil. This process helps refine the oil, making it cleaner and safer for consumption.
There are some drawbacks, though. The process involves high temperatures, which can degrade heat-sensitive compounds.
Also, the process may not effectively extract all desirable components from the raw material. Some compounds might remain dissolved in the water phase, leading to lower overall concentration.
Ethyl Ester Fish Oil vs Triglyceride Fish Oil
One of the mini debates regarding fish oil is whether to choose ethyl ester fish oil or triglycerides fish oil.
The purpose of ethyl ester is to deliver a highly concentrated form of fish oil to the body.
More On Ethyl Ester
To create ethyl esters, the natural fats from fish are treated with ethanol (a type of alcohol) during processing for a variety of reasons:
Conversion Process: Ethanol acts as a solvent during fish oil processing. It helps convert the natural fats from fish into ethyl esters, a more concentrated form of omega-3 fatty acids. This conversion is essential for creating supplements that deliver higher doses of omega-3.
Stability: Ethanol helps create an environment that is less conducive to oxidation. Oxidation can lead to rancidity, which negatively affects flavor, odor, and nutritional value. By using ethanol in a controlled reaction, the exposure of fish oil to air (oxygen) is minimized, thereby reducing the likelihood of oxidative damage.
Cost-Effectiveness: Ethanol-based production of ethyl esters is often more cost-effective than other methods, allowing manufacturers to produce concentrated fish oil supplements at a lower price point for consumers.
Because alcohol is used in the processing and the metabolism of ethyl esters and can be produced as a byproduct, there has been some unwarranted concern.
However, it is essential to note that only a minuscule amount of alcohol is produced. You will find more in fruit juices.
More On Triglycerides Fish Oil
Stability: TG fish oil is a bit more stable than EE oil. Top manufacturers do what they can to keep their fish oils capsules, regardless of form, from air, light, and metals to maintain purity. One way this is done is to put their capsules in bottles where light cannot get through.
Do The Differences Matter
The way the body handles fish oil (pharmacokinetics) can be slightly different depending on whether it is in the ethyl ester (EE) form or the triglyceride (TG) form.
When you take ethyl ester fish oil, your body breaks it down and rebuilds it into triglyceride form. This process takes a short time, but the body knows how to initiate an effective conversion.
Many consumers might miss this next e point: what fish oil does for your body (pharmacodynamics) is precisely the same for both forms. The health benefits you get from either form are the same.
Furthermore, there are voluminous studies of fish oil done with the ethyl ester without any concern for the form.
So, which form should you take?
Considering the abovementioned factors, the absorption level is the “major” difference between both forms.
You will need to decide if the slightly better absorbability of TG is worth its extra price and the fact that it takes more of it to get the same amount of EE fish oil.
If you want the slightly better absorbed TG fish oil, check out this high-quality TG fish oil here. Use code CURBSUGAR for a 15% discount.
Fish Oil Guide References:
1.Thompson, M., Hein, N., Hanson, C., Smith, L. M., Anderson-Berry, A., Richter, C. K., Bisselou, K. S., Appiah, A. K., Kris-Etherton, P., Skulas-Ray, A. C., & Nordgren, T. M. (2018). Omega-3 Fatty Acid Intake by Age, Gender, and Pregnancy Status in the United States: National Health and Nutrition Examination Survey 2003–2014. Nutrients, 11(1). https://doi.org/10.3390/nu11010177
2.Froyen, E., & Maarafi, Z. (2022). The Consumption of Omega-3 Fatty Acids in American Adults. Current Developments in Nutrition, 6, 902. https://doi.org/10.1093/cdn/nzac067.022
3. Jannat Bhangal. (2017). Ask an Expert with Warren Maginn: Enteric Coating – Thera Health. Thera Health. https://therahealth.com.au/ask-expert-warren-maginn-enteric-coating/
4.Schneider, I. (2011). Effect of gastric acid resistant coating of fish oil capsules on bioavailability of EPA and DHA. ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S1756464611000132
5. Zupo R, Castellana F, Piscitelli P, Crupi P, Desantis A, Greco E, Severino FP, Pulimeno M, Guazzini A, Kyriakides TC, Vasiliou V, Trichopoulou A, Soldati L, La Vecchia C, De Gaetano G, Donati MB, Colao A, Miani A, Corbo F, Clodoveo ML. Scientific evidence supporting the newly developed one-health labeling tool “Med-Index”: an umbrella systematic review on health benefits of mediterranean diet principles and adherence in a planeterranean perspective. J Transl Med. 2023 Oct 26;21(1):755. doi: 10.1186/s12967-023-04618-1. PMID: 37885010; PMCID: PMC10601192.
6. Mediterranean Diet Cuts Heart Disease Risk by Nearly Half – American College of Cardiology. (2024). American College of Cardiology. https://www.acc.org/About-ACC/Press-Releases/2015/03/04/16/36/http%3a%2f%2fwww.acc.org%2fAbout-ACC%2fPress-Releases%2f2015%2f03%2f04%2f16%2f36%2fMediterranean-Diet-Cuts-Heart-Disease-Risk-by-Nearly-Half
7. Angelo Campanella, Giovanni Misciagna, Antonella Mirizzi, Maria Gabriella Caruso, Caterina Bonfiglio, Laura R Aballay, Liciana Vas de Arruda Silveira, Antonella Bianco, Isabella Franco, Paolo Sorino, Claudia Buongiorno, Anna Maria Cisternino, Maria Notarnicola, Vito M B Guerra, Alberto R Osella, The effect of the Mediterranean Diet on lifespan: a treatment-effect survival analysis of a population-based prospective cohort study in Southern Italy, International Journal of Epidemiology, Volume 50, Issue 1, February 2021, Pages 245–255, https://doi.org/10.1093/ije/dyaa222
8. Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother. 2002 Oct;56(8):365-79. doi: 10.1016/s0753-3322(02)00253-6. PMID: 12442909.
9. Gerster H. Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)? Int J Vitam Nutr Res. 1998;68(3):159-73. PMID: 9637947. https://pubmed.ncbi.nlm.nih.gov/9637947/
10. Brenna JT. Efficiency of conversion of alpha-linolenic acid to long chain n-3 fatty acids in man. Curr Opin Clin Nutr Metab Care. 2002 Mar;5(2):127-32. doi: 10.1097/00075197-200203000-00002. PMID: 11844977.
11. Mary Jane Brown, PhD, RD (UK). (2018). Should You Avoid Fish Because of Mercury? Healthline Media. https://www.healthline.com/nutrition/mercury-content-of-fish
12. PCB.pdf. (2018). purdue.edu. https://www.purdue.edu/hhs/nutr/fish4health/HealthRisks/PCB.pdf
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