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What Are Omega-3s?
Dr. Clemens von Shacky • 2026-04-07
Dylan Carnahan:Welcome to the Simple Questions Podcast. This is your host, Dylan Carnahan. The question for this episode is, what are omega-3s? You will learn in this episode what omega-3 fatty acids are and why they matter, how fish oil impacts cardiovascular health, and how to measure your omega-3 levels with the omega-3 index. Our guest is a leading cardiovascular researcher with over 15,000 scientific citations, an H index of 59, and is the creator of the omega-3 index. I introduce to you Dr. Clemens von Schacky. I am very young when I go to the market with my mom. And I'm walking through the aisle, and we stop in the supplement section to get a multivitamin. When I look at the names of a lot of the products and I see fish oil, and this immediately, as a younger person, strikes me as very odd. I'm wondering, what is fish oil? How is it derived? And it wouldn't be until I'm much older now, that I've kind of understood things more. However, there's much that I would like to learn, as well as our listeners. So with that being said, I'm curious, how did you initially get into your research of fatty acids?
Dr. Clemens von Shacky:Well, that's a long time ago. Well, that's, you know, I'm old. And there was more than 40 years ago. And I wrote my thesis on aspirin, which was an old drug at the time. And then they gave me a job for to investigate something even older. And that was the fish oil, which has a history of millennia in Europe for all sorts of reasons. And so we started playing around with fish oil. And when you are in a field for more than 40 years, you sort of soak it up bit by bit, and you get to learn things one by one. And science is always some sort of a puzzle, you know. You try to piece things together. And this trying to piece things together is also a question of perspective. And how you do that, and what pieces of the puzzle you consider more important, what pieces of the puzzle you consider less important. And so the omega-3 index, that was invented more than 20 years ago. And that is a perspective on the field that turned out to be very, very fruitful. And because we didn't look at what people ate, we looked at what's in people. And it's sort of a change in perspective, because not everything you eat ends up in your body. We have minor issues like bioavailability. And so we took care of that, and we realized that we have a very fruitful perspective on the field, and we learned so much. And I think we know now a lot of things that we didn't know before.
Dylan Carnahan:Now, when I hear a change in perspective, especially kind of in an academic setting, I could see that there will be some resistance. You know, we're in this year and this time. What was some of the friction that you experienced, say, 20 years ago?
Dr. Clemens von Shacky:Well, there's always friction in life. And especially if you're ahead of all the others, they start complaining, we can't give up and we thought that we were right so long, such a long time and so on and so forth. But that's irrelevant. You know, truth is not something that comes with expiry date. It just stays, so everybody will catch up eventually.
Dylan Carnahan:Now, I appreciate your comment on friction as a whole. You know, a lot of the people that are going to be listening, there's quite a bit of asymmetry. There are a lot of things that we don't know that maybe have not been emphasized. There are a lot of things that we don't know that maybe have not been emphasized. You know, can you just share, as generally speaking, what are fatty acids?
Dr. Clemens von Shacky:That's, that's actually, that's pretty simple, because humans are a bunch of cells, right? A lot of cells, okay? And these cells have membranes on the outside, on the inside, and these membranes are composed basically of fatty acids and some other stuff. But the fatty acids are the more important stuff as far as we know. But the fatty acids are the more important stuff as far as we know. And so each and every cell in us has an idea what fatty acid it wants in its cell membrane. And to give an example, humans are humans because they have a big brain, right? And the most important fatty acid in the brain is an omega-3 fatty acids, it's the cosahexaenoic acid or DHA. And we cannot synthesize that fatty acid, we have to eat it and we have to be able to absorb it. To first build our brain and then maintain our brain. And if we don't get enough of that, we're in trouble. And that's why, you know, nature is a good teacher. Nature put in pumps, fatty acid pumps into placenta, and these fatty acids pumps pump fatty acids to the fetus, to the upcoming life. And the fatty acids that these fatty acids pumps pump are the ones the brain requires to be built. And what these pumps do is they try to adjust the fetus to a target range for fatty acids, for omega-3 fatty acids, which is precisely the target range that we defined earlier because of data in the cardiovascular context. So we think that if we are in line with nature, we can't be all that wrong.
Dylan Carnahan:Now, there are a couple of things you mentioned there that I kind of want to tease out. One of the things is you spoke of DHA. Can you talk about what that distinction means and what other distinctions of that fatty acid there are?
Dr. Clemens von Shacky:Now, it gets complicated. Because DHA is, that's the easiest way to talk about it. The full name is Stochocosahexaenoic acid. And it has 22 carbon atoms and six double bonds. And it is a very specific fatty acid which we cannot, as I said, which we cannot manufacture. We cannot synthesize it. And we have to take it in. And it is an omega-3 fatty acid, and it is a very important omega-3 fatty acid. But there's other omega-3 fatty acids like EPA or icosapentaenoic acid, which has 20 carbon atoms and five double bonds. And that one we can manufacture to some degree from plant derived, from a plant derived omega-3 fatty acid, but not in sufficient amounts. So we need to ingest both of these fatty acids, and that's the stuff that you saw in the store when you were a kid, because that's in fish oil.
Dylan Carnahan:And you spoke of that, thank you for that breakdown, that's greatly helpful. You spoke of earlier also, you know, talked about kind of the importance and how kind of things work physiologically for the fetus. But you also spoke about some other biological implications, such as the cardiovascular. So could you delve into that a little bit further for us?
Dr. Clemens von Shacky:When we had, when we were dreaming up the omega 3 index at the time, we thought, well, we have to give it some reason. And then we looked at the cardiovascular data and saw that the risk to have a cardiovascular event of some kind, sort of levels off at an omega 3 index of above 8% in that case. And then we thought, okay, that's good, sounds nice. And then I thought, well, in nature, you have the phenomenon that can be too much of a good thing. So I looked at the kinetics of this leveling off of the positive effect, and that leveled off at 11. And I thought, okay, let's be careful. Let's say, here we have a target range between 8 and 11, and maybe something's happening above this 11 cutoff, and many years later, it turns out it does. Things happen. And the thing is that the risk for atrial fibrillation, which is a heart rhythm disease, increases above these 11 percent for the omega 3 index. Actually, the risk relationship is U-shaped, meaning that it also increases at levels below 8. So that's what you have here, and which gives you sort of a confirmation for the target range. Say, okay, here the positive effects tend to level off, and the negative effects tend to appear on both sides of the target range. And what we also learned is that there's an amazing variety of effects, and that's true for cardiovascular, it's true for the brain, it's true for the skin, it's true for you name it. And that's why I started thinking that, well, what sets us apart from all these animals, it's our brain. We have a bigger brain than any animal, and a more complex brain than any animal. And the anthropologists, the ones who research on how humans became humans, they say that at the time that humans became humans, they could only do so because they had so much building material for their brains available. And again, we're speaking in that case of DHA. And if you have nature doing something like that, it's usually not just one organ, not just the brain, but also all the other organs in a body. And so once we started looking from the perspective of the cell membrane, we learned that, for instance, muscle soreness. Everybody's experienced muscle soreness. But you can minimize it by bringing your omega-3 index into the target range. Or age-related muscle loss, same thing. You can minimize it by bringing the omega-3 index in the target range. And I could go on for quite some time. I could talk about eyes. I could talk about cognitive function, brain functions. I could talk about psychiatric disease, whatever. That's a very staggering phenomenon that all these issues, health issues, are minimal as far as we know, in the target range for the omega-3 index. This is not to say that nobody is going to fall ill anymore. No. You can still, I mean, develop some sort of disease, but the risk for developing all sorts of diseases is smaller.
Dylan Carnahan:That's fascinating. In talking, we've name dropped it several times, the omega-3 index. We've talked about some of the ranges and the implications of those. What is the omega-3 index? How was it created and what's the benefit?
Dr. Clemens von Shacky:Well, it was created in 2002 in Chicago over a beer that we had at the American Heart Association meeting. We dreamt up the omega-3 index and we said, okay, this is where we're going to invest some work. And so we got to develop an analytical method that would really be suitable to be used in everyday clinical medicine. And it took us two years to develop that method and to start gathering the first data. And that has played out ever since.
Dylan Carnahan:What, you know, being, you speak of 2002, you know, again, this is some time ago. What was the, I guess, methodology or analysis that was conducted prior to that?
Dr. Clemens von Shacky:Oh, huge amounts of research went into omega-3s prior to that, of course. We now have 40,000 publications on omega-3s and of these publications, 7,000 are on intervention trials. That's a huge body of evidence. And it's the fourth or fifth best studies, study compound that we have. So it's a huge amount of data. And what happened at that time is that everybody was complaining about the data not fitting. There were inconsistencies. Some found this, the others found that. And with the Omega 3 index and using the perspective of the Omega 3 index, we now can say, okay, you did it wrong. You didn't look at the levels that your trial participants had before they went into the trial. You know, if somebody has sufficient amount of Omega 3s on board, you're not going to see an effect, because that person is optimal already. So you would want to conduct a trial in a population that is not optimal. That was one of the mistakes that we discovered as having been made later. And there are other things. One of the things that we learned the hard way was that the bioavailability is so variable from person to person. So what you put in your mouth doesn't necessarily show up in your body as well as it does in somebody else, or maybe better. So you have to, in a trial design, you have to factor that in. And the same thing in clinical medicine, you just have to factor that in and look how does this person react to the supplementation with omega-3s. And these two facts that we found made a lot of the previous work useless, unfortunately, because when the trials were designed, nobody thought of that because there was no way of determining the levels. They just gave a fixed dose of omega-3s, and then they said, okay, it works, or they said, okay, it doesn't. It's like, if you want to know what water does, it doesn't really help to give everybody half a liter of water every day. You're not going to learn much because some people need more, some people need less, but everybody does. And it's basically, from hindsight, it's simple, but nobody thought of it at the time. And we were the first to be able to demonstrate that. And now the trials are being far more effective and far more, well, conclusive. We learn a lot more and we learn a lot faster.
Dylan Carnahan:What are some of the things that now that you have, you know, this index and your level ability to analyze things, and that paradigm is very helpful, what are some things that we're looking into now as far as omega-3s?
Dr. Clemens von Shacky:You know, what happens now is that there's groups from some universities coming to me saying, okay, we think that, let's say, acne, okay, depends on the omega-3 index, and I say, you got to be kidding. So, we agree on doing it properly, say, okay, first, we're going to observe whether the ones who have the more severe cases have a lower omega-3 index than the less severe cases. That turn out to be true. And then we did an intervention trial, and that did away with acne in the trial participants. And the other topic that recently showed up, it hasn't been published yet, but another university group, obstetricians in that case, they came up and say, we think that the duration of giving birth depends on the omega-3 index. And I said, nah. But they were right. And that's how we learn. We do studies, we do trials, and we learn a lot of things that we were not able to learn before, because now we have this perspective.
Dylan Carnahan:No, that's fascinating to hear kind of the different applications of things.
Dr. Clemens von Shacky:It goes back to being a huge amount of cells, and each and every cell needs these omega-3s in its cell membrane. And there's not a single human being out there that does not have omega-3s on board. That's another thing that we learned. So you need it. You need it to be alive.
Dylan Carnahan:You know, in my time talking to other researchers, I think back to Dr. Richard Kreider, who had done a lot of research on creatin. And there is a separation. Again, you're doing a lot of fantastic work. You've done a lot of fantastic work. But there are, you know, the average person, their perception may be different, right? So can you talk about what are some of the things that you hear that are misunderstandings about omega-3s?
Dr. Clemens von Shacky:Well, if you have like 20,000 publications that have methodological issues that haven't been done properly, there's a lot of confusion out there. And we're still dealing with all this confusion because it's very hard for a researcher to say, okay, I didn't know it at the time, but I was wrong. Nobody likes to say that. So that's one of the issues we are dealing with. And for instance, nutrition people, they hate being wrong, just like everybody else. And the issue with them is that they are not used to the perspective of a biomarker. They like to look at what people eat. But in that case, in the case of omega-3s, it's not all that relevant. And for them, it's hard to grasp.
Dylan Carnahan:When we look at the optimal range that you spoke of, what have you found to be the most effective thing to get into that optimal range?
Dr. Clemens von Shacky:Well, if you take omega-3s, you better take it with your main meal. That's another thing that we learned. Because a lot of these trials were done like drug trials. And if you hand out a drug trial to a clinical research organization, what they do is they say, okay, you're going to have your study drug in the morning. But not everybody has scrambled eggs in the morning, and not everybody has a breakfast that starts fat digestion. And omega-3 is a fat. And if you don't start digestion, the fat's not going to get into you. And that's billions were just squandered. And by not thinking about bioavailability, they thought, well, we have a drug here, and we're going to study it like a drug. Well, something that you have on board cannot be a drug. It's something else. You have to use smarter ways of investigating it.
Dylan Carnahan:And this also seems like something that is a constant. Again, you talk about this importance biologically, that this is, I'm thinking just to the average person, as far as this is something that would be habitual as well. Right? This isn't something that you could take sparingly.
Dr. Clemens von Shacky:Well, you would have to take it constantly and according to how much you need. And you need as much as you need to maintain your levels. And you maintain your level in the target range. There are some populations that tend to have low levels. And that's the thing that we started in 2015. We studied like 100 athletes. And it turned out that they were really, really low. Why are they so low? Well, they burn a lot of calories. And with these lots of calories, they also burn their omega-3s. And that finding has been repeated like a dozen times. And that's the perfect population to run a trial in, because they have low levels to start with. And even if you don't check the levels, you're going to be lucky, because you're going to increase the levels and you're going to see an effect. That's what happened. A lot of effects were seen. And last year, the International Society for Sports Nutrition said, okay, we're going to pour all this into a scientific statement. And we recommend that all athletes should have their omega-3 index checked and then be given omega-3s in an amount that's sufficient to get them into the target range. And so that's an official statement of a scientific society now. And that statement has been expended to the American military, because these people also depend on the proper functioning of the body. I mean, if you have bullets flying around your head, and you're too slow to duck, you're in trouble. So that's another area. And the next area that's going to be covered by the scientific guidelines will be pregnancy. Because it turns out that a lot of women, especially in the Western world, have low levels. And then these pumps start functioning, I was talking about, that deplete the mother to feed the fetus. And it turns out that low levels of omega-3s in pregnancy come with a higher risk for premature birth, with a higher risk that the child is going to die at birth, and a higher risk for complications around birth, and a higher risk for postpartum depression. And so that's another area that's going to be, you know, following suit to what has been stated for the athletes. And so I think that one area after the other is going to, you know, fall in line saying, okay, we need to measure the levels, and we need to get these people into the target range so they don't have problems.
Dylan Carnahan:You know, just thinking on a personal note, from a personal perspective, being someone that's been in this field for so long, you know, how does it feel to see the contributions you've made now that it impacts so many things?
Dr. Clemens von Shacky:Couldn't feel better. It all started with a beer, and now it has become, you know, one of, to me, one of the major things. You know, there's so many, so many issues that we see that can be, you know, at least relieved by getting the omega-3 index in this target range. Talking about brain functions, for instance, it's ADHD is a deficiency disease, depression as well, all of psychiatry. If your brain doesn't function properly, just check your omega-3 index and you will find something and then get it in order and you will see improvement. And that's especially true for the kids, because kids born to mothers that have low levels in pregnancy, they don't have, you know, the proper materials to build their brains. So they will have problems. Of course they do.
Dylan Carnahan:Yeah, this is a very practical approach and I appreciate kind of your earlier explanations that they're all feeding to this. When we talk about a big thing, a big thing is distribution and products, right? There are all sorts of products that are being marketed. What advice do you have for a consumer?
Dr. Clemens von Shacky:Well, I'm not talking about supplements, because at least in Europe, supplements are being checked regularly by the regulatory authorities. What's on the market in terms of supplements is okay, usually. That is not the case in the US. You have a different regulatory system, and some of the supplements you have on the market are of low quality. I would go for a reliable brand in the US. The other thing is that when you want to check your levels, there's a lot of, I would say we are in the Wild West phase. Because there's a lot of labs that say, okay, we can check your level, but they're using a different method and they're giving you different results and some of these results are really off the mark or I should say, most of these are results. So that's a bit difficult for the time being. That's why we branded our analysis, HS omega 3 index to be so people can recognize us. And but that's we haven't moved to the US yet, but we will in the hopefully near future. It's become a bit more difficult now, but we will manage.
Dylan Carnahan:Yeah, there's just, I'm hearing, you know, there are just some consumer decisions you have to make as far as the ingestion of supplements and then as well as the testing, right? Because there's variance, variance per market. I'm grateful for that education on that. What, you know, you spoke in a great deal already, but to our listeners, what advice would you give to the average person?
Dr. Clemens von Shacky:To the average person, I would say, just think about how important omega-3s are. Have your baseline measured in a proper way and then decide whether you want a supplement or not. Because now it's basically supplements, because fish is no longer a good source, because, for instance, salmon is a, the percentage of omega-3s in salmon has gone down. You have to eat like two times as much now than you had to eat in 2015. So other fish like tuna has a lot of toxic materials. So I wouldn't eat that either. And, you know, it also comes down now, unfortunately, to supplements. And the supplement market in the US is far more difficult than it is here.
Dylan Carnahan:Wow, I had no idea about the reduction in omega-3s in salmon. I mean, I've heard frequently about the metal toxicity in fish as a whole, but that's surprising to hear.
Dr. Clemens von Shacky:Yeah, because it's simple, you know, everybody wants fish oil now. So they are turning salmons into vegans. That's how it goes.
Dylan Carnahan:Um, man, this is, this is fascinating. How, how can people learn more about you and the work you do?
Dr. Clemens von Shacky:Well, they can check our website, omegametrics.eu or.com. And we have an English version of it, and we explain a lot of things there. And that would be the first step. Then of course, the scientific world, that's all publications and stuff like that, which is far more complicated than what we put on our website.
Dylan Carnahan:I'm grateful for the conversation we've had, and I just want to say on behalf of myself and our listeners, thank you for sharing your time and knowledge today.
Dr. Clemens von Shacky:I'm happy to do so. Thank you very much for the opportunity.
Dylan Carnahan:That wraps up our conversation with Dr. von Schacky. We talked about the science behind omega-3s, how to interpret your omega-3 index results, and whether fish oil supplementation is actually worth it. Go to this episode's show notes to see any resources Dr. von Schacky mentioned during our episode. And lastly, subscribe to the Simple Questions Podcast to get notified when our latest episodes are released. Thank you for listening, and remember to keep asking questions.