I Think So, Let’s Find Out Why

Omega-3 supplementation may be one of the most important interventions to both reduce one’s future risk of fatty liver disease and to help fight back for those who already have it.

In 2023, the Frontiers In Nutrition journal published a paper examining the risk of new liver disease over an 11-year period in people who either supplemented with omega-3 fatty acids or did not.

They found that the risk of any liver disease was reduced by 27% in people who used omega-3 supplements and NAFLD which is, of course, the most common liver disease globally.

What might explain these findings?

There are two facets to consider:

#1 It is hard to optimize omega-3 status without supplementation - As I discussed at much greater length in my previous Foodguides.com piece, it can be very challenging to optimize one’s omega-3 status in the absence of supplementation because there is uncertainty around plant-based omega-3s (flax, walnuts, soy, chia, hemp) ability to achieve that end and the parallel reality that most people don’t consume much fatty fish (salmon, sardines, trout, mackerel, herring) which is the only dietary source of the potentially more important omega-3s EPA & DHA. 

#2 Omega-3s play a significant role in optimal liver health - Which is to say they affect multiple bodily systems directly related to the healthy functioning of the liver, all of which could be compromised in the absence of sufficient intake.

Understanding each of these facets is fundamental to appreciating and taking advantage of the benefits of omega-3 supplementation for liver health and fatty liver disease.

In today’s article, we’ll explore both, but let’s start with a deeper exploration of why omega-3s are so important for fatty liver.

The Role Of Omega-3s In Fatty Liver Disease 

People living with a fatty liver consistently demonstrate lower levels of omega-3 fatty acids in their liver cell membranes, where they would otherwise be responsible for signaling and gene expression related to fat metabolism.

Fatty liver disease is characterized by improper fat metabolism, which is a fancy way to say that fat ends up where it shouldn’t – in the liver.

This is only the tip of the iceberg because omega-3 fatty acids play a role in each of the four physiological pillars of fatty liver disease.

These include:

• Insulin Resistance – Omega-3s are known to improve insulin sensitivity, with good evidence showing that individuals with better omega-3 status generally demonstrate less insulin resistance.
• Inflammation – While they are far from the only anti-inflammatory dietary component, omega-3 fatty acids are very much among the quintessential anti-inflammatory compounds.
• Microbiome Dysbiosis – Emerging evidence has demonstrated a strong correlation between omega-3 intake and status and diversity in the human gut microbiome ( a good thing).  I spoke about this relationship at length in a previous Foodguides.com piece.
• Elevated Triglycerides – Owing to their previously mentioned role in fat metabolism, omega-3s are known to contribute to lowering blood triglycerides, which means there are fewer fats floating around in your blood that might otherwise end up in the liver.

Now that’s a four pronged attack if I’ve ever seen one, and perhaps it lessens the surprise when we see a growing body of scientific evidence demonstrating that EPA/DHA supplementation lowers both liver fat and enzyme levels in people living with a fatty liver.

But what can you do with this information?

Which Omega-3 Supplement Is The Best Fit?

This is a much harder question to answer since the science in this area is still evolving. 

What the best research shows us so far is the following:

1. EPA & DHA are the forms of omega-3 you want to supplement. They are available either extracted from fish or algae (vegan-friendly) supplements – if you can find a supplement with a higher proportion of DHA than EPA, that is advisable based on current evidence. 

2. The most effective dose is unclear, but it may take up to 3 grams per day*. I recommend aiming for a minimum combined dosage of 1,000 mg ( 1 gram) of EPA & DHA, but supplementing up to 3 grams daily may be more effective. Those who consume larger amounts of fatty fish on a weekly basis could perhaps get away with supplementation on the lower end of this spectrum.

*Consult with your healthcare practitioner particularly if you take blood-thinning medications.

Putting It All Together & Looking Ahead

Omega-3 supplementation is one of the more well-supported supplemental strategies for fighting fatty liver disease.

Ultimately, It represents only one small piece of the puzzle, which must also revolve around a great deal of attention paid to nutrition, physical activity, and even other key supplements like probiotics. 

Even with supplementation present, I still strongly encourage the regular inclusion of plant-based omega-3-rich foods such as flax, chia, hemp, soy, walnuts, and fatty fish due to the numerous benefits of these unique foods. 

Swapping red meat intake for fatty fish has actually been demonstrated in human trials to improve liver health. Based on my assessment of current research, both flaxseeds (lignans) and soy (isoflavones) contain complementary compounds that may offer even more unique liver health benefits. 

I put a great deal of confidence in all of these foods, and I hope after today’s piece, you will too. 

1. _{Albert, B. B., Derraik, J. G., Brennan, C. M., Biggs, J. B., Smith, G. C., Garg, M. L., Cameron-Smith, D., Hofman, P. L., & Cutfield, W. S. (2014). Higher omega-3 index is associated with increased insulin sensitivity and more favourable metabolic profile in middle-aged overweight men. Scientific reports, 4, 6697.}
2. _{He, K., Guo, L. L., Tang, H., Peng, X., Li, J., Feng, S., Bie, C., Chen, W., Li, Y., Wang, M., & Tang, S. (2022). A Freshwater Fish-Based Diet Alleviates Liver Steatosis by Modulating Gut Microbiota and Metabolites: A Clinical Randomized Controlled Trial in Chinese Participants With Nonalcoholic Fatty Liver Disease. The American journal of gastroenterology, 117(10), 1621–1631.} 
3. _{Musa-Veloso, K., Venditti, C., Lee, H. Y., Darch, M., Floyd, S., West, S., & Simon, R. (2018). Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease. Nutrition reviews, 76(8), 581–602.}
4. _{Vell, M. S., Creasy, K. T., Scorletti, E., Seeling, K. S., Hehl, L., Rendel, M. D., Schneider, K. M., & Schneider, C. V. (2023). Omega-3 intake is associated with liver disease protection. Frontiers in public health, 11, 1192099.}