Why “To Flax or To Fish?” is The Wrong Question…and The Right Answer

By David Blyweiss, M.D., Advanced Natural Wellness

February 10, 2012

  • Putting the ‘essential’ back into essential fatty acids
  • Solving the fish vs. flax debate once and for all
  • Complicating factors to discuss with your doctor

While the debate between fish oil vs. flaxseed oil rages on, I’d like to tell you today why it’s the wrong question… and how you can use a few key pieces of data to find the right answer for you.

The basic premise behind the recommendation to supplement with fish or flax oil is this: your body needs essential fatty acids, but doesn’t produce them on its own. Which means you must get them either through your diet or your supplements. Achieving a balance between the two types – omega-3 and omega-6 fatty acids – is the key.

The challenge is that the Standard American Diet (often referred to as SAD, because it is!) can create a radical imbalance, with Omega-6 fatty acids outstripping Omega-3’s by as much as 20:1. This kind of imbalance can create a whole host of symptoms, ranging from fatigue, dry skin, and poor memory to more serious heart problems and circulation issues.

Both fish oil and flax oil contain EFA’s – that much is true. But contrary to much of what has been written on this subject (and there is plenty out there) they are not interchangeable, and one is not necessarily better than the other. Rather, the decision should be based more on your individual needs.

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Here are some criteria to help you decide which is right for you…

Consideration #1: Inflammation and Your Immune System

While inflammation is a perfectly normal, healthy response to disease in our bodies, an imbalance in our diet can cause it to flare up unnecessarily – and actually create rather than fight off disease. This is one of the primary problems with getting too many omega-6 fatty acids – it causes your body to generate inflammation you don’t need.

There are currently over 80 identified autoimmune diseases, including lupus, type I diabetes, celiac disease, multiple sclerosis, Crohn’s disease, rheumatoid arthritis, Graves’ disease, and Sjogren’s syndrome… to name a few. Most, if not all, of these diseases include an inflammatory response.

Fish oil has been proven to decrease inflammation more than flaxseed oil – making this one of the main determining factors in your decision.

Consideration #2: Vision

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There are a few vision conditions that respond particularly well to fish oil, flaxseed oil, flaxseeds – or some combination of all three. Both fish and flaxseed oil can help lubricate dry eyes, and lower your risk of macular degeneration and cataracts – although oddly, too much ground flaxseed in your diet can increase your risk of macular degeneration. While both fish oil and flaxseed oil appear to be effective on these vision-related conditions, flaxseed oil appears to do the job on its own, if needed.

Consideration #3: Your Overall Diet

This is perhaps the most personalized way to make this decision. Only you know what your ratio of omega-3 to omega-6 might be, based on your daily diet. Do you have a Dunkin’ Donuts weakness? Do you cook with vegetable oil or olive oil? Do live on salmon and prefer more fresh veggies to processed foods?

If you like fish and eat it regularly, and your diet isn’t overloaded with processed foods – you may do just fine with flaxseed oil. Also, if you are concerned or have a family history of cataracts or macular degeneration, taking both flax and fish oil could be the best approach.

If you are like me, and you don’t like fish, but you can handle the fish oil in capsules or liquid, that is my recommendation. And in this case, take a higher dose.

I will tell you that a good lemon or other naturally flavored fish oil can give you a full days measure in a teaspoonful vs. having to take four or more gelcaps…. and it’s tasty too. If you eat fish occasionally – maybe once a week – you can take a lower dose.

If you are vegetarian, you’ll have to go with flaxseed oil – but also add in some walnuts, borage oil, and evening primrose. You will also want to be sure to include other anti-inflammatory foods in your diet if you can’t take fish oil, such as green tea, turmeric, kelp, blueberries and olive oil instead of vegetable oil.

But if you have any kind of autoimmune disease, or chronic inflammation of any kind, fish oil is your best bet. Along with eating a diet that balances your omega-3 and omega-6.

Last but not least, if you have other conditions that may be affected by supplementing with fish or flax, keep reading…

There are a few conditions that might further complicate your decision. For example, if you are on any blood-thinning medications, you should consult a functional medicine physician to see if fish oil supplementation makes sense for you.

If you have diabetes or schizophrenia, you may not be able to convert the alpha-linolenic acid (ALA) in the oil to docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are the forms more readily used by the body. Also, both fish and flaxseed oils may cause an increase in blood sugar levels, so it should be taken into account with diet and other considerations before you get started.

Because of the anti-inflammatory response of fish oil, be cautious of combining it with NSAID’s – non-steroidal anti-inflammatory drugs, such as ibuprofen.

Considering the complex interactions of pharmaceuticals, diet and supplements can take some finesse. It is always best to work with a physician who is knowledgeable about all three to help guide you to the right decision for you.


Duda MK, et. al., Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction. Cardiovasc Res. 2009 Feb 1;81(2):319-27. Epub 2008 Nov 17.

Pinheiro MN Jr, et. al., Oral flaxseed oil (Linum usitatissimum) in the treatment for dry-eye Sjögren’s syndrome patients. Arq Bras Oftalmol. 2007 Jul-Aug;70(4):649-55.

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