Why Writing About Fish Oil Is Taking Me Forever

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This post isn't the fish oil post. This is the post about why the fish oil post doesn't exist yet.

I went in thinking: omega-3s, fish oil, well-trodden ground. Long and complex, sure, but manageable.

I was wrong. Oh, so wrong.

My standards are simple:

• Base things on authoritative dietary and clinical guidelines. Not brands. Not wellness influencers.
• Massive systematic reviews, studies of studies. Not small, individual, cherry-picked studies.
• When the evidence doesn't support a reasonable recommendation, say so.

Fish oil keeps forcing me to say "it's complicated" at every turn.

A taste (hah) of what I've been wrestling with:

• Does seafood reduce cardiovascular risk because of omega-3s? Or because healthier people eat more seafood? Or because seafood displaces fries and fried chicken? There's evidence for eating seafood. But omega-3 supplements? Not really. For most people anyway. AHA has specific recommendations for certain patient groups though.
• There's evidence for eating seafood. But omega-3 supplements? Not really. For most people anyway. AHA has specific recommendations for certain patient groups though.
• Are LDL and triglyceride changes meaningful clinical endpoints, or just numbers moving on a chart?
• Are the placebo arms in major trials actually neutral? Corn oil and mineral oil aren't metabolically inert.
• Ethyl ester (EE) vs. re-esterified triglyceride (rTG). Studies used EE. Supplements are moving toward rTG. Technically better absorbed. But does better absorption mean better outcomes? Nobody knows. And guidelines don't provide a recommendation.
• What dose? Based on what, exactly? Guidelines don't even note that.

That's before krill vs. fish vs. algae, oxidation, rancidity, certifications, pill size, serving size, and misleading labels.

Which are, somehow, the easy parts.

I split this into atomic essays. That felt right. Easier to organise, easier to write. Then I started writing those and realised: still hard.

So. The fish oil post is coming. Just not today.