Fish oil supplements have a long and illustrious history.
In Roman times, people used to mash up fish intestines with salt to make a special (and very stinky) fish oil-based sauce. Fast forward to the 19th century, cod liver oil became the first dietary supplement to be marketed to the public and taken on a mass scale.
Today, the fish oil industry is worth billions, with people popping capsules to help with heart disease to brain health.
But can fish oil help acne?
This article covers the science behind fish oil and acne—and how best to use fish oil to enhance your skin.
Let’s dive in.
Fish oil is the naturally occurring fat extracted from fish. It can be sourced from various oily fish (including mackerel and salmon), but most of the world’s fish oil supply comes from anchovies .
Fish oil is special because it is a rich source of omega-3 fats, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) . There are two important things to know about these fats:
1) Unlike other fats, our bodies can’t make them. That means we must get a regular supply of them in our diet .
2) Our bodies can turn ALA into EPA and DHA, but the conversion is inefficient . ALA is also found in plant foods such as flaxseed and walnuts, but pre-formed DHA and EPA are only found in algae, oily fish and breastmilk .
So, to get enough EPA and DHA in our diets as adults, we either need to a) eat a lot of algae and oily fish or b) take fish oil supplements. Most people don’t do a), which is why b) can be a good idea.
Still with me? Great. Read on to discover why EPA and DHA are critical for calm skin.
To get the point of fish oil, you need to understand a little about essential fats and inflammation.
Don’t worry, this won’t take long! First, let’s look at the basic facts:
Basic fact 1 There are two types of essential fats: omega-3 and omega-6. Omega-6 fats have a pro-inflammatory effect in your body, while omega-3 fats have an anti-inflammatory effect in your body .
Basic fact 2 To maintain a healthy state, we should eat omega-6 fats and omega-3 fats in a ratio of 1:1, and certainly no more than 4:1 . But the average Western diet contains way more omega-6 fats than omega-3 fats, which means most of us eat a ratio closer to 16:1 [2,7].
Basic fact 3 Too much omega-6 and too little omega-3—as found in the Western diet—can contribute to inflammation in the body. And inflammation in the body is a prerequisite for developing acne .
The forms of omega-3 fats with the most anti-inflammatory action are EPA and DHA. As mentioned, our bodies can make EPA and DHA from ALA, which is also found in flaxseed, walnuts, dark green leafy vegetables, soybean oil and rapeseed (canola) oil .
OK, you’re thinking, why can’t I just eat lots of walnuts and let my body do the rest?
Here’s the problem: our bodies can convert ALA to EPA and DHA, but it’s not very good at it. Only 5–10% of ALA is converted to EPA, and a miserable 1% is converted to DHA . Conditions need to be great for this conversion to happen, and it can be thrown off overeating saturated fat, sugar or alcohol, or eating too little protein .
In the modern world, with our convenience-focused diets, supplementing with fish oil may be necessary to achieve the correct ratio of omega-3 to omega-6 fats and maintain an anti-inflammatory state .
So, we know that acne is an inflammatory condition, and that taking fish oil can help to rebalance inflammation. But what does the science say about fish oil and acne specifically?
Let’s look at the evidence:
– In the 1960s, a study of over 1,000 US teenagers found that those who ate more fish and seafood had fewer blackheads and breakouts .
– A later Italian study found that eating fish was associated with a protective effect against developing moderate to severe acne .
Sounds promising, right? The problem is these studies are observational only. This means they show associations, but they can’t prove that eating more fish (and consequently fish oil) helps acne.
The good news is that we also have some interventional studies, which can prove causality. Let’s look at these:
– Of five patients who took fish oil daily (containing 1,000mg EPA, plus other antioxidant nutrients), four experienced an improvement in their breakouts after two months. The supplements seemed to make the biggest difference to inflammatory lesions .
– In another study, 16 adult men with acne took fish oil capsules with a total daily dose of 930mg EPA and 720mg DHA. 13 men completed the entire 12-week study, eight of whom experienced an improvement in their breakouts. But it wasn’t all good: four men’s mild acne got worse .
– In a randomised, double-blind, controlled trial (a particularly high-quality study), 15 patients took fish oil supplements containing 1,000mg EPA and 1,000mg DHA daily . After ten weeks, their inflammatory lesions were reduced by almost half. There was also evidence of less inflammation at a cellular level.
So, what does this all tell us?
More high-quality trials are needed but, for now, it’s reasonable to say that taking the right amount of fish oil may help reduce inflammatory breakouts.
Put more simply: fish oil can help your acne.
As you’ve likely grasped by now, fish oil’s effect on acne mostly boils down to its effect on inflammation.
Remember how the balance of omega-6 to omega-3 fats is so important? One study found that people with acne have significantly lower levels of omega-3 in their blood and a significantly higher ratio of omega-6 to omega-3 . In other words, people with acne are in a pro-inflammatory state.
When you take fish oil, the essential omega-3 fats compete with other omega-6 fats from your diet to get into your cell membranes [13,15]. Once embedded in your cell membranes, omega-3 fats reduce the pro-inflammatory signals emitted at a cellular level—which reduces inflammation around your body, including at your skin surface [16,17,18].
Less inflammation in your skin = less acne .
Fish oil does a couple of other things too:
The most critical thing to understand is that EPA and DHA are the real workhorses of fish oil . That’s why eating other forms of omega-3 fats (which include ALA but not pre-formed EPA and DHA) won’t have the same effect on your acne.
If you choose not to eat animal products (including fish oil), you can get your EPA and DHA dose from algae supplements instead.
Funnily enough, algae are the reason certain fish are so rich in EPA and DHA. Algae produce EPA and DHA, the fish eat the algae—and the fish become replete in EPA and DHA !
The only thing to be aware of is that algae supplements tend to contain a lower total dose of EPA and DHA than fish oil supplements. Therefore, you may have to take more algae supplements to achieve the anti-inflammatory effect.
If you want to take fish oil for acne, you need to consider two things:
1) The dose you’re taking
2) The context in which you’re taking it
Let’s look at these in a little more detail:
1) The dose you’re taking
Participants took close to 1,000mg EPA daily in all the clinical trials mentioned above. If you want to achieve an acne-reducing effect, you need to take a similar dose.
This is where quality matters. Cheap fish oil tends to have less active ingredients—EPA and DHA—while higher quality (and thus more expensive) fish oil tends to have more.
Take this drugstore brand of fish oil. It’s a steal at £2.50 for 30 capsules, but it doesn’t give you much of the good stuff:
Presuming it contains roughly equal amounts of EPA and DHA, you’d need to take eight capsules daily to reach 1,000mg dose of EPA. Yes, eight!
Now look at this higher-quality brand:
It costs £14.25 for 30 capsules, but it has a much higher dose of EPA and DHA. So, to reach around 1,000mg EPA, you’d need to take 2–3 capsules daily.
More expensive doesn’t always mean better, but it’s often a good benchmark. When choosing a supplement, look at the EPA dose on the back of the label. Then, look for other marks of quality such as the IFOS (International Fish Oil Standards) star rating. A five-star rating means the fish oil is both pure and sustainably sourced.
Switching up the fats in your diet can change the composition of your cell membranes in as little as six days . But to truly give fish oil a chance to work, you should plan to take it for at least two months.
On to the second point:
2) The context in which you’re taking it
We know that people with acne are in a pro-inflammatory state, and that taking fish oil can help redress the balance at a physiological level.
But an imbalance of omega-3 and omega-3 is unlikely to be the only reason you’re inflamed. What else could be a driving factor for your inflammation and skin issues? Poor gut health? Food sensitivities? Hormonal imbalance?
You likely need to address several aspects of your diet and lifestyle for a genuine, long-term solution to your acne. Taking fish oil may help, but you’re simply practising green pharmacy if you do nothing else. A single pill is rarely the answer.
As I’ve said before: the clue is in the name. Supplements should only ever supplement other dietary and lifestyle habits.
Let’s recap what we’ve learnt:
– Fish oil is the natural fat extracted from fish. Most of the world’s fish oil is sourced from anchovies.
– Fish oil is special because it’s a rich source of omega-3 fats, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Our bodies can’t make these fats, so we must eat them.
– Our bodies can turn ALA (found in plant foods) into EPA and DHA, but it’s not very good at it. So, to get enough EPA or DHA, we either need to eat lots of algae and oily fish, or supplement with fish oil.
– Omega-3 fats, particularly EPA and DHA, help reduce inflammation in the body. Acne is driven by inflammation.
– Various trials show that taking a daily dose of around 1,000mg EPA from fish oil can help to reduce acne.
– When choosing a supplement, you need to consider the dose and quality of the fish oil.
– Taking fish oil shouldn’t be the only thing you do for your acne. A genuine, long-term solution will involve dietary and lifestyle tweaks too.
Fiona Lawson is a former national magazine editor turned registered nutritionist and skin specialist. She holds an MSc in Nutritional Medicine and a BANT-registered post-graduate qualification in Nutritional Therapy.