Omega-3: Why the Balance Matters More Than the Supplement
- Dr Anupa Dharamsi
- Jun 11
- 11 min read
By Dr. Anupa Dharamsi, Chiropractor | Handcrafted Chiropractic, Māngere, Auckland Nervous system-focused chiropractic care | ACC & WINZ welcome
It's Not Just About Adding More Fish Oil
Most conversations about omega-3 start in the wrong place.
They frame it as a deficiency problem — you're not getting enough, so take a capsule. And while intake does matter, that framing misses something more fundamental about what's actually happening in the modern body.
The real issue isn't only that omega-3 intake is too low. It's that omega-6 intake is dramatically too high — and the imbalance between the two is what drives the inflammatory state so many people are managing.
Here's the ratio picture. The ideal omega-6 to omega-3 ratio in the diet is somewhere around 4:1 or less. Modern diets — heavy in vegetable oils, processed foods, fried food, and grain-fed animal products — typically deliver a ratio closer to 15:1. In some Western populations it's as high as 20:1.
Omega-6 fatty acids are not inherently harmful. They play important roles in the body. But when consumed in excess relative to omega-3, they shift the body's biochemical signalling toward a more pro-inflammatory state. Cell membranes built predominantly from omega-6 produce different signalling molecules than those built with adequate omega-3. Inflammatory pathways are more easily activated. Resolution of inflammation is slower.
This is the background operating environment of a significant proportion of people in modern New Zealand — including many of the patients I work with in South Auckland.
Omega-3 supplementation without addressing the ratio is addressing half the problem. This post is about the full picture.
What Omega-3 Fatty Acids Actually Are
There are three main forms of omega-3 fatty acids — and understanding the difference between them changes how you approach both diet and supplementation.
ALA (alpha-linolenic acid) is the plant-based form, found in flaxseed, chia seeds, walnuts, and hemp seeds. It is technically an omega-3 — but it is the short-chain form, and the body must convert it into the longer-chain forms (EPA and DHA) to use it for most of its critical functions. That conversion is inefficient for most people — typically under 5-10% of ALA converts to EPA, and
DHA conversion is even more limited. This means that plant-based omega-3 sources, while useful and not without value, are not equivalent to marine sources when it comes to EPA and DHA status.
EPA (eicosapentaenoic acid) is the primary anti-inflammatory driver. It competes with omega-6 for the same enzymes used to produce inflammatory signalling molecules, reducing the overall inflammatory output of the body. EPA is also the form most strongly associated with mood regulation and pain modulation, and has the most compelling recent research on chronic pain and migraine reduction.
DHA (docosahexaenoic acid) is the structural form. It is the primary fat in the brain's grey matter — constituting approximately 30-40% of the fatty acids in neuronal cell membranes — and is found in high concentrations in the retina, heart, and nervous system tissue. DHA is the building material the brain and nervous system uses to construct and maintain itself. Without adequate DHA, cell membranes are less fluid, less adaptable, and less efficient at transmitting signals.
These are not interchangeable. EPA and DHA do different jobs, and both matter.
Where New Zealand Sits
A 2024 global omega-3 index mapping study measured omega-3 status across 48 countries and found that New Zealand moved from an "orange" rating — indicating a deficient omega-3 index between 4-8% — to a "yellow" rating, indicating a suboptimal range. The optimal range is "green," representing an omega-3 index above 11%.
New Zealand has improved. It is still not optimal.
Most New Zealanders are not getting enough EPA and DHA from diet alone to reach the range associated with meaningful cardiovascular, neurological, and anti-inflammatory protection. This is not about poor food choices per se — it reflects the reality that the foods highest in EPA and DHA (cold-water fatty fish like salmon, sardines, mackerel, and anchovies) are not daily staples in most New Zealand households.
Add to this the high omega-6 load from processed food and cooking oils that characterises modern NZ diets, and the ratio problem described above becomes a meaningful daily physiological burden.
Signs Your Omega-6:Omega-3 Balance May Be Off
Because this is a ratio issue rather than a single-nutrient deficiency, the signals can be diffuse:
Persistent joint stiffness or aching, particularly in the morning
Skin that's dry, inflamed, or prone to eczema
Mood that's flat, low, or emotionally reactive without clear cause
Brain fog or difficulty with sustained concentration
Slow recovery from exercise or physical activity
Frequent or prolonged inflammatory episodes
Poor sleep quality, particularly difficulty staying in deep sleep
Fatigue that doesn't fully resolve with adequate rest
Many of these overlap with other nutritional imbalances — the stress-depletion of magnesium and vitamin C, low vitamin D in winter, or chronic nervous system dysregulation. Often these patterns appear together, because the body's systems are interconnected. Omega-3 status is one thread in a larger web.
Omega-3 and the Nervous System — The Architecture of the Brain
This is the connection I find most compelling — and most absent from standard omega-3 content.
DHA is not merely beneficial for the brain. It is structural material the brain is literally built from.
Neuronal cell membranes are approximately 30-40% DHA. The fluidity, flexibility, and signal-transmission efficiency of every nerve cell in your body depends on the fatty acid composition of that membrane. Membranes built with adequate DHA are more fluid, allowing receptor proteins to move freely and signals to transmit cleanly. Membranes built predominantly from omega-6 fats are less fluid and less efficient at the moment-to-moment transmission of neural signals.
From a chiropractic standpoint, this matters in a very specific way. The work we do — restoring movement to restricted spinal joints, improving the quality of sensory signalling between the spine and the brain, supporting the nervous system's capacity to reorganise and adapt — depends on a nervous system that is biologically capable of that adaptation. Neuroplasticity requires adequate DHA at a cellular level.
EPA, meanwhile, protects that structure. It modulates the inflammatory signalling that, when chronically elevated, directly damages neuronal tissue, reduces neurogenesis, and impairs the kind of nervous system reorganisation that chiropractic care is trying to facilitate.
Research from Molecular Psychiatry found that both EPA and DHA prevented the reduction in neurogenesis and the increase in cellular apoptosis triggered by inflammatory cytokines — providing direct evidence for the neuroprotective role of omega-3s in inflammatory environments.
Omega-3 fatty acids also modulate the function of the gut-brain axis — the complex communication network connecting the gastrointestinal tract and the central nervous system through neuronal, endocrine, and immune pathways. For patients where gut health, mood, and nervous system regulation are interconnected (which is many of the people I see), the omega-3 piece is foundational.
"DHA isn't just good for the brain. It's structural material the brain is built from. Every nerve cell membrane in your body is approximately 30-40% DHA — and that composition directly affects how cleanly your nervous system transmits signals."
The Pain Research — What the Evidence Now Shows
The pain-modulating evidence for omega-3 has strengthened significantly in recent years.
A 2024 network meta-analysis of 40 randomised controlled trials — involving over 6,600 participants — reported that high-dose EPA/DHA supplementation produced the greatest reductions in migraine frequency and severity among all prophylactic interventions evaluated. A follow-up 2025 randomised controlled trial found that daily supplementation with 2,000mg of EPA significantly reduced migraine headache days and attack frequency in patients with chronic migraine, with accompanying improvements in quality of life.
Beyond migraines, omega-3 fatty acids have demonstrated analgesic and anti-nociceptive effects — directly reducing pain signalling — in studies of chronic musculoskeletal pain, inflammatory joint conditions, and post-exercise recovery.
For the patients I see with recurring neck pain, mid-back tension, or lower back complaints, this is clinically relevant. Omega-3s don't replace structural care — but they reduce the inflammatory environment that makes pain more intense and more persistent, and they support the tissue recovery between appointments.
Fascia, Connective Tissue, and Recovery
Fascia — the connective tissue network that wraps every muscle, nerve, and organ in the body — is richly innervated and metabolically active. Research published in 2025 confirmed that fascia undergoes pathological changes in chronic pain conditions, including fibrosis, densification, and inflammatory activity. Patients with myofascial pain syndrome show tenderness on fascial palpation, imaging evidence of stiffness, and symptomatic improvement after fascia-focused therapies.
Omega-3s support the anti-inflammatory environment that keeps fascial tissue hydrated, pliable, and able to glide between tissue layers as it should. In a body with a chronically elevated omega-6:omega-3 ratio, the biochemical environment shifts toward the densification and inflammatory reactivity that drives fascial restriction.
This is one reason why patients whose diets are heavily processed — high in omega-6 from cooking oils and fried food — often present with denser, less responsive fascial tissue. Improving the ratio is one meaningful step toward improving tissue quality at a cellular level, complementing what myofascial release and chiropractic care can achieve manually.
You can read more about the fascial health and structural recovery picture in Why Your Body Takes Longer to Heal Than You Think and Vitamin C and Stress.
How This Connects to Chiropractic Care
Chiropractic adjustments work at the neurological and structural level — restoring movement, improving sensory input quality, and supporting the nervous system's capacity to regulate. But the cellular environment those adjustments work within matters enormously.
A nervous system built with adequate DHA is more neuroplastic — more capable of the adaptive reorganisation that care is trying to facilitate. An inflammatory environment modulated by good omega-3 status allows tissue to recover more efficiently between sessions. Fascial tissue that isn't locked in a chronically pro-inflammatory state responds more readily to manual work.
Omega-3 supplementation is not an alternative to chiropractic care. It's part of the nutritional foundation that allows care to work at its best.
Read more about the nutritional environment for healing in our posts on Magnesium, Vitamin C, and Vitamin D.
Getting Omega-3 Through Food
Marine sources — the most bioavailable:
Salmon — one of the richest EPA/DHA sources; farmed NZ salmon is widely available year-round
Sardines and anchovies — among the highest omega-3 concentrations per gram, affordable, and low in mercury due to their short lifespan
Mackerel — excellent omega-3 profile; more common in tinned form in NZ
Tuna — useful but lower in omega-3 than the above
Mussels — a NZ seafood staple with a meaningful omega-3 profile and a low environmental footprint
Aim for 2-3 servings of oily fish per week as a practical food-based target.
Plant-based sources — ALA:
Flaxseed (ground is more bioavailable than whole)
Chia seeds
Walnuts
Hemp seeds
These are valuable as part of a balanced diet, but the ALA they contain converts to EPA and DHA at rates too low for most people to rely on them as a primary omega-3 source. They are a useful complement — not a substitute for EPA and DHA.
A personal note — for those who don't eat fish:
As someone who lives vegetarian, I navigate this question myself. The solution I've come to — and that I suggest to patients who don't eat fish — is algae-based EPA and DHA.
Here's the thing: fish don't make omega-3 themselves. They accumulate it by eating marine algae and smaller marine organisms. The omega-3 originates in the algae. Algae-based EPA/DHA supplements go directly to that source — delivering the same long-chain fatty acids as fish oil, without the animal product, and with a lower environmental footprint.
Quality algae-based omega-3 supplements are now widely available in NZ health stores and online. They're the same molecules. The body doesn't know the difference.
Smart Supplementation — What to Look For
If you're supplementing, quality matters significantly. The omega-3 supplement market is large and variable.
What to look for:
Clear labelling of elemental EPA and DHA content — not just total fish oil or total omega-3 weight
A meaningful combined EPA+DHA dose — for general maintenance, 1,000–2,000 mg of combined EPA+DHA daily; for therapeutic purposes (pain, inflammation, mood), research typically uses 2,000–3,000 mg EPA+DHA
Triglyceride form rather than ethyl ester form — better absorbed, particularly with meals
Third-party tested for heavy metals (mercury, PCBs) — particularly important for fish-derived supplements
For algae-based: confirmed EPA and DHA content, not just DHA alone (many algae products are DHA-only)
EPA vs DHA ratios: For inflammation, pain, and mood support, a higher EPA:DHA ratio (e.g. 2:1 or 3:1 EPA:DHA) tends to be the preference. For brain health, cognitive support, and nervous system development, a more balanced or DHA-forward ratio may be preferable. Most quality combined supplements offer a roughly 2:1 EPA:DHA ratio, which covers both functions reasonably well.
Take with food: Omega-3 fatty acids are fat-soluble — absorption improves significantly when taken with a meal containing fat.
Address the other side of the ratio too: Supplementing omega-3 while maintaining a high omega-6 diet is a partial solution. Reducing vegetable oils (sunflower, canola, soy, corn), fried food, and ultra-processed snacks meaningfully improves the ratio alongside supplementation.
Frequently Asked Questions
Is there a test for omega-3 status? Yes — the omega-3 index test measures the percentage of EPA and DHA in red blood cell membranes, which reflects tissue status over the past 2-3 months. It's more informative than a serum fatty acid test, which reflects recent intake rather than tissue incorporation. The test isn't routinely offered by GPs in NZ but is available through some integrative health practitioners and private labs. An omega-3 index above 8% is generally considered a minimum target; above 11% is optimal.
Can I get enough omega-3 from flaxseed and chia seeds? For ALA, yes. For EPA and DHA — which are the forms the body uses for most of its critical functions including brain structure, inflammation modulation, and pain signalling — plant-based ALA sources convert too inefficiently in most people to meaningfully raise EPA and DHA status. If you don't eat fish, algae-based EPA+DHA supplements are the clinically meaningful solution.
How long does it take to notice a difference from omega-3 supplementation? Cell membranes turn over gradually — it takes approximately 3-4 months of consistent supplementation for tissue EPA and DHA levels to meaningfully change. Many people notice some improvement in joint comfort, skin quality, or mood within 4-8 weeks, but the full structural benefit (including neuronal membrane
composition) requires longer consistent intake.
Does omega-3 interact with medications? At high doses (above 3,000mg EPA+DHA daily), omega-3s have a mild blood-thinning effect. If you are on anticoagulant medications (warfarin, aspirin, or other blood thinners), discuss omega-3 supplementation with your GP before starting or increasing dose. At standard maintenance doses (1,000-2,000mg), this is generally not a clinical concern for most people.
Is there such a thing as too much omega-3? At very high doses over extended periods, there is some evidence of increased oxidative stress from omega-3 peroxidation. Quality supplements contain added vitamin E to address this. At the doses discussed above (up to 3,000mg EPA+DHA), adverse effects are rare in healthy adults. The more common error is taking too little rather than too much — many people take a fish oil capsule with only 300-400mg of actual EPA+DHA, which is far below any therapeutic dose.
The Bigger Picture
Omega-3 fatty acids sit at the intersection of inflammation, nervous system architecture, tissue recovery, mood, and cellular function. They are not a single-purpose supplement — they are foundational structural and signalling molecules that the body cannot manufacture on its own.
Getting the ratio right — reducing the omega-6 load while consistently providing adequate EPA and DHA — is one of the highest-leverage nutritional changes most people can make. It supports the anti-inflammatory environment in which healing occurs. It provides the building materials the nervous system needs to be neuroplastic and adaptive. And it complements the structural and neurological work of chiropractic care at the cellular level.
Alongside magnesium, vitamin D, and vitamin C, omega-3 completes the nutritional foundation we discuss at Handcrafted Chiropractic — the environment in which the body's own healing capacity can fully express itself.
Ready to Look at Your Whole Picture?
If you've been managing chronic inflammation, pain, slow recovery, or a nervous system that feels stuck — the nutritional environment may be part of what's missing.
At Handcrafted Chiropractic in Māngere, we work with people across South Auckland —
Māngere, Māngere Bridge, Ōtāhuhu, Māngere East — who are ready to address the root causes rather than manage symptoms indefinitely. ACC and WINZ welcome.
Want to understand how your nervous system is currently functioning? Take our free 2-minute Nervous System Quiz — a useful starting point.
Dr. Anupa Dharamsi is the founder and lead chiropractor at Handcrafted Chiropractic, a nervous-system-focused, trauma-informed practice in Māngere, Auckland. She works with patients to understand the whole nutritional and neurological picture behind their health — building genuine resilience from the inside out. ACC & WINZ welcome.
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