What do fish oil and cod liver oil have to do with acne, anyway?
In a nutshell, fish oil – or rather, omega-3 fatty acids – appears to help some people clear up their skin faster. This is because omega-3s reduce inflammation in a few different ways.
Sounds good, right?
Well, inflammation is a major contributor to acne, so it’s tempting to think it’s a good idea to start taking fish oil.
But before you go running to the store or your favorite retail website for a bottle, let me say this: although we used to recommend supplementing with fish oil, we advise against it now. 2017 update: Same with fermented cod liver oil! We longer recommend taking this either.
In fact, taking fish oil (or cod liver oil, or any other marine oil) may ultimately make your acne worse.
First, I’ll tell you how fish oil “works.”
Fish oil contains a large amount of omega-3 fatty acids, particularly EPA and DHA, which interact with omega-6 fatty acids to reduce or end your body’s inflammatory response.
When you have a really skewed omega-3:6 ratio in your diet – as in, way too much omega-6 and not enough omega-3 – your inflammation levels skyrocket.
And for some years now, people have been using large doses of fish oil to treat inflammation by balancing out those pesky omega-6s.
How does inflammation relate to acne? Well, It’s responsible for the redness and swelling that makes acne so embarrassing. Reduce inflammation, and your acne won’t swell up so much (or get so cherry-red).
Cod liver oil, which we used to recommend, works to heal acne mainly because it gives you a big boost of vitamin A, which is a critical vitamin for preventing acne breakouts.
Okay… so what are fish oil and cod liver oil, exactly?
Fish oil is basically oil that’s extracted from fish bodies, while cod liver oil is taken from the livers of codfish (or pollock, or something else… I’m looking at you, Green Pastures! False marketing alert!).
And like I said above, fish oil is a powerful source of omega-3s, and omega-3s have anti-inflammatory effects.
What’s the big deal with inflammation?
You see, these days, most of the common Western diet is highly inflammatory.
What does that mean, exactly?
Well, it means that most people are eating way too many foods loaded with omega-6 fats, sugar, trans fats, and gluten, all of which are pro-inflammatory.
These inflammatory foods drive your immune system to do insane things, like causing swelling where you least want it – arthritis, for example, and of course, acne.
When your immune system is on constant red alert, and it stumbles across a clogged pore on that lovely face of yours, it dives in for the attack! The clogged pore becomes inflamed, red, and swollen, leading to nasty-looking zit-monsters.
You see, if your immune system were healthy and normal, a clogged pore wouldn’t cause a big fuss. Your body would heal the ruptured pore pretty quickly and then go on functioning normally. No big deal! But when your body is in a constant state of hyper-immune-activation and inflammation, any little thing sets off your immune system – and that leads to disastrous consequences for your face.
How do omega-3s affect inflammation?
Before I get to that, let me explain a few things about the essential fatty acids: omega-3s and omega-6s. While there are many different fatty acids in the omega-3 and omega-6 families, only a couple are actually really useful and needed in the body. These are docosahexaenoic acid (DHA), an omega-3, and arachidonic acid (AA), an omega-6.
Arachidonic acid is critical to the initiation of an inflammatory response, which is why it gets a bad rap. However, AA also turns on the cellular machinery that activates DHA, which helps to bring that inflammatory response to an end.
Together, these two fatty acids are a part of an intricate chemical dance in the body that starts an inflammatory response when it’s needed and then stops it when it isn’t needed anymore.
(Another omega-3 found in fish and fish oils, eicosapentaenoic acid, or EPA, reduces inflammation mostly by interfering with AA… and therefore with the whole process of inflammation and its resolution. It can actually depress growth and immune function, which is why we’re not too excited about EPA.)
As you can see, omega-3 fats – namely DHA – have an incredibly powerful role in quickly resolving inflammation when it is no longer needed.
The key here is your ratio of these omega-3s to pro-inflammatory omega-6 fats. The rub is that if the inflammation-initiating omega-6 fats aren’t balanced by sufficient omega-3s, your immune system goes vigilante on you (boom! Faceful of acne). Even worse, though, is having a large overall load of PUFA. We really want to balance omega 3s and 6s close to a 1:1 ratio, while bringing down our overall consumption of them as much as possible.
Now, if you were eating like a hunter-gatherer of yesteryear – e.g. wild game (nose-to-tail eating), tubers, edible plants, a few legumes and grains here and there, a few berries, the odd beehive – you’d have an omega-3 to omega-6 ratio of around 1:1 (ideal, by some estimates).
But in this day and age, omega-6 fats are in everything – canola oil, safflower oil, vegetable oil, corn, soy, wheat – basically most of the JFBBs (Junk Food Building Blocks) in today’s fast-food world. Most cookies, crackers, snacks, breakfast cereals, and granola bars are made primarily with these JFBBs, which, again, are highly inflammatory.
That’s bad news for acne!
In short, you’ve got to optimize your omega 3:6 ratio if you want clear skin, as well as reducing your overall intake of PUFA.
This will help quiet your immune system down, taking it from red alert down to orange alert, yellow, maybe even just “Ready for action, we’re here when you need us!”
And that’s where you want it.
You want a perfectly functioning immune system that shoots into action when there’s a real problem in your body, not when you get a stinkin’ little clogged pore. And you want an immune system that quiets the heck down when the problem is solved, rather than sticking around for days, partying in your pores and creating red, swollen, painful acne. You’ve had enough of that, right?
So why shouldn’t I take fish oil?
The common wisdom goes like this: fish oil gives you a huge blast of omega-3s (EPA and DHA), which is good because it balances out your omega-6 intake, reducing inflammation.
That seems like a good idea on the surface.
However, I haven’t gotten to the nasty part yet: all omega-3 and omega-6 fatty acids are highly reactive in the body.
Why? Well, they’re polyunsaturated fats (PUFAs). In chem-speak, they contain two or more double bonds, which makes them billions of times more reactive than, say, saturated fat (grass-fed animal fat, coconut oil, red palm oil, etc.). And millions of times more reactive than monounsaturated fat (olive oil, avocados, etc).
Why is this potentially dangerous?
Health researcher Chris Masterjohn came up with a really apt metaphor for PUFAs – he compares them “delicate glass.”
Now, glass is incredibly useful in our modern world (can you imagine windows made from steel?). But glass is also extremely delicate – it shatters easily, fragmenting into a million pieces that spread far and wide across the floor, can cause all kinds of bodily harm, and can take a long time to clean up.
PUFAs are very similar. Like glass, they’re very useful for the body for some critical bodily functions, but they’re extremely delicate. When they “shatter” – i.e., when they get oxidized by a free radical – they set off chain reactions that oxidize other PUFAs, which oxidize still more PUFAs, which oxidize yet more PUFAs – it’s a gigantic, damaging ripple effect.
Worst part? These oxidized PUFAs (known as lipid peroxides) eventually break down into dangerous compounds like malondialdehyde (MDA), which can directly damage DNA and proteins throughout the body, causing widespread damage to all body systems (slowly, over time, so it’s insidious and difficult to see in the short term – acne breakouts can be a great early warning flag for PUFA overload, actually, which is better than getting heart disease or something else nasty down the road!).
Oxidative stress like this can damage just about every biological tissue in the body, and – yep, you guessed it – can worsen acne as well.
Wolfing down a bunch of fish oil might reduce inflammation / redness / swelling in the short term, but can create a potentially worse long-term problem of oxidative stress, as you start to deplete vitamin E, glutathione, iodine, and other lipid-peroxidation-blocking antioxidant systems in the body.
(And if you need any additional convincing, consider this: in the longest and one of the largest fish oil trials ever conducted, the heart disease patients taking fish oil had a 30% increase in heart-related death!)
Okay, so what should I do instead?
- Focus on getting your omega-6 intake as low as possible.
- Slightly increase your omega-3 by switching to grass-fed and pasture-raised meats (and raw, grass-fed dairy from heritage-breed animals, if tolerated).
Let’s go over these separately.
How to reduce your omega-6 intake
The main sources of omega-6 are:
- Sunflower oil
- Safflower oil
- Peanut/groundnut oil
- Cottonseed oil
- Soybean oil
- Corn oil
- Grapeseed oil
- Canola oil
- Deep fried foods (which contain large amounts of the above oils)
- Processed foods (which contain large amounts of the above oils)
- Walnut oil
- Flax oil
- ALL nuts and seeds, except macadamia nuts
And if you’re not convinced already, here’s a roundup of the key clear-skin benefits to improving your omega-3 to omega-6 ratio (by reducing omega-6 consumption):
Improving this fatty acid ratio can help…
- Reduce redness and puffiness of acne lesions.
- Moisturize your skin naturally, making your skin softer.
- Reduce stress, preventing excess acne-causing sebum production.
- Slow down skin cell over-production, keeping your pores open and free.
- Balance hormone production, making your skin less oily.
In addition to helping clear your skin, a healthier omega-3 to -6 ratio can also provide the following benefits:
- Reduced joint pain.
- Improved mood.  
- Improved brain performance. 
- Stronger hair.
- More energy.
- Improved cholesterol levels.
- Enhanced male fertility. 
- Fat loss.  
That’s a key theme in this blog – by targeting the root causes of acne, you’ll also become healthier, fitter, and more radiant. You’ll be giving your body clean, high-octane food that’s loaded with essential nutrients that perform millions of complex, tiny functions in the body and lead to an awesome, healthy, clear you.
Why you should NOT take fermented cod liver oil (FCLO)
We used to recommend taking FCLO due to the high retinol-form vitamin A content.
Pre-formed vitamin A especially is pretty difficult to get unless you’re regularly eating organ meats (e.g. liver), shellfish, large quantities of egg yolks, butter, other dairy, etc.
These fat-soluble vitamins are incredibly important to achieving clear skin. Did you know Retin-A and Accutane are actually forms of Vitamin A? That’s one reason why they can be so effective at clearing acne. Now, they’re extremely dangerous with lots of side effects, so I’d never recommend doing these treatments. But the Vitamin A you get from whole foods (like grass-fed liver, etc.) is quite safe in the context of adequate Vitamin D (I’ll get to that in a minute).
(As an aside for our veg-loving readers, vitamin A from animal sources, (retinol, e.g. from cod liver oil), is much more readily absorbed by the body than Vitamin A from vegetables (beta-carotene). Vitamin A from carrots, for example, is a lot more difficult for your body to work with, so even if you eat lots of carrots, you could still be deficient in retinol-based Vitamin A.)
As of 2017, we no longer recommend taking cod liver oil, fermented or not, due to the high PUFA content. We think it’s best to reduce your overall consumption of omega-fatty-acids (PUFA) as much as possible. When you switch to naturally-raised pastured meats, occasional seafood if available, etc., and avoid all vegetable oils and almost all nuts and seeds (except macadamias), you’ll be naturally balancing your omega 3:6 ratio while keeping your overall intake of PUFA as low as possible.
Wait! How do I get vitamin A then, if I can’t take cod liver oil?
Good question! Grass-fed liver, desiccated liver capsules, or a quality vitamin A supplement. Aim for 10,000-20,000 IU per day if you’re really struggling with acne, though it’s important to make sure you’re getting enough K2, D, and E as well. More details in our book – sorry this is so dang complicated! :/
- Do NOT take regular fish oil, period. It’s often rancid and increases lipid peroxidation in the body (BAD).
- Do NOT take cod liver oil, either, since it’s also basically pure PUFA, increasing lipid peroxidation (BAD for skin).
- Eat grass-fed liver, or take desiccated liver capsules, or take a quality vitamin A supplement to get adequate pre-formed vitamin A. More details and specifics in our book.
- Vitamin A is exremely important, but it’s just one of a wide range of players and triggers in the vicious acne cycle. A holistic diet- and lifestyle-based treatment for acne is really the only way to be free of it forever, in our experience (that’s what our book is all about!).
- Yes, we are a business. Yes, we do make money if you buy our book. That said, we try to do our best to over-deliver our end of the bargain – we think our complete book program is a small price to pay for the knowledge on how to clear up your acne for good! It takes a lot of time, research, and diligence to figure out what the root triggers of acne are, and come up with a holistic, easy-to-understand plan that fits a wide range of lifestyles for people all around the world. We’ve done our best to make this as easy and straightforward as possible, because we know how much of a soul-sucking pain acne can be!
- Inflammation. Wikipedia. http://en.wikipedia.org/wiki/Inflammation ^
- Masterjohn, Chris. Precious Yet Perilous. The Weston A. Price Foundation, 2010. ^
- Masterjohn, Chris. Precious Yet Perilous. The Weston A. Price Foundation, 2010. ^
- Freeman MP. Omega-3 fatty acids in major depressive disorder. J Clin Psychiatry. 2009;70 Suppl 5:7-11. Review. ^
- 44 Conklin SM, Manuck SB, Yao JK, Flory JD, Hibbeln JR, Muldoon MF. High omega-6 and low omega-3 fatty acids are associated with depressive symptoms and neuroticism. Psychosom Med. 2007 Dec;69(9):932-4. Epub 2007 Nov 8. ^
- Fontani G, Corradeschi F, Felici A, Alfatti F, Migliorini S, Lodi L. Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects. Eur J Clin Invest. 2005 Nov;35(11):691-9. ^
- Safarinejad MR, Hosseini SY, Dadkhah F, Asgari MA. Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men. Clin Nutr. 2010 Feb;29(1):100-5. Epub 2009 Aug 8. ^
- Couet C, Delarue J, Ritz P, Antoine JM, Lamisse F. Effect of dietary fish oil on body fat mass and basal fat oxidation in healthy adults. Int J Obes Relat Metab Disord. 1997 Aug;21(8):637-43. ^
- Chambrier C, Bastard JP, Rieusset J, Chevillotte E, Bonnefont-Rousselot D, Therond P, Hainque B, Riou JP, Laville M, Vidal H. Eicosapentaenoic acid induces mRNA expression of peroxisome proliferator-activated receptor gamma. Obes Res. 2002 Jun;10(6):518-25. ^