Fish Oil vs. Cod Liver Oil for Acne: A New Perspective

Sonia taking fermented cod liver oil for clear skin

Sonia demonstrates the joys of taking fermented cod liver oil for clear skin!

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? 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.

In fact, taking fish 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.

Not good!

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, on the other hand, works to heal acne mainly because it gives you a big boost of vitamins A and D, both of which are critical, acne-curing vitamins. While it also contains some omega-3s, the dosage is far smaller than what you’d get in a dose of fish oil. We do recommend taking fermented cod liver oil, which I’ll explain more later on.

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. Pretty simple.

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.[1]

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.)[2]

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).

Now, if you were eating like a hunter-gatherer of yesteryear – e.g. wild game, tubers, nuts, vegetables, 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 to -6 ratio if you want clear skin.

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.

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.

(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!)[3]

Okay, so what should I do instead?

Better solution?

  1. Focus on getting your omega-6 intake as low as possible.
  2. Slightly increase your omega-3 intake using fermented cod liver oil.

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

Here’s a more in-depth list of the omega-6 content of foods from 180 Degree Health: Omega-6 content in common foods.

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. [4]  [5]
  • Improved brain performance. [6]
  • Stronger hair.
  • More energy.
  • Improved cholesterol levels.
  • Enhanced male fertility. [7]
  • Fat loss. [8]  [9]

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 take fermented cod liver oil (FCLO)

There’s an exception to the “no fish oil” guideline – fermented cod liver oil. Why? Because as I indicated above, it’s an incredible source of fat-soluble vitamins like A and D. 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, and butter. (FCLO also contains DHA and EPA, but in smaller quantities since the daily dosage is smaller.)

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 fermented cod liver oil, 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.)

FCLO is oil naturally extracted from cod livers using a natural fermentation process, which – according to supplement company Green Pasture – helps to preserve these precious fat-soluble vitamins better than other methods involving heat.

The only company I know of that makes FCLO, currently, is Green Pasture.

We take the cinnamon tingle flavor – it’s pretty a-ok, actually – at 2 mL per day. If you’re really not up for tasting the stuff, you can buy it in capsule form, but you end up paying a lot more (you have to take about 4 capsules per day).  I’ve heard the chocolate gel is disgusting, but if anyone out there has actually tried it, let us know how you liked the taste.

You could also take their “fermented cod liver oil + butter oil blend,” which includes high-vitamin butter oil for an extra-big dose of the super-rare Vitamin K2, in a very biologically available form. However, if you suspect you might be dairy-sensitive, which many acne sufferers are, the straight FCLO is probably a better choice.

You can buy the FCLO directly from Green Pastures – shipping’s not free, but it’s the cheapest way at the time of this writing. (If you prefer to buy from Amazon, you can do that here.)

Important note if you take fermented cod liver oil

It’s important that you take Vitamin D as well, since it protects against Vitamin A toxicity. Cod liver oil has large amounts of Vitamin A, which are perfectly safe if you’re getting adequate Vitamin D, but can lead to Vitamin A toxicity if you’re deficient in Vitamin D.

See our Vitamin D article for dose recommendations.

Key Takeaways

  • Do NOT take regular fish oil, period. It’s often rancid and increases lipid peroxidation in the body (BAD).
  • Cod liver oil, however, especially fermented cod liver oil, can help acne by providing essential fat-soluble vitamins (A & D).
  • Cod liver oil is not a complete treatment for acne, because it doesn’t fix the root causes of acne.
  • Cod liver oil can be a helpful addition to a holistic diet- and lifestyle-based treatment for acne.
  • You need to fix your diet and lifestyle to really cure the root causes of acne (that’s what our book is all about!).

While cod liver oil can give you a great boost in skin-healthy fat-soluble vitamins, there’s even more you can do to kickstart your journey to clear skin.

If you’d like to be walked through the whole process of tweaking your diet for clear skin, we (Devin and Sonia) have written an e-book that does just that. It’s called Clear Skin Forever (a very original name, right?).

For this complete guide to taking an all-natural, diet-based approach to getting rid of acne and having clear skin for life (no kidding!), go here.

Sources (click to expand)

  1. Inflammation. Wikipedia ^
  2. Masterjohn, Chris. Precious Yet Perilous. The Weston A. Price Foundation, 2010. ^
  3. Masterjohn, Chris. Precious Yet Perilous. The Weston A. Price Foundation, 2010. ^
  4. Freeman MP. Omega-3 fatty acids in major depressive disorder. J Clin Psychiatry. 2009;70 Suppl 5:7-11. Review. ^
  5. 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. ^
  6. 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. ^
  7. 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. ^
  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. ^
  9. 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. ^

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    • Sonia Carlson says

      Hi Lisa, great question. It is possible that the very small amount of dairy hormones in the butter oil portion of the FCLO-butter oil blend could trigger acne in an extremely sensitive person. The high-vitamin butter oil component contains K2, an important vitamin that many people are lacking. However, if you’re at all concerned that you might be sensitive to the dairy, just take straight FCLO.

  1. Andre says

    I’m gonna get this fermented cod liver oil off Ebay, it’s $44 but i don’t care i wanna have a clear face again. I’m sure it’s worth a try.

    • Sonia Carlson says

      Haha, yep, it ain’t cheap… but we think it’s worth it for the health/acne benefits. And if you consider this in relation to how much most other acne treatments cost, the price doesn’t seem quite so steep!

      • Andre says

        I have a big question, should i go ahead and buy this stuff even though i have already bought Clearazene off Ebay just yesterday. Or should i first try out the Clearazene and if it doesn’t work to just buy the liver oil.?

        • Sonia Carlson says

          Clearazene is an herbal approach to treating acne, while fermented cod liver oil comes at acne from a whole other angle – providing vital, fat-soluble vitamins that are lacking in many people’s diets. As to what you should do, it’s up to you! If you think both have the potential to help you, take both for quickest results. If you really want to know what works and what doesn’t, try one for a month, then try the other for a month, and see which seems to work better. If you do this, be aware of the possibility of a carry-over effect on your skin in the second month that’s caused by what you took in the first month.

          Of course, I want to mention that all the liver-supporting herbs you can get (which, there are some in Clearazene) aren’t going to do a bit of good long-term if you have a diet and/or lifestyle that continues to tax the liver. Which is to say, no supplement is in itself likely to be a cure – we see them more as a crutch that can help ease your body’s transition to a healthier way of eating and living.

  2. Isabella says

    Hi! I take Evening Primrose Oil which is about 1500 mg plus a spoon with fish oil a day, is this bad and should I quit it?

    • Sonia Carlson says

      Hi Isabella! We don’t recommend evening primrose oil because of its high omega-6 content. However, if you are taking it for some other non-acne health reason and feel that it benefits you, then by all means keep taking it and instead focus on dialing in other diet and lifestyle factors, as touched on elsewhere on the blog and set out in detail in the book. As far as the fish oil, we suggest that folks take (fermented) cod liver oil instead, as discussed in the article above. If you are continuing to take the EPO, it might make sense to take a small quantity of fish oil to counteract those omega-6s with an equal amount of omega-3s. Keep your intake of fish oil to a single shy teaspoon per day, in this case.

      • Isabella says

        I only take EPO because I’ve heard it helps get rid of hormonal acne, but for me I feel like It has gotten worse and I’ve gotten a lot of breakouts between my eyebrows and forhead, maybe like 6 small whiteheads. I don’t know if it is my skin ”purging” or whatever because some people say it gets better after a while. So maybe I should quit taking it and only take cod liver oil and zinc? Earlier I have been on acne medication called roaccutane, therefore I feel bad when I still get breakouts… I don’t know why I get them other than when its due to hormonal changes.. What should I do?

        • Sonia Carlson says

          As far as supplementing with EPO, there is evidence that it can help – in fact there’s a brand-new study that just came out about GLA (the effective omega-6 in EPO) and EPA/DHA (omega-3s found in fish oil), and their effect on acne. Both reduced acne lesion count and severity to a similar degree. In that study, the participants taking GLA (in the form of borage oil) were taking almost 3x what you’re taking.

          However, instead of amping up your EPO intake, I’d suggest eliminating it altogether, taking cod liver oil and zinc, and then exploring some other options for dietary change on the blog.

          As to why you get breakouts – it’s almost certainly related to some things you’re eating, some things you’re not eating, and some other aspects of your life that could be more health-promoting. Have you seen the milk and acne article yet? For most people, acne is much, much more than just supplementing with this or that, so starting to look at the whole diet (as well as lifestyle factors) is important.

  3. ME says

    Per Devin’s previous recommendations I was taking fish oil, vitamin D and zinc daily. If i switch to cod liver oil, should I nix the vitamin D dosage as well?

    • Sonia Carlson says

      Good question – check your cod liver oil ingredients / label. Some brands add D3 to their product; if yours does, figure out how much you’re getting in a dose of oil, and then add vitamin D in the amount necessary to get your 5,000 IU per day. If D3 is not added, continue with the D supplement as before.

  4. Abhinav Vats says

    Nice post! Thanks for sharing.

    I am from India and do not have access to fermented cod liver oil. I am providing you with a link. Is this okay to take and how many pills a day would you recommend.

    the composition is given down in the page as well as here:

    Serving Size 1 Softgel Amount per Serving % Daily Value
    Vitamin A(From Cod Liver Oil)
    1250 IU
    Vitamin D(From Cod Liver Oil)
    135 IU
    Other Ingredients : Cod liver oil, gelatin, glycerin, purified water. Contains Fish (cod).
    How to use : As a dietary supplement, take one (1) to three (3) softgels daily, preferably with a meal.

    it mentions it has DHA but not EPA. which one is more necessay for healthy skin: EPA or DHA?

    • Sonia Carlson says

      Hi Abhinav,

      Those cod liver oil capsules look just fine. Regarding how many you should take, you’ll have to do the math – the recommended dose of FCLO/CLO is 2.5 grams per day, so if there’s any indication on the bottle of how much oil you’re getting with each pill, you should be able to figure it out! My guess is 2 or 3.

      Regarding DHA/EPA, I’ll first emphasize that these fatty acids are not the reason we recommend taking FCLO; rather, it’s for the fat-soluble vitamins. Furthermore, I’m not sure that either one is particularly important to skin health. However, according to some new research Devin has read recently, EPA is not in fact a necessary part of the diet after all… so one might argue that DHA is more important!

  5. curious says


    I was wondering what the fermentation process involves? Also, what does it do for the fish oil? If the omega-3 double bond gets oxidized, then the bond breaks and it’s no longer an omega-3 fatty acid right?

    • Sonia Carlson says

      Hi Curious! I don’t know what process is used to ferment the cod livers – that might be a question for Green Pasture or another producer! Fermentation was traditionally undertaken to naturally preserve foods – and thereby protect their nutrients better. Regarding the oxidation of omega-3s, I don’t know what happens to them in the fermentation process – but the omega-3s aren’t really why we recommend taking FCLO anyway! We suggest that you take it for the vitamins, particularly the good animal-based vitamin A. (Green Pasture does say that their FCLO contains DHA and EPA, which suggests that they come through the fermentation intact.)

  6. Andrew says

    Hey Devin,

    I’ve been following the 2000 of EPA which is 10g of fish oil because that is what it said in CSF. Just to be clear. Now I should totally eliminate fish oil and just take 1/2 tbs of that perfmented cod liver oil? What about krill oil?

    • Sonia Carlson says

      Hi Andrew – yes, we have changed our recommendation from fish oil (no longer recommended) to fermented cod liver oil. Krill oil, like fish oil, is primarily taken for the omega-3s, so we don’t suggest that, either.

  7. Girly says

    Hi! Great post!
    I have two questions:
    1) What dosage of FCLO do you recommend daily? And is it safe to take in the long run?

    2) Can I break open a fish oil capsule and apply the oil directly to my skin? Does that have any benefits??


    • Sonia Carlson says

      Thanks Girly!
      1) We take the dose recommended on the FCLO bottle, which is 1/2 teaspoon. FCLO is pretty dense stuff, so you don’t need a lot! To our knowledge, it is safe to take long-term.
      2) As far as applying fish oil directly to your skin, I don’t know that there would be any benefit in that. On top of which, your face would smell fishy! :) In general, our approach is that working from the inside out is the most effective way to cure acne, and anything you put on your skin is purely secondary, so it would be much better to take FCLO (not fish oil) internally.

  8. Mae says

    Hi Devin? I’m 20 now and having acne breakouts due to stress and genes. Currently, i just started eating Omega 3 fish oil 1200mg. I usually eat one pill a day even if the bottle said 3 times a day. Should I take 3 times a day? And will it help to lessen at least my acne scars if I eat the Omega 3?

    • Sonia Carlson says

      Hi Mae! We don’t actually recommend supplementing with fish oil anymore – see the post above, starting with the section “So What About Fish Oil?” I haven’t heard of fish oil helping with reducing scarring, either. What you say is probably important – you’re breaking out due in part to stress. For that, the best thing you can do is work on coping better with those things in your life that stress you out, and also to address other things your body perceives as stressors like poor diet and inadequate sleep. It’s always worth it to reduce stress levels and take better care of yourself, even when it seems like the hardest thing to do!

  9. emma says

    Hey devin,

    I read all your posts and I’m ready to have a new diet going. But is it okay to eat fast foods or acne- causing foods once in a while?
    And what fish oil brands do you recommend?

    • Sonia Carlson says

      Hey Emma! To answer your second question first – we don’t actually recommend taking fish oil anymore (see the second half of the post above). If you’re interested in taking fermented cod liver oil, which we do recommend, Green Pasture is a great brand. For your first question – that is a very individual thing. I personally am less acne-prone than Devin, for example, and so over the holidays I might eat just whatever for a day or two and not have big consequences. For Devin, he basically never goes off the diet, and that’s both because he knows that even the occasional “bad” food can cause breakouts for him, and because that’s something he really doesn’t want. Once you try the diet for awhile, it can be good to experiment with non-Devin-approved foods that you really want to eat to see if they cause you to break out (it’s best to reintroduce only one at a time, though, so your results are clearer). Ultimately, it’s all about finding the happy medium that gets you the best results AND has the right amount of flexibility / enjoyment for you… a balance you’ll get to feel out for yourself :). Good luck with all this! It takes a bit of time to perfect, but is really worth it.

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