Omega-3 test – omega-3 index & fatty acid analysis (capillary blood)

The omega-3 index states what percentage of all fatty acids consists of the long-chain omega-3 fatty acids EPA and DHA. It was originally defined in red blood cells, because these reflect intake over a longer period (PubMed 15208005). In observational studies, an index below 4% was associated with the highest and an index above 8% with the lowest risk of death from coronary heart disease (PubMed 15208005, PubMed 28511049).

Important for interpretation: this test measures in whole blood; the report shows the value as "Lc omega-3 index". Values from whole blood and from red blood cells are not directly comparable. The reference range of the laboratory that carried out the analysis is decisive. A low value shows a low supply of EPA and DHA but is not a diagnosis.

The omega-6/3 ratio relates the sum of omega-6 fatty acids to the sum of omega-3 fatty acids. Both groups compete for the same enzymes; they give rise to messenger substances with partly opposing effects on inflammation and blood vessels.

How meaningful the ratio is remains disputed: a review concludes that the ratio, both on theoretical and evidential grounds, is of little value and that metrics covering only EPA and DHA are more promising (PubMed 17045070). The ratio is therefore considered together with the omega-3 index.

Arachidonic acid (AA) is an omega-6 fatty acid from which the body forms, among other things, pro-inflammatory messenger substances; EPA gives rise to messengers with weaker or opposing effects. The report shows the ratio of the two fatty acids as "eicosanoid balance".

The ratio describes which precursors predominate in the blood – not whether inflammation is taking place in the body. Metrics based on individual fatty acids are assessed differently in research (PubMed 17045070); "silent inflammation" cannot be diagnosed from them.

The test measures the omega-3 fatty acids alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as well as their sum. EPA and DHA come mainly from oily fish and algae; ALA from plant oils such as linseed oil is converted to EPA and DHA in the body only to a small extent.

In the Framingham study, higher levels of EPA and DHA in red blood cells were associated with lower total mortality (PubMed 29559306). This is an association from an observational study, not evidence that a single value predicts health.

The report also lists saturated fatty acids (myristic, palmitic, stearic, arachidic and behenic acid), monounsaturated fatty acids (oleic, palmitoleic and nervonic acid) and omega-6 fatty acids (linoleic acid, gamma-linolenic acid, dihomo-gamma-linolenic acid, arachidonic acid), each with a sum. The profile mainly reflects the fat composition of the diet over recent weeks.

Individual values outside the reference range usually have no independent meaning on their own; they are discussed as part of the overall picture.

Omega-3 and omega-6 fatty acids are polyunsaturated fatty acids that the body cannot make itself and must therefore obtain from food. They are incorporated into cell membranes and give rise to messenger substances that influence, among other things, inflammatory reactions, blood vessels and blood clotting (PubMed 17045070).

You collect capillary blood from your fingertip at home and fill a capillary tube. In the laboratory, the fatty acids from whole blood are separated and determined individually by gas chromatography; from this the laboratory calculates the sums, the omega-3 index and the ratios.

Other providers often measure in red blood cells or from dried blood spots. Values from different laboratories and sample types can therefore only be compared to a limited extent.

The omega-3 index is well studied as a marker of EPA and DHA supply; the cut-offs of 4% and 8% come from observational studies on coronary heart disease (PubMed 28511049). Whether someone who raises their value actually becomes ill less often is not shown by these studies. The index is not part of standard diagnostics in medical guidelines on cardiovascular prevention (PubMed 31504418).

A test can show what the fatty acid composition in the blood looks like. Whether that matters for you belongs in a conversation.

Research describes the following associations with a low supply of omega-3 fatty acids, with varying strength of evidence:

• Cardiovascular disease: a low omega-3 index was associated in cohort studies with a higher risk of death from coronary heart disease – observed in studies (PubMed 28511049).
• Total mortality: higher in the Framingham study with lower EPA and DHA levels – observed in studies (PubMed 29559306).
• Dry, scaly skin: described with essential fatty acid deficiency, which occurs mainly with severe absorption disorders or artificial nutrition – rare (PubMed 31144371).
• Inflammatory diseases: the role of the omega-6 to omega-3 ratio is discussed but not established (PubMed 17045070).

Noticeable omega-3 deficiency is rare; a low index usually causes no complaints.

These are associations from studies and textbook knowledge, not causes in an individual person. A blood test cannot explain complaints and does not provide a diagnosis. Persistent complaints should first be assessed by a doctor.

With chest pain, shortness of breath, palpitations with dizziness or fainting, signs of paralysis or speech disorders, call the emergency number 112 immediately. With known cardiovascular disease, high blood lipids or heart attacks and strokes in the family, prevention belongs in medical care – a fatty acid test does not replace it.

If you take blood-thinning medication or have surgery coming up, discuss taking fish oil or omega-3 supplements with your doctor.

This page does not recommend supplements, diets or therapies. Whether a value means anything at all and which steps make sense depends on your overall situation: complaints, previous illnesses, medication and diet.

What makes sense for you belongs in a conversation with the ORY expert team or with your doctor or naturopath, for example from the ORY expert network. The results consultation is included in the price.

Do not take omega-3 supplements such as fish oil, algae oil or linseed oil capsules for 48 hours before sampling. No particularly fatty meal and no alcohol for 24 hours beforehand. Keep to your normal diet, without dieting or fasting directly before the test. Preferably collect the sample in the morning, before breakfast or 2 hours after it.

Fill in the request form with the date and time of sampling and stick the barcode on the tube. Warm your hand, disinfect the fingertip, prick the side of the tip, wipe away the first drop, fill the capillary tube up to the mark and close it immediately. Preferably send the sample from Monday to Thursday and do not store it in heat or sunlight.

Analysis usually takes 7–21 days from the arrival of the sample at the laboratory. As soon as your report is ready, we let you know. A results consultation with the ORY expert team is included in the price.

The omega-3/6 test costs €90 including VAT, shipping, return postage and results consultation.

Statutory health insurance in Germany generally does not cover fatty acid analyses you order yourself. With private insurance, reimbursement may be possible; how it works is described under "Reimbursement by private insurance".

The omega-3/6 test (€90) measures the fatty acid profile with the omega-3 index and ratios. Blood lipids such as LDL and HDL cholesterol, triglycerides and hs-CRP are measured by the OM Vital blood test (€205), vitamins by the basic vitamin check (€98.50).

Which scope makes sense for you can be clarified in the free initial consultation.