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The Risks of Fish Oil Supplements

It’s been a bad few years for fish oil, as I discuss in my video, Omega 3s, Prostate Cancer, and Atrial Fibrillation. Claims were crushed that the long-chain omega 3s in fish oil—EPA/DHA—would stop the progression of heart disease. Then, DHA was associated with increased risk of prostate cancer and “monumentally” failed to treat macular degeneration. This over-the-top rhetoric sounded a little suspicious, and, indeed, the paper was retracted because the author sells some rival supplement he failed to disclose, but he does have a point.

I covered the fish oil failure for heart disease in my Is Fish Oil Just Snake Oil? video. But, what about the increased cancer risk? Men with the highest circulating levels in their blood of the long-chain omega 3 fat DHA were found to be at higher risk for prostate cancer, though a subsequent compilation of all such studies suggested EPA, the other major long-chain omega 3 in fish and fish oil, may be more closely associated with increased cancer risk. Either way, these long-chain omega 3s have been promoted for prevention of heart disease and cancer. We now know, however, that not only does there appear to be no benefit for death, heart attack, or stroke, there may be an elevation in cancer risk. The general recommendations to increase the intake of these fats should consider its potential risks.

How could eating more fish or fish oil increase cancer risk? Well, there are some industrial pollutants, like PCBs, linked to increased prostate cancer risk, and the “primary source of exposure in the general population is believed to be through diet from fish, meat, and dairy products.” If you do a supermarket survey, the PCBs are highest in freshwater fish and lowest in plant-based foods. Vegans have been tested, and they were found to be significantly less polluted than omnivores of the PCB linked to prostate cancer.

However, the prostate cancer study was done in North America where people don’t eat a lot of fish, and indeed, even the group with the highest DHA levels weren’t that high. So, maybe the confounding factor was meat consumption in general, not just fish. Lower meat consumption may be a reason for the lower rates of prostate cancer in the lower DHA group, as the consumption of well-done meat is associated with an increased risk of prostate cancer, and intake should therefore be restricted.

We also used to think omega 3s could protect us from arrhythmias—abnormal heart rhythms, like atrial fibrillation. Millions suffer from the condition, which causes an irregular heartbeat and a higher risk of stroke and death, but fish and fish oil consumption does not appear effective for preventing it or treating it.

Other arrhythmias can be life-threatening and can cause sudden death. Despite initial encouraging results, more recent studies have not only failed to reduce sudden cardiac death with omega 3s, but have actually increased mortality in cardiac patients. For example, men with heart disease advised to eat more oily fish or supplied with fish oil capsules were found to have a higher risk of cardiac death, possibly because of the contaminants in fish, such as mercury. In either case, given the inconsistent benefits and the potential adverse effects, omega 3s must be prescribed with caution and generalized recommendations to increase fish intake or to take fish oil capsules need to be reconsidered.

I was as surprised as you to learn that fish oil doesn’t help with heart disease. Learn why in my Is Fish Oil Just Snake Oil? video. I do still recommend taking 250 mg daily of pollutant-free (yeast- or algae-derived) long-chain omega-3’s (EPA/DHA). 

In terms of PCB contamination, see Food Sources of PCB Chemical Pollutants and PCBs in Children’s Fish Oil Supplements. Our oceans and waterways have become humanity’s sewer—everything eventually flows into the sea. For discussion of all the other industrial contaminants that build up in the aquatic food chain, see:

For ways to decrease the risk of prostate cancer and slow its progression, see:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

155 responses to “The Risks of Fish Oil Supplements

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    1. Howdy Richard. The article (blog post) suggests that it’s the contaminants that come with the fish and fish oil that increase cancer risk. Algae oil is from algae grown in vats away from the pollution in the ocean and rivers causing the contamination.

      TLDR: You’re in the clear for also algae oil! And though EPA and DHA don’t provide cardiovascular benefits, if you do a search on this site you’ll see that they still provide a cognitive boost.

      1. The Blog post also says that there are increased risks for cancer in general and prostate cancer for men, with excess DHA/EPA levels. I watched the video on DHA/EPA on brain function, which recommends supplementation for Vegans. So the there seems to be a dichotomy here, with a plus for brain health and a negative for cancer risk. As others have requested, I would like to see this questions further addressed, specifically with regard to Algae based DHA/EPA, removing the confounding factor of potential contaminates in Fish Oil.


      2. Contaminants in fish oils from all sources, algae or fish carcasses, have a three fold origin: process related impurities, toxic oxidation products on in vitro exposure to oxygen and light during atorage and in vivo in the oxidant rich blood stream. Molecular distillation produces highly refined fish oil essentially odorless and tasteless. Oxidation is easily detected as yellowing, off odor and bitter taste. Fish oil is best stored in the freezer and taken along with 200-400 U alpha tocopherol and 500 mg ascorbate as oil and water soluble protective antioxidants. DHA is a major component in human brains, especially critical in infants which require DHA supplements or better yet DHA found naturally in breast milk. I suspect the contradictory medical reports may well have been caused by low quality fish oils and improper dosing. I personally prefer distilled codliver oil.

      1. Yes, I would love to see a blog or video addressing the risks vs benefits of using ‘purified’ fish oil products. What does that mean and what we should consider if using fish oil products. Also a discussion on the best methods for purification would be helpful.

        Also, a separate blog/video on the risks/benefits of using algae based DHA/EPA products.

        Thank you,

        1. Yes, I would love to see a blog or video addressing the risks vs benefits of using ‘purified’ fish oil products. What does that mean and what we should consider if using fish oil products. Also a discussion on the best methods for purification would be helpful.

          Also, a separate blog/video on the risks/benefits of using algae based DHA/EPA products.

          Thank you,

        2. I know when a was running 210 total cholesterol and was asked by my doctor to lower it I started taking purified fish oil it was reduced within 6 months to 165. This new information really bothers me.

      1. Hi, I would not recommend going cold turkey off of any pharmaceutical blood thinner…don’t want to cause a stroke from a rebound effect. However, our doctor recommends you use Nattokinase supplement to use as blood thinner instead, and it has worked well for me. AND, I am an AFib sufferer, but have done very well with Nattokinase, just like the Japanese do. I use the one from Vitacost, the SDK version, take 2,000 fu x 2/night on empty stomach. Works for me! My husband only takes 1, but I feel best on 2. When I took 3, I started bruising, so reduced to 2 caps. and feel very good on that…In fact, once I started taking that and Cholesteine from Body As Doctor, I could tell a noticeable difference in how I felt.

    2. All the Doctor is doing is reporting the latest best evidence. The science in these things follows the usual curve of lauding something to rafters, flogging loads of product on the back of the new health information, and then sure as apples are apples it becomes first difficult to replicate the benefits and then the evidence starts pointing to converse. What was supposed to be so good, often actually turns bad.

      All I can tell you is what I do. I go by what my own body seems to be telling me about whether it is happy with what I eat, and my conscience.

      1. What a wonderful talkative body you have, Gillian! I wish mine was like this. My body doesnt tell me anything about the vitamin D I need and even doesnt clear out excessive vitamin B12, so dosing that one is a huge challenge. My body doesnt even give me a slightest hint what levels of ALA conversion does it run on, so I am in the blind, having to take algae EPA and DHA supplements. In fact, my body is very happy. It is happy with absolutely everything I eat, so I became WFPB very very late in life. My body never said – no, stop eating butter! I remember it was salivating wildly and got all excited whenever I had it. It also always ordered a lot of cheese.

        As my body refuses to talk to me in the same way as yours talks to you and obviously plays tricks with me, I need to resort to science. Then I have to come here and see what dr. Greger thinks about it and we are both often left in a blind, as no sufficient science exists on certain topics. But we will follow closesly.

    3. RichardW–
      Brains need the long-chain omega3 fatty acids, and utilize them much faster than plant-based (non-fish / algae) substitutes. The long-chains typically are animal-sourced, which puts vegans in a difficult position.

      As others have commented, humans can convert short-chain omega3s to long-chain, but there is too much variation of conversion efficiency in the general population to establish a minimum dietary intake of the short-chain sources. We are left with guessing about proper short-chain intake, although individual blood testing offers a better guide.

      Clearly, the world needs a better way than fish and krill to provide the long-chain omega3 fatty acids everyone needs, and nutrition industry pioneers are thinking about the problem. Meanwhile, the flood of fish oil (principally, soy oil) rolling toward consumers cannot be an unalloyed blessing.

  1. I had eye-bleeds/blood vessels, and overall felt terrible after taking algae omega 3 supplements.
    I’m focusing on getting this stuff from real food for now.

    1. Hi Buzzy,
      I too have seen this as an RN where people tend to bruise and bleed more while on fish oil. I too bruised more easily on it and stopped it all together.

      1. It seems like something is going askew with the blood clotting factors perhaps? Anyone got any scientific feedback on this issue? Dr. Greger?

        A proud and healthy monthly supporter of

      2. Bobbi,
        Strange that I should find your comment on bruising and bleeding tendencies, just after discovering a small puddle of blood below my ankle, only minutes after scraping it against an object. Although I have “thin” skin, it is not supposed to be that easily injured.

        BTW– My clotting response is OK, but the idea is to reduce the number of bleeding cuts. I cannot wait to find a better long-chain alternative to fish oil.

    2. hi Buzzy, I too had similar bleeding problems with omega 3 supplements and refuse to take them. (the algae sourced ones are prohibitively expensive for me anyway). My dad suffered a brain hemorrahge and I don’t want to go there. With taking 1/2 daily baby aspirin and 1 tbsp ground flax I am bleeding and bruising still too much.

      1. Raw Garlic, cinnomin, ginger, onion vitamin E, are all blood thinners, and raw Garlic and cinnomin are, I believe, the most powerful. Sometimes it’s not just one thing but a but several things that cause issues.

        1. ty Liisa and David for your comments.. and yes, you are both right. The fact that I am eating whole foods, and using spices daily (1/2 tsp cumin can equal a baby aspirin) does make matters ‘worse ‘ in some ways. I have had heart surgery, and there is a protocol , baby aspirin being one of the requirements. The docs know about aspirin in plants, but they want a known quantity/potency. I am taking liberties by cutting the aspirin in half. Cinnamon, ginger, garlic, onion are all daily fare for me so I might take Deb’s suggestion and try reducing the aspirin further.
          Thanks again.

        1. I would suggest that you should not give advice regarding the use of ASA for secondary prevention in someone who has had cardiac surgery. WFPB diet prevents most CAD and reverses most CAD who are strict about their diet, lifestyle etc. Advice should be guarded unless you know a person’s full past medical history…. best left to patient and their doc.

          1. Please note that I asked a question and that I did not tell her what to do. My question was not intended as advice but rather to share.

            When I had cancer, I would have like to have had input about nutrition and I had absolutely none. When my father had cancer, I certainly would have liked to have heard about WFPB eating, but did I or did he in our circumstances? No. I know both of us would have changed our diet if we had known, but no one pointed it out to us.

  2. Omega-3s (Fish oil) Reduce Cardiac Death Risk: Study
    Results from the study that reviewed 14 randomized, controlled trials found that EPA and DHA omega-3 fatty acids reduced the risk of cardiac death. Omega-3s reduced the risk of cardiac death in people who had elevated triglycerides or LDL cholesterol.

    “One notable feature of EPA and DHA omega-3 supplementation is the low risk associated with its use,” Maki said. “Because of the low risk for adverse effects, even a modest benefit is clinically meaningful.” The American Heart Association recommends eating two servings of fish each week. Two servings supply 250-500 mg of EPA and DHA per day. In addition, the AHA also recommends 1 gram of EPA and DHA per day for those who have been diagnosed with heart disease. Fish oils can also be obtained from supplements, and can cost as little as $10 a month.

    1. ““People in the general population who are taking omega-3 fish oil supplements are taking them in the absence of scientific data that shows any benefit of the supplements in preventing heart attacks, stroke, heart failure or death for people who do not have a diagnosis of cardiovascular disease,” Siscovick said. Approximately 18.8 million U.S. adults reported taking omega-3 fish oil supplements in 2012. ”

      1. Hi, Tom … and the assumption that, hell, they do not harm, is precisely the assumption that needs looking at, otherwise all we are pointing up is people wasting their money. The big media push for fish consumption and fish oils came at a time of an alarming decline in fish consumption …. (alarming, that is, to the various vested interests.) Coincidence?
        There is an old adage that says… follow the money if you want to find out what something is really about.

  3. If fish oil has zero benefits that’s one thing. But to say its the contaminants, most fish oil supps are filtered and tested. reports on the analysis, they test for PCBs as well mercury.

  4. Subsequent to the use of Nordic Naturals Omegas all 6 of my chronic golf ailments have vanished. I am all improved with balance and memory. You can tell me this stuff will eventually grow a third arm out of my head and I won’t stop taking it!

    1. Schloomp, can you go into some detail of your 6 chronic golf ailments? What are they and how have they improved. I would be interested in what you are taking. Thank you.

      1. Right.
        1. Left calf pain for a few days, on and off every couple months for several yrs. Sometimes severe enough to make me take a knee on the green.
        2. Right calf…..same as above except less frequent.
        3. Outside of left foot sharp pain a few times per year for several years.
        4. Left tennis/golf elbow every few weeks for many years.
        5. Base of left thumb mild to moderate pain all year round for 3 years.
        6. This is the big one. Strained left rotator cuff for 2 years. It started out as severe pain and leveled off as moderate pain for 1.5 years. I tried PT, massage, and even accupuncture. Nothing put a dent in it!! After 2 months of Omegas, it’s gone! Has not returned and it’s been over a year. Numbers 1-5 have also been put to rest with no setbacks.
        I use the Nordic Natural Ultimate Omega (650 EPA – 450 DHA) daily. And the DHA Extra (410 EPA – 960 DHA) daily. I take more DHA because albeit at the ripe age of 93, my mom passed from Alzheimers, I’m hoping the DHA helps the brain as much as the EPA has helped with my pain. And I may be imagining things but, I feel as if my memory has received a boost, and my balance is better. Cheers!!

        1. Wow! Thank you for the feedback and taking the time to explain all that. I like to play golf too. My main concern is the Dupuytren’s nodules in my right hand. I’m desperate to find something to at least keep it from getting worse. Besides eating a container of Chobani yogurt once per day, and fish 1-2 times a week, (small portions) I am essentially on a plant-based diet.

          Does anyone know if there are issues with flaxseed oil capsules for EPA/DHA? Should I continue to take it with the Nordic Ultimate Omega?

          Thank you

          1. I second what Doc said. Flax oil would probably do squat for your pain. Although I DO put a heaping TBLSP of flax meal on my cereal 3 times / week. :)))

          2. Jack, As one of the volunteers for NFO, I wanted to respond to your question, You said you are eager to avoid the Dupuytren nodules from getting worse.Although nutrition isn’t recognized as a major cause of the nodules, as you can read in this research article
            inflammation is listed as a cause and we know high protein animal foods can promote inflammation, so that daily yogurt might be problematic. Could you make a switch and try soy yogurt? Of course carefully monitoring the contracture and working with a dr you trust to determine if and when surgery might be necessary is prudent, as this is a fairly standar treatment (removing nodules) if necessary.
            Others have already commented on the Flaxseed oil capsules.If you are taking flaxseed, why the oil capsules? AND other Omega supplements? The recommendation as NFO Director Kate Porigow (below) has mentioned stands “Dr. Greger still recommends DHA/EPA. More info is here:” Hope that helps.

        2. mkelman1 — Thank you for your post. Maybe I will give the Nordic omega 3’s a shot. Your testimony is really interesting. You are 93 and on the computer…your testimony is inspirational. Right now, I just eat plants just like the Apache Indians did for thousands of years. But, hey, if Omega 3’s did all that for you, it seems like the benefits out weigh the risks that Dr. Greger has pointed out.

    2. I second the vote for Nordic Naturals! It seems they are thoroughly tested and of the highest quality. I take the DHA / EPA supplement which I can usually get at the Vitamin Shoppe less than MSRP.

  5. Okay but Dr Greger what about krill oil capsules?organic ones?aren’t they supposed to be the crème de la crème as far as omega 3s are cocerned?
    Please i hope you or someone else bring some light on this for me as i’ve been an avid consumer of krill oil capsules lately and actually do feel great since taking them!

    1. Okay but Dr Greger what about krill oil capsules?organic ones?aren’t they supposed to be the crème de la crème as far as omega 3s are concerned?
      Please i hope you or someone else bring some light on this for me as i’ve been an avid consumer of krill oil capsules lately and actually do feel great since taking them!

  6. Yes. Confused
    Is it beneficial to continue algae based epa/dha per Dr Greger’s previous recommendation. What is his new recommendations for someone who follows his WFPB life style? My only supplements are B12, vit D and algae dha/epa in addition to my daily dozen.

    1. Same here.. WFPB NO added OIL diet. Addition of algae based omega 3 (DHA/EPA), B12 and Vitamin D. Should we continue the algae based supplement?

  7. We have to take into account the fact that animal proteins may be a cofactor for developing cancer, in addition to the presence of a carcinogen like arsenic, pesticides, mercury, PCBs, etc.

    Cf Campbell’s work about casein as a cofactor of aflatoxin for liver cancer in rats.

    1. We have to take into account the fact that animal proteins may be a cofactor for developing cancer, in addition to the presence of a mutagen like arsenic, pesticides, mercury, PCBs, etc or infectious virus.

      Cf Campbell’s work about casein as a cofactor of aflatoxin for liver cancer in rats.

      1. Absolutely!

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      2. That’s a good point.

        many people think that Campbell’s rat experiments showed that casein turned cancer on and off. However, there is no evidence to my knowledge that casein consumption alone causes cancer in humans. The only thing I was able to find (this was some years ago now) was a study that showed casein consumption was associated with prostate cancer progression

        1. On the other hand, if you go into any oncology ward and ask the patients hooked up to chemo about their diet you will struggle to find vegan WFPBs or at any rate, committed ones, not the people who take every weekend off (yes really, many people do the vegan WFPB thing during the week and then go for a blow out every weekend.) The truth is probably a lot starker than any of the studies ever suggest, and the pool of those who properly follow the ideal diet a lot smaller than it first appears.

          Everyone on this board…… who do you know has a degenerative illness? What is/was their diet like? Honestly, now.. what is your own diet really like (I don’t mean you Tom I know a superman when I see one).

        2. You have to bear in mind that Campbell was working on the problem of malnutrition in Philippines, and that at this time, it was suggested that protein deficiency is the main cause of malnutrition.

          So his studies involved rats in a situation of “protein deficiency”, that is, in a situation of malnutrition. And a malnourished rat inevitably has health hazards including highest sensibility to chemical contaminants, as showed by the studies.

          Nevertheless, protein deficiency is not the same as low protein diets. For rats, 5% proteins is a protein deficiency, but for humans, 5% proteins is a low protein diet that is considered an acceptable amount for our health. So it is not malnutrition for human beings.

          The change in strains of rats in Campbell’s work showed that within a same species (rats) there are different sensibilities to the variation of dietary protein levels, also considering that rats do need more proteins than human beings.

          The results were that rats fed with adequate amounts of proteins for their species protect themselves better from cancer initiation compared to malnourished rats, but also that high proteins diets stimulates cancer growth. So it indicates that a minimal amount of protein was needed for optimal health, and that high amounts are detrimental.

          In fact, as the human milk is composed of only 1% protein, compared to 11% in rat milk, and that plant foods have no less than 4% proteins, we can extrapolate that protein deficiency in human beings can not exist on whole foods plant based diet when the calories are met, while diets rich in proteins, particulary animal based proteins, may promote cancer growth.

          The cancer growth promoting effect was associated, according to Campbell’s studies, to the quantity AND the quality of the proteins. That is, animal based proteins (as complete proteins) were cancer promoting, as well, as plant proteins supplemented with their main limiting amino acids, like gluten + lysine.

          This would suggest that a low protein diet is protective against cancer and that high protein diets (either animal based meals or plant-based meals with complete amino-acid profiles) may promote cancer growth (without considering any other protective effects coming from other nutrients).

          To eat grains with legumes, is it really a good idea, then ?

          1. Thanks. Good points again.

            But to answer your last question, yes I think that eating grains and beans probably is a good idea from a cancer prevention perspective (taking gluten and lysine as isolated supplements may be another matter though). Whether this would constitute a high protein diet in any case, is moot. I understand that the US Institute of Medicine advises that protein should not exceed 35% of total calories (to avoid chronic disease)

            “People who regularly eat beans and whole grains are frequently spotlighted for increased longevity and lower chronic disease burden, including obesity, cardiovascular disease (CVD), type II diabetes, and CRC [6–11]. The Polyp Prevention Trial stated that an intake of over 39 grams of beans per day was associated with a 65% lower rate of recurrence of advanced colorectal adenomas [11]. Bobe et al. and Hangen and Bennink both reported lower incidences of colon carcinogenesis in mice or rats consuming NB [12, 13]. Eating brown rice once a week may reduce risk of colorectal polyps by 40% [14] and diets consisting of 30% RB fiber formulation had a preventive effect on adenomas in mice [15]. RB has also been shown to modulate the human stool microbiome and metabolome that may influence CRC outcomes [16]. The numerous studies and diverse chemopreventive mechanisms for RB bioactive compounds have been reviewed in [8, 15].”

            My understanding also is that methionine may be the key protein to restrict in order to reduce cancer risk and premature mortality generally, and even to treat cancer

            “We examined the specific inhibitory effects of amino acid deprivation on the metastatic phenotypes of the human triple-negative breast cancer (TNBC) cell lines MDA-MB-231 and Hs 578T, as well as the orthotopic 4T1 mouse TNBC tumor model. Among the 10 essential amino acids tested, methionine deprivation elicited the strongest inhibitory effects on the migration and invasion of these cancer cells. Methionine deprivation reduced the phosphorylation of focal adhesion kinase, as well as the activity and mRNA expression of matrix metalloproteinases MMP-2 and MMP-9, two major markers of metastasis, while increasing the mRNA expression of tissue inhibitor of metalloproteinase 1 in MDA-MB-231 cells. Furthermore, methionine restriction downregulated the metastasis-related factor urokinase plasminogen activatior and upregulated plasminogen activator inhibitor 1 mRNA expression. Animals on the methionine-deprived diet showed lower lung metastasis rates compared to mice on the control diet. Taken together, these results suggest that methionine restriction could provide a potential nutritional strategy for more effective cancer therapy.”


            1. I’m really wondering what ‘methionine restriction’ means in the context of a WFP diet. No matter how much I eat from 1900 to 2100 cals/d, I get from 76 to 90 grams protein including lots of methionine as well as all the other essential AAs. I do eat quite a lot of beans, nuts/seeds and whole grains but it’s hard for me to imagine anyone really significantly restricting methionine on a well-balanced WF diet.

  8. How about these studies?

    1. Fish-derived omega-3 best for” preventing” breast cancer –

    2. Weekly fish consumption linked to better sleep, higher IQ, study –

    3. Danish Study Links Fish Oil During Pregnancy With Lower Asthma Risk In Kids –

    4. New review bolsters evidence for benefits of fish oil –

    5. Fish Oil–Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring — NEJM –

    6. Rheumatoid arthritis: Regular fish intake may ease symptoms –

    7. Eating fish weekly raises IQ by almost 5 points in children, study finds –

    *”[This research] adds to the growing body of evidence showing that fish consumption has really positive health benefits and should be something more heavily advertised and promoted,” said Prof. Jennifer Pinto-Martinone, executive director of Penn’s Center for Public Health Initiatives and one of the team leaders.

    “Children should be introduced to it early on”. “It really has to be a concerted effort, especially in a culture where fish is not as commonly served or smelled. Children are sensitive to smell. If they’re not used to it, they may shy away from it.”

    1. >>”Children should be introduced to it early on”. “It really has to be a concerted effort, especially in a culture where fish is not as commonly served or smelled. Children are sensitive to smell. If they’re not used to it, they may shy away from it.”

      Found this kind of funny since in the US most fish smells because it is not fresh. My wife, who is from Japan, has commented on this many times.

    2. Interesting links thanks.

      However, in the first one they compared DHA/EPA from fish with the same amounts of ALA from plants. They did not compare DHA/EPA from fish with DHA/EPA from algal oil. Note also that this study was about breast cancer and the results from the Adventist health study indicate that “vegans”, by which they actually mean people who eat a completely vegetarian diet, have a much lower risk of breast cancer than pesco vegetarians. Consequently, I don’t think there’s a convincing argument for choosing to consume fish (oil) if breast cancer avoidance is the aim.

      As for the other links (and I didn’t have time to check them all out. sorry) one of the problems with such studies is the substitution factor. That is, are the reported benefits actually due to fish consumption or are they the result of eg eating less meat or cheese or refined carbohydrates or whatever.

      I’d certainly agree that eating carefully selected fish (or fish oil)i n place of meat, dairy and refined carbohydrates would deliver improvements. But whether that approach would be superior to a whole food plant-based diet is another discussion.

  9. Here is what fish oil has done for me. For years my ears would clog up with wax. Masses of wax on q-tips daily. Every six months or so both ears would be totally blocked. I would have to go into the doctor and have my ears vacumed out.

    While in Mexico 2 years ago, my ear doctor there suggested that 3-6-9 fish oil would fix the problem and it has. Something to do with an ear gland.

    I do not even use q-tips any more. Have not needed a cleaning since… and when I ran out of the oil, within 4 days my ears were producing wax again.

    I have switched to an oil primarily with 3. As my 6 was to high and i did not want to stop taking any oil. Maybe another oil would also work. Snake oil????

  10. Humans for millions of years lived successful lives without running down to the health food store to pay $29.95 for a bottle of Nordic Omega 3 fish capsules or algae capsules. Take the Apache Indians for example, they lived in the Arizona, and New Mexico deserts far, far, far away from the ocean. Their diet consisted of rattle snake, rabbit, deer, plants, and just about anything else that “moved”. Many of them lived to the age of 60 or even 70 years of age. Now how in the world did they do that without having a bottle of Nordic Omega 3 fish or algae oil with a load of DHA and EPA. How did they do that? Gawwwly, Shazam, Seargent Carter…how in the world did they do that?

      1. Grant, I think the Apache Indians were getting their omega 3’s from the chia seeds they consumed by the truck load. Sage plants grow all over the area of the Apache home, and these plants provide chia.

  11. I don’t have a dog in this fight, and just one anecdotal case does not a well-designed study make, but a relative of mine was having depression refractory to counseling and antidepressants, but with the addition of about 1000 mg (?) of a high-EPA fish oil his symptoms markedly improved. I recommended to him that he should switch over to a supplement recommended by so as to avoid (or at least minimize) the heavy metal problem.

    1. Barry, yes, Omega 3 is said to be effective for depression. I have read many articles on that.

      Wonder if the vegan version would help the same way.

      B3 is also supposed to be good for depression.

      I read that Bill W. from Alcoholics Anonymous had switched his focus to B3 by the end of his life, because of how it helped Alcoholics with mental health issues.

      1. Hi Deb … B3 is niacin, correct? I’ve read anecdotal reports of it helping various mental disorders such as schizophrenia, but have not seen actual medical studies regarding this (though they may be out there). The guy I referenced in my original post just happened to be on high-dose, immediate-release niacin for his high lipids; he had previously experienced an adverse reaction to Zocor so his doc put him on the niacin. He had already been on that for a few years when he began struggling with depression. So, at least in his case, niacin was not a help.

        1. Many years ago, I used niacin for cholesterol reduction purposes – the sustained release version. However, it appeared to cause liver problems which resolved when I ceased supplementing with niacin.

          “Niacin can cause mild-to-moderate serum aminotransferase elevations and high doses and certain formulations of niacin have been linked to clinically apparent, acute liver injury which can be severe as well as fatal.”

          I’d suggest caution if considering niacin use.

          1. Thank you Tom for that “heads up” on niacin. I also have experimented with niacin off and on in the past. I have no idea if it hurt my liver or not.
            Presently, I am eating raw Indian Gooseberries twice a day to lower my cholesterol. The last time I checked it was 160 for total cholesterol.
            But, I want to get it below 150.

          2. True dat, Tom! As I understand, liver abnormalities or damage  are more common with the sustained-release form than the immediate-release variety, but for folks on niacin — either form — close monitoring by a physician is pretty much mandatory, I would think.

  12. While some important points are raised here, it is a mixed bag like much of Greger’s stuff. For one, some of the main omega-3 studies cited are based upon single readings taken at baseline. This tells you nothing about what happened over the subsequent years and is simply not a reliable means of determining causation. At best it can generate hypotheses. I looked at one of these studies in detail a year or two ago and it had so many questionable methods that I eventually decided it was worthless for providing any guidance. This is not to say that another study may not make a better case, but it does reduce the strength of the argument.

    Further, there is the same word confusion we see in so many nutrition studies. While Greger does make the point that it may be due to contaminants in the fish, his switching between “fish oil” and “omega-3s” as though the terms were synonymous confuses the issue. We see the same thing with studies of “high fat” diets that almost invariably upon investigation are actually testing high SATURATED fat diets. The terms are NOT synonymous. Clarity in terminology is needed.

    What I know is that after about 30 years as a vegan I found my memory greatly improved and the clearing of years of brain fog within months of starting an algal omega-3 supplement. I still support a vegan diet and remain over 99% vegan myself, but I tell everyone who asks that they need to take an omega-3 supplement. Greger is singularly obsessed with heart disease issues and this is understandable since it remains our top killer. However, there are other health benefits to consider and my guess is that many of the readers of this site really don’t have any concerns with heart disease. For me, any such purported benefits of omega-3s are of little interest. In fact, if anything I want to raise my cholesterol – the result of a drug side effect but one that is made more difficult by my diet.

  13. I am also confused. Dr Greger should come out with a definitive opinion on on whether algae based EPA/DHA is beneficial or based on this blog should be avoided.

      1. I don’t read any sentence above that says that Dr. Greger is against Vegan sources. He is for Vegan sources is what he has said.

        I am not understanding that is what this is about at all.

        Steven, you are acting like he is against vegan sources and that is not what I have read on this site at all.

        1. Sorry if I came off sounding too strong, but there is no clear endorsement of vegan omega-3 here and the confusing use of terminology clouds the issue. I think he has largely endorsed it in the past but the conflation of omega-3 and fish oil is confusing as several posts on this thread demonstrate. That said, I hope the take away for most here will be to avoid fish oil and look at algal sources. BTW, I know non-vegetarians who use algal supplements simply because they don’t like the fish burps they get from fish oil.

          1. Steven, thank you for your comment. I am sorry if I responded strongly to it.

            You are right. He didn’t mention it above and I do value that people here do look at the studies.

            That is a valuable contribution to this site and I welcome people like you who will do that process.

            1. Recommends in WHAT FORM, Please be more specific in your post. Marine Algae Based DHA/EPA? Thank you. This post has created a lot of anxiety clearly!!!!

              1. I’ve also been a bit bewildered & frustrated with the lack of a mention of the algae-based DHA-EPA supplements Dr. Greger’s recommended in the past in his latest pieces warning about fish-oil based supplements, the conflation of the two, & Kate’s response. A simple “but I continue to recommend algae-based DHA/EPA supplements for brain health, as there’s no evidence they increase cancer risk or harm the heart” would have provided important clarity (and maybe new info for new readers), if indeed there are no such concerns with it (other than cautions about any Omega-3 supplementation for people on blood thinners) as I assume from this and other articles. At any rate, he still recommends the algae supplement in “How Not to Die,” which was just published a few months ago, and since he clearly is NOT advocating fish-sourced DHA/EPA, the only DHA/EPA Kate could be talking about in her answer would be the algal variety.
                If it helps, neurologists & researchers Drs. Dean & Ayesha Sherzai also recommend algal DHA/EPA supplementation in their new book, “The Alzheimer’s Solution,” as does Dr. Joel Fuhrman ( – all recommending against fish and fish oil-derived DHA/EPA.
                We are continuing to take the recommended dose of algal DHA/EPA until we hear otherwise from trusted sources citing trusted studies.

        2. I like that Dr. Greger is posting these topics and I would want them posted even if some of the studies are weaker, because most people are still being told to take fish oil. Most of the people around me are being told to take fish oil by their doctor.

          I appreciate that he gathered all of this information together.

          Steven, I appreciate your insights into specific studies, but I do not agree that Dr Greger is overly focused on heart disease. I have only been here a few months, but I have seen so many videos on Cancer and which foods are healthier and a whole range of topics.

          I am going to honor him for what he is doing right now, because I feel like you have something against him and he isn’t the one who ran that study.

          Most of the people around me are on fish oil. Not vegan sources.

          They don’t even know that there are vegan sources.

          Most of them have never once heard that there is a toxicity or effectiveness issue at all.

          I wouldn’t have, if I hadn’t come to sites like his.

          I went on regular fish oil, when I was trying to sort out my brain issues and it is Dr. Greger posting things like this that switched me, so I am going to defend him putting this information up in the form it is.

  14. I experienced complete resolution of PAC’s with the addition of flax seed oil to my dietary habits after getting an introduction to Udo Erasmus’s book on the benefits and need for EFA’s. At the time I was a 20-30 mile per week runner with no medical history, a coffee drinker, in a high stress work environment, and I attribute the resolution of this admittedly mild dysrhythmia to my consumption of flax seed oil and its inherent fatty acid ratios.

    This was back in 1991.

    As of that date I have had maybe 2 breakthrough episodes of PAC’s or PAC-like sensations, and when I do experience these, it is an indication to resume my consumption of EFA’s as it generally occurs when I have neglected the habitual consumption of flax oil or other sources.

    Understand that the confounders will always be medication of any kind, especially statins, a sedentary lifestyle, and an omnivorous diet. These factor may limit the efficacy of EFA’s by alterations of their uptake/metabolism.

  15. Two more things to consider against high Omega 3 fish oil:

    1 The omega 3 fatty acids oxidize fast. This causes the fat in the brain to create reactive oxygen species and cause premature aging specially on the brain. To find more about this topic

    2 High fat diets (fish) increase HDAC3. This enzyme packs the DNA too hard and makes it non flexible with age (long term). This in turn makes it difficult to read DNA and creates an accumulation of problems (lower memory, etc)

    1. Panchito,
      Do you have a source for ” High fat diets (fish) increase HDAC3.”.? It’s not mentioned in your 2nd link. The only study I could find in a quick search was on mice, and it did not show much of any increase in HDAC3 on a high fat diet (sufficient to cause obesity). Fasting, unlike the weight-increasing high fat diet did significantly increase production of HDAC3. But fasting, at least in mice, has been shown to increase their health and lifespan.

  16. One of the earliest, most memorable NutritionFacts videos for me was about the finding that, while vegetarians and vegans have better health markers than others, they do not live longer, and the reason suggested by Dr. Greger was Omega 3 and vitamin B-12 deficiencies. Adequate amounts of either nutrient would be unlikely unless actively and knowledgeably sought out. Of course, non-animal sources of both were recommended. I trust that, not-withstanding the findings reported in this article, this is still believed to be true, that adequate amounts of Omega 3’s and vitamin B-12 from plant/fungal sources are essential for good health and longevity.

    1. Steve,

      I think it’s more like vegetarians and vegans were eating added oils full of Omega 6s which was throwing the Omega 3s balance off. If you do not eat added oils then supplementation is probably unnecessary. I know Dr. Greger recommends supplementing with omega-3 because of a study showing prevention of brain shrinkage, but meditation has also shown the same thing.

      1. David, I think there are two issues here. You address one, the abundance of omega 6’s in vegetarian diets. While you don’t state it explicitly, you probably know that the nutritional challenge is both 1) adequate amounts of omega 3’s and 2) a reasonable balance of omega 3’s and 6’s. You are right that most plant-based sources of omega fatty acids are high in omega 6s and low or absent in omega 3’s. I think the bigger problem is that, unless one is aware of which plants have decent amounts of omega 3’s (flax, soy, walnuts, canola, hemp, chia and that’s about it) and you include them in your daily diet, you are very unlikely to get enough. (And, of course, best from whole foods rather than oils.)

        1. There’s another list here of plant omega 3 sources

          I understand also that purslane is quite high in omega 3 and I have seen it argued that one of the reasons the traditional Mediterranean diet was associated with good health was the inclusion of significant amounts of wild-picked purslane.

          Qf course, most of these are ALA omega 3s rather than EPA or DHA so the conversion efficiency is an issue.

  17. How about the possible effects on the brain, cognition, and depression?

    My father has mild cognitive impairment which may progress to Alzheimer’s. The recent book The End of Alzheimer’s by Dr. Dale Bredesen suggests fish oil may be beneficial.

    Any thoughts?

    P.S. – My father is not a vegetarian and never will be so that is not an option. :-)

  18. Dr. Gregor,
    There is a drug made from a highly purified form of EPA that has lowered triglycerides without elevating bad cholesterol. They’re completing an outcome study pairing the drug with a statin to see if it lowers heart attacks, strokes and deaths. I understand that its a random and double blind study and involves thousands of people over 4 years in Europe and North America. I think the study is called Reduce it. Do you know anything about it?

  19. >>but meditation has also shown the same thing.
    But it has never been shown that any brain benefits of meditation could offset brain deficits from a chronic lack of EPA/DHA. Men, in general, convert ALA to EPA less efficiently. People differ in terms of genetic ability to convert ALA. But it’s true, as you said, that many/most vegans/ vegetarians have their O6: O3 ratios out of whack and this is known to reduce conversion deficiency. It’s a tricky subject.

  20. Some point to issues with nuclear power plant exhaust and waste. Many don’t know to test for the waste and don’t even know how to test for it. Some say though to put a unexposed piece of photographic paper over the food stuff leave it in the dark , of course, let it sit that way for a couple of days. If the photo paper when developed shows spots of light then there is nuclear waste involved. It’s difficult to even get involved with the nuclear effects issues and still don’t need to be a test case of what it would,could, or might do to me. Just saying.

  21. So here you have it, cut out animal flesh- all of it. Don’t then reduct it to its constituent parts and try to filter out some essence of animal that is nonetheless good… even necessary for human health! Eating animals is bad for us, physically, mentally, emotionally and spiritually.

    Maybe it was not so bad when people ran around spearing food in order to avoid starvation, but animals in the modern industrial food chain are just about the most toxic thing you can consume unwittingly. Most animal flesh and especially fish and fish oil, is rancid, and worse, it is treated to conceal that fact. It is called masking ‘off odours’. Really.

    We vegans can just walk away from this feast of lies and poisons, grateful we do not have to even think about chowing down some weird vegan version of some constituent part of a dead animal. Poor animals. How could anyone seriously believe that animals could be so badly treated in modern farming/fishing and yet remain good to eat?

    And hey, you do not need to munch on inedible materials that animals eat to get some benefit you are missing by not eating animals. Bye bye algae and prairie grass…. or whatever.

      1. Hi, JJ. I eat the full range of whole grains and buckwheat, quinoa and amaranth and rice, brown and white, to which I add variously cooked vegetables and pickles and chutneys and casseroles of veg and beans- all the different beans, especially as curries and dals, because I like spicy food. I eat fruit and make my own granola which I have with home made milk oat- coconut- nut, rice or I compress it into bars. I try to eat nuts whole and sparingly not because of the fat content but just because they do not seem to meant to be eaten in bulk. A few brazils say, with a few pieces of dark chocolate- the sort that is just cocoa butter and cane sugar. I eat avocado and tomato and aubergines very occasionally and even more rarely white potatoes. this is because I have never been able to shift the feeling that the nightshades are not good as a regular part of the diet. Sweet potato is fine. I eat pasta and noodles very occasionally but they feel like junk and I prefer to eat the whole grains.
        I eat tofu occasionally although I always treat soya warily, and seaweed because I love it. I have a pressure cooker which helps hugely in the cooking of all this stuff. Variety is not a problem and I do not miss animal products or processed food and I never eat from the vegan junk aisles. I used to not eat like this and I had stomach problems all my life until I finally wised up.

          1. Thanks, John. I so agree with you on the issue of what people are really actually eating, because so often all we know is what they abjure. We have no idea what they actually do consume (and imbibe… and their prescription and recreational meds) and there is such a world of difference between heathy and awful vegan/vegetarian diets.

            So for the sake of completeness, I do not drink alcohol or take any prescription meds or recreational meds. I occasionally take an over the counter thing for a passing issue but if it doesn’t work in days, I stop that and look for some other solution. I do not regularly take any supplements- none.

            I do not smoke, needless to say. I do drink coffee more than modestly! I am older than 60, neither over nor underweight. I walk everyday sometimes long walks because I love walking. I like to get out amongst the trees. I still work, although from home. I never eat out or buy take aways or fall for the nonsense about ‘treating’ myself as I am no longer an infant to be coddled into bad habits. I have managed to leave behind an incredibly toxic upbringing.That’s about it.

            It is no exaggeration to say that in my case this lifestyle, all of it, all its restrictions as well as inputs, have not just saved my life but improved it beyond my wildest dreams. That is why I come on this board so long as it will have me (I know profiling the ethical element is strictly beyond its TsOR), to share what has brought me such good fortune and express some gratitude. Long may it last, for all of us.

    1. Absolutely, I get so sick and tired of all the arguments and reductionist disagreements regarding the particulars of Dr.Greger’s recommendations.

      Eat plants. Be kind to all. Life is sacred.

      The entire culture is steeped in this barely veiled civility toward people and all our ravaging blood thirstiness is directed toward the creatures that have co-evolved to help sustain this crumbling world.

      And we’ve been compulsively conditioned to eat them with greater and greater frequency.

      1. I agree with you. The earth would be much better if humans would stop killing all of the whales, tuna, elephants, and so on. Humans are causing extinctions to occur and if we loose to many of our furry friends the ecological cycles will be impaired and in the end might make life impossible for humans.

  22. Bottom line is that essential fatty acids are essential and older people don’t covert omega 3 precursors to EPA/DHA. So unless these facts are wrong…..

      1. Did you read the study?

        “Studies generally agree that whole body conversion of 18:3n-3 to 22:6n-3 is below 5% in humans, and depends on the concentration of n-6 fatty acids and long chain polyunsaturated fatty acids in the diet.”

        The conversion isn’t zero but it gets worse with age and there are confounding factors.

        1. Conversion rates differ based on genetics, gender and age (at least for postmenopausal women). I have not been able to find a source showing that rates drop necessarily for older men, but in general it seems likely because of reduced ability to absorb cofactors like B6, B3. According to the Linus Pauling Institute, conversion rates for healthy young women are: ALA to EPA 8 to 20%, EPA to DHA ~8%; for healthy young men, 1 to 9% EPA, 0 to 9% DHA. Because of these factors, EPA and DHA can be considered ‘conditionally essential’. Conclusion for those not eating fish, although healthy young women might get by without supplementation, others should as Dr. Greger and Dr. Fuhrman (and I think, Dr. Klaper) recommend. But I’m pretty sure Tom also already knows this.

          1. “Because of these factors, EPA and DHA can be considered ‘conditionally essential’.”

            Agreed. That is the bottlom line which is not controversial which was my only point.

  23. The 2nd paragraph of this article appears to contradict Dr. Greger’s recommendation to take supplemental (algae-derived) DHA/EPA. We need clarification! Thank you, Douglas Hoffman, M.D.

    1. Douglas,
      Dr. G still recommends algae-derived DHA/EPA for “brain health.” The following video references a study using algae-derived omega 3 and found it minimized age related brain atrophy.

      The heart and cancer studies referenced here used fish oil. The contamination of fish oils was likely a confounding factor. I hope this provides some clarification based on the evidence we have at this point in time.

  24. glad to see that Gillian23 brought up the moral and ethical aspects which so often get ignored. add in the horrendous environmental devastation inherent in ALL forms of raising and killing animals for food and it is a no brainer as to what the only true solution is to many of the most critical problems humans have made for ourselves and everyone else with whom we share this planet.

    btw, there is going to be a new documentary coming out this year called “Seaspiracy” which was not created by Kip & Keegan but they have become involved with it’s production.

    also, please check out this website for a ton of info on the subject of fishes:

  25. Hello there, can someone tell me are there any fish oil replacer? Fish oil is also for vitamin E and i badly need vitamin E… Are there any replacer for vitamin E? Please help me.

    1. Hesha,
      DEVA Nutrition is a vegan supplement company; they have a vitamin e product. However, if you are eating WFPB including seeds and nuts you are getting a significant amount of vitamin e.

  26. I am laughing reading all these comments, because I think it is official that this one confused people by not including Dr. Greger’s position on the topic.

  27. Hello,
    Regarding fish oil and its contaminants, I would like to see results of people taking krill oil, because krill oil should have less contaminants because of the short life span of krill.

  28. All I can say is.. let’s put it to the test is highly floored. The validity of omega 3 benefits were published in countless papers. Were they all flawed? If so… how can you believe research papers full stop. Next they’ll say vit E doesn’t help the heart.

  29. I would greatly appreciate knowing which is the most effective for CHD, a high quality fish based EPA/DHA such as produced by Nordic Naturals, OR the algae-based, preferred by WFPB practitioners (and preferred for alzheimers prevention). Leaving all other considerations aside, if you will please. Thank you for your opinion.

  30. I have been advising people against taking fish oil supplements for years. It is gratifying to have solid evidence to back up my position. Unfortunately, most doctors will continue to recommend fish oil supplementation since, as a group, they are very resistant to change. In fact, at a class about supplements given by a doctor, he suggested just that. I asked him about the evidence that showed no benefit with respect to reducing the incidence of cardiac events. He responded that even if that were the case, he would still recommend it for its anti-inflammatory benefits. He added, “Why would you not want to take a fish oil supplement?” I simply responded, “I don’t want to kill fish.”

    1. I have never found a supplement worth taking. At best you notice no benefit and more often than not, the stuff actually makes you ill. I suspect that the whole inflammatory-anti-inflammatory thing is based on a faulty model, and that will become apparent in due course. Sometimes you just have to be patient and wait for the science to catch up with the intuition.
      Dr Greger pointed this up in relation to certain supplements taken in the third trimester, ante natal, but treated that as a special case. Eating across the range of whole foods excluding only those that are  animal based, seems to be the way to go.  By the by, I have encountered this myself and had others confirm it- that supplementing with B vits can be quite acutely sick making.  Ditto so called ‘nutritional’ yeast. WFPB should mean just that, not WFPB plus all sorts of weird highly processed props without which WE WILL DIE!  We won’t, although there is a lot of other stuff that will do us in, alcohol, prescription meds… endless invasive tests……

      1. You are exactly right. I have never felt any improvement from taking supplements. But, I have felt tremendous improvement from eating a strict whole plant spartan food diet.

  31. Here is Dr Sears reply to a question about the these studies. Basically the studies showing no benefit are done with such low levels that you would not expect to see any. Dr Sears has referred to most commercial fish oil as “sewage of the sea” for good reason. If it isn’t IFOS tested DON’T BUY IT.

    Q. The New York Times Recently Published an article that fish oil doesn’t protect against heart disease. What are your thoughts on this?

    A. This article was based upon a meta-analysis looking at various studies using fish oil and markers of heart disease. The highest dose of fish oil used in any of these trials was 1,800 mg of EPA and DHA per day, with the majority using around 400 mg of EPA and DHA per day. What this study showed is that when you don’t give therapeutic levels of fish oil, you won’t see the benefits. You will see no effects on the resolution of inflammation, a driver of heart disease, until you reach about 5,000 mg of EPA and DHA per day.

    1. And if you ramp up the dose you create a risk of toxicity eg with vitamin D but people have poisoned themselves with heavy metals as well. Unless you are going to run your own lab and test every product personally this is a processed product the contents of which you can only guess at. You can create all sorts of snap shot bodily changes with a high dose of anything- until the body readjusts and the old problems restore themselves which is why people find these thing stop working or start doing bad things. There really is no solution to a  WFPB diet full of stuff your body recognises as food and and that you can reasonably rely upon to be what it says it is.  You would not include animal products in this diet because the flesh is generally rancid and the fats contains so many poisons now, it is amazing they do not make people sicker than they do. And that sick we know about is bad enough.

  32. Ii’d suggest you review this comment Dr. Greger made on krill and share it with your husband:
    Remember krill is made from animals and we’re talking OIL here, both of which pose health hazards. If your husband is taking the krill oil supplements for the Omega-3 benefit, Dr. Greger recommends: taking 250 mg daily of pollutant-free (yeast- or algae-derived) long-chain omega-3’s (EPA/DHA) as seen here:
    Hope that helps

  33. I believe quality cod liver oils are worth their weight in gold. There are very few brands that I would trust and most are rancid. However, I’ve found the omega 3 profile and k2 content is extremly beneficial to the body. Its anti inflammatory properties are also unmatched in my opinion when compared to any other food. Once you find a quality source (rosita, nutripro, dropi, green pastures) clo is worth its weight in gold


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