HIV and AIDS: Symptoms, Causes, Treatments, and More
Cake-Seeking Iguana Bites 3-Year-Old Girl, Leading To Mycobacterium Marinum Infection
A case report to be presented at the European Congress of Clinical Microbiology & Infectious ... [+] Diseases (ECCMID) shows how a cake-induced iguana encounter in Costa Rica led to an unusual infection. Here a common green iguana (Iguana iguana) bathes in the sun in Costa Rica. (Photo by Sylvain CORDIER/Gamma-Rapho via Getty Images)
Gamma-Rapho via Getty ImagesWhen iguanas want cake, let them eat cake. That's one of the take home messages from a case report entitled "Never get between an iguana and his cake: a cautionary tale of a subcutaneous mass following an iguana bite." Jordan Mah, MD, from the Stanford University School of Medicine is scheduled to present this case report on April 18 at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Copenhagen, Denmark. It's a case of a reptile dysfunction that resulted in an infection.
It can be considered a "dysfunction" because iguanas don't tend to bite humans. Instead, their diet typically consists of leaves, weeds, flowers, and fruits. But cake can make you (and apparently iguanas) do things that you normally wouldn't do. In this case, everything started when a 3-year-old girl was vacationing in Costa Rica, sitting on the beach eating cake. The girl presumably wasn't vacationing by herself because 3-year-olds don't tend to say, "I need a break from this stressful life of speaking in four-to-five word sentences and asking 'why' dozens of times a day and should book a vacation on Expedia."
While the girl was taking her sweet time on the beach, an iguana "suddenly ran up and bit her on the back of her left-hand before snatching the cake," to quote a press release from the European Society of Clinical Microbiology and Infectious Diseases. Apparently, the girl had given the iguana her middle finger, so to speak, since the health professional at a local clinic found a not-too-deep wound on the back of her middle finger. She received a five-day supply of amoxicillin to cover possible exposure to Salmonella bacteria, which reptiles can carry. The wound seemed to heal well over the next few days.
But this wasn't a case of all's well that ends swell. Five-months down the road, her parents noticed that she had developed a small bump on the back side of her left hand that was progressively getting larger, more red, and somewhat tender. Eventually, the girl went to Stanford Children's Health. An ultrasound of her hand showed that the lump appeared to be a cyst filled with fluid. However, when an orthopedic surgeon removed this lump, pus came out, suggesting this was instead the result of an infection.
This extreme close-up of a plate culture of Mycobacterium marinum reveals a smooth colony margin ... [+] with transmitted light. (Photo by Smith Collection/Gado/Getty Images).
Getty ImagesA closer look at the tissue from this mass revealed necrotizing granulomatous inflammation. Now, necrotizing ain't a good word to hear. You never want your date to say, "I found you rather necrotizing," since necrotizing means causing death. So, necrotizing inflammation is when the inflammation is resulting in the death of tissue. Doctors also found Mycobacterium marinum in the mass, a microbe that tends to be resistant to common antibiotics such as amoxicillin. Therefore, the doctors started the girl on different antibiotics, rifampin and clarithromycin, that seemed to do the trick.
M. Marinum is a very fishy pathogen as it's more commonly known to cause an illness that resembles tuberculosis in fish. Infected fish can develop skin lesions or ulcers as well as bulging eyes and swelling of their abdomens. Getting cartoon-looking eyes is not a fun thing. Neither are the other possible effects such as spinal deformities and sudden death.
Assuming that you are not a fish, you as a human can catch this bacteria, too, when you expose any open skin wounds to either fresh or salt water that's been contaminated with M. Marinum. You are not likely to get bulging eyes. Rather, skin lesions, such as nodules or ulcers, are more common. As seen in the case of the lizard's tale mentioned earlier, without treatment, these skin lesions can possibly last for months. When you have a strong immune system, these infections tend to stay localized to the skin and soft tissue. Occasionally, however, especially when your immune system is much weaker, this pathogen can spread to other parts of your body like your bones and joints. Death is possible, but is quite rare and usually occurs only in those with weakened immune systems.
When you are eating cake, make sure that there aren't any iguanas around. (Photo: Getty)
gettyIguana bites are not common. You don't hear of too many people complaining, "There I was minding my own business during the job interview, when an iguana bit me. Of course, since it was the iguana who was interviewing me, I didn't say anything." Iguanas usually should be pretty harmless towards you as long as you are not a leaf. Therefore, you don't have to spend your days worrying, "Is an iguana gonna bite me? Is an iguana going to bite me? Is an iguana going to bite me," while hoarding rolls of toilet tissue. That doesn't mean that you should go around kissing iguanas. They can carry various bateria such as Salmonella enterica, Serratia marcescens, and Staphylococcus aureus. Although this was the first reported case of a M. Marinum after an iguana bite, apparently iguanas can carry such a pathogen as well.
This cake and iguana story may have had many layers. But it does provide a reminder that you should be careful when carrying cake. You never know when some co-workers, friends, family, reptiles, or anyone who may be a combination of these may start eyeing your cake as if it were a hot person on Tinder. After all, cake has a way of saying, "Do you want a piece of me?" You can have your cake and eat it too. You can even have cake by the ocean, as long as there aren't any iguanas around.
Fish Around The World Are Shrinking
Fish are becoming smaller and we humans are most likely to blame. Climate change and overconsumption have drastically altered fish populations and could lead to food struggles in the future. Other species are also seeing changes due to climate change, which could lead to a shift in the aquatic ecosystem as it is currently known. Nonetheless, many marine ecosystems are actively adapting to the changing ocean and climate conditions, showing more resilience than expected.
A whole lot of small fryThe world's fish supply is getting smaller, physically. A study published in the journal Science said that body size trends "varied across communities," but "marine fish more consistently shifted toward smaller body size." This trend is concerning for scientists as more than 3 billion people worldwide rely on fish as a source of food. "Organisms becoming smaller has important effects, as the size of animals mediates their contribution to how ecosystems function and how humans benefit from them," professor Maria Dornelas, one of the authors of the study, said to The Guardian. "Bigger fish can usually feed more people than smaller fish."
"Smaller fish produce less offspring than larger fish and therefore less productive fish populations," said Firstpost. "Fishermen will catch smaller fish. This will in turn reduce the global fish supply." This could alter the global food supply, as well as economies dependent on fishing. "It's a problem for the fishery," Art Bloom, a salmon fisherman in Alaska's Bristol Bay, said to The Washington Post. Smaller fish "don't present as well in the supermarket."
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The changing demographic can also permanently alter the ecosystem. "In marine and other aquatic ecosystems, size determines whether you are a prey or predator," Asta Audzijonyte, who studies fish at the University of Tasmania, said to the Post. And fish are not the only aquatic species seeing changes in size. The research showed that several plants and other invertebrate species are also shrinking, while some other species are actually getting larger. "Unfortunately, we currently lack data on many organisms other than fish to draw clear conclusions — future research will benefit from a greater investment in these kinds of measurements, particularly when exploring food webs and other species interactions," Franziska Schrodt, a co-author of the study, said to The Guardian.
Fishing for answersWhile scientists can confirm that fish are becoming smaller, they cannot pinpoint a specific reason. Experts have considered two reasons: overfishing and warming oceans. "One undisputed reason so much marine life is getting smaller is fishing. Recreational anglers and commercial fishers alike like to catch large fish," said the Post. "That quest for the big ones leaves the small fries behind." An abundance of small fish will continue to produce small fish, bringing down the physical size of the population.
Research has also shown that fish tend to be smaller in size in warmer water, a phenomenon called the temperature-size rule. Though the rule has been widely observed, scientists do not know the reason. One theory was that fish gills were unable to keep up with the fish's oxygen demands in warmer water, which holds less oxygen than colder water. However, this theory did not apply across the board, and experts debate its validity. Another theory is that "fish have evolved to stay small to survive hot spells, or that some other body system besides gills is limiting oxygen uptake and growth," said the Post.
While smaller fish are a concern, ecosystems have shown signs of adapting. "The relationship between abundance change and body size change is complex and variable, but there are signs that the overall reduction in body size is being counteracted by increasing overall abundance," the study said.
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11 Best Fish Oil Supplements In 2024, According To Dietitians
We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission or other tangible benefit. Optum Store, Optum Perks, and Healthline Media are owned by RVO Health. Here's our process.
How we vet brands and productsHealthline only shows you brands and products that we stand behind.
Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:Was this helpful?
Nordic Naturals is our pick for the best overall fish oil supplement. Read on for the full list plus tips for choosing the best product for you.
If you do not regularly consume fish, consuming fish oil in supplement form can be a quick and convenient way to increase your intake of omega-3 fatty acids.
These fatty acids play an important role in supporting heart, eye, and brain health, and for lowering inflammation and cholesterol, among other benefits.
They are abundant in cold water fish and seafood and in lesser amounts in plant-based foods, such as nuts and seeds, and plant oils.
Omega-3 supplementation is an easy and helpful process to increase your intake of this essential nutrient if you do not get enough from whole food sources. If you consume animal products, you can take fish oil in softgel, liquid, and gummy forms. They're available in a range of price points and dosages.
Keep reading to see our picks of the 11 best fish oil supplements on the market.
Disclaimer: Some of the products below were provided to Healthline testers for free. Our opinions and reviews are ours alone, and have not been reviewed, approved, or otherwise endorsed by the brands.
Best overall fish oil supplementNordic Naturals Ultimate Omega Soft Gels is our pick for the best overall. It's a high quality supplement that provides 1,280 mg of combined EPA and DHA sourced from wild-caught sardines and anchovies.
The softgels are lemon flavored, which can help eliminate the fishy aftertaste often found in other fish oil supplements.
All Nordic Naturals products are certified by Friend of the Sea, an organization that ensures that seafood is sourced from sustainable fisheries and aquaculture.
A certificate of analysis (COA) is also available for all Nordic Naturals products. This document provides detailed information on the purity, strength, and quality of supplements.
What our tester saysKelli McGrane, Healthline editor and registered dietitian, shared that this supplement is her go-to for omega-3s.
"As a dietitian, Nordic Naturals has been on my radar for years as being one of the most transparent supplement brands on the market.
"While the capsules are quite large, I've found them easy to swallow. Plus, as someone who dislikes the smell and taste of fish, I particularly appreciate that the softgels have a pleasant lemon flavor that masks any fishiness that might otherwise be off-putting."
Kelli McGrane, Healthline editor and registered dietitian, shared that this supplement is her go-to for omega-3s.
"As a dietitian, Nordic Naturals has been on my radar for years as being one of the most transparent supplement brands on the market.
"While the capsules are quite large, I've found them easy to swallow. Plus, as someone who dislikes the smell and taste of fish, I particularly appreciate that the softgels have a pleasant lemon flavor that masks any fishiness that might otherwise be off-putting."
Pros & consHUM Nutrition OMG Omega the Great capsules are designed to support healthy skin thanks to their inclusion of DHA, EPA, and vitamin E.
Each 2-capsule serving provides 1,400 mg of total omega-3s, including 400 mg of DHA and 800 mg of DHA, sourced from wild anchovies. While more research is needed, studies suggest that consuming adequate amounts of DHA and EPA may help protect against sun damage and keep your skin moisturized.
These softgels also include 13.4 mg of vitamin E. Some research has found that inadequate intake of vitamin E may contribute to skin conditions, such as acne and atopic dermatitis.
However, keep in mind that it's unclear whether vitamin E supplements have any additional benefits if you're already getting enough of this vitamin in your diet.
All HUM Nutrition products are third-party tested, non-GMO, gluten-free, and free of artificial sweeteners and colors.
You can purchase it without subscribing, but it's much less expensive to sign up for a 3-month subscription.
What our tester says"I've taken [other] omega-3 capsules before, and these are on the larger side with a distinctly fishy aroma. However, I like the brand and I have no problem swallowing bigger pills, so I would definitely continue with these."
— Jessica Timmons, Healthline contributor
"I've taken [other] omega-3 capsules before, and these are on the larger side with a distinctly fishy aroma. However, I like the brand and I have no problem swallowing bigger pills, so I would definitely continue with these."
— Jessica Timmons, Healthline contributor
Pros & consThis high quality fish oil supplement pairs omega-3 fatty acids with coenzyme Q10 (CoQ10), a heart-healthy antioxidant that protects against oxidative damage and helps generate energy in your cells.
Each gelcap contains 630 mg of combined EPA and DHA sustainably sourced from cold water fish, along with 30 mg of CoQ10.
It's worth noting that while CoQ10 supplements have been linked to benefits for heart health, exercise performance, and more, most studies suggest a dose of at least 100 mg per day. Because this supplement only provides 30 mg, people interested in the benefits of CoQ10 may need to take an additional supplement.
Thorne's fish oil supplement has been certified by the Therapeutic Goods Administration (TGA), an Australian government agency that regulates medications and supplements.
All Thorne Research products undergo four rounds of extensive testing to ensure that you're getting the best quality possible. Thorne's manufacturing facility is third-party certified by NSF International.
Pros & consA daily fish oil supplement is a worthwhile addition to your daily prenatal vitamin during pregnancy.
Omega-3 fatty acids like DHA are necessary for brain development, and one 2021 study found that women who supplemented with omega-3 in pregnancy had children with improved early language development and fewer behavioral issues.
Additionally, omega-3 supplementation while breastfeeding can ensure that infants are getting enough DHA and EPA via breastmilk.
This omega-3 supplement from FullWell provides EPA and DHA from small ocean fish, which are lower in mercury than other fish. High levels of mercury can cause developmental issues, so it's important for pregnant people to be mindful of the mercury sources in their diet.
The softgels are also very small and easy to swallow, and the supplement is third-party tested for the presence of heavy metals, such as mercury, and other potentially harmful substances.
What our tester says"I have been taking these most of my postpartum journey so far while breastfeeding, along with FullWell's prenatal supplement. I absolutely love that I have not experienced any fishy burps from the DHA, which I know can be common with this ingredient.
"It doesn't seem to matter for me whether I take them with or without food. Some supplements give me a stomach ache if not taken with food, and I know that's a common side effect, so I appreciate this is one that I don't have to worry about. If I forgot to take them during the day, I can easily take them before bed without having to worry about any queasiness keeping me up.
"I find them easy to swallow, and pretty much tasteless, which is always a plus with a fish oil supplement."
— Catherine Conelly, Healthline editor
"I have been taking these most of my postpartum journey so far while breastfeeding, along with FullWell's prenatal supplement. I absolutely love that I have not experienced any fishy burps from the DHA, which I know can be common with this ingredient.
"It doesn't seem to matter for me whether I take them with or without food. Some supplements give me a stomach ache if not taken with food, and I know that's a common side effect, so I appreciate this is one that I don't have to worry about. If I forgot to take them during the day, I can easily take them before bed without having to worry about any queasiness keeping me up.
"I find them easy to swallow, and pretty much tasteless, which is always a plus with a fish oil supplement."
— Catherine Conelly, Healthline editor
Pros & consUse code "HEALTHLINE20" for 20% off.
Healthline's reviewMindbodygreen's omega-3 softgels feature organic lemon oil and rosemary extract to help mask the unpleasant taste and smell of fish oil.
Each 2-capsule serving provides 1,500 mg of total omega-3s, sourced from wild-caught anchovies.
Omega-3 potency+ is certified by ORIVO, a third-party organization that confirms purity and potency of omega-3 supplements.
What our tester says"When I first got the omega-3 supplements from mindbodygreen, I was impressed by the look of the bottle, as it's a thicker amber glass that looks nice versus the typical plastic colorful vitamin bottles.
"As I am not the best at taking pills, I was a bit scared of the size of these pills. However, given it's a gelcap it was relatively easy to swallow the two pills each day.
"As directed, I took the pills with food, choosing to have it each morning with my breakfast. I was happily surprised to not have any taste, knowing these are made of anchovy. Also, I know 'fish burps' are common with fish oil supplements, but I did not experience any burping.
"The price point is high enough that it does give me pause to continue with this brand, although I have enjoyed the tasteless aspect and just the overall look."
— Jenna Shippee
"When I first got the omega-3 supplements from mindbodygreen, I was impressed by the look of the bottle, as it's a thicker amber glass that looks nice versus the typical plastic colorful vitamin bottles.
"As I am not the best at taking pills, I was a bit scared of the size of these pills. However, given it's a gelcap it was relatively easy to swallow the two pills each day.
"As directed, I took the pills with food, choosing to have it each morning with my breakfast. I was happily surprised to not have any taste, knowing these are made of anchovy. Also, I know 'fish burps' are common with fish oil supplements, but I did not experience any burping.
"The price point is high enough that it does give me pause to continue with this brand, although I have enjoyed the tasteless aspect and just the overall look."
— Jenna Shippee
Pros & consFor people who prefer using liquid fish oil instead of softgels or capsules, this supplement is a great option.
Each teaspoon (5 mL) contains 1,600 mg of omega-3 fatty acids, with 1,300 mg from EPA and DHA sourced from wild-caught anchovies, sardines, and mackerel.
It's not only certified by IFOS but also non-GMO verified, meaning that it's free of any genetically modified organisms.
It's also rich in vitamin E, a fat-soluble vitamin that doubles as an antioxidant.
Plus, it's available in several flavors, including Lemon, Orange, Mixed Berry, and Just Peachie, which make it great for mixing into smoothies or juices.
Pros & consWith 900 mg of omega-3 fatty acids packed into a single softgel, this Triple Strength Omega-3 supplement is an excellent option for people seeking to simplify their routine. Plus, it's the most affordable option on our list.
In addition to earning a 5-star rating from IFOS, all InnovixLabs pills are produced from sustainably sourced fish like anchovies, sardines, and mackerel and are purified to remove harmful compounds like mercury.
The capsules have an enteric coating to keep them from breaking down and dissolving in your stomach. This is thought to help minimize side effects, such as fishy burps and aftertaste.
Pros & consThis simple fish oil formula supplies 2,000 mg of omega-3 fatty acids in every serving, with 1,880 mg of combined EPA and DHA.
In addition to being IFOS certified, it's produced from small, wild-caught fish like mackerel, anchovies, and sardines that have been caught using sustainable fishing practices.
The oil also undergoes a purification process that helps eliminate any fishy odor or aftertaste.
Pros & consIf you don't like taking softgels, these gummies are a great alternative to bump up your intake of omega-3 fatty acids.
They contain 57 mg of combined EPA and DHA per serving and are sourced from wild-caught ocean fish.
They're also verified by USP and free of any synthetic dyes and flavors.
However, keep in mind that these gummies supply a much lower dose of omega-3 fatty acids than most other fish oil supplements. They also contain 3 grams of added sugar per serving.
Instead of relying on gummies to meet your omega-3 needs entirely, it's best to use them as part of a balanced diet filled with plenty of foods rich in omega-3 fatty acids.
Pros & consCod liver oil is a unique type of fish oil pressed from the livers of cod, a type of fish that's a rich source of the fat-soluble vitamins A and D in addition to omega-3s.
Sourced exclusively from wild Arctic cod from the Norwegian Sea, this supplement is available in liquid and softgel forms. It provides 600 mg to 850 mg of combined EPA and DHA, depending on which product you select.
Nordic Naturals supplements are sustainably produced, non-GMO, and certified by third-party organizations, such as Friend of the Sea and European Pharmacopoeia.
This product is available in several flavors, including unflavored, orange, strawberry, and lemon.
Pros & consLooking for a fish oil your kid might take without complaint? Nordic Naturals makes our list again, this time for its children's DHA supplement.
The supplement comes in two kid-approved flavors, Strawberry and Orange, and is also available in gummy form.
It provides 255 mg of DHA and 170 mg of EPA per each 1/2 teaspoon (2.5 mL) serving.
The product is made for children ages 1–6.
It's important for children to get enough omega-3s, particularly DHA, because it's vital for brain development and eye health.
However, there are currently no specific guidelines for DHA intake. Instead, there are guidelines for total omega-3 intake, which are as follows:
Healthline editor Crystal Hoshaw regularly purchases the gummy softgel version of this supplement for her son.
She shared, "I love these products. I know I'm getting the best bang for my buck when I buy Nordic Naturals. My son never has trouble taking these, and when he gets bored of one flavor, we switch to the other for a while to change things up."
Healthline editor Crystal Hoshaw regularly purchases the gummy softgel version of this supplement for her son.
She shared, "I love these products. I know I'm getting the best bang for my buck when I buy Nordic Naturals. My son never has trouble taking these, and when he gets bored of one flavor, we switch to the other for a while to change things up."
Pros & consWhen rounding up the best fish oil supplements, we considered the following factors:
*Third-party testing refers to whether the purity and potency of a product has been confirmed by a third-party lab.
Photos provided by Kelli McGrane, MS, RD
Fish oil is a top source of omega-3 fatty acids, called polyunsaturated fats, which play important roles in many processes in your body, including those involving inflammation, immunity, heart health, and brain function.
There are three main types of omega-3 fatty acids:
All omega-3s are anti-inflammatory and may have a positive effect on many conditions thought to be related to chronic inflammation — particularly heart disease. EPA and DHA may also help lower high triglyceride levels, a risk factor for heart disease.
Additionally, omega-3s play a key role in vision and eye health, as they're necessary for eye development. However, while some studies suggest that they may help in the treatment of dry eye disease, other research has turned up conflicting results.
Omega-3s are also important for brain health. During infancy and childhood, they're necessary for proper neurological development.
In older adults, omega-3 supplementation may play a role in promoting brain function and preventing cognitive decline.
The most common side effect of fish oil supplements is fishy burps, but there are now several "burpless" fish oil products on the market that claim to cut down on this unpleasant but harmless side effect.
Some people might also experience digestive issues after taking fish oil, including nausea, vomiting, diarrhea, or constipation.
If you experience nausea or vomiting after taking fish oil, you can check the expiration date. The oil may deteriorate and become rancid. Consider lowering your dosage or taking the supplement with a meal to decrease any uncomfortable side effects.
You should also check with a doctor before taking fish oil if you're taking other medications or have any underlying health conditions, as high doses could increase the risk of bleeding or suppress immune function.
What is the best fish oil supplement for cholesterol?The simple answer is that there is no simple answer. Research on the potential effects of fish oil on cholesterol levels has been conflicting. According to a 2021 study, higher blood levels of DHA could be linked to lower LDL (bad) cholesterol levels.
On the other hand, one review concluded that fish oil supplements could actually increase LDL cholesterol, while other research suggests that eating fresh fish might be a better option for improving cholesterol and triglyceride levels.
Therefore, it's best to consult a doctor before taking fish oil if you have high cholesterol levels.
The simple answer is that there is no simple answer. Research on the potential effects of fish oil on cholesterol levels has been conflicting. According to a 2021 study, higher blood levels of DHA could be linked to lower LDL (bad) cholesterol levels.
On the other hand, one review concluded that fish oil supplements could actually increase LDL cholesterol, while other research suggests that eating fresh fish might be a better option for improving cholesterol and triglyceride levels.
Therefore, it's best to consult a doctor before taking fish oil if you have high cholesterol levels.
How do I take fish oil?You can take fish oil every day, at whatever time works for you. Because fish oil does not offer immediate benefits, what's most important is that you take it consistently, ideally alongside a fat-containing meal to boost absorption.
If you experience side effects from fish oil supplements, such as nausea or acid reflux, you may find the supplement easier to tolerate by splitting it into two smaller doses throughout the day.
Keep in mind that omega-3 products and fish oil supplements can have blood-thinning effects in high doses. Fish oil might also cause other side effects, including diarrhea, insomnia, and high blood sugar levels.
A doctor can provide guidance on how much you should take. It's also important to check with a healthcare professional before taking fish oil if you're also taking a blood-thinning medication, such as warfarin or another anticoagulant.
You can take fish oil every day, at whatever time works for you. Because fish oil does not offer immediate benefits, what's most important is that you take it consistently, ideally alongside a fat-containing meal to boost absorption.
If you experience side effects from fish oil supplements, such as nausea or acid reflux, you may find the supplement easier to tolerate by splitting it into two smaller doses throughout the day.
Keep in mind that omega-3 products and fish oil supplements can have blood-thinning effects in high doses. Fish oil might also cause other side effects, including diarrhea, insomnia, and high blood sugar levels.
A doctor can provide guidance on how much you should take. It's also important to check with a healthcare professional before taking fish oil if you're also taking a blood-thinning medication, such as warfarin or another anticoagulant.
Should you take fish oil every day?You can take fish oil every day. However, taking high doses of fish oil (at least 900 mg of EPA plus 600 mg DHA) over time may promote immune system suppression because of the powerful anti-inflammatory effects of omega-3 fats.
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