A practitioner’s guide to the Opti-O-3 biomarker test

Opti-O-3 visual logo - square low resOmega-3 deficiency or increased omega-3 requirements are very common in modern health conditions, certainly in cases where inflammation is present. Introducing omega-3 fatty acids to a client’s nutrition protocol therefore offers considerable value to their nutritional intervention, but new evidence suggests that the benefits of supplementation are strongly influenced by baseline omega-3 red blood cell (RBC) levels. The Igennus Opti-O-3 biomarker test is designed to assist practitioners in delivering successful health outcomes for their clients by correctly identifying the optimal omega-3 dose required to restore biomarkers to ‘optimal’ within six months.

Why use omega-3 fatty acids?

It is well established that low omega-3 status (especially EPA and DHA) is linked with poor health and can initiate and drive a number of disease states. Unsurprisingly, an overwhelming body of evidence supports the use of long-chain omega-3 fatty acids (specifically pure EPA and EPA/DHA) for both the prevention and the treatment of chronic disease by raising omega-3 levels (EPA and DHA) and lowering levels of the omega-6 fatty acid AA.

Why do patients respond differently to similar treatments?

Relying solely on manufacturers’ recommended dosing on packaging or generic treatment protocols (essentially a ‘one size fits all’ approach) can lead to disappointing outcomes or even no observed health benefits. This is because generalised dosing fails to take into account the many important factors known to affect the outcome of fatty acid treatments.

What are the significant variables that influence therapeutic outcomes of a treatment?

There are a number of variables that influence omega-3 success, including genetics, age, gender and health status, but bodyweight and omega-3 baseline levels appear to be the most important in predicting omega-3 treatment success. Determining baseline omega-3 and total fatty acid levels in the cell makes possible the calculation of accurate dosing (mg/kg/day) according to individual needs. Providing a bespoke dose maximises the chance of achieving cellular levels necessary for therapeutic outcomes.

How do I establish my clients’ baseline levels?

The Opti-O-3 biomarker test is a simple, minimally invasive blood spot test that can be performed by the client at home. As the test doesn’t require a phlebotomist to draw blood, it is both cost effective and convenient. The client uses a finger-prick lancet to acquire small drops of blood that are then dropped onto a ‘spot saver’ card. Only one circle needs to be filled per card but the sample must cover the whole circle. Once the blood has air dried (approx. one hour), the sample is posted directly to the Igennus lab and the analysis is performed. Results are returned within 10-14 working days from when samples are received. If any issues arise (i.e. insufficient sample) we will contact you or your client and issue a replacement kit.

Does the client need to fast before taking a sample?

An overnight fast is important to ensure the most accurate result. Please ask that your client drinks only water in the morning before performing the test. We suggest taking the test first thing before breakfast, and ideally on a Monday to avoid any potential postal delays. Unlike tests that use whole blood to isolate fatty acids from RBC, fatty acids from dried blood spots are isolated from both RBC and plasma. Avoiding fatty foods prior to taking a sample reduces the impact of plasma fatty acid content. There is a significant positive correlation (R=0.96, p<0.0001) between fatty acids isolated from whole blood and dried blood spots, making this an extremely useful and convenient alternative to blood draw analysis.

What does the test screen for?

Fatty acids within RBC give an overview of long-term dietary intake and comprehensive screening of 26 individual fatty acids (including trans fatty acids) allows us to accurately determine total omega-6 and total omega-3 membrane levels. Unlike other tests that screen only for a number of ‘significant’ fatty acids, we screen for the full spectrum of fatty acids used to validate the highly published omega-3 index. [1] From this fatty acid analysis, we provide accurate information on the AA to EPA ratio, the omega-6 to omega-3 ratio and the omega-3 index – key biomarkers related to health.

The AA to EPA ratio provides valuable information regarding the inflammatory potential of a given individual. Chronic stimulation of inflammatory processes is the core driver of most health conditions so restoring a healthy AA to EPA ratio is a priority for a successful intervention.

The omega-3 index is the sum of EPA + DHA as a percentage of total fats and provides valuable information about the amount of long-chain omega-3 fatty acids within cells and tissue. The omega-3 index is a structural target useful for assessing both baseline risk and a change in risk as a result of omega-3 intake.

What do the biomarkers tell me about my clients’ health?

The omega-3 index is an established cardiovascular risk indicator, with ≤4% offering the lowest protection against cardiovascular disease and ≥8% the greatest protection. Achieving an omega-3 index of ≥8% appears to be critical for positive general health outcomes as well as cardiovascular health; indeed, studies are starting to link the omega-3 index with many other clinical conditions. Whilst the omega-6 to omega-3 ratio is an established marker of long-term health and chronic illness, the AA to EPA ratio provides a specific measure of ’silent’ or chronic inflammation, with an ideal AA to EPA ratio falling between 1.5:1 and 3:1. There is a strong correlation between the omega-3 index and the AA to EPA ratio, thus by increasing the omega-3 index we see a corresponding decrease in the AA to EPA ratio.

Why don’t you include reference ranges for individual fatty acids?

Although we provide the percentage of fatty acids that make up RBC membranes, there are currently no validated reference ranges for what is considered ‘optimal’ for each individual fatty acid. Most laboratories provide reference ranges that have been determined using in-house data and therefore these generally reflect ranges for individuals who are not ‘optimally’ healthy. Given that this data fails to take into account fatty acid ranges from a ‘normal’ healthy population, the ranges themselves are highly skewed. As reference ranges for optimally healthy people become available, we will include these in the test report. For now, we base our recommendations on validated and recognised health biomarkers known to correlate with disease risk.

How does the Opti-O-3 determine my clients’ personalised dose?

Once we know the baseline omega-3 index, we calculate the dose that is needed to raise omega-3 levels to ‘ideal’ within 6 months, using a scientifically validated equation developed by the researchers who established the omega-3 index. The equation determines the optimal dose of omega-3 EPA and DHA required to achieve an omega-3 index that falls between 8-10% [2] and to optimise the AA to EPA ratio to 1.5:1-3:1.

Generally, individuals with the lowest omega-3 index require the highest doses, with daily doses of 2-3g not uncommon. These doses are considerably higher than listed on most omega-3 supplements and may explain some of the poor outcomes seen in the clinic setting.

How do I incorporate the RESTORE and MAINTAIN protocol with the Opti-0-3 test?

Coupled with our Opti-O-3, our therapeutic Pharmepa RESTORE and MAINTAIN products are formulated to optimise dose, concentration and bioavailability – the three key factors that influence omega-3 uptake and benefits. If taken at the suggested doses for the recommended period of time, the RESTORE and MAINTAIN protocol can quickly and efficiently improve fatty acid levels (AA, EPA and DHA) to those required to deliver noticeable effects.

Inflammation is at the core of the majority of chronic modern health conditions and as a result we recommend that anyone whose AA to EPA ratio is ‘suboptimal’ should take their determined dose as pure EPA (Pharmepa RESTORE) for the initial 6-month intervention period. This is the most effective way to restore a healthy AA to EPA ratio before introducing DHA to further raise and protect a healthy omega-3 index. Maintaining a high EPA to DHA ratio, as in Pharmepa MAINTAIN, ensures long-term maintenance of both the AA to EPA ratio and the omega-3 index.

When should I suggest re-testing?

Testing fatty acid levels clearly illustrates omega-3 deficiency and the extent to which the omega-3 fats are needed. Low biomarker levels often correlate significantly with symptoms. Testing not only encourages compliance with the supplement regime but also tracks improvements. We usually recommend re-testing your clients’ fatty acid levels no less than 6 months from the start of dietary intervention, with a 12-month rolling period of routine testing recommended where required. A 6-month re-test period after the initial test allows adequate time to observe a shift in cellular fatty acid levels, that should correspond with physical (and/or psychological) symptom improvements, in order to determine long-term maintenance doses.


Regulating the delicate balance of omega-6 and omega-3 fatty acids is crucial for maintaining both immediate and long-term optimal health. Our compressive fatty acid screen allows us to offer bespoke dosing and identifies key biomarkers to give a comprehensive overview of your clients’ health status.

Using the Opti-O-3 fatty acid biomarker test in combination with Pharmepa RESTORE & MAINTAIN offers the ideal solution to optimising omega-6 and -3 levels for noticeable results and takes the guesswork out of fatty acid dosing.


  1. Harris WS, Von Schacky C: The Omega-3 Index: a new risk factor for death from coronary heart disease? Prev Med 2004, 39:212-220.
  2. Flock MR, Skulas-Ray AC, Harris WS, Etherton TD, Fleming JA, Kris-Etherton PM: Determinants of erythrocyte omega-3 fatty acid content in response to fish oil supplementation: a dose-response randomized controlled trial. Journal of the American Heart Association 2013, 2:e000513.



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Dr Nina Bailey

About Dr Nina Bailey

Nina is a leading expert in marine fatty acids and their role in health and disease. Nina holds a master’s degree in Clinical Nutrition and received her doctorate from Cambridge University. Nina’s main area of interest is the role of essential fatty acids in inflammatory disorders. She is a published scientist and regularly features in national health publications and has featured as a nutrition expert on several leading and regional radio stations including SKY.FM, various BBC stations and London’s Biggest Conversation. Nina regularly holds training workshops and webinars both with the public and health practitioners.