Many chronic diseases are related with progression of chronic inflammation. In heart problems, mental health, asthma and musculoskeletal pain, inflammation is a marker for disease severity. We now look into the role of omega-3 poly-unsaturated fatty acids in inflammation, and their subsequent role in improving the quality of life in patients with chronic disease.
There may be a relationship between elevated inflammatory markers and lipid profile.
In a study on serum C-reactive protein and other markers of inflammation in men with hypertriglyceridemia, 17 men aged between 39 to 66 years old participated in a double-blind, randomized, placebo-controlled parallel study. Over 90 days, 7.5 grams of omega-3 docosahexaenoic acid versus olive oil as placebo was given. By day 45, those who used DHA a decrease in neutrophils by 11.7% and by day 91, a decrease of 10.5% – a very significant number with a p-value of <0.05. By 91 days, it significantly reduced C-reactive protein by 15%, interleukin-6 by 23% and granulocyte monocyte-colony stimulating factor by 21%. It also increased the concentration of anti-inflammatory matrix metalloproteinase-2 by 7%. These are multiple markers of inflammation. Another study found that a supplement dose of EPA+DHA totaling 3.4 grams per day lowered triglycerides by 27% compared with a regular nutritional dose of 0.85 grams per day from the usual diet.(1,2)
There was also an association with DHA supplementation and decreased VLDL size. Because VLDLs are associated with plasma concentrations of neutrophils and CRP, a decrease in VLDLs caused by DHA may also decrease inflammation. (3) In a Cochrane review of 1075 diabetics who were given omega-3 versus placebo, they were able to decrease the levels of triglycerides and very low-density lipoprotein, both of which promote atherosclerosis. This would help prevent subsequent strokes and myocardial infarction, especially for those with diabetes.(4)
Several studies have looked into the role of fish oil in lung inflammation. In a systematic Cochrane review, a total of 91 participants in four studies compared omega-3 supplements to placebo in patients with cystic fibrosis, a genetic disease with disabling impacts on lung function. In two studies ranging longer at six months, it was observed that omega-3 increases levels of essential fatty acids in white blood cell membranes and phospholipids, resulting in decreased inflammation. Within a span of six weeks, those who took omega-3 supplements showed improved lung function, clinical status and decreased sputum production.(5)
Asthma is related to chronic inflammation and, and according to guidelines, is frequently treated with inhaled corticosteroids and leukotriene inhibitors when uncontrolled. In a prospective study of 4162 Americans observed over 20 years, aged between 18 to 30 years old, previously diagnosed with asthma in 1985, they monitored omega-3 polyunsaturated fatty acid intake in the years 1985, 1992 and 2005. They found that omega-3 PUFA intake had an inverse association with the incidence of asthma after they have adjusted for sociodemographic, major lifestyle, and dietary confounders. DHA appeared to have a greater effect than EPA in asthma.(6)
Studies on the mechanism of omega-3 and depression have been investigated. Clinical depression has been found to be associated with low-grade inflammation.(7) Omega-3 fatty acids have been found to act as inflammatory agents in various other studies(3) and were observed to smoothen the rigid cell membrane in participants.(8) Because of the role of omega-3 in inflammation, it may also have a significant role in depression.
Major depressive disorder or MDD is a prolonged depressed mood and/or a markedly decreased pleasure or interest in all activities. It may create a significantly decreased quality of life. In a study comparing the use of omega-3 versus antidepressants that were already used in Major Depressive Disorder, researchers found that there omega-3 and antidepressants were comparable in reducing depressive symptoms, and in the rates of response to treatment.(9)
Another study conducted a meta-analysis on the use of omega-3 polyunsaturated fatty acids in depressed women, where 182 patients received placebo and 185 patients received DHA and EPA. Using eight randomized clinical trials, it was found the combination of EPA and DHA as monotherapy brought about a 65% difference in mean without heterogeneity.(10) Studies also show that Ethyl-EPA, a synthetic derivative of EPA, has antidepressive properties that have demonstrated efficacy against bipolar depression. (11)
Musculoskeletal and Arthritic Pain
In a study on pain management, 250 patients were surveyed for 75 days and were given 1200 mg per day of omega-3 eicosapentaenoic acid and docosahexaenoic acid. They all had nonsurgical neck and back pain. Seventy-eight percent were taking 1200 mg and 22% were taking 2400 mg of EFAs. Among these patients who were previously taking NSAIDs, fifty-nine percent were able to discontinue taking NSAIDs after 75 days of using of omega-3. Sixty percent stated that their overall pain was improved, and 60% stated that their joint pain had improved. Eighty percent stated they were satisfied with their improvement, and 88% stated they would continue to take the fish oil. There were no significant side effects.(12)
Because NSAIDs and opioids have their own side effects in managing long-standing pain, it is worth looking into omega-3, something that may provide relief without the cardiac and gastrointestinal risks of NSAIDs, and the addictive potential of opioids.
Finding the right Omega-3
Due to the risks of other omega-3 supplements with impurities, it is important to find supplements with a high omega-3 ratio as well as the elimination of environmental pollutants. Safety standards by the European pharmacopeia (EP) and Global Organization of EPA and DHA Omega 3s (GOED) prescribes elimination of arsenic, cadmium, mercury, and lead in fish oil and omega-3 products. They also recommend higher ratios of Omega-3s DHA relative to the rest of the components. One example of a supplement that fits this description is Ultra Omega by Neomega, an omega-3 supplement with 60% essential fatty acids more than the average fish oil capsule (usually at 30%), made in Germany, which can be ordered online in the Philippines. Ultra Omega has EPA 800mg and DHA 400mg per serving, with a recommended serving of 2 capsules a day. It is suggested for consumers to consult their physicians before the use of supplements. Neomega reaches out to give options for health professionals who seek to find more cost-effective options for their patients. Learn more about their Doctor Affiliate Program. They can be reached at www.neomegalife.com, emailed at email@example.com or called at 7275975 or +639177016363.
Disclaimer: This article is produced through Filipino MD staff research. It is sponsored by Neomega Life, a trademark of Omniceutical corp.
(1)Skulas AC, Kris-Etherton PA, Harris WS, Vanden Heuvel JP, Wagner PR, West SG. Dose-response effects of omega-3 fatty acids on triglycerides, inflammation, and endothelial function in healthy persons with moderate hypertriglyceridemia. Am J Clin Nutr February 2011
vol. 93 no. 2 243-252. http://ajcn.nutrition.org/content/93/2/243.full
(2)Kelley DS, Siegel D, Vemuri M, Mackey BE. Docosahexaenoic acid supplementation improves fasting and postprandial lipid profiles in hypertriglyceridemic men. Am J Clin Nutr. 2007 Aug;86(2):324-33. https://www.ncbi.nlm.nih.gov/pubmed/17684201
(3)Kelley DS, Siegel D, Fedor DM, Adkins Y, Mackey BE. DHA supplementation decreases serum C-reactive protein and other markers of inflammation in hypertriglyceridemic men. J Nutr. 2009 Mar;139(3):495-501. doi: 10.3945/jn.108.100354. Epub 2009 Jan 21. https://www.ncbi.nlm.nih.gov/pubmed/19158225
(4)Hartweg J, Perera R, Montori VM, Dinneen SF, Neil AHAWN, Farmer AJ. Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus. 2008. Cochrane. http://www.cochrane.org/CD003205/ENDOC_omega-3-polyunsaturated-fatty-acids-pufa-for-type-2-diabetes-mellitus
(5)Oliver C, Watson H. The use of omega-3 supplements in people with cystic fibrosis. 2016. http://www.cochrane.org/CD002201/CF_use-omega-3-supplements-people-cystic-fibrosis
Li J1, Xun P, Zamora D, Sood A, Liu K, Daviglus M, Iribarren C, Jacobs D Jr, Shikany JM, He K. Intakes of long-chain omega-3 (n-3) PUFAs and fish in relation to incidence of asthma among American young adults: the CARDIA study. Am J Clin Nutr. 2013 Jan;97(1):173-8. doi: 10.3945/ajcn.112.041145. Epub 2012 Nov 28. https://www.ncbi.nlm.nih.gov/pubmed/23193002
(6)Rapaport MH, Nierenberg AA, Schettler PJ, Kinkead B, Cardoos A, Walker R et al. Inflammation as a predictive biomarker for response to omega-3 fatty acids in major depressive disorder: a proof-of-concept study. Mol Psychiatry 2016; 21: 71–79 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581883/
(7)Kelley DS1, Siegel D, Fedor DM, Adkins Y, Mackey BE. DHA supplementation decreases serum C-reactive protein and other markers of inflammation in hypertriglyceridemic men. J Nutr. 2009 Mar;139(3):495-501. doi: 10.3945/jn.108.100354. Epub 2009 Jan 21. https://www.ncbi.nlm.nih.gov/pubmed/19158225
(8)Hirashima F., Parow A.M., Stoll A.L., Demopulos C.M., Damico K.E., Rohan M.L. Omega-3 fatty acid treatment and T(2) whole brain relaxation times in bipolar disorder. Am J Psychiatry. 2004;161:1922–1924.
(9)Appleton KM, Sallis HM, Perry R, Ness AR, Churchill R. Omega-3 fatty acids for depression in adults. 2015. http://www.cochrane.org/CD004692/DEPRESSN_omega-3-fatty-acids-depression-adults
(10)Yang JR, Han D, Qiao ZX, Tian X, Qi D, Qiu XH.Combined application of eicosapentaenoic acid and docosahexaenoic acid on depression in women: a meta-analysis of double-blind randomized controlled trials. Neuropsychiatr Dis Treat. 2015 Aug 10;11:2055-61. doi: 10.2147/NDT.S86581. eCollection 2015. https://www.ncbi.nlm.nih.gov/pubmed/26300645
R J T Mocking, I Harmsen, J Assies, M W J Koeter, H G Ruhé, and A H Schene. Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry. 2016 Mar; 6(3): e756. Published online 2016 Mar 15. doi: 10.1038/tp.2016.29 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872453/
(11)Maroon J1, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31. https://www.ncbi.nlm.nih.gov/pubmed/16531187