The importance of Omega-3s

 

The importance of Omega-3s

Omega-3 and omega-6 are polyunsaturated fatty acids that can only be obtained through diet. In the body, these essential fatty acids are components of cell membranes, particularly in the retina and brain tissues. They are also precursors of prostaglandins and leukotrienes that modulate the processes of inflammation.¹

The discovery of the preventive effects of a diet rich in omega-3 against cardiovascular diseases, as well as their anti-inflammatory properties, has sparked keen interest from the public and the scientific community. Studies undertaken to explore the therapeutic potential of essential fatty acids have revealed that they could contribute to the prevention and treatment of chronic inflammatory diseases such as arthritis and lupus, as well as dyslipidemias, diabetes, depression, and osteoporosis. All these therapeutic applications are related to acute or chronic inflammation. (low grade inflammation).

Active ingredients

Eicosapentaenoic acid (EPA), 20:5*; docosahexaenoic acid (DHA), 22:6*.

* These numbers indicate the number of carbon atoms in the chain and the number of double bonds. For example, 20:5 corresponds to a molecule containing 20 carbon atoms and 5 double bonds. Source: Simopoulos AP. Am J Clin Nutr. 1999.

Regular consumption of fish reduces the risk of coronary heart disease, death related to a heart attack, and myocardial damage.²

A study among the Inuit shows that a high omega-3 level increases HDL and lowers triglycerides.³

Long-chain omega-3s lead to a significant reduction in cardiovascular deaths (OR: 0.87, 95% CI: 0.79–0.95, p = 0.002); sudden cardiac deaths (OR: 0.87, 95% CI: 0.76–0.99, p = 0.04); all-cause mortality (OR: 0.92, 95% CI: 0.85–0.99, p = 0.02); and non-fatal cardiovascular events (OR: 0.92, 95% CI: 0.85–0.99, p = 0.02).⁴

Omega-3 index: The level of long-chain omega-3 (EPA & DHA) in the cell membranes of red blood cells is inversely associated with the incidence of heart disease (≥ 8% offers the most protection [equivalent to an intake of 1 g of omega-3 per day]). ⁵

The intake of omega-3 (900 mg/day) combined with a diet reduces systolic (-12.2%) and diastolic (-8.2%) blood pressure, serum triglycerides (-21.4%), insulin resistance (-13.1%) (P<0.05), and serum IL-6 concentration (-28.5%) (P=0.034) compared to the diet alone.⁶

Omega-3s reduce insulin and adiponectin resistance and lower inflammation and triglycerides.⁷

4 g per day of omega-3 reduce the percentage of fat in the liver (non-alcoholic fatty liver disease).⁸

In teenagers (10 to 18 years old) suffering from MetS, 2.4 g of omega-3 per day increased blood HDL and significantly reduced VEGF.⁹

In patients with moderate hypertriglyceridemia (fasting triglycerides: 150 to 500 mg/dL [1.69 to 5.65 nmol/l]), 3.4 g of omega-3 per day for 8 weeks significantly reduced triglycerides by 27% compared to placebo (173 ± 17.5 compared to 237 ± 17.5 mg/dL [1.95 to 2.68 nmol/l]; p = 0.002).¹⁰

In patients with severe hypertriglyceridemia (TG ≥ 500 mg/dL [5.65 nmol/l], < 2,000 mg/dL [22.6 nmol/l]), 2 to 4 g of omega-3 per day for 12 weeks significantly reduced triglycerides and non-HDL cholesterol.¹¹

A low-carbohydrate diet combined with omega-3 intake significantly helps control polycystic ovary syndrome and normalizes FSH and testosterone levels.¹²

Taking 4 g of omega-3 per day, for 12 weeks, reduces the vicious cycle of inflammation by decreasing the number of macrophages in adipose tissue; increasing adipose capillaries, and lowering the levels of monocyte chemoattractant protein-1 (MCP-1) in volunteers with insulin resistance.¹³

The effect of omega-3 on membrane fluidity and inflammation is useful in pain relief.¹⁴

Omega-3s normalize the adrenal response (catecholamines).¹⁵

Neuropathies

Omega-3s (640 mg, 3 times a day) help prevent chemotherapy-induced neuropathy. (paclitaxel).¹⁶

 

Leaky gut

Prevent injuries to the gastrointestinal mucosa caused by irritants (ex: anti-inflammatories).¹⁷

Omega-3s maintain the intestinal barrier function due to a loss of blood perfusion. (in vivo).¹⁸

 

Indications

Reduction of inflammation.^19,20

Prevention of cardiovascular diseases ²¹ (antithrombotic, blood pressure, ²² cholesterol and triglycerides ²³).

 

Inflammatory diseases: rheumatoid arthritis, lupus, irritable bowel syndrome.

Central nervous system: depression, attention deficit hyperactivity disorder, bipolar disorder ²⁴, schizophrenia ²⁵, improves fetal and newborn development up to 4 months ²⁶, prevention of cognitive decline and Alzheimer's disease.

Asthma and COPD. ²⁷

Psoriasis: treatment adjuvant. ²⁸

Autoimmune diseases. ²⁹

Pregnancy: Despite the poor methodology of the studies, the evidence is sufficiently strong to establish that taking fish oil supplements improves pregnancy outcomes and reduces the risk of postpartum depression.^30,31

Fetal development: The consumption of omega-3 during pregnancy reduces several health risks in infants, such as allergies.³² However, even though they improve the neurological development of the fetus and the baby, omega-3s do not make them smarter, except perhaps if the mother comes from a poor and deprived background.

 
Dosages
 
The doses commonly used to achieve a therapeutic anti-inflammatory effect range between 3,000 and 9,000 mg of omega-3 (EPA + DHA) per day, taken in multiple doses.³³ However, there is no contraindication for the use of higher doses. On the other hand, there is no consensus regarding a recommended minimum intake.

 

Cardiovascular and metabolic syndrome

 

Dietary prevention: 3 servings of fatty fish per week.

Primary prevention: 500 to 650 mg of omega-3 (EPA & DHA), once a day.

Secondary prevention or intervention (1 risk factor or more): 1,000 mg of omega-3 and more per day.

Triglycerides: 2,400 to 4,000 mg per day.

 

A study on overweight but otherwise healthy young adults did not note any change in inflammation markers (dose too low [1,700 mg per day] and duration too short [4 weeks]).³⁴

 

Ophthalmology

1,800 mg of omega-3 (EPA and DHA) per day.

 

Side effects

High doses of fish oils can cause mild digestive disturbances: loose and/or oily stools, belching (reports), halitosis. (bad breath).

Cod liver oil and halibut liver oil are not recommended. Their high vitamin A content can led to exceeding the tolerable upper intake level, which is 3 mg (or 10,000 IU) per day.

 

Interactions

Theoretical interaction with anticoagulants (warfarin, heparin) and antiplatelet agents is not significant. For very high dosages, INR should be closely monitored, but below 3,000 mg (AEP+ADH), it is not necessary.^35,36,37

According to the FDA, omega-3s have GRAS (generally recognized as safe) status up to 3 g of omega-3s (10 g of oil).

Pregnancy and breastfeeding

Omega-3s are not only safe during pregnancy but are also increasingly recommended.

 

Contraindication

Fish allergy. (Anaphylaxis)

 

Notes

A concept regarding fish oil is particularly overused by marketing: the concentration ratio between EPA and DHA. In fact, the only documented EPA/DHA ratio concerns indications related to the nervous system: mood disorders, depression, stress resistance, anxiety, etc. In these cases, products containing a high content of EPA and a low amount of DHA are preferred (the EPA/DHA ratio should be between 7:1 and 20:1). In all other cases, the ratio between the two is not documented. We will therefore focus on the total dose (EPA+DHA) and not on any ratio between the two.

Products manufactured in Canada and bearing a Natural Product Number (NPN) are free of toxins and have adequate quality control.

International Fish Oil Standard has established the highest quality standards. Visit the IFOS website for the list of companies that adhere to these standards.

 

Omega 3: what ratio?

What type of omega-3 product should I take: one with a lot of EPA, a lot of DHA, or both?

Omega-3 products found on the shelves contain 2 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Do they have different roles? Is the ratio of these two omega-3s (EPA/DHA) important?

 

What do the studies say?

Except for products targeted at depression and mood disorders, the EPA/DHA ratios of the products on the market are based on... very little.

Here is the current state of knowledge on this subject:

Depression and mood disorders

For these indications, the weight of the evidence leans towards a product containing at least 1000 mg of EPA and as little DHA as possible.^1,2 Omega-3 products will therefore be in the form of ethyl ester (EE) or monoglycerides (MG), forms that allow for easier modulation of the EPA/DHA ratio compared to the triglyceride form. (TG).

 

Inflammation

For indications of inflammation (such as arthritis), it would make sense to primarily use EPA since it is the precursor of certain anti-inflammatory chemical mediators produced by our cells (eicosanoids). However, almost all studies have been conducted with fish oils in the form of TG (therefore containing a significant proportion of DHA).³ Moreover, recent discoveries have identified anti-inflammatory chemical mediators derived from DHA, collectively known as docosanoids.⁴ Some of these molecules actually have very evocative names, such as defensins and protectins. Finally, the EPA/DHA ratio is probably not very important.

 

Cardiovascular

Regarding cardiovascular indications, there is no consensus on the predominance of one omega-3 over the other. You will find several studies that use products richer in DHA, and just as many that use products richer in EPA. Experts agree on recommending overall dosages of omega-3, without mentioning a ratio.

 

Brain development

The brain of the fetus, infants, and children up to the beginning of adolescence (the last period of brain growth) has the ability to incorporate DHA as a building material. It is therefore important that children do not lack it.

Adults have much less of this ability. Thus, DHA has shown the ability to prevent cognitive decline only if it is consumed over a very long period, that is, throughout life. Here, DHA is no longer considered a unique compound, but rather as a marker of fish consumption, a lifestyle habit. Boasting about the merits of a product rich in DHA to prevent Alzheimer's or cognitive decline is not based on the most rigorous science... It may be useful, but it doesn't reverse the disease. So, here too, what matters most is the total amount of omega-3, not a specific ratio.

 

Conclusion

Long-chain omega-3s are among the most important substances for health and the most useful for a variety of indications.

 

What you need to remember is that, with the exception of mood disorders, the total dose of omega-3 is more important than the EPA/DHA ratio or the chemical structure (TG, EE, or MG) under which they are presented to us. To have significant effects, the dose of omega-3 must be substantial (depending on the initial blood level, the person's condition, and weight) to impact the blood level known as the omega-3 index.

 

 

References

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Warning:  Maison Jacynthe disclaims all responsibilities. The information contained on this page does not seek to substitute a justified allopathic treatment nor to dismiss the expertise of the medical profession. It is up to each individual to take charge of their health, to inform themselves, and to make the necessary changes to improve their condition. Therapeutic supervision by a qualified healthcare professional is obviously recommended.