Are Omega-3s In Your Chronic Pain Plan?
Omega-3s get a lot of notoriety — and for good reason! Not only is one of them essential for good health, but it can also be a powerful part of your chronic pain plan.
Unfortunately, many of us don’t get enough Omega-3s in our diets.
Omega-3s are a kind of fat. Fats are not just a storable source of 9 calories per gram. Different fats are used by our bodies for different essential functions. They’re part of the membranes that surround each cell and are especially important in the brain and nerves. They can mediate the effect of our immune cells as well as influence the production of neurotransmitters and hormones. Omega-3s are anti-inflammatory and an important part of nourishing your immune system, brain health, and mental well-being.
“Omega-3s are anti-inflammatory and an important part of nourishing your immune system, brain health, and mental well-being.”
In fact, it’s thought that the reduced intake of omega-3s over the last few generations is one of the reasons for the increase in many of the chronic diseases we see today.
Let’s look at what exactly omega-3s are, why they’re so good for our health, and how to get enough of these lovable fats.
What Are Omega-3s?
Roll up your sleeves, we’re about to get geek gears goin’.
There are several types of fats (a.k.a. fatty acids). They’re broken down into two main categories: saturated and unsaturated. Unsaturated fatty acids are further broken down into monounsaturated (MUFAs) and polyunsaturated (PUFAs).
The main types of PUFAs are omega-3s and omega-6s. We don’t hear much about omega-6s because we tend to get too much of these in our diet already. Omega-6s are found in meat, poultry, and many common seed oils like corn and sunflower. So, the focus has been to educate people to swap out some of those omega-6s to get more omega-3s as our ancestors did.
Three of the omega-3 fatty acids are particularly important for health.
Yep! There are more than one.
Alpha-linolenic acid (ALA) - essential fatty acid
Eicosapentaenoic acid (EPA) - biologically active fatty acid
Docosahexaenoic acid (DHA) - biologically active fatty acid
ALA is essential - literally essential for health, just like essential vitamins and minerals. This is because the body can’t create it from other nutrients. It is this omega-3 that the body needs in order to create the biologically active EPA and DHA. In fact, research shows that the primary role of ALA is to be the building block for EPA and DHA.
ALA is the plant-based omega-3 and is found in many seeds like flax, hemp, and chia. It’s also found in walnuts, and oils from olives, canola, and soy.
Biologically active: What I mean by “biologically active” is that EPA and DHA are the forms of omega-3s that provide the health benefits. They’re the ones that are active in the body.
EPA and DHA, on the other hand, are found in seafood, especially oily fish. They are also found in algae, which is a vegetarian source.
GEEK SQUEAK: Fish have the biologically active forms of omega-3s because they eat the algae and store extra EPA and DHA in their fat.
The conversion of plant-based essential ALA into the biologically active EPA and DHA is complex and requires several steps and enzymes. Unfortunately, the process isn’t very efficient. The conversion rate of ALA to EPA is about 8-12%, while the conversion to DHA is only about 1%. Some studies show that women may have slightly higher conversion rates compared to men.
Despite all of this biochemistry, the real question is how do they work in the body and what are these health benefits?
Health Benefits of Omega-3s
There is a lot of research about the health benefits of omega-3 fatty acids. Things like anti-inflammation, heart and brain health, as well as better moods.
Omega-3s & anti-inflammation
There are many inflammatory diseases like allergies, asthma, arthritis, and autoimmune diseases. There are also many other diseases that may not be inflammatory per se but have a substantial inflammatory component. These include diabetes, obesity, cancer, heart disease, depression, and neurodegenerative diseases such as Alzheimer’s.
Many of these conditions are becoming more common. Reasons include allergens, infections, environmental and dietary toxins, and even stress. As mentioned earlier, one of these reasons is our inflammatory diets
Yes! What you eat can increase or decrease the amount of inflammation in your body.
An inflammatory diet contains a much higher intake of omega-6s compared with omega-3s. In fact, the higher the intake of certain omega-6s, the higher the production of certain inflammatory molecules.
“What’s super Sci-Fi fly is that Omega-3s become incorporated into the membranes of immune cells and affect their inflammatory response. ”
Many animals and some clinical studies have found reduced inflammation when omega-3 supplements were taken.
A review of 30 studies showed that fish oil supplements reduced the pain of arthritis, particularly rheumatoid arthritis.
How do omega-3s reduce inflammation?
Two ways. First, they are used to create anti-inflammatory molecules themselves. Second, they can inhibit some of the mechanisms that cause inflammation in the first place.
Omega-3s are used to produce certain anti-inflammatory molecules (e.g. prostaglandins, resolvins, etc.) that combat inflammation.
They also reduce the production of enzymes that create inflammatory molecules, and can even reduce the expression of certain inflammatory genes.
What’s super Sci-Fi fly is that Omega-3s become incorporated into the membranes of immune cells and affect their inflammatory response.
Omega-3s & The Brain
If you take away the water weight, your brain is about 60% fat. DHA is the main fatty acid in the brain’s grey matter, while EPA makes up about 1% of the total brain fatty acids.
DHA is the most important PUFA in the central nervous system. It’s the most abundant component of the membranes of nerve cells and plays important roles in both structure and function. DHA helps nerve cells insulate their electrical signals, stabilize their membranes, and reduce inflammation.
It’s important to ensure enough omega-3s for optimal brain health, as well as a baby’s brain development during pregnancy and beyond.
Pregnancy & Babies
The last trimester of pregnancy sees the greatest need for DHA for the baby. This is when the brain and eyes are maturing. More DHA is transported to the infant during this last trimester compared to the first two. Children born preterm are more vulnerable to deficiency, and studies show they have lower levels of omega-3s in their blood compared to infants born at full term.
Preterm infants were given a formula that includes omega-3s show a small improvement in neurodevelopmental outcomes compared to preterm infants given formula without omega-3s. This does not seem to affect full-term infants.
DHA is found in breast milk. If mothers reduce the amount of omega-3s they eat, there is a reduction in the amount of omega-3s in their breast milk.
Recent studies found positive effects in cognition (ability to think) and brain connectivity in young children who had higher DHA intake during infancy.
Aging Well
On the other side of the spectrum, in terms of neurodegeneration, age is the greatest risk factor for Alzheimer’s disease (AD). There’s been a lot of research on the effects of omega-3s and Alzheimer’s disease. People with higher omega-3 intakes have a lower risk of AD; people with AD tend to have lower levels of DHA in their blood.
Because of DHA’s effect on certain brain cells (glial cells), it was thought that supplementing with DHA may help with AD. This was tried in animal models and was shown to boost an enzyme that helps to clear the detrimental Aβ plaques that are common in AD. Also, animals given an omega-6 enriched diet had higher levels of plasma Aβ as well as more mood issues.
A recent review of several high-quality clinical studies looked at the use of omega-3 supplements to try to help with mild to moderate AD. After combining the results of those trials, researchers found that after six months, there was no consistent benefit in quality of life, cognition (ability to think), or mental health. One study showed a small improvement in activities of daily living among those who had the omega-3 supplements.
A more recent larger study showed that omega-3 supplements may have a small benefit if taken early in the development of AD, but other studies don’t show the same benefit.
More research is needed to understand the role omega-3s have for people with AD.
FUN FACT: One symptom of deficiency of the essential omega-3 (ALA) is visual dysfunction. This is because of how important DHA is, not only for the brain but also for the retina of the eye.
Omega-3s & Mental Health
The links between mental health and inflammation are many. For one, certain medications that cause inflammation can induce mental health symptoms. At the same time, some antidepressant medications are anti-inflammatory. In fact, taking omega-3s along with antidepressant medications has an improved effect over antidepressant medications alone.
The role of omega-3s in mental health is not just due to their anti-inflammatory abilities. There is also evidence that omega-3 deficiency can lead to impaired function of the neurotransmitters serotonin and dopamine, and these can result in some mental health issues.
There is also a connection with stress hormones. People who feel depressed tend to have higher levels of the stress hormone cortisol in their blood. The omega-3 EPA may reduce the production and release of stress hormones.
Anxiety & Depression
People who regularly eat and/or have higher blood levels of omega-3s are less likely to feel depressed or anxious.
One randomized double-blind study looked at depressed undergraduate students. They found a significant reduction in symptoms in those who took omega-3 supplements, compared to those who took a placebo.
Studies have also shown a mild to moderate benefit in symptoms for those taking omega-3s versus placebos. Some of those studies also showed comparable results to certain antidepressant medications. These studies also concluded that the evidence was not very strong yet, and more research with higher-quality studies is needed.
Aggression
In terms of aggression, a recently published double-blind randomized study tested whether omega-3 supplements could help reduce aggression. They gave one group a supplement with EPA and DHA, and another got a placebo. The participants taking the omega-3s found that after 6-weeks they felt that their aggressiveness significantly decreased.
Eat Your Omega-3s
In order to get the health benefits, you have to regularly eat enough foods that are high in omega-3s. It’s thought that our ancestral diets included approximately equal amounts of omega-3s and omega-6s. Now, our intake of omega-6s is up to 20x higher than our intake of omega-3s. This is why there is such an emphasis on getting enough omega-3s.
Plant-Based Sources
When it comes to plant-based sources of omega-3s, flax is the winner! Up to half of the flax’s total fatty acids are the essential omega-3 ALA. So, try adding some flax seeds or flax seed oil into your nourishing diet. Then mix it up with some of these other vegan sources:
Walnuts
Seaweed and Algae (spirulina, nori and chlorella)
Hemp Seeds
Chia Seeds
Kidney Beans
Kale
Brussels Sprouts
Fish-Based Sources
To eat the recommended amount of omega-3s have at least two servings of fatty fish each week. Fatty fish include salmon, mackerel, herring, and sardines. This is a recommendation from the World Health Organization, as well as other health authorities.
In the US, there have been consistent recommendations to increase fish intake for almost 20 years. Despite this, the average American still only eats about 1.3 servings of fish per week.
Eating fish and seafood gives you a lot more nutrition than simply taking a supplement. They contain protein, vitamins D and B12, as well as the minerals iodine, selenium, potassium, and magnesium, to name a few.
When it comes to choosing fish, bigger is not better! Large fish that feed on smaller fish have higher concentrations of toxins in their fat. To reduce your intake of things like methyl mercury and organic pollutants, limit your intake of tile-fish, king mackerel, shark, and swordfish. And anyone who is pregnant, breastfeeding, or a child, should avoid these types of fish altogether.
Other Ways To Get More Omega-3s
Some foods are fortified with omega-3 oils. Some baked goods, pasta, dairy, eggs, dressings, and spreads may contain added flax, algal, or fish oils. Omega-3 eggs are produced by hens who’ve had flax seeds, chia seeds, and/or fish oil added to their feed. In fact, hens fed the plant-based ALA produce eggs with ALA, and those fed fish oil produced eggs with EPA & DHA.
Omega-3 Supplements
NOTE: Omega-3 supplements are by no means a “treatment,” but can help in cases of insufficiency. In terms of safety, fish oil supplements have a long history of safety. However, be cautious if you’re planning or recently had surgery, or have a compromised immune system. Speak with your physician or pharmacist if you take pain, anti-inflammatory, or blood-clotting, or blood lipid/cholesterol medications. Speak with your health care professional before changing your supplement regimen.
For those who don’t eat fish, supplements can be an option. Omega-3 supplements are one of the most popular supplements taken.
It’s recommended that most adults get at least 0.5-1.6 g per day of combined EPA and DHA, preferably from food. In terms of ALA, 1.5-3 g per day is beneficial, and that can be from plant-based foods or supplements.
Fish liver oil, is from the livers of the fish, and also contains fat-soluble vitamins like vitamins A and D.
PRO TIP: Refrigerating your fish oil supplements can help prevent the delicate fats from going rancid.
Conclusion
Omega-3 fatty acids are essential for good health!
Some of the health benefits include reduced inflammation, improved brain function, and enhanced mental health.
Flax is the best plant-based source of the essential omega-3, ALA. The two biologically active omega-3s, EPA and DHA, are from fish or algae. It’s always recommended to get your nutrients from food as much as possible. At least two servings of fatty fish each week is recommended.
If you consider supplementing, make sure to follow direction on the label and keep them refrigerated. If you have any medical conditions or are taking medications, make sure to speak with your health care professional.
+ References
Abdulrazaq M1, Innes JK1, Calder PC2.(2017). Effect of ω-3 polyunsaturated fatty acids on arthritic pain: A systematic review. Nutrition, 39-40:57-66. doi: 10.1016/j.nut.2016.12.003. LINK: https://www.ncbi.nlm.nih.gov/pubmed/28606571
Calder, P. C. (2013). Omega‐3 polyunsaturated fatty acids and inflammatory processes: nutrition or pharmacology? British Journal of Clinical Pharmacology, 75(3), 645–662. http://doi.org/10.1111/j.1365-2125.2012.04374.x LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575932/
Calder P.C. (2017). Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans, 15;45(5):1105-1115. doi: 10.1042/BST20160474. LINK: https://www.ncbi.nlm.nih.gov/pubmed/28900017
Baker, E.J., Miles, E.A., Burdge, G.C., Yaqoob, P. & Calder, P.C. (2016). Metabolism and functional effects of plant-derived omega-3 fatty acids in humans. Prog Lipid Res, 64:30-56. doi: 10.1016/j.plipres.2016.07.002. LINK: https://www.ncbi.nlm.nih.gov/pubmed/27496755 LINK: https://eprints.soton.ac.uk/398743/1/__soton.ac.uk_ude_PersonalFiles_Users_lce_mydocuments_Eprints%2520-%2520Prof%2520Calder_Accepted%2520publications%2520for%2520eprints_Baker%2520et%2520al%2520%2520Final%2520Version%2520Revised.pdf
Burckhardt, M., Herke, M., Wustmann, T., Watzke, S., Langer, G. & Fink A. (2016). Omega-3 fatty acids for the treatment of dementia. Cochrane Database Syst Rev, 11;4:CD009002. doi: 10.1002/14651858.CD009002.pub3. LINK: https://www.ncbi.nlm.nih.gov/pubmed/27063583 LINK: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009002.pub3/pdf
Bègue, L., Zaalberg, A., Shankland, R., Duke, A., Jacquet, J., Kaliman, P., Pennel, L., Chanove, M., Arvers, P. & Bushman, B.J. (2017). Omega-3 supplements reduce self-reported physical aggression in healthy adults. Psychiatry Res, 261:307-311. doi: 10.1016/j.psychres.2017.12.038. LINK: https://www.ncbi.nlm.nih.gov/pubmed/29331711
Carlson, S. E., & Colombo, J. (2016). Docosahexaenoic Acid and Arachidonic Acid Nutrition in Early Development. Advances in Pediatrics, 63(1), 453–471. http://doi.org/10.1016/j.yapd.2016.04.011 LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5207030/
Chaddha, A & Eagle, K.A. (2015). Omega-3 Fatty Acids and Heart Health. Circulation, 132:e350-e352. https://doi.org/10.1161/CIRCULATIONAHA.114.015176 LINK: http://circ.ahajournals.org/content/132/22/e350.long
oorey, R., Novinda, A., Williams, H. & Jayasena, V. (2015). Omega-3 fatty acid profile of eggs from laying hens fed diets supplemented with chia, fish oil, and flaxseed. J Food Sci, 80(1):S180-7. doi: 10.1111/1750-3841.12735. LINK: https://www.ncbi.nlm.nih.gov/pubmed/25557903
Gintya, A.T. & Conklinb, S.M. (2015). Short-term supplementation of acute long-chain omega-3 polyunsaturated fatty acids may alter depression status and decrease symptomology among young adults with depression: A preliminary randomized and placebo controlled trial. Psychiatry Research. 229(1–2); 485–489. LINK: http://www.sciencedirect.com/science/article/pii/S0165178115003844
Gioxari, A., Kaliora, A.C., Marantidou, F. & Panagiotakos, D.P. (2018). Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysis. Nutrition, 45:114-124.e4. doi: 10.1016/j.nut.2017.06.023. LINK: https://www.ncbi.nlm.nih.gov/pubmed/28965775
Health Canada, Natural and Nonprescription Health Products Directorate, Single Monographs, Fish Oil. Accessed March 2, 2018. LINK: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/atReq.do?atid=fish.oil.huile.poisson&lang=eng
Jayarathne, S., Koboziev, I., Park, O.-H., Oldewage-Theron, W., Shen, C.-L., & Moustaid-Moussa, N. (2017). Anti-Inflammatory and Anti-Obesity Properties of Food Bioactive Components: Effects on Adipose Tissue. Preventive Nutrition and Food Science, 22(4), 251–262. http://doi.org/10.3746/pnf.2017.22.4.251 LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758087/
Langlois, K. & Ratnayake, W.M. (2015). Omega-3 Index of Canadian adults. Health Rep. 26(11):3-11. LINK: http://www.statcan.gc.ca/pub/82-003-x/2015011/article/14242-eng.pdf
- Martínez-Cengotitabengoa, M. & González-Pinto, A. (2017). Nutritional supplements in depressive disorders. Actas Esp Psiquiatr, 45(Supplement):8-15. LINK: https://www.actaspsiquiatria.es/repositorio//suplements/19/ENG/19-ENG-947497.pdf
Molfino, A., Amabile, M. I., Monti, M., & Muscaritoli, M. (2017). Omega-3 Polyunsaturated Fatty Acids in Critical Illness: Anti-Inflammatory, Proresolving, or Both? Oxidative Medicine and Cellular Longevity, 2017, 5987082. http://doi.org/10.1155/2017/5987082 LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488236/
Whittington, R. A., Planel, E., & Terrando, N. (2017). Impaired Resolution of Inflammation in Alzheimer’s Disease: A Review. Frontiers in Immunology, 8, 1464. http://doi.org/10.3389/fimmu.2017.01464 LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681480/
Rapaport, M. H., Nierenberg, A. A., Schettler, P. J., Kinkead, B., Cardoos, A., Walker, R., & Mischoulon, D. (2016). Inflammation as a Predictive Biomarker for Response to Omega-3 Fatty Acids in Major Depressive Disorder: A Proof of Concept Study. Molecular Psychiatry, 21(1), 71–79. http://doi.org/10.1038/mp.2015.22 LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581883/
Rogers, L. K., Valentine, C. J., & Keim, S. A. (2013). DHA Supplementation: Current Implications in Pregnancy and Childhood. Pharmacological Research : The Official Journal of the Italian Pharmacological Society, 70(1), 13–19. http://doi.org/10.1016/j.phrs.2012.12.003 LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602397/
Rutkofsky, I.H., Khan, A.S., Sahito, S. & Kumar, V. (2017). The Psychoneuroimmunological Role of Omega-3 Polyunsaturated Fatty Acids in Major Depressive Disorder and Bipolar Disorder. Adv Mind Body Med, 31(3):8-16. LINK: https://www.ncbi.nlm.nih.gov/pubmed/28987035
Senftleber, N.K., Nielsen, S.M., Andersen, J.R., Bliddal, H., Tarp, S., Lauritzen, L., Furst, D.E., Suarez-Almazor, M.E., Lyddiatt, A. & Christensen, R. (2017). Marine Oil Supplements for Arthritis Pain: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients, 9(1). pii: E42. doi: 10.3390/nu9010042. LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295086/
Siscovick, D.S., Barringer, T.A., Fretts, A.M., Wu, J.H., Lichtenstein, A.H., Costello, R.B., Kris-Etherton, P.M., Jacobson, T.A., Engler, M.B., Alger, H.M., Appel, L.J. & Mozaffarian, D. (2017). Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association. Circulation, 135(15):e867-e884. doi: 10.1161/CIR.0000000000000482. LINK: http://circ.ahajournals.org/content/circulationaha/135/15/e867.full.pdf
Watanabe, Y. & Tatsuno, I. (2017). Omega-3 polyunsaturated fatty acids for cardiovascular diseases: present, past and future. Expert Rev Clin Pharmacol, 10(8):865-873. doi: 10.1080/17512433.2017.1333902. LINK: https://www.ncbi.nlm.nih.gov/pubmed/28531360
Zárate, R., el Jaber-Vazdekis, N., Tejera, N., Pérez, J. A., & Rodríguez, C. (2017). Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine, 6, 25. http://doi.org/10.1186/s40169-017-0153-6 LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5532176/
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