Omega-3’s underrated impacts on inflammation, pain, anxiety and depression
Omega-3s are foundational nutrients for patients and practitioners alike. Before diving into the details of how omega-3s have such far-reaching benefits for the body, it is more helpful to take a more broad-picture approach. For omega-3 connoisseurs, feel free to jump ahead a few paragraphs to the specific applications. A brief overview of these essential nutrients helps set the stage for the importance of omega-3 supplementation and how to choose the best option.
Omega-3s belong to a family of lipid molecules called polyunsaturated fatty acids (PUFAs). While the body can make most of the biologically-necessary lipids from other raw materials, certain PUFAs are considered essential and therefore must be ingested through dietary or supplementary sources. These essential fatty acids include omega-3s. The omega-3 family contains over 15 different molecules, with docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) gaining the most attention.
Increasing cellular flexibility
The distinguishing feature for PUFAs is the presence of at least two double bonds in their tail. When intake is sufficient, omega-3s are incorporated into the semipermeable lipid bilayer of our plasma membrane that surrounds each cell. The double bonds in the tails of omega-3s create somewhat of a zigzag effect, whereas the tails of saturated fatty acids (which lack double bonds) stick straight out into the lipid bilayer. The omega-3s positively alter the structure of the plasma membrane by adding more fluidity and flexibility, since the fatty acids are unable to be packed as tightly.
I’ve used a marine life analogy with patients when talking about omega-3s and our plasma membranes. Imagine you are a fish trying to swim through a bed of densely packed seaweed that is sticking straight up from the ocean floor — it’s very tough to maneuver around. But, if you’re swimming through seaweed that is twisty and wavy, there are spaces created between the seaweed, making it easier to swim about. The molecules being transported in and out of our cells need space to swim and it’s the job of omega-3s to help make that happen.
The plasma membrane regulates the passage of nutrients into the cell and waste materials out of the cell, promotes signaling between cells, encourages cell membrane receptor functionality, and creates balance between pro-inflammatory and anti-inflammatory activity. Therefore, omega-3s are crucial for proper functioning of every cell inside our body, from heart cells to brain cells to immune cells.
The connection to specialized pro-resolving mediators (SPMs)
Research by Charles Serhan, PhD, in the early 2000s found that omega-3 metabolites may be even more beneficial than their parent molecules.
Serhan discovered novel lipids called specialized pro-resolving mediators (SPMs) that are enzymatically derived from omega-3s fatty acids. Aptly named molecules, like resolvins and protectins, are necessary for resolving inflammation and tissue damage. Therefore, omega-3 deficiencies reduce the body’s ability to resolve acute inflammation and increase the likelihood of developing chronic, unresolved inflammation — the spark for countless chronic conditions.
Omega-3s improve musculoskeletal function and reduce pain
When discussing omega-3s with patients the conversation often focuses on the cardiovascular system. However, research demonstrates extensive uses for omega-3s in musculoskeletal conditions and pain.
First, omega-3s help regulate skeletal muscle mass and reduce muscle atrophy. Recovery from muscle injuries and fractures becomes more difficult across the life span. Hip fracture is a serious risk factor for mortality in older adults. Within the first three months after such a fracture, adults over 50 years old have at least a five times greater risk of dying versus adults without a hip fracture. The recovery from fracture can be a long road, especially as muscles atrophy from disuse. Supplementation with omega-3s has been shown to increase the rate of muscle protein synthesis. Interestingly, these effects have also been demonstrated in healthy adults.
Pain is one of the most common conditions treated by practitioners today. While many patients may reach for an over-the-counter pain reliever, like non-steroidal anti-inflammatory drugs (NSAIDs), they may be unaware of the risks. Not only can NSAIDs damage the liver, kidneys and gastrointestinal tract, the real kicker is they also delay wound healing.
Omega-3s have been shown to have similar efficacy to ibuprofen for multiple types of pain relief. One study in particular found that omega-3s were shown to reduce nonsurgical neck or back pain. As many chiropractors, acupuncturists and other integrative practitioners are aware, patients with nonsurgical pain are left with few options other than NSAIDs or prescription analgesics. After just 75 days of taking omega-3s, 59% of the patients were able to discontinue their prescription NSAID medications; 60% of patients noted improvements in joint pain; and 88% said they would continue taking the omega-3s.
Some of the analgesic effects of omega-3s may come from their involvement in the synthesis of endocannabinoids. Another newer branch of research, the endocannabinoid system is highly involved in the pain response and modulation of inflammatory pathways. As some patients and practitioners have experienced, plant-based cannabinoids — cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) — can be helpful for various types of pain. However, another approach is to increase omega-3 levels in the body to optimize the production of endocannabinoids. In essence, omega-3s can produce some of the same beneficial effects of cannabis, but without any of the psychotropic effects.
Reducing anxiety and depression with omega-3s
Mood disorders, such as depression and anxiety, are unfortunately quite common occurrences in chronic pain conditions. Up to 85% of patients with chronic pain have severe depression.
While mental health and pain may seem unrelated at first glance, when determining root causes of these issues, the thread of chronic inflammation is weaved throughout. Depression and anxiety are neuroinflammatory conditions, and if the brain is on fire, it’s likely there is inflammation elsewhere.
Research has shown that levels of omega-3s in people with depression tend to be lower, while the pro-inflammatory forms of omega-6s are higher.
In a 2018 cross-sectional study, patients who were in a current depressive episode, particularly those who were more severe and had a comorbid anxiety disorder, had lower circulating omega-3 levels versus patients who were in remission or healthy controls. In a randomized, controlled trial, use of omega-3s was associated with a 50% reduction in the Hamilton Depression Rating Scale score.
Phospholipid-based omega-3s from salmon
When it comes to supplemental omega-3s, patients (and practitioners) may find themselves swimming in a sea of possibilities. Unfortunately, many of the traditional options are oil-based (triglycerides), subjecting the delicate omega-3s to oxidation and rancidity. One of the key advantages to a phospholipid delivery system is greater protection from free radical damage to those sensitive double bonds that are characteristic of omega-3s. This helps to deliver the omega-3s in their biologically active and intact forms — that is, not oxidized.
How are the omega-3s extracted? This is a key question that in many fish oil products involves different chemicals and very high heat. However, there is a newer process called vectorization that uses only cold-water and proteolytic enzymes to obtain omega-3s from salmon. The omega-3s are kept in their natural 2:1 ratio of DHA:EPA without any chemical alterations or artificial spiking. Instead of being attached to triglycerides (like traditional fish oils), the omega-3s are attached to phospholipids and bioactive peptides. Phospholipid-based omega-3s have been shown to be better absorbed in the brain, red blood cells and other tissues. As a bonus, the improved absorption means less chance of those unpleasant regurgitations and odors that can decrease patient adherence.
The end result of this unique extraction process means the omega-3s are attached to phospholipids and peptides, but in a solid form, which means zero issues with rancidity. Some of the naturally occurring phospholipids include phosphatidylcholine, phosphatidylserine and phosphatidylinositol. Plus, the peptides themselves have been shown to have anxiolytic properties, neutralize oxidative stress, and support mental well-being and the neurological system.
Last, but certainly not least, is the safety of these phospholipid-based omega-3s. Each batch is third-party tested for purity, including analysis for heavy metals, polychlorinated biphenyls (PCBs) and other toxins. Unfortunately, all ocean life has some measurable level of PCBs, but you would have to take over 150,000 servings at one time of this form of omega-3 to exceed the Prop 65 regulations for PCB levels.
Here is a summary of key features:
- The vectorization process uses only cold-water and proteolytic enzymes. Say goodbye to excessive heat, chemicals and harsh solvents.
- Omega-3s are attached to phospholipids and bioidentical to the omega-3s found in fish and the human body.
- Provides bioactive peptides not found in traditional fish, krill or flax oils.
- Increases patient adherence due to better absorption that minimizes regurgitation.
- Regularly tested for purity and safety, including heavy metals, PCBs and other toxins.
How much should patients take? Research on fish oil has historically used high dosages because there are limitations to absorption. When I’m recommending phospholipid-based omega-3s to patients, I find that just once- or twice-daily dosing provides beneficial results.
LEXI LOCH, ND, received her Doctorate in Naturopathic Medicine from the National University of Natural Medicine, where she graduated with highest honors. In addition to her practice, she is a medical writer and editor, researcher, educator and patient advocate. Her articles have been published in various natural health periodicals and reference books. Prior to her education as a physician, she worked in veterinary medicine as a licensed veterinary technician, and is a member of the Scientific Affairs and Education team for EuroMedica Inc.
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