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Discovering the Wonders of Fish Oil: A Guide to Your Health and Fertility

March 29, 2024 Nadera Mansouri-Attia

Fish oil, a potent mixture of polyunsaturated ω3 fatty acids, is akin to a health elixir for the human body. Its benefits are far-reaching, extending from cardiovascular health to fertility enhancement, making it a subject of interest for many seeking a natural boost to their wellbeing.

Is Fish Oil Safe?

Absolutely! Omega-3 fatty acids are an essential part of our diet, typically absorbed through the foods we eat as triglycerides. A common concern with fish oil is the risk of increased bleeding; however, studies, such as the comprehensive Cochrane meta-analysis1, have shown that consumption of less than 7 grams per day is safe, with no significant increase in bleeding risk.

How Much Should You Take?

The recommended dose of fish oil varies and should be tailored based on individual test results (fatty acid profile included in our IRMA Report). It’s not a one-size-fits-all solution but rather a personalized supplement strategy.

Understanding the Science: Structural Differences

To enhance the concentration of omega-3 in fish oil, a process known as ethylation is employed. This changes the structure from a triglyceride — three fatty acids (FA) bound to a glycerol backbone — to an ethyl ester, which has an ethanol backbone instead.
But what does this mean for absorption and bioavailability? Research shows mixed results. Long-term use seems to reveal little difference between the ethyl ester (EE) and triglyceride (TG) forms. However, short-term studies2 suggest better absorption with TGs over a two-week period. Moreover, pancreatic lipase breaks down TGs more efficiently than EEs, as demonstrated by an older study3.

Can ALA Boost EPA/DHA Levels?

Alpha-linolenic acid (ALA) is another fatty acid that can be converted into energy — with up to 35% metabolized into CO24. Although a diet high in ALA can lead to greater oxidation of ALA, the capacity to convert ALA to the more beneficial eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) varies greatly among individuals, even with similar diets5.
For women, a study6 indicated that 21% of ALA converts to EPA and less than 9% to DHA. This points to a significant variability in the body’s ability to synthesize these crucial fatty acids from ALA.

So what is the Most Effective Approach?

Given the body’s varying ability to convert ALA to EPA and DHA, the most effective strategy to increase plasma levels of a particular ω3 fatty acid is to supplement directly with that specific fatty acid.

Harnessing Omega-3’s Powers: Fighting Inflammation and Supporting Fertility

The healing virtues of omega-3 fatty acids, particularly their anti-inflammatory and antioxidative properties, are creating ripples in the medical community. In the intricate dance of the body’s biochemistry, omega-3 fatty acids like EPA (eicosapentaenoic acid) play a critical role in subduing inflammation, offering hope for conditions such as endometriosis and improving chances for successful conception.

The Anti-inflammatory Effects of Omega-3

At the molecular level, omega-3 fatty acids are masters of interference. EPA directly competes with arachidonic acid (AA), dampening the latter’s ability to produce eicosanoids, compounds that typically encourage inflammation7. Moreover, omega-3 fatty acids stifle the Toll-Like Receptor/NFκB pathway and the COX2 enzyme, both of which are crucial in pro-inflammatory cytokine production, as observed by researchers8-9. This effectively curbs the inflammatory response, offering therapeutic potentials in various medical scenarios.

Further down the inflammatory cascade, omega-3 fatty acids inhibit T lymphocyte activation10 and spur the production of molecules like resolvin, maresin, and protectin—factors with formidable anti-inflammatory capacities. These compounds, derived from EPA and DHA, are particularly noted for their role in preventing pregnancy complications that arise from excessive inflammation11.

The Antioxidative Might of Omega-3

In terms of antioxidative action, omega-3 fatty acids shine by obstructing the generation of reactive oxygen species (ROS) and reducing both peroxide production and NOS enzyme activity, which are associated with reactive species production12-13. This antioxidative activity lends a protective effect against cellular damage and age-related diseases.

Omega-3 and Endometriosis

In the realm of reproductive health, the findings from the Nurse Health Study are particularly revealing14. The study highlighted a stark difference in the incidence of endometriosis in women with the highest Polyunsaturated Fatty Acids (PUFA) intake compared to those with lower intake levels.
In vitro15 and animal studies16-18 show that omega 3 can reduce size and number of endometriotic lesions, and reduce the pain associated with endometriosis.
In women, clinical studies have shown that adolescents with endometriosis who took fish oil supplements experienced a significant decrease of 50% in their VAS (pain) scores19. Further, women with increased levels of EPA in their system are 82% less prone to developing endometriosis20.

Through these mechanisms, omega-3 fatty acids not only provide a shield against inflammation and oxidative stress but also open new doors for managing fertility issues and supporting a healthy pregnancy.

References

  1. Hooper L, Thompson RL, Harrison RA, Summerbell CD, Moore H, Worthington HV, Durrington PN, Ness AR, Capps NE, Davey Smith G, Riemersma RA, Ebrahim SB. Omega 3 fatty acids for prevention and treatment of cardiovascular disease. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003177.
  2. Dyerberg J, Madsen P, Møller JM, Aardestrup I, Schmidt EB. Bioavailability of marine n-3 fatty acid formulations. Prostaglandins Leukot Essent Fatty Acids. 2010 Sep;83(3):137-41.
  3. Vermunt SH, Mensink RP, Simonis MM, Hornstra G. Effects of dietary alpha-linolenic acid on the conversion and oxidation of 13C-alpha-linolenic acid. Lipids. 2000 Feb;35(2):137-42.
  4. Emken EA, Adlof RO, Gulley RM. Dietary linoleic acid influences desaturation and acylation of deuterium-labeled linoleic and linolenic acids in young adult males. Biochim Biophys Acta. 1994 Aug 4;1213(3):277-88.
  5. Burdge GC, Jones AE, Wootton SA. Eicosapentaenoic and docosapentaenoic acids are the principal products of alpha-linolenic acid metabolism in young men. Br J Nutr. 2002 Oct;88(4):355-63.
  6. Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010 Mar;2(3):355-374.
  7. Weldon SM, Mullen AC, Loscher CE, Hurley LA, Roche HM. Docosahexaenoic acid induces an anti-inflammatory profile in lipopolysaccharide-stimulated human THP-1 macrophages more effectively than eicosapentaenoic acid. J Nutr Biochem. 2007 Apr;18(4):250-8.
  8. Martinez-Micaelo N, González-Abuín N, Terra X, Richart C, Ardèvol A, Pinent M, Blay M. Omega-3 docosahexaenoic acid and procyanidins inhibit cyclo-oxygenase activity and attenuate NF-κB activation through a p105/p50 regulatory mechanism in macrophage inflammation. Biochem J. 2012 Jan 15;441(2):653-63.
  9. Kew S, Mesa MD, Tricon S, Buckley R, Minihane AM, Yaqoob P. Effects of oils rich in eicosapentaenoic and docosahexaenoic acids on immune cell composition and function in healthy humans. Am J Clin Nutr. 2004 Apr;79(4):674-81.
  10. Serhan CN, Yacoubian S, Yang R. Anti-inflammatory and proresolving lipid mediators. Annu Rev Pathol. 2008; 3:279-312.
  11.  Komatsu W, Ishihara K, Murata M, Saito H, Shinohara K. Docosahexaenoic acid suppresses nitric oxide production and inducible nitric oxide synthase expression in interferon-gamma plus lipopolysaccharide-stimulated murine macrophages by inhibiting the oxidative stress. Free Radic Biol Med. 2003 Apr 15;34(8):1006-16.
  12.  Gazvani MR, Smith L, Haggarty P, et al. High omega- 3:omega-6 fatty acid ratios in culture medium reduce endometrial-cell survival in combined endometrial gland and stromal cell cultures from women with and without endometriosis. Fertil Steril. 2001 Oct;76(4):717-22.
  13. Pereira F, Medeiros FDC, Rocha HAL, et al. Effects of omega-6/3 and omega-9/6 nutraceuticals on pain and fertility in peritoneal endometriosis in rats. Acta Cir Bras. 2019 May 6;34(4):e201900405.
  14. Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC, Hankinson SE. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010 Jun;25(6):1528-35.
  15. Netsu S, Konno R, Odagiri K, et al. Oral eicosapentaenoic acid supplementation as possible therapy for endometriosis. Fertil Steril. 2008 Oct;90(4 Suppl):1496-502.
  16. Tomio K, Kawana K, Taguchi A, Isobe Y, Iwamoto R, Yamashita A, Kojima S, Mori M, Nagamatsu T, Arimoto T, Oda K, Osuga Y, Taketani Y, Kang JX, Arai H, Arita M, Kozuma S, Fujii T. Omega-3 polyunsaturated Fatty acids suppress the cystic lesion formation of peritoneal endometriosis in transgenic mouse models. PLoS One. 2013 Sep 10;8 (9): e73085.
  17. Covens AL, Christopher P, Casper RF. The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit. Fertil Steril. 1988 Apr;49(4):698-703.
  18. Nodler JL, DiVasta AD, Vitonis AF, Karevicius S, Malsch M, Sarda V, Fadayomi A, Harris HR, Missmer SA. Supplementation with vitamin D or ω-3 fatty acids in adolescent girls and young women with endometriosis (SAGE): a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2020 Jul 1;112(1):229-236.
  19. Hopeman MM, Riley JK, Frolova AI, Jiang H, Jungheim ES. Serum Polyunsaturated Fatty Acids and Endometriosis. Reprod Sci. 2015 Sep;22(9):1083-7.