Omega-3 and Omega-6 (n-6) fatty acids constitute the two families of Essential Fatty Acids (EFAs).

EFAs are considered "essential" because they are needed throughout the human life cycle, cannot be produced in the human body, and therefore must be provided through diet.

EFAs aid in the maintenance of cell membrane fluidity and stability, development and function of brain and nerve tissue, oxygen transfer and energy production, immune functions, and conversion into compounds involved in all body functions including local hormones governing inflammatory responses.

Today there exists scientific evidence for effects from omega-3 on the prevention of diseases like colon cancer, pain relief during rheumatoid arthritis and certain psychiatric and skin disorders. Research is also focused on the positive effects during pregnancy, during lactation, brain development and a number of other conditions.

Th-e scientific body of evidence is anyhow 00 the impact from omega-3 suppfements like "Active Flow" on the prevention of cardiovascular diseases and this is also most accepted and has the highest awareness among customers.

There is, in particular, a very large double blind clinical study with 11.000 post cardiac arrest patients showing the positive effect from omega-3, which in fact is in line with effects earlier reported 00ly for statins {synthetic cholesterol1owering drugs).

After this study was published numerous heart specialists has come forward in the media stating that intake of fish rich in fat or omega-3 supplements is recommended both for with and without symptoms of cardiac diseases

Approximately 30 years ago Danish researchers showed interest for the phenomenon that disease patterns among Eskimos at Greenland was totally different from that observed among Danes. Of special interest was the finding that the prevalence of cardiac diseases, diabetes, and certain inflammatory conditions was very low among Eskimos with a traditional diet. This was in contradiction to the generaUy accepted belief that diets rich in fat was associated with a high risk of developing cardiac diseases. The hypothesis was made that the special diet among Eskimos, with a high intake of omega-3 s and low intake of omega-6, could be one of the explanatory factors for such observations.
In the aftermath, numerous sciemjftC papers from ~tivatjon of ce~ ~tures to experimentat research in animals combined with several large clinical studies have supported the idea that omega-3 is the min cause of these observations.

Based on archeological findings and considerations, it is obvious that the primitive diet for humans was significantly different from present with regards to fat fatty acid composition. The primitive man had an omega-6:omega-3 intake ratio of 1: 1 J and different from today's ratio of 20:1. And we are in fact talking about the diet humans ingested during its development -the diet to which our genes did adapt at an early stage.
This change in balance our modem diet have caused, may again cause a shift in disease patterns. From known biological mechanisms one would expect that a high ratio of omega-6 to omega-3 this would cause increased inflammatory reactions and increased incidence of cardiac diseases.

In figure 1 is shown the main finding from the GISSI study. The number of deaths in a group of 5600 patients was reduced from 293 (placebo) to 236 (drug treatment) (20% reduction, relati risk=0.8), while the number of sudden deaths was reduced from 99 to 55 (40% reduction, 0,relativ risk=55), respectively.

Prevention of cardiovascular diseases in healthy individuals. There is strong evidence from epidemiological studies that a diet rich in fish or fish oil prevent cardiovascular diseases among healthy individuals. In addition such a diet reduces blood pressure, makes blood more fluid, reduce the coagulation (clotting) tendency and has a positive effect on the blood lipid composition. In deed, regulatory bodies and authorities does recommend a high intake of fat fish or add dietary supplements containing omega-3 to the regular diet.

Omega-3 fatty acids derived from fat fish and as found in the product "Active Flow" has a proven protective effect against cardiovascular diseases and is recommended to the population in general. Regular omega-3 dietary supplementation revealed positive effects among persons with an established cardiac disease or a high risk of developing such conditions.

Literature and suggested reading
GISSI-Prevenzione Investigators: Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarct: results of the GISSI-Prevenzione trial.

Lancet 1999, Aug 7; 354 (9177) 447-55.

O`Keefe, J.H., Harris, W.S: From Inuit to implementation: Omega-3 fatty acids come of age. Mayo Clin Pros. 2000; 75: 607-614.

Christian A. Drevon: Omega-3 fatty acids: Essential nutrients with several beneficial effects.

Published by Peter Møller, Norway.

A recent study has investigated the beneficial effects of fish oil supplementation and atherosclerosis. A randomized, double-blind, placebo-controlled clinical trial involved 162 patients with confirmed atherosclerosis. Half the patients were given 6 grams of fish oils per
day for three months while the other half were given 6 grams per day of placebo capsules containing a fatty acid composition resembling that of the average European diet. After three months the dosages were reduced to 3 grams/day for a further 21 months. Angiograms were taken at the start of the trial and at the end of the two-year study period. At the end of the
treatment twice as many of the patients in the fish oil group (16) showed regression of their atherosclerotic deposits when compared to the placebo group. Three patients in the placebo group suffered a nonfatal heart attack during the 2-year period as compared to only one in the fish oil group. Seven patients in the placebo group had a cardiovascular event (heart attack or stroke) as compared to only two in the fish oil group. The researchers conclude that fish oil supplementation may be beneficial for atherosclerosis patients and is safe and well-tolerated.

Reference:
von Schacky, Clemens, et al. The effect of dietary omega-3 fatty acids on coronaryatherosclerosis. Annals of Internal Medicine, Vol. 130, April 6, 1999, pp. 554-62 Co sponsor:Pronova A.S

04/01/03- Eating fish regularly reduced the risk of heart disease in diabetic women by as much as 64 percent, according to an American study out today.

"We found that women with type 2 diabetes who ate more fish had significantly lower risk of coronary heart disease and total death than those who rarely ate fish," said Dr Frank B. Hu, lead author and associate professor of nutrition and epidemiology at the Harvard School of Public Health in Boston.

His findings support previous research that has found fish consumption to reduce the risk of heart disease in a largely healthy population. But this is the first study to look at the relationship among diabetic patients, who have a very high risk of heart disease.

National health associations usually recommend that adults, except pregnant women, eat two servings of fish a week. The researchers suggest that for those with, or at high risk of cardiovascular disease (CVD), supplementing fish in the diet with fish oil capsules may be advisable in consultation with a doctor.

Omega-3 fatty acids from fish have been shown to reduce the risk of irregular heartbeats that can lead to sudden death, decrease blood triglyceride levels, improve the functions of blood vessels and reduce blood clot formation – all important factors in reducing risk for heart
disease among diabetics.

However there is little prior evidence confirming that diabetics who eat fish can gain the same benefits as people without diabetes who eat fish, Hu said, writing in the rapid access issue of Circulation, the American Heart Association journal. The researchers were also concerned that fish oil might worsen control of blood sugar among diabetic patients.

Hu and colleagues analyzed data from women with diabetes participating in the Nurses' Health Study (lifestyle and medical history data on more than 121,000 female nurses). They found 5,103 women had reported type 2 diabetes at any time from 1976-94. Women with a history of heart disease, stroke or cancer reported on the 1980 questionnaire (when diet was first assessed) or before they were excluded.

The women were divided into five categories according to how often they ate fish: less than once a month, one to three times a month, once a week, two to four times a week, and five or more times a week.

Between 1980-96, the researchers documented 362 cases of heart disease. They found that diabetic women who ate fish at least once a month were older, slightly heavier, typically did not smoke, tended to have hypertension and high cholesterol, and took multivitamin and vitamin E supplements. Those who ate more fish also ate more fruits and vegetables but ate less red and processed meats.

Compared with diabetic women who seldom ate fish (less than once a month), the risk of developing heart disease was reduced on average by 30 percent in those who ate fish one to three times a month, 40 percent for those who ate it once a week, 36 percent in those who ate fish two to four times a week, and 64 percent in those who ate fish five or more times a week. Higher fish consumption was also associated with a significantly lower death rate.

Hu suggested that the association between higher fish consumption in diabetic women and better heart health can also be extended to diabetic men based on similar findings in studies of healthier men and women.

However he admitted that the study was limited because it was not a randomized clinical trial. "Thus, the benefits we observed for fish may be due to other dietary and lifestyle factors related to fish intake," he said. Even so, Hu argued that their findings are solid because of their "careful adjustment for many important cardiovascular risk factors."

The team concluded that regular fish consumption should be considered as part of a healthy diet for diabetes management, with at least two servings weekly for individual patients. Fatty fish such as mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in omega-3 fatty acids.

In an accompanying editorial, Dr Scott M. Grundy, director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas, said Hu’s research supports previous studies on omega-3 fatty acids. However, he urged that clinical trials of omega-3 fatty acids after a heart attack be conducted to determine if they can reduce coronary deaths in the short term.

In the 8 February issue of The Lancet, researchers reported that Omega-3 fatty acids apparently reduced the build up of atherosclerosis and helped to stabilize the health in stroke patients who are at high risk of atherosclerotic plaques rupturing or forming clots.

http://www.nutraingredients.com/news/news.asp?id=6736

Cost-effectiveness analysis of n-3 polyunsaturated fatty acids (PUFA) after myocardial infarction: results from Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto (GISSI)-Prevenzione Trial.

Author: Franzosi MG, Brunetti M, Marchioli R, Marfisi RM, Tognoni G, Valagussa F.

Source: Pharmacoeconomics. 2001;19(4):411-20

OBJECTIVE: To estimate the cost effectiveness of treatment with n-3 polyunsaturated fatty acids (PUFA) for secondary prevention after myocardial infarction (MI).

DESIGN AND SETTING: The cost-effectiveness analysis of n-3 PUFA treatment after MI was based on morbidity and mortality data and the use of resources obtained prospectively during the 3.5 year follow-up period of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto (GISSI)-Prevenzione study. The cost-effectiveness analysis took into account the
incremental number of life-years gained and the incremental costs for hospital admissions, diagnostic tests and drugs, applying a 5% discount rate. The value for money of n-3 PUFA treatment was assessed using the cost-effectiveness ratio and the number needed to treat (NNT) approach.

PERSPECTIVE: Third-party payer.

MAIN OUTCOME MEASURES AND RESULTS: The incremental cost-effectiveness ratio for n-3 PUFA in the basecase scenario was 24,603 euro (EUR, 1999 values) per life-year gained (95% confidence interval: 22,646 to 26,930). Sensitivity analysis included the analysis of extremes, producing estimates varying from EUR15,721 to EUR52,524 per life-year
gained. 172 patients would need to be treated per year with n-3 PUFA, at an annual cost of EUR68,000, in order to save 1 patient. This is comparable with the NNT value, and associated annual cost for simvastatin, but less costly than that for pravastatin.

CONCLUSIONS: The cost effectiveness of long term treatment with n-3 PUFA is comparable with other drugs recently introduced in the routine care of secondary prevention after MI. Since the clinical benefit provided by n-3 PUFA is additive, this therapy should be added to the established routine practice, with additive costs.

08/26/02 - Pregnant women who eat more of a key fatty acid found in fish give their babies better chances of mature brain development, finds a new study in the September issue of the American Journal of Clinical Nutrition.

The study also found that mothers with more docosahexaenoic acid (DHA) in their blood had babies with heartier sleep patterns in the first 48 hours after delivery compared to those whose mothers consumed less of the compound.

In a report on the study, Healthscoutnews noted that infant sleep patterns are thought to reflect the maturity of a child’s nervous system, and have been associated with more rapid development in their first year of life.
The omega-3 fatty acid, DHA, along with another substance, arachidonic acid (AA), are key building blocks in breast milk that contribute to healthy brain and eye development. Infant formula makers, such as Ross Products and Mead Johnson Nutritionals, are beginning to recognize the value of the compounds and have said they will add them to some of their brands.

The two substances are also passed from mother to foetus across the placenta. Some 70 percent of brain cell development takes place during gestation.

In the study, Carol Lammi-Keefe and her colleagues at the University of Connecticut compared DHA levels and newborn sleep patterns in 17 women and their babies. Ten of the women had high blood concentrations of DHA - considered to be more than 3 per cent of their total circulating fatty acids - while seven had less than that amount.

Healthscoutnews noted that Lammi-Keefe's group did not ask the women about their diets. None of the subjects in the study had DHA levels that reflected eating fish more than three times a week, as recommended by many experts. Other foods, like eggs and red meat, contain modest amounts of the nutrient, but cold-water fish such as tuna and mackerel are considered the best source.

Women with low DHA were more likely to be minorities and to have received fewer years of education. They were also five years younger, on average, than those in the high DHA category - 24 versus 29 years, according to the report.

All the babies were delivered vaginally and none of the women had been given drugs known to make newborns lethargic, the researchers said.
Using a motion-sensing pad to measure breathing and movement during sleep cycles, the researchers found babies of women in the low-DHA group had less advanced sleeping patterns than the other infants. They had a greater ratio of "active" to "quiet" sleep, spent more time transitioning between sleeping and waking, and spent less time fully awake than those of women with higher blood levels of the fatty acid.

"As an infant matures, normally you would see the infant spending more time in a wakeful state," Lammi-Keefe said. "Infants born to mothers with more DHA have sleep characteristics of a more mature central nervous system compared with the infants of mothers with lower
DHA levels."

June Machover Reinisch, director emerita of the Kinsey Institute and a child development expert, said the findings seemed to echo the importance of breast feeding for optimal infant growth, although she noted that many other factors, from method of delivery and the use of anesthesia during labour to the infant’s gender, can influence a newborn’s wakefulness.

"We have to be flexible in our definition of development," Machover Reinisch said. "With the child who sleeps not as well at two days, it may be related to the DHA, but it doesn’t necessarily mean that there’s going to be a problem with that child."

Researchers have correlated newborn sleep states with performance on mental and motor developmental tests at 9 months of age. However, both Lammi-Keefe and Reinisch said there is no way to predict whether a child with less mature sleeping habits in the first week of life will be anything other than healthy.

The researchers are currently organizing a one-year study to investigate dietary intake of DHA in pregnant women.

http://www.nutraingredients.com/news/news.asp?id=5217

Author: Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, Lipp SR, Burgess JR

Address:Department of Foods and Nutrition, Purdue University, West Lafayette, IN 47907-1264, USA.

Source: Am J Clin Nutr 1995 Oct;62(4):761-8

Abstract: Attention-deficit hyperactivity disorder (ADHD) is the term used to describe children who are inattentive, impulsive, and hyperactive. The cause is unknown and is thought to be multifactorial. Based on the work of others, we hypothesized that some children with ADHD have altered fatty acid metabolism. The present study found that 53 subjects with ADHD had significantly lower concentrations of key fatty acids in the plasma polar lipids (20:4n-6, 20:5n-3, and 22:6n-3) and in red blood cell total lipids (20:4n-6 and 22:4n-6) than did the 43 control subjects. Also, a subgroup of 21 subjects with ADHD exhibiting many symptoms of essential fatty acid (EFA) deficiency had significantly lower plasma concentrations of 20:4n-6 and 22:6n-3 than did 32 subjects with ADHD with few EFAdeficiency
symptoms. The data are discussed with respect to cause, but the precise reason for lower fatty acid concentrations in some children with ADHD is not clear.

Reference:
von Schacky, Clemens, et al. The effect of dietary omega-3 fatty acids on coronaryatherosclerosis. Annals of Internal Medicine, Vol. 130, April 6, 1999, pp. 554-62 Co sponsor:Pronova A.S

A certain type of brain wave called Òp300Ó is linked to memory and learning. The faster the rate of transmission, the more efficiently the brain is functioning. The rate declines with age, and is slower in people with dementia. To demonstrate if Omega-3 fatty acids influence this brain function, researchers took 26 normal adult volunteers hooked them up to electrodes and gave them a test that determined their p300 rate. Immediately after taking the test, they were given supplements of either EPA or DHA (both are derivatives of Omega-3 from fish). Two hours later, their brain waves were measured, and this time the p300 rate was significantly faster in the group given the DHA supplements, supporting their hypothesis that DHA might enhance mental abilities in adults as well.

Reference:
Myanaga, K., K. Yonemura, and K. Yazawa. DHA shortens P300 latency in healthy persons. In International Conference on Highly Unsaturated Fatty Acids in Nutrition and Disease Prevention. 1996 Barcelona, Spain.

Fights Depression: Skimping on fish may depress you. Norman Salem Jr., a researcher at the National Institutes of Health, notes that populations consuming large amounts of fish have low rates of major depression. A lack of fish oil is linked to depression in alcoholics, people with multiple sclerosis and women with postpartum depression. Further, he says, some dieters who reduce overall fat, including fish fat, tend to get depressed.

A recent Australian study of 21 depressed patients confirmed that the most severely depressed had imbalances of fatty acids in their blood and cell membranes. Evidence suggests DHA type fish oil helps regulate serotonin, a neurotransmitter known for its "feel-good" qualities.

Depressed people often have low levels of serotonin.

Reduces Aggression: You are less likely to express stress-induced aggression if your brain is under the influence of fish oil, according to Japanese researchers. In a new double-blind test of 41 adult students, those taking 1.5 to 1.8 daily grams of DHA fish oil for three months did not become more socially aggressive at a time of severe mental stress: final exams. In contrast, students taking a dummy look-alike capsule showed significant jumps in social aggression, as measured by psychological tests. This effect on stress may help explain how
fish oil prevents heart disease. Stress hormones triggered by hostility and anger can constrict arteries and accelerate the formation of blockages, research shows; fish oil may suppress the release of those hormones.

Stimulates young minds: Fetuses and infants must get sufficient omega-3 oils for optimal brain development, says William Connor, Oregon Health Sciences University. In one telling study of premature infants, those fed breast milk had 8 points higher IQ at age 8 than those fed standard infant formula. Connor credits breast milk's higher amounts of DHA for that superior intelligence.

In infant rhesus monkeys deprived of omega-3-type oils, Connor found
severely impaired visual acuity and behavior indicative of a neurological defect. Autopsies revealed abnormalities in brain cells. Connor advises pregnant women to eat fish a couple of times a week, especially during the last trimester, the time of greatest fetal brain growth. And breast-feeding is preferable to infant formula, he says.

Blunts Brain Damage? Fish oil may eventually be proved to lessen alcohol-induced brain damage, Salem says. He explains that excessive alcohol depletes brain levels of omega-3’s --DHA in particular -- which leads to neurological damage and impaired vision. He put experimental animals on high-alcohol, low omega-3 diets for six months to three years. They suffered severe losses of DHA in brain cells and detrimental changes in brain functioning.

Some scientists speculate that fish oil also may have a protective role in degenerative brain diseases leading to memory loss and dementia. The brains of deceased Alzheimer’s sufferers, for example, show low levels of omega-3 fats. Influences Behavior: Children deficient in omega-3 oils may be more likely to have behavioral and learning problems known as attention deficit hyperactivity disorder or ADHD, according to new research at Purdue University. John R. Burgess, assistant professor of foods and nutrition, tested the omega-3 blood levels of 96 boys, ages 6-12; about half had been identified as having ADHD. Clearly, Burgess says, "boys with lower levels of the omega-3 fat scored higher in frequency of behavioral problems," such as hyperactivity, impulsivity, anxiety, temper tantrums and sleep problems.

The big question: Does taking more omega-3 and other appropriate fats cure the deficiency and improve ADHD behavior? That’s what Burgess is trying to find out in a follow-up study. He cautions that only 40 percent of kids with ADHD in his study had low omega-3, so obviously it wouldn’t work in most cases. Burgess also says it’s unclear how much of what type of oils each individual child may need. Whatever you do, he advises working with health professionals and not stopping other treatments or medications for ADHD without proper
medical advice.

Smart tips: Restrict omega-6 oils (corn oil, regular safflower and sunflower seed oils, and most margarines), which tend to negate the benefits of omega-3.

Recommended: canola and olive oils.
WARNING: Pregnant women should avoid freshwater sports fish, which may be
contaminated with environmental chemicals. One of the safest and best for everybody:sardines.

Jean Carper’s current best-selling book is Stop Aging Now!
Comments? Write: Eat Smart, 1000 Wilson Blvd., Arlington, Va. 22229-0012

http://www.usaweekend.com/food/carper_archive/961117carper_eatsmart.html
http://www.stoltseafarm.com/americas/nutritiontrends.asp A. Simopoulos

Clearly there is much evidence to show that under well-controlled laboratory and dietaryconditions fatty acid intake can have profound effects on animal models of autoimmune disease. Studies in human autoimmune disease have been less dramatic; however, human trials have been subject to uncontrolled dietary and genetic backgrounds, infection and other environmental influences, and basic trial designs have been inadequate.

The impact of dietary fatty acids on animal autoimmune disease models appears to depend on the animal model and the type and amount of fatty acids fed. Diets low in fat, essential fatty acid deficient, or high in n-3 fatty acids from fish oils increase the survival and reduce disease severity in
spontaneous autoantibody mediated disease, and linoleic acid rich diets appear to increase disease severity. In experimentally induced T-cell mediated autoimmune disease, essential fatty acid-deficient diets or diets supplemented with n-3 fatty acids appear to augment disease, whereas n-6 fatty acids prevent or reduce the severity. In contrast, in both T-cell and antibody mediated autoimmune disease the desaturated and elongated metabolites of linoleic acid are protective.

Suppression of autoantibody and T lymphocyte proliferation, apoptosis of autoreactive lymphocytes, and reduced pro-inflammatory cytokine production by high-dose fish oils are all likely mechanisms by which n-3 fatty acids ameliorate autoimmune disease. However, these could be undesirable long-term effects of high-dose fish oil which may compromise host immunity. The protective mechanism(s) of n-6 fatty acids in T-cell mediated autoimmune disease are less clear, but may include dihomo-gamma-linolenic acid and arachidonic acid sensitive immunoregulatory circuits such as Th1 responses, TGF beta 1 mediated effects and Th3-like responses. It is often claimed that n-6 fatty acids promote autoimmune and inflammatory disease based on results obtained with linoleic acid only. It should be appreciated that linoleic acid does not reflect the functions of dihomo-gamma-linolenic and arachidonic acid, and that the endogenous rate of conversion of linoleic to arachidonic acid is slow (Hassam et al. 1975, 1977; Phylactos et al. 1994; Harbige et al. 1995).

In addition to effects of dietary fatty acids on immunoregulation, inflammation as a consequence of immune activation in autoimmune disease may also be an important mechanism of action whereby dietary fatty acids modulate disease activity. In conclusion, regulation of gene expression, signal transduction pathways, production of eicosanoids and
cytokines, and the action of antioxidant enzymes are all mechanisms by which dietary n-6 and n-3 fatty acids may exert effects on the immune system and autoimmune disease.

Probably the most significant of these mechanisms in relation to our current understanding of immunoregulation and inflammation would appear to be via fatty acid effects on cytokines.

The amount, type and balance of dietary fatty acids and associated antioxidant nutrients appear to impact on the immune system to produce immune deviation or immunosuppressive effects, and to reduce immune-mediated inflammation which will in turn affect the susceptibility to, or severity of, autoimmune disease.

Reference:
Harbige LS; Dietary n-6 and n-3 fatty acids in immunity and autoimmune disease., Proc Nutr Soc o Volume 57 o Issue 4.

Rheumatoid arthritis (RA) is a chronic disease affecting about 1% of the population, women three times more often than men. About 80% develop the disease between the ages of 35 and 50. Family studies indicate that RA is a hereditary disease. About 79% of people with the genetic code of HLA-DR4 develop RA compared to only 28% of those with other constitutions. However, genetic risk factors cannot fully account for the incidence of RA,
suggesting that dietary habits and other environmental factors also play a role in the etiology of the disease.

Even if the Japanese population is genetically exposed to the same risk of
getting RA as the Western population the prevalence of the disease is much lower (1). Dietary habits may influence the risk of acquiring the disease and may also influence the course and symptoms related to the disease.

Inhabitants of Greenland and the Faroe Islands have less rheumatic problems compared to people in the Nordic region. A cohort study in these two populations revealed that RA occurred with prevalence similar to elsewhere in the World. But the clinical picture and the long-term outcome of the disease were quite different. Patients with an overt clinical picture of RA and a history of 10-30 years were working full time in the fishing industry with exposure to a cold and humid environment. Even more interesting x-ray pictures of their hands showed very little joint deformations. And they had only traces of inflammatory cytokines (IL-1 and TNF) in plasma, laboratory parameters that are constantly elevated in
these patients.

The inhabitants of Greenland, the Faroe Islands and the coastal population of Japan have easily access to fish and seafood is accepted as very healthy. In seafood and sea mammals we find the omega-3 fatty acids known to interfere with a series of inflammatory events in the human body protecting against RA and other autoimmune diseases.

The London Medical Journal published the first scientific publication on effects of fish oil against rheumatism in 1783 describing the current practice at Manchester Infirmary. This report was based on positive observations in a disease with no treatment at that time.

However, the modern documentation on omega-3 fatty acids in rheumatic disease comprise well designed, controlled studies showing positive effects on symptoms such as pain, morning stiffness and grip strength. A meta-analysis on all these studies has been published (2) and recommendations on dose have been given (3).

The modern basis for treatment of patients with RA constitutes a combination of symptom treatment and prevention of joint deformation. Symptom relief increase quality-of-life but even more important is prevention of joint destruction, which inevitably will lead to reduced function and invalidity. Pharmacological treatment reduces or prevents negative effects of compounds released by the immune system responsible for the disease. Potent pharmaceuticals have been developed which may change the long-term outcome for RA.

However, the omega-3 fatty acids from fish oil, EPA and DHA do the same thing as the pharmaceuticals. The mode-of-action may be different and the potency lower but the effects brought about is certainly more natural compared to the drugs. This may explain why treatment with omega-3 capsules is usually well tolerated with no risk of serious side effects.

It has also been demonstrated that omega-3 fatty acids reduce the cartilage destructing enzymes responsible for joint destruction (4). This finding is very important and places omega-3 fatty acids as a natural supplement in combination with anti-rheumatic drugs.

A therapeutic effect on RA utilizing omega-3 fatty acids cannot be achieved by means of increasing the number of fish meals only. A high-quality omega-3 concentrate in the dose of 3g or more daily should be used. Clinical response will not occur immediately but will start after 2-3 months and may even increase further during chronic use (5). At the same time the intake of red meat (high in AA and saturates) should be restricted (2). Omega-3 capsules may be used concomitantly with antirheumatic pharmaceuticals, which may increase efficacy or even reduce the risk of gastrointestinal discomfort, which is a regular problem for so called NSAID drugs (6). For people with only minor or transient joint problems omega-3 fatty acids could be the first choice for self-medication.

Reference:

1.	Shichikawa K et al. Ryumachi. Prevalence of rheumatoid arthritis in the Japanese population 1981;21:35-43.
2.	Fortin PR et al. Validation of a meta-analysis: The effects of fish oil in rheumatoid arthritis. J Clin Epidemiol 1995;48(11):1379-90.
3.	James MJ and Cleland LG. Dietary n-3 fatty acids and therapy for rheumatoid arthritis. Semin Arthritis Rheum 1997;27:85-97.
4.	Curtis CL, Hughes CE, Flannery CR, et al. n-3 fatty acids specifically modulate catabolic factors involved in articular cartilage degradation. J Biol Chem 2000;275:721-724.
5.	Geusens P et al. Long-term effect of omega-3 fatty acid supplementation in active rheumatoid arthritis. Arhtr & Rheumat 1994;37:824-829