Omega-3 fatty acids at the 2017 EULAR Annual Meeting in Madrid

The most interesting feature of omega-3 fatty acids (ω-3 FA) is the conversion into docosahexaenoic acid [DHA], out of which resolvins are derived [1], which are termed specialized proresolving mediators [SPMs]. SPMs possess potent anti-inflammation, tissue protection, and tissue healing activities.

Let’s see what science told us at the 2017 EULAR Annual Meeting in Madrid on omega-3 fatty acids.

H.A. Benabdoune and colleagues presented [2]: “REGULATION OF OSTEOCLAST RECRUITMENT AND ACTIVATION BY RESOLVIN D1”. The study is on murine macrophages and human osteoblasts. The results show, that RvD1 [resolvin D1] strongly reduces osteoclast recruitment and activation. RvD1 decreases bone resorption. The authors concluded: “Our in vitro results clearly show that RvD1 may play an important role in the regulation of bone metabolism. Additionally to our previous data, our findings suggest that RvD1 may offer a novel and original perspective to make a real contribution to musculoskeletal and bone diseases therapy.”

R. Castillo and colleagues looked at [3]: “THE EFFECT OF OMEGA-3 FATTY ACIDS ON DISEASE ACTIVITY, ENDOTHELIAL FUNCTION, INFLAMMATORY MARKERS, AND LIPID PROFILE IN SYSTEMIC LUPUS ERYTHEMATOSUS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED, CONTROLLED TRIALS”. But they had to conclude: “The limited data on the use of omega-3 fatty acids has not shown clear benefit in improving disease activity, endothelial function, inflammatory markers, or lipid profile in patients with SLE [stemic lupus erythematodes]. Larger studies for longer durations using standardized scales for measuring outcomes are needed.”

Am I disappointed? Yes.

In 2013 S.M. Proudman and colleagues published [4]: “Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use”. The authors concluded: “FO [fish oil] was associated with benefits additional to those achieved by combination ‘treat-to-target’ DMARDs [disease modifying anti rheumatic drugs] with similar MTX [methotrexate] use. These included reduced triple DMARD failure and a higher rate of ACR [American College of Rheumatology] remission.”

So, why am I disappointed? Patients ask for guidance in dietary interventions. We as the scientific part of therapy leave this field open to quacks. I think that there is quite a lot of research to be done, which won’t be sponsored by the pharmaceutical industry, yet we need this basic research.

Links and References:

[1] https://en.wikipedia.org/wiki/Resolvin

[2] DOI: 10.1136/annrheumdis-2017-eular.2934

[3] DOI: 10.1136/annrheumdis-2017-eular.2666

[4] http://ard.bmj.com/content/74/1/89

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Fish oil in knee osteoarthritis?

“Fish oil in knee osteoarthritis?” is an interesting question. I’ve already mentioned a study here on this blog:

Fish oil and knee OA

Poster #2147: Fish oil doesn't have an effect on structural progression of knee OA. They used 9 g, which would be 18 cps. in Germany.

29.10.2013

The researchers sit predominantly in the area of Adelaide (University of Adelaide) and I’ve been in contact with them. In different groups they research fish oil in rheumatoid arthritis and other diseases.

Now, they’ve published two year data on Fish oil in knee osteoarthritis (OA). 202 patients with knee OA were randomised 1:1 to high-dose fish oil (4.5 g omega-3 fatty acids) 15 ml/day or low-dose fish oil (blend of fish oil and sunola oil; ratio of 1:9, 0.45 g omega-3 fatty acids) 15 ml/day. “The primary endpoints were Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score at 3, 6, 12 and 24 months, and change in cartilage volume at 24 months. Secondary outcomes included WOMAC function, quality of life, analgesic and non-steroidal anti-inflammatory drug use and bone marrow lesion score.” Results: “…the low-dose fish oil group had greater improvement in WOMAC pain and function scores at 2 years compared with the high-dose group …” Other endpoints didn’t reach statistical significance. The authors concluded: “In people with symptomatic knee OA, there was no additional benefit of a high-dose fish oil compared with low-dose fish oil. The combination comparator oil appeared to have better efficacy in reducing pain at 2 years, suggesting that this requires further investigation.”

Maybe, maybe not. The study didn’t have a placebo arm. Maybe omega-3 fatty acids like in fish, fish oil or flax oil will have a place in the treatment of rheumatoid arthritis or other auto-inflammatory diseases, but knee osteoarthritis might not benefit. However, I don’t want to sound too apodictical – please go on with your research.

References:

http://rheumatologe.blogspot.de/2013/10/acr-meeting-2013-in-san-diego.html

CL Hill et al.: Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose. Ann Rheum Dis. 2016 Jan;75(1):23-9. doi: 10.1136/annrheumdis-2014-207169. http://www.ncbi.nlm.nih.gov/pubmed/26353789

Rheumatoid Arthritis and Omega 3 Fatty Acids

There has been a study on rheumatoid arthritis and omega-3 fatty acids recently. D. di Giuseppe and colleagues published: “Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women.” The authors collected data on diet via a self-administered food-frequency questionnaire in 1987 and 1997. “Among 32 232 women born 1914-1948, 205 RA cases were identified during a mean follow-up of 7.5 years (1 January 2003 to 31 December 2010; 2 41 120 person-years).” They concluded: “This prospective study of women supports the hypothesis that dietary intake of long-chain n-3 PUFAs may play a role in aetiology of RA.” Link: http://www.ncbi.nlm.nih.gov/pubmed/23940215.

Some people already think that we all have to take fish oil supplementation to avoid getting rheumatoid arthritis. I think that most of the population need more omega-3 fatty acids, but I don’t think that we need supplementation. Y.H. Lee and colleagues published a meta-analysis in 2012: “Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis.” At ≥2.7 g omega-3 polyunsaturated fatty acids per day there has been reduced nonsteroidal anti-inflammatory drug (NSAID) consumption over the 10 RCTs. Tender joint, swollen joint count, morning stiffness, and physical function only showed a trend but did not reach statistical significance. Link: http://www.ncbi.nlm.nih.gov/pubmed/22835600.

So what can one do? Reduce omega-6 fatty acids and increase omega-3 fatty acids. I don’t think that fish or krill oil is necessary. If you eat fish, prefer fish to meat (meat is bad anyway). If you live the happy vegetarian life watch out to significantly reduce omega-6 fatty acids (especially if you’re going vegan) and use more oils and seeds containing omega-3 fatty acids, linseed contains the most.

Krill Omega Red Oil - English version

I've been asked to translate my German blogpost on Krill Omenga Red Oil

I had seen an advertisement in a German magazine called tina "the premium women's magazine" No. 16 of the 10.04.2012 edition, p. 65, concerning Krill Omega Red Oil.

We see Kirsten, a "busy and helpful lady" in retirement. She has dressed up for the poster in the colour of the advertised product. The ad wants to tell us, what "krill Omega unlike fish oil" can do. In the first paragraph after under the title "I look after my heart" but no difference to fish oil is presented. Then addressed as"the secret of krill Omega", the krill capsules are described as odor-free - same applies to the salmon oil capsules from ALDI, Lidl & Co.[German discounter chains]. Secondly, it is claimed that krill is a more effective source of than omega-3 fatty acids than fish oil . "1 Capsule contains: 200 mg phospholipids, of which 60% are omega-3 phospholipids." 115 mg omega-3 fatty acids with the following composition: 50% EPA, 28% DHA and 22% other fatty acids. "Antioxidant: astaxanthin 25 µg." The ALDI (South) salmon oil capsule contains 191 mg omega-3 fatty acids, of which 148 mg are DHA and EPA (in a capsule of krill Omega there are only 90 mg). Well, there's something fishy! Moreover it's advertised, that krill oil comes from the most unpolluted sea - this may be true, but also the fish oil capsules are free of pollutants. Whether krill oil or fish oil can maintain heart health, is still under discussion. There is not a single study that describes an advantage of krill oil.

Let's have a look at costs. Most sites on the Internet charge about €27 for 60 pills [German sources]. At ALDI, you pay approx. 5 ct (approximately €3.00 for 120 capsules) per gram of fish oil. For Krill Omega Red Oil you'd pay a whopping €2.50 per gram of krill oil.

Krill Oil is a by-product of the extraction of krill powder for animal fodder.

Learn more about: Krill Oil Supplementation
http://rheumatologe.blogspot.de/2012/10/krill-oil-supplementation.html