The role of omega-3 unsaturated acids in the prevention and treatment of various diseases

Benefits for the pancreas

The pancreas needs fish oil, especially in case of a chronic inflammatory process that damages cells and tissues. Omega-3 acids also reduce the need for insulin in type 2 diabetes.

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Regular intake of dietary supplements with omega-3 acids leads to the following results:

• lowering blood cholesterol levels;
• prevention of atherosclerotic plaques;
• improvement of the condition of skin, hair, nails;
• activation of memory and learning processes;
• relief of arthritis;
• strengthening immunity;
• increasing fertility.

About the benefits of omega acids for the body, watch the video:

Omega-3 or fish oil

The role of omega-6 and omega-3 fatty acids for the body of a sick person

• enteral nutrition

Why "omega"?
Everyone, if not heard, then saw these almost cosmic words “omega-3” and “omega-6” on product packaging. Just as I read that these are uniquely useful food components. What does this “cipher” of Greek letters and numbers mean? This is part of the full chemical name of organic compounds - polyunsaturated fatty acids (PUFAs). They are present in the body of humans, animals and plants. The combination of a letter and a number indicates the number of the carbon atom (counting from the end), where the molecule of such an acid is bent in a certain way - due to the double bond. Further such bends of the molecule are repeated. What do these acids look like?

The shape of the molecule and the number of double bonds between carbon atoms affect its properties.

Omega-3 and omega-6 acids are essential substances. Linoleic acid and alpha-linolenic acid cannot be produced in any way in the human body. Other omega-6 and omega-3 - also very necessary substances - can be obtained through metabolism from linoleic and alpha-linolenic acid, respectively.

But the activity of the enzymes that convert some omega acids into others varies greatly from person to person. To avoid a deficiency of any of these acids - especially omega-3 - they all must be present in food.

What role do PUFAs play in the body?

• Converted into components of cell membranes. A molecule bent in a certain way - due to double bonds - allows the membranes to be dense enough so that the contents of the cell do not leak out of it. At the same time, there is space for other molecules that help various substances penetrate into and out of the cell.
• They are precursors of signaling substances that regulate the process of inflammation and the functioning of smooth muscles of the body, affect immunity and fat metabolism.
• Serve as a source of energy.

What is the difference between the effects of omega-3 and omega-6?

1. What is omega-6, what effect does it have on the body?

The body produces arachidonic acid from linoleic acid. It can also come with food.

This acid is a precursor of biologically active substances in the body - eicosanoids, which are responsible for the development of the inflammatory reaction, constriction of blood vessels, and blood clotting.

2. What is omega-3, what effect do they have on the body?
In addition to alpha-linolenic acid, omega-3 includes two more unsaturated acids that are important for the normal functioning of the body:

What is the peculiarity of their role in the body?

• Docosahexaenoic acid is predominantly found in the cell membranes of the retina and areas of the membranes of nerve cells that are responsible for the perception of nerve impulses. Therefore, omega-3s are important for normal vision and nervous system function.
• Eicosapentaenoic acid also produces eicosanoids, just like omega-6. But their structure and functions are slightly different from the latter. They regulate rather the final stage of the inflammatory process, “turning off” it. Therefore, omega-3 acids are believed to have anti-inflammatory effects.

3. What ratio of omega-6 to omega-3 fatty acids should be in the diet of a sick person, and why is this important?

For food to contribute to normal well-being, it must be generally balanced. The same thing works for a special case: the ratio of essential fatty acids in food.

Acceptable proportion of omega-3: omega-6

may vary: from 1:10 to 1:1.
The optimal ratio for the average adult is omega-3: omega-6 ratio 1:4
. Why is it important? This provides a balance of eicosanoids that promote the development of the inflammatory response with those that “extinguish” it. During an illness – for example, with cancer – an inflammatory process occurs in the patient’s body. If it goes too violently, it exhausts a person. In this regard, in specialized medical nutrition products for cancer patients, for example, Nutrien Fort, the ratio of omega fatty acids shifts towards increasing anti-inflammatory omega-3s. The right balance of substances that affect the inflammatory response and immunity can help the body maintain an adequate immune response.

It is believed that omega acid needs are met when there is enough fatty ocean fish and vegetable oils (unrefined, cold pressed) in the diet.

But there is a situation when a person cannot eat the “right” foods. For example, cancer patients find it difficult to eat well. Due to radiation and chemotherapy, the mucous membranes of their mouth and pharynx become inflamed, and their sense of taste changes. Healthy food may seem inedible. So that they can eat nutritiously, there are medicinal foods with a neutral taste.

4. The ratio of omega-6 to omega-3 in the Nutrien Fort product is very good and is suitable for cancer patients

The hypercaloric mixture Nutrien Fort was developed to support cancer patients. It can be taken as a drink or used as enteral nutrition.

It contains essential acids, and it contains many more deficient omega-3s. This can help curb the inflammatory process that is always present when the body is fighting a tumor.

Nutrien Fort mixture is a complete food product in itself. See its composition and nutritional value here.

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Indications for use for pancreatitis and cholecystitis

Fish oil can be prescribed for chronic pancreatitis and cholecystitis for the following indications:

• lack of vitamins A and D;
• frequent viral and skin diseases;
• recovery period after severe, long-term illnesses;
• bone fractures;
• long-term non-healing burns, wounds, bedsores;
• general exhaustion of the body;
• deterioration of memory, attention, mental fatigue;
• hypercholesterolemia.

The main condition for safe use of a dietary supplement is the absence of exacerbation of a chronic inflammatory disease.

Important! Only a doctor can accurately determine the stage of pathology. The absence of pain does not always indicate a successful period of remission.

Before you start taking fish oil, you need to do general and biochemical blood tests: determine the main markers of inflammation, alpha-amylase, bilirubin. Then an ultrasound of the abdominal organs should be performed to measure the thickness of the gallbladder wall, the width of the bile and pancreatic ducts, the size of the pancreas, and also examine the contents of the bladder, which should be homogeneous, without stones.

The benefits of fish oil for pancreatitis

Despite the fact that fats in the diet are significantly limited due to pancreatitis, this does not mean that they should not be on the patient’s menu at all. Fats, especially unsaturated fats, are necessary for humans - their synthesis from other foods is difficult, and for some fatty acids it is impossible, and they must come from outside with food. In addition, the polyunsaturated fatty acids and antioxidants in fish oil have some anti-inflammatory and cytoprotective activities. They are able to protect pancreatic cells from damage, according to some data, even preventing severe exacerbations - of course, provided that they are used correctly and in moderation.

Contraindications and precautions

Fish oil for cholecystitis

The supplement is contraindicated in the presence of gallstones or inflammation with or without stones. Having a strong choleretic effect, fat can provoke contraction of the bladder, increased pain, even colic if a stone is wedged into the duct. Blockage of the papilla of Vater (the place where bile and pancreatic enzymes exit into the duodenum) can lead to the development of acute pancreatitis and cause complications.

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Fish oil for pancreatitis

The drug should not be taken if there are signs of pancreatic inflammation or insufficiency of gland function, when little enzymes are produced and the process of food digestion is disrupted.

Make a note! You can drink fish oil for pancreatitis only during stable remission.

Conditions when dietary supplement use is not recommended:

• excess vitamins A and D;
• allergy to additive components;
• high levels of calcium in the blood;
• urolithiasis disease;
• renal failure;
• active pulmonary tuberculosis;
• pregnancy, lactation;
• thyrotoxicosis;
• exacerbation of gastritis or stomach ulcers;
• sarcoidosis

Pregnant and breastfeeding women are in dire need of polyunsaturated fatty acids. However, the effect of fish oil on a child has not been fully established, so the use of food supplements containing it during these periods is not recommended.

The role of omega-3 unsaturated acids in the prevention and treatment of various diseases

Part 2. Read the beginning of the article in No. 7, 2022.

Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis

Omega-3 polyunsaturated fatty acids have been studied in patients with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis because of their potential hypotriglyceridemic, insulin-sensitizing, and anti-inflammatory effects. Observational studies have shown that patients with non-alcoholic fatty liver disease have low plasma levels of ω-3 PUFA. Several preliminary studies on the effects of ω-3 PUFA supplementation on various aspects of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (biomarkers of liver damage, liver fat accumulation, and liver fibrosis) have shown some encouraging results. It is noted that the intake of ω-3 PUFAs can reduce radiological and histological indicators of liver steatosis and fibrosis in patients without cirrhosis. In addition, consumption of ω-3 PUFAs is inversely associated with the risk of hepatocellular carcinoma. One study included 442 nondiabetic patients in whom ω-3 PUFA supplementation significantly improved lipid profiles (decreased TG and total cholesterol and increased serum high-density lipoprotein cholesterol) and reduced plasma alanine aminotransferase levels, but with unclear results. implications for signs of steatosis and liver fibrosis and significant heterogeneity between studies. Similar results were also found in a meta-analysis of 4 randomized clinical trials that included 263 children and adolescents with non-alcoholic fatty liver disease. The results of this meta-analysis showed that ω-3 PUFA supplementation reduced hepatic steatosis as assessed by ultrasound and blood tests after at least 1 year of treatment [27, 28].

Application of ω-3 PUFAs in the treatment of inflammatory and dystrophic joint diseases

Omega-3 PUFAs are used in the treatment of inflammatory and dystrophic diseases of the joints - rheumatoid arthritis, osteoarthritis, reactive arthritis, etc. Omega-3 PUFAs are included in antirheumatic therapy in addition or in combination with other antirheumatic drugs. A combined preparation based on ω-3 PUFAs and plant extracts has received recognition from the European League Against Rheumatism (EULAR 2003, 2004, 2007) [29].

The anti-inflammatory effect of ω-3 PUFAs is due to a decrease in the production of pro-inflammatory eicosanoids (prostaglandin E2, leukotriene B4) from AA, an increase in the production of anti-inflammatory eicosanoids (prostaglandin E3, leukotriene B5), a decrease (due to suppression of the synthesis of leukotriene B4) in the production of platelet aggregation factor, interleukin- 1 and tumor necrosis factor, allows the use of ω-3 PUFAs in the treatment and prevention of various inflammatory diseases with an autoimmune and/or allergic component of pathogenesis, such as rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease and ulcerative colitis, bronchial asthma and atopic dermatitis. For example, during a comparative study of the effectiveness of low doses of EPA and DCG (27 mg/kg and 18 mg/kg, respectively) in 20 patients with rheumatoid arthritis and higher doses (54 mg/kg and 36 mg/kg) in 17 patients, a pronounced reduction, compared with 12 patients in the control group who received olive oil capsules containing 6.8 g of oleic acid, in the number of patients who noted joint pain (at a low dose - by the 24th week and at a higher dose - by the 18th week week (p = 0.04)); the production of leukotriene B4 in neutrophils decreased by 19% at a low dose and by 20% at a higher dose (p = 0.03), while the production of interleukin-1b by macrophages in the control group decreased by 38.5% (not statistically significant), with when prescribing ω-3 PUFAs in small doses by 40.6% (p = 0.06) and when prescribing higher doses of ω-3 PUFAs - by 54.7% (p = 0.0005). A repeat trial attempted nonsteroidal anti-inflammatory drug (NSAID) withdrawal with fish oil and olive oil. In the main group, 8 weeks after discontinuation of diclofenac, patients did not experience a worsening of the disease compared to the control group receiving NSAIDs [30].

Treatment of autoimmune diseases

Because ω-3 PUFAs influence humoral as well as cellular immune factors, they have been used to treat autoimmune diseases. The effectiveness of complex therapy for systemic lupus erythematosus has been shown to increase when ω-3 PUFAs are included in its composition. A similar effect was obtained in the treatment of skin inflammatory and allergic diseases - atopic dermatitis and psoriasis. These studies found that in individuals with skin diseases, the level of arachidonic acid in affected tissues was 8 times higher than in healthy skin. The counteraction of ω-3 PUFAs to the proinflammatory effects of arachidonic acid metabolites (prostacyclin, leukotrienes, lipid peroxides, etc.) largely explains their therapeutic effect [31].

Renoprotective effect of ω-3 PUFA

The use of ω-3 PUFAs in patients with diabetic nephropathy helps reduce oxidative stress and has a positive effect on the condition of the kidneys. Preliminary data have been obtained on the possibility of reducing the rate of sclerosis of the glomerular apparatus in patients with chronic kidney pathology with the use of ω-3 PUFAs. It is possible that this drug may inhibit the progression of chronic renal failure in individuals with chronic kidney disease, which requires further study [32].

Application of ω-3 PUFAs in malignant neoplasms

The basis for studying the possibilities of using ω-3 PUFAs in malignant neoplasms were the results of a number of epidemiological studies that showed that women in Japan and Greenland have an extremely low incidence of breast cancer, which is most likely associated with diet. Traditionally, the diet of the inhabitants of Japan and Greenland includes large amounts of fish and seaweed containing ω-3 PUFAs. The results of subsequent studies revealed that the use of ω-3 PUFAs prevents the development, limits the growth and metastasis of breast cancer. In the mechanism of the protective effect of ω-3 acids against breast carcinogenesis, a decrease in the production of a number of arachidonic acid metabolites (prostaglandins E2 and F2, thromboxane A2), which are stimulators of tumor growth, is important. Along with the effect of ω-3 PUFAs on the synthesis of prostaglandins, a decrease in the immunoinhibitory effect of cortisol and a cytotoxic effect due to stimulation of peroxidation in tumor cell membranes are expected.

The inclusion of ω-3 PUFAs in the diet of women with an increased risk of developing breast cancer for 4 months leads to a significant reduction in the content of a tumor risk biomarker in the blood. In recent years, positive results have been obtained from the use of ω-3 PUFAs in experiments and in clinical settings also for a number of other tumors - colon, prostate [33].

Prevention and treatment of skin diseases

Docosahexaenoic acid is a structural component of the skin and is responsible for the health of the cell membranes that make up the majority of the skin. Healthy cell membranes mean soft, hydrated and elastic skin without wrinkles. Eicosapentaenoic acid provides the following skin benefits [34, 35]:

• controls sebum secretion;
• controls skin hydration;
• prevents follicular hyperkeratosis (small red pimples on the surface of the skin);
• prevents premature skin aging;
• prevents acne.

Omega-3 fatty acids can also protect your skin from sun damage. EPA helps block the release of substances that break down collagen in the skin after sun exposure.

ω-3 PUFAs are very promising for psoriasis, which is considered as a kind of lipoidosis (liponodosis) of the skin. The positive effect of ω-3 PUFA preparations was noted in almost all patients with psoriasis. Good results have been obtained in the treatment of patients with lichen planus and atopic dermatitis [36, 37].

central nervous system

Considering the high content of DHA in the organs of the central nervous system, its participation in the processes of myelination and transmission of nerve impulses, attempts are being made to use PUFAs in the treatment of patients with bipolar mental disorders [11]. Thus, 64.3% of patients who took part in a double-blind, placebo-controlled study of the effectiveness of a dietary supplement with ω-3 PUFAs showed a marked improvement in response to standard therapy, versus 18.8% of patients in the control group (p = 0 ,02). In schizophrenia, a significant relationship was found between the level of ω-3 PUFAs in the diet and the severity of symptoms. In a randomized, double-blind study of hyperexcitability syndrome in combination with decreased attention in children, it was shown that an increase in the content of these acids in the blood serum under the influence of a dietary supplement with ω-3 PUFAs significantly correlates with a decrease in symptoms of hyperexcitability.

Fish oil and Alzheimer's disease have been studied for several years with consistent results. Essential fatty acids, vital to brain function, found in fish oil may not only slow cognitive decline, but also help prevent brain atrophy in older adults. The study, published in the FASEB Journal, looked at the health effects of four to 17 months of supplementation with ω-3 fatty acids and antioxidants. The findings further support the possibility of using fish oil as a weapon to combat the onset of cognitive decline and Alzheimer's disease [38].

Low levels of ω-3 PUFA are associated with sleep problems in children and obstructive sleep apnea in adults. Low levels of DHA are also associated with decreased levels of the hormone melatonin, which helps you sleep. Studies in children and adults have shown that taking ω-3 PUFA supplements increases sleep duration and quality.

ω-3 PUFA supplements help prevent and treat depression and anxiety. EPA is the most effective PUFA in the fight against depression. In people suffering from mental disorders, the level of ω-3 PUFAs is significantly reduced. Supplementation with ω-3 PUFAs has been shown to reduce the incidence of mood swings and relapses in people with schizophrenia and bipolar disorder. Taking ω-3 PUFA supplements may also reduce aggressive behavior [39].

ω-3 PUFAs during pregnancy and in infants after birth

ω-3 PUFAs contribute to normal brain development in the fetus during pregnancy and in infants after birth. PUFA ω-3 fatty acids play a critical role in brain growth and development in young children. 40% of the PUFA DHA is found in the brain and 60% in the retina. It is therefore not surprising that children fed infant formulas supplemented with DHA have better vision than children fed infant formulas without this fatty acid [40, 41].

Getting enough ω-3 PUFAs during pregnancy is associated with numerous health benefits for the baby, including:

• higher level of intelligence;
• better communication and social skills;
• fewer behavioral disorders;
• reducing the risk of developmental delay;
• reducing the risk of developing attention deficit hyperactivity disorder (ADHD), autism and cerebral palsy.

Omega-3s may reduce ADHD symptoms in children

ADHD is a neurobehavioral developmental disorder characterized by inattention, hyperactivity, and impulsivity in children. Some studies have shown that ADHD in children is associated with lower blood levels of ω-3 PUFAs compared to their healthy peers. Moreover, numerous studies have shown that ω-3 PUFA supplementation can actually reduce ADHD symptoms. ω-3 PUFAs help improve alertness and task performance. They also reduce hyperactivity, impulsivity, anxiety and aggression. Recently, researchers have assessed the evidence for the effectiveness of various ADHD treatments. They found that one of the most effective natural treatments for ADHD is fish oil [42].

Noteworthy is the fact that ω-3 PUFA drugs are well tolerated and there are virtually no side effects. It was noted that taking therapeutic doses did not cause serious side effects. However, in certain groups of patients, for example, those with an increased risk of bleeding, ω-3 PUFA preparations should be prescribed with caution.

Optimal ratio of polyunsaturated fatty acids

According to nutritional biochemist William Landes, a National Institutes of Health researcher and world-class expert on the action of essential lipids, ω-3 and ω-6 fatty acids are in constant competition for possession of the enzyme desaturase. This active substance is included in the structure of all cell membranes, maintaining their normal structure. It has a greater affinity for ω-3. But, due to the excess of lipid compounds of the ω-6 type, they combine to a greater extent with this enzyme, which leads to their accumulation in the body. This means that in conditions of deficiency of ω-3 lipids in the food consumed, the human body cannot provide its tissues with these essential fatty acids. Since nature abhors a vacuum, ω-6 compounds take their place. All these data indicate only one thing: food must contain a sufficient amount of fatty acids from the ω-3 PUFA category. This will not only provide the body with vital components, but also protect it from the harmful effects of competitors of these compounds. In case of prolonged deficiency, the body slows down and distorts metabolic processes so much that it becomes very difficult to restore them.

A number of medical studies have shown that an excess of ω-6 PUFA relative to ω-3 PUFA significantly increases the risk of a number of diseases. The diet of modern people includes large quantities of ω-6 PUFAs and a lack of ω-3 PUFAs. These acids should enter the body in a ratio of 3:1, but we get approximately 40:1 from our food. This means that ω-6 PUFA is supplied in excess, and ω-3 PUFA is in deficiency. This leads to an imbalance in metabolic processes and a number of diseases. With an excess of ω-6 PUFAs, a weakening of the body’s protective functions, the immune system, disorders of the cardiovascular system, various types of inflammation and other diseases, including cancer, can occur. Why do Americans, and now not only them, suffer from excess weight: because they were brought up on fast foods and processed foods, in which the content of ω-6 PUFAs and saturated fats is off the charts. Abuse of fatty meat begins irreversible processes that can affect the nervous system, cause infertility, eczema and liver destruction. For children, this threatens to delay growth and overall development.

Scientists from the Division of Health Problems of the National Academy of Sciences (NAS) recommend consuming fatty acids in a ratio of 10:1. This is significantly higher than what is recommended in Sweden (5:1) or Japan (4:1). Perhaps it is due to this indicator that these countries have a relatively low level of heart and vascular diseases, and great progress has been made in the treatment of oncological pathology. At the same time, food should not contain more than 30% of the total calories. Based on this, it is recommended that less than 8% of calories come from PUFAs, with an ω-6/ω-3 ratio of 5:1–3:1. It must also be remembered that due to the participation of PUFAs in the processes of lipid peroxidation, it is advisable to take them simultaneously with antioxidants (tocopherol, etc.). Considering that food sources of ω-3 PUFAs are quite limited and the ratio of ω-6/ω-3 PUFAs in the modern human diet is far from optimal, biologically active food supplements that enrich the diet with PUFAs have now been developed and are available on the market in large quantities [ 43].

Recommendations for use of ω-3 PUFA

Recommendations from the Research Institute of Nutrition of the Russian Federation provide for daily consumption of 0.8–1.6 g of ω-3 fatty acids. More precise dosages depend on many factors and are suggested by foreign recommendations. According to experts, those who want to protect their hearts should eat a variety of oily fish (such as salmon, tuna and mackerel) at least twice a week. Those with heart problems should get 1 g of ω-3 PUFA per day, preferably from fatty fish. About 50 g of fish contain 1 g of ω-3 PUFA. 30 g, or one handful, of walnuts contains about 2.5 g ω-3. This is equal to approximately 100 g of salmon. Flaxseed oil contains alpha-linolenic acid, the most potent plant source of alpha-linolenic acid, which the body can use to produce eicosapentaenoic acid and decosahexaenoic acid. It's much better to choose whole flax seeds, as they also contain 3 grams of fiber per tablespoon as well as beneficial phytoestrogens. Other sources of ω-3 include canola oil, broccoli, cantaloupe, beans, spinach, grape leaves, bok choy, cauliflower and walnuts. Additionally, by consuming more ω-3, you can replace some ω-6 fatty acids from cooking oils (sunflower, soybean, etc.) with a third type of omega fatty acid known as ω-9 (oleic acid). It is a monounsaturated fat found primarily in olive oil.

Are all ω-3 PUFA preparations “equally beneficial”? Based on their origin, ω-3 fatty acids can be divided into two groups: “vegetable” and “marine”. The “sea” type primarily includes DHA. It is mainly found in fish, shrimp, crabs and the tissues of marine animals. The second representative of the “marine” ω-3 acids, DPA, is a substance found only in marine mammals.

Plants, both terrestrial and aquatic, almost do not synthesize “marine” forms of ω-3 polyunsaturated fatty acids and cannot serve as their source.

Plant-based ω-3 fatty acids include ALA and EPA. Plants mainly synthesize ALA. Once in the body of a healthy person, it is completely converted into the active “plant” form of ω-3 fatty acids EPA. When choosing a preparation of ω-3 polyunsaturated fatty acids, you should first of all pay attention to the amount of “marine” forms of DHA and DPA. The content of “plant” forms of EPA and ALA will be sufficient in any preparation. DPC-rich drugs deserve preference because they can more effectively cope with any form of ω-3 polyunsaturated fatty acid deficiency in the body. Required "marine" forms: 500 mg. Thus, it is necessary to compensate for the lack of ω-3 polyunsaturated fatty acids, amounting to at least 200 mg of “marine” forms (DHA, DPA) and 300 mg of “vegetable” forms (EPA and, optionally, ALA).

For effective prevention of atherosclerosis, it is recommended to take 300 mg of type ω-3 polyunsaturated fatty acids per day. In order to prevent malignant tumors, ω-3 type polyunsaturated fatty acids must be taken for a long time - for many years. In prophylactic doses, ω-3 type polyunsaturated fatty acids are well tolerated and have no side or toxic effects [45, 46].

In accordance with the recommendations of the European Association of Perinatal Medicine (EAPM), the daily dose of DHA and EPA for pregnant and lactating women is at least 300 mg, with an acid ratio of 5:1; and for patients with cardiovascular insufficiency, the ratio of EPA to DHA = 1.5:1.

Experts from the US National Institutes of Health have not established recommended amounts of ω-3 fatty acids, with the exception of alpha-linolenic acid. The average daily recommended amounts for alpha-linolenic acid are listed below in grams (Table 1).

For cardiac patients, ω-3 PUFAs are included in the recommendations of the All-Russian Scientific Society of Cardiology (2017) - “you can resort to prescribing polyunsaturated fatty acids in a dose of 2–4 g/day to reduce triglyceride levels”; and recommendations of the American Heart Association (American Heart Association, AHA 2003) (Table 2). The maximum safe amount depends on the sources of ω-3 - no more than 7–8 g per day in the form of fish oil capsules and unlimited in the form of regular food [47].

Based on the available scientific evidence, it is most advisable to prescribe ω-3 polyunsaturated fatty acids for the prevention of breast, colon and prostate cancer in patients at risk. In global oncology, it is planned to conduct long-term interventional clinical trials on the chemoprevention of cancer of these localizations using type ω-3 PUFAs. For auxiliary treatment of cancer patients: increasing the effectiveness of radiation and chemotherapy, during the period of preoperative preparation and rehabilitation, combating cancer cachexia during generalization of the tumor process, ω-3 type polyunsaturated fatty acids should be prescribed in doses of at least 1.8–2 g per day, in maximum doses - 13–18 g per day.

Tolerance of ω-3 PUFA

ω-3 PUFA preparations have proven high safety and good tolerability. No serious side effects have been reported when taken in therapeutic doses. If you have an individual intolerance to fish products, allergic reactions to taking ω-3 PUFAs are possible. Taking ω-3 PUFAs at a dose of up to 3 g per day does not lead to the development of undesirable reactions. However, in certain groups of patients, for example, those suffering from diabetes mellitus, with an increased risk of bleeding or with a high baseline level of low-density lipoproteins, ω-3 PUFAs should be prescribed with caution. Taking ω-3 PUFAs at a dose of more than 3 g per day increases the risk of bleeding, but cases of serious bleeding have not been reported. High doses are more likely to cause nosebleeds or hematuria. Very high intake of ω-3 PUFAs (“Eskimo” intake) increases the risk of hemorrhagic stroke. The reasons for such disorders are the ability of ω-3 PUFAs to reduce thrombus formation, prolong bleeding time and reduce von Willebrand factor.

An overdose of these compounds can be dangerous, which is much more severe than their deficiency. But it is extremely difficult to achieve an excess of polyunsaturated fatty acids in the body, since they accumulate very slowly. Therefore, only systematic and long-term intake of high doses of ω-3 PUFAs can be considered dangerous.

Symptoms of intoxication:

• headache;
• nausea;
• vomit;
• dyspeptic intestinal disorders;
• chest pain;
• heavy periods.

Among the side effects from the gastrointestinal tract, dyspeptic disorders in the form of nausea and, in some cases, diarrhea are possible, mainly against the background of high doses of ω-3 PUFAs. However, these phenomena are unstable and quickly passing. A number of scientific publications recommend cold-water fatty fish as a possible alternative to ω-3 PUFA intake, which is recommended to be consumed at least twice a week. At the same time, one should remember about the possible contamination of fish with potentially hazardous products - such as heavy metal salts, dioxins, methylmercury and polychlorinated biphenyls. Ingestion of heavy metal salts can lead to dysfunction of the central nervous system and other disorders. In addition, unrefined fish oil may contain pesticides. Therefore, for the prevention and treatment of cardiovascular diseases, it is recommended to use highly purified ω-3 PUFAs.

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E. Yu. Plotnikova1, Doctor of Medical Sciences, Professor M. N. Sinkova, Candidate of Medical Sciences L. K. Isakov, Candidate of Medical Sciences

Federal State Budgetary Educational Institution of Higher Education Kemerovo State Medical University, Ministry of Health of the Russian Federation, Kemerovo

1 Contact information

The role of omega-3 unsaturated acids in the prevention and treatment of various diseases (part 2) / E. Yu. Plotnikova, M. N. Sinkova, L. K. Isakov For citation: Attending physician No. 8/2018; Page numbers in the issue: 56-61 Tags: polyunsaturated lipids, ratio, nutrition, cardiovascular diseases, prevention

Release forms

Liquid fish oil

The liquid is measured out with spoons and consumed orally. But this dietary supplement option is not considered optimal.

Pros:

• low price.

Minuses:

• the product deteriorates quickly;
• loses properties upon contact with air, light, heat;
• has a pungent odor;
• after taking it, heartburn, fishy belching and an unpleasant aftertaste often appear.

Capsules

The main form of fish oil release is soft gelatin capsules, which are suitable for adults and children. The shell protects the contents from oxidation and retains beneficial properties.

Pros:

• the drug has a long shelf life;
• without taste or smell.

Minuses:

• Difficulty swallowing large capsules.

Mode of application

Fish oil for pancreatitis and cholecystitis in remission should be taken 30-50% less than recommended in the instructions for healthy people. The daily norm should not exceed 1000-1500 mg. It is necessary to start taking it with a minimum dose, with a gradual increase in the frequency and number of capsules.

You should take a dietary supplement with omega acids 1-3 times a day with meals: due to fat taken on an empty stomach, the gallbladder and pancreas are overloaded, which can provoke an exacerbation of the disease.

Course duration is 1 month with a break of 6-8 weeks.

The doctor should decide whether it is possible to use fish oil for pancreatitis and cholecystitis, what dosages are needed, and the duration of therapy.

How can fish oil be dangerous for pancreatitis?

When following a diet for pancreatitis, limiting fat is a prerequisite. During acute periods of illness, fat is, if possible, completely excluded from the diet (at least in its pure form); during the remission phase, its amount is strictly regulated and calculated. These restrictions are associated with insufficient production of the enzyme lipase, which is responsible for the breakdown of fats, by the damaged pancreas. In case of lipase deficiency, incoming fats are not digested, causing abdominal pain, nausea, vomiting and loose stools.

Fish oil is a pure fat, and in case of pancreatitis and cholecystitis, its absorption is greatly hampered. Taking fish oil before achieving stable remission or in large quantities can provoke a severe exacerbation of the disease.

Overdose

Fish oil contains vitamins A and D, which can accumulate in the body and, if taken in excess, cause overdose symptoms:

• lack of appetite;
• dry mucous membranes;
• stomach ache;
• nausea, vomiting;
• headache;
• irritability;
• hair loss;
• cracks in the skin;
• orange palms and soles;
• convulsions;
• menstrual irregularities;
• calcium deposition in soft tissues;
• increased arterial and intraocular pressure.

There is no specific therapy for quickly removing excess vitamins, so symptomatic treatment, discontinuation of dietary supplements, and a diet low in calcium and retinol are recommended.

Reviews about the application

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Fish oil for pancreatitis and cholecystitis

Average rating: Number of reviews: 0

An analysis of reviews showed that even if there is a history of gallbladder or pancreas disease, dietary supplements with fish oil provide only positive effects. Despite the reduced dosage, there is a normalization of cholesterol levels, an increase in immunity, performance, and an improvement in the condition of the cardiovascular and nervous systems.

Negative feedback only notes a fishy aftertaste and difficulty swallowing the capsule.

How to take fish oil for pancreatitis?

For therapeutic and prophylactic purposes, you can take fish oil only in the phase of stable remission, preferably after consultation with your doctor. In acute pancreatitis, fish oil is strictly contraindicated.

Both liquid, traditional fish oil and capsule preparations are suitable for treatment. Capsules are more convenient to use, and, in addition, they do not have the unpleasant odor and taste of the liquid product.

When taking fish oil, it should be taken into account in the overall calorie and fat component of the menu, and accordingly reduce the proportion of other fats in your diet. It is more convenient to calculate using “pure” fats: for example, if you take about 5 g of fish oil per day, then remove 5 g of butter or vegetable oil from the menu.

For pancreatitis, it is recommended to reduce the average daily dosage of fat by about 1/3 compared to that indicated in the annotation. On average, it is permissible to take from 5 to 10 ml of fish oil per day or 2-3 capsules with a dosage of 500 mg (in 2-3 divided doses) during or immediately after meals. The duration of treatment ranges from 3 weeks to 2–3 months, subject to good tolerance. During the first week of use, the dosage should be even lower (within 5 ml or 500 mg per day), and if discomfort occurs (abdominal pain, nausea, belching), it should be discontinued immediately.

An adequate and relatively safe replacement for fish oil for pancreatitis can be the weekly (2-3 times a week) inclusion of medium-fat sea fish, baked or steamed, in the diet.