Omega-3 Fatty Acids
“Omega-3s” are a class of polyunsaturated fatty acids. They have important roles in the human body, including as precursors for resolvins, protectins, and maresins, which are immunoregulatory1. The long-chain types of omega-3s – including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – have been associated with significant anti-inflammatory (especially EPA), neuro-protective (especially DHA), and immunomodulatory properties2,3 relevant to MS.
In a randomized, controlled clinical study with RRMS patients, fish oil supplements yielding EPA 1.98 g and DHA 1.32 g were added to a low-fat diet (15% of calories from fat). After six months of treatment, the fish oil group was found to have significantly better clinical outcomes than controls in terms of quality of life, mental health, and physician’s assessment, with trends toward decreased pro-inflammatory makers (cytokines and chemokines)4.
Significantly decreased inflammatory markers were observed in another randomized, placebo-controlled clinical study with RRMS patients, using a fish oil supplement yielding 0.8 g EPA and 1.6 g DHA5.
In an uncontrolled clinical study with RRMS patients, a fish oil supplement yielding 2.9 g EPA and 1.9 g DHA per day was associated with decreased levels of pro-inflammatory matrix metalloproteinase-9 (MMP-9)6. MMP-9 is a type of enzyme involved in the degradation of the matrix that provides structural and biochemical support to cells in tissues, and has been implicated in neurodegenerative and immunological disorders, including MS7,8.
In a randomized, placebo-controlled clinical study, RRMS patients were given a daily dose of placebo or a combination of omega-3 and omega-6 (12.15 g at a 1:1 ratio) with the antioxidants vitamin A (600 mcg or 2000 IU), vitamin E (22 mg or IU), and gamma-tocopherol (a relative of vitamin E, 760 mg or IU). Two years of omega+vitamin treatment resulted in significant improvements in walking and sit-to-stand movement compared to placebo9.
Omega-3 fatty acids have been researched and applied extensively in human perinatal – both pregnancy and nursing – care, with demonstrated benefits and safety to both mother and offspring10-12.
Notable food sources of EPA and/or DHA include fatty fish (e.g., herring, mackerel, salmon, sardines, swordfish, trout, tuna), marine algae (e.g., nori, spirulina, chlorella), and pastured and fortified animal products (e.g., omega-3 eggs, which are usually made by feeding laying hens flaxseed). EPA and DHA can generally be made in the body from the essential shorter-chain omega-3 alpha-linolenic acid (ALA, found in plant foods such as canola oil, chia and flax seeds, kale, and walnuts), but the conversion is often not optimal in humans. For this reason, people are often encouraged to consume preformed EPA and DHA from foods or supplements for basic health and healing properties.
References
1.Hesselink JMK. Chapter 4. Palmitoylethanolamid and Other Lipid Autacoids Against Neuroinflammation, Pain, and Spasms in Multiple Sclerosis. Nutrition and Lifestyle in Neurological Autoimmune Diseases: Multiple Sclerosis. Academic Press (Elsevier); 2017:29-37.
2.Selmi C, Tsuneyama K. Nutrition, geoepidemiology, and autoimmunity. Autoimmun Rev. Mar 2010;9(5):A267-70. doi:10.1016/j.autrev.2009.12.001
3.Shahidi F, Ambigaipalan P. Omega-3 Polyunsaturated Fatty Acids and Their Health Benefits. Annu Rev Food Sci Technol. Mar 25 2018;9:345-381. doi:10.1146/annurev-food-111317-095850
4.Weinstock-Guttman B, Baier M, Park Y, et al. Low fat dietary intervention with omega-3 fatty acid supplementation in multiple sclerosis patients. Prostaglandins Leukot Essent Fatty Acids. Nov 2005;73(5):397-404. doi:10.1016/j.plefa.2005.05.024
5.Ramirez-Ramirez V, Macias-Islas MA, Ortiz GG, et al. Efficacy of fish oil on serum of TNF alpha , IL-1 beta , and IL-6 oxidative stress markers in multiple sclerosis treated with interferon beta-1b. Oxid Med Cell Longev. 2013;2013:709493. doi:10.1155/2013/709493
6.Shinto L, Marracci G, Baldauf-Wagner S, et al. Omega-3 fatty acid supplementation decreases matrix metalloproteinase-9 production in relapsing-remitting multiple sclerosis. Prostaglandins Leukot Essent Fatty Acids. Feb-Mar 2009;80(2-3):131-6. doi:10.1016/j.plefa.2008.12.001
7.Bever CT, Jr., Rosenberg GA. Matrix metalloproteinases in multiple sclerosis: targets of therapy or markers of injury? Neurology. Oct 22 1999;53(7):1380-1. doi:10.1212/wnl.53.7.1380
8.Fields GB. The Rebirth of Matrix Metalloproteinase Inhibitors: Moving Beyond the Dogma. Cells. Aug 27 2019;8(9)doi:10.3390/cells8090984
9.Aristotelous P, Stefanakis M, Pantzaris M, et al. The Effects of Specific Omega-3 and Omega-6 Polyunsaturated Fatty Acids and Antioxidant Vitamins on Gait and Functional Capacity Parameters in Patients with Relapsing-Remitting Multiple Sclerosis. Nutrients. Oct 19 2021;13(10)doi:10.3390/nu13103661
10.Amza M, Haj Hamoud B, Sima RM, et al. Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA)-Should They Be Mandatory Supplements in Pregnancy? Biomedicines. Jul 3 2024;12(7)doi:10.3390/biomedicines12071471
11.Reis AEM, Teixeira IS, Maia JM, et al. Maternal nutrition and its effects on fetal neurodevelopment. Nutrition. Sep 2024;125:112483. doi:10.1016/j.nut.2024.112483
12.Singh M. Essential fatty acids, DHA and human brain. Indian J Pediatr. Mar 2005;72(3):239-42.