Efficacy of omega-3 fatty acids in musculoskeletal and skin conditions

Steven J. Hausman, PHD – President, Hausman Technology Presentations (former deputy director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland)

There are many exceptional health benefits to omega-3 fatty acids (OFA) that have been well documented in scientific and clinical research studies. Most of the research on OFA began with observations that certain populations which had high levels of fish oils in their diet had lower levels of serum cholesterol, triglycerides and harmful low-density lipoproteins. This observation was validated when the United States’ Food and Drug Administration permitted OFA products, in 2004, to state that there was a reduced risk of coronary heart disease associated with OFA ingestion. Since that time there has also been a good deal of research in areas other than cardiovascular.

Ophthalmological Investigations: Including OFA in the diet by eating fish two or more times a week has been associated with a reduced risk of age-related macular degeneration[1]. In contrast, a decreased dietary intake of OFA has been linked to dry eye syndrome, but supplementation with OFA has been shown to lead to a subjective improvement in these symptoms[2].

Neurological Investigations: It has been demonstrated that an adequate intake of OFA seems to prevent cognitive decline in middle and older ages. A study has found a correlation between low levels of OFA in red blood cells and both decreased brain volume and poorer performance in cognitive and memory testing[3]. At least one review study[4] found a slight improvement in attention deficit and hyperactivity disorder symptoms that was associated with OFA supplementation While OFA treatment was less effective than pharmaceutical treatments for this disorder the side effects are benign and might be more acceptable than pharmacological therapy for some families.

Dermatological Investigations: It appears that some skin conditions, such as the clinical symptoms of psoriasis, can potentially benefit from OFA supplementation[5]. There may also be beneficial effects of OFA supplementation in protecting the skin from solar ultraviolet radiation injury. Many individuals think that topical application of sunscreens is sufficient to protect against all sun damage. However, it has been demonstrated that topical sunscreens are usually not applied as evenly or as thickly as the manufacturers recommend, resulting in lowered protection levels. In addition, there are many occasions when sunscreens are not even applied (for example, in daily activities when people are not on vacation), thus resulting in low levels of sun damage over time. It is thus possible that nutritional supplementation with OFA can provide protection from these routine chronic exposures. This would therefore enhance the topical application of sunscreens when longer times in the sun are anticipated. Authors of a review article[6] wrote that “combined dietary and standard topical sunscreen measures may optimise human skin protection from sunlight.” One study[7] showed a reduction in sunburn sensitivity after short-term OFA supplementation and the authors suggest that “longer-term supplementation might reduce skin cancer in humans.”

Rheumatologic Investigations: Many of the effects of OFA supplementation tend to be based on its well-documented anti-inflammatory actions[8]. Because of its anti-inflammatory effects OFA supplementation also has therapeutic efficacy in the treatment of rheumatoid arthritis. It has also been conjectured (but not yet proven) that other diseases with an inflammatory component might also theoretically benefit from OFA supplementation. These include systemic lupus erythematosus, Crohn’s disease, chronic obstructive pulmonary disease and cystic fibrosis. One study showed that fish oil supplements were as effective, and a safer alternative to non-steroidal anti-inflammatory drugs in the treatment of patients with nonsurgical neck or back pain[9].

Most clinical trials of OFA supplementation have dealt with rheumatoid arthritis. Indeed, the Mayo Clinic noted that “studies suggest fish oil supplements might help reduce pain, improve morning stiffness and relieve joint tenderness in people with rheumatoid arthritis. While relief is often modest, it might be enough to reduce the need for anti-inflammatory medications.”[10]. A study in Sweden demonstrated that dietary consumption of OFA was associated with a greatly decreased risk of rheumatoid arthritis[11].

Skeletal Muscle Health Investigations: One of the factors associated with physical decline during the aging process is the lack of an ability to maintain muscle health and muscle mass. It is clear that the ability of skeletal muscle to deal with glucose is a key to maintaining glycemic control. The loss of skeletal muscle thus could lead to obesity or even diabetes. A recent clinical trial has clearly demonstrated that supplementation with fish oil[12] “slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.” In another trial[13] it was shown that strength training increased muscle strength in elderly women and that supplementation with fish oil “caused greater improvements in muscle strength and functional capacity.”

It can be concluded that there is substantial clinical research demonstrating that the consumption of dietary OFA leads to better health outcomes on a variety of medical conditions including cardiovascular disease, improved infant health, the maintenance of skeletal muscle with aging, certain skin diseases and rheumatic diseases.

References

1. Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis. Arch Ophthalmol. 2008 Jun;126(6):826-33. doi: 10.1001/archopht.126.6.826.
2. Nutritional supplements for dry eye syndrome. Curr Opin Ophthalmol. 2011 Jul;22(4):279-82. doi: 10.1097/ICU.0b013e3283477d23.
3. Red blood cell -3 fatty acid levels and markers of accelerated brain aging. Neurology. 2012 Feb 28;78(9):658-64. doi: 10.1212/WNL.0b013e318249f6a9
4. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2011 Oct;50(10):991-1000. doi: 10.1016/j.jaac.2011.06.008. Epub 2011 Aug 12
5. Nutrition and psoriasis. Clin Dermatol. 2010 Nov-Dec;28(6):615-26. doi: 10.1016/j.clindermatol.2010.03.027
6. Omega-3 polyunsaturated fatty acids: photoprotective macronutrients. Exp Dermatol. 2011 Jul;20(7):537-43. doi: 10.1111/j.1600-0625.2011.01294.x. Epub 2011 May 16
7. Effect of eicosapentaenoic acid, an omega-3 polyunsaturated fatty acid, on UVR-related cancer risk in humans. An assessment of early genotoxic markers. Carcinogenesis. 2003 May;24(5):919-25
8. Omega-3 Fatty Acids and Inflammatory Processes Nutrients. 2010 Mar; 2(3): 355–374
9. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31
10. https://www.mayoclinic.org/drugs-supplements-fish-oil/art-20364810
11. Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women. Ann Rheum Dis. 2014 Nov;73(11):1949-53. doi: 10.1136/annrheumdis-2013-203338. Epub 2013 Aug 12
12. Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr. 2015 Jul;102(1):115-22. doi: 10.3945/ajcn.114.105833. Epub 2015 May 20
13. Fish-oil supplementation enhances the effects of strength training in elderly women. Am J Clin Nutr. 2012 Feb;95(2):428-36. doi: 10.3945/ajcn.111.021915. Epub 2012 Jan 4