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Omega-3 fatty acids and IBD

Narinder Duggal, MD, FRCPC

Ulcerative colitis (UC) and Crohn's disease (CD), together known as inflammatory bowel diseases (IBD) are gastrointestinal disorders indicated by chronic inflammation of the wall of the digestive tract, usually in the ileum or large intestine. Major symptoms include intestinal pain, diarrhea and malabsorption of nutrients. The disease is characterized by periods of active symptoms, followed by periods of remission.

IBD has a multifactorial etiology that includes genetic, environmental and immunological factors.¹ Some researchers also believe that an imbalance in the consumption of essential fatty acids is associated with an increased risk of CD.²  One group of researchers carried out a case-controlled study in children and adolescents with newly diagnosed CD. They found that a higher ratio of omega-3/omega-6 fatty acids was significantly associated with lower risks for CD.

By virtue of their anti-inflammatory action, omega-3 fatty acids, give hope to patients with IBD. The omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) inhibit omega-6 fatty acid derived inflammatory eicosanoids and also give rise to anti-inflammatory mediators.³ A large body of evidence supports a protective effect of omega-3 fatty acids in experimental, animal and ex-vivo models of CD and UC.^{4, 5}

A double-blind, placebo-controlled study revealed that omega-3 fatty acids are beneficial in the treatment of active ulcerative colitis.6 The study involved 11 patients diagnosed with active ulcerative colitis. Of these, one group was given fish oil supplement containing 2.7 g of EPA and 1.8 g of DHA. At the end of the treatment period, these patients showed a significant beneficial effect. Their disease severity score declined by 56% as compared to the 4% in the placebo group. Moreover, 72% patients were able to reduce or stop the medications while taking supplements.

Similarly, an open trial involving 10 patients with mild to moderate ulcerative colitis, were given 15 capsules of fish oil daily containing a total of 2.7 grams of EPA and 1.8 grams of DHA.⁷ At the end of the 8 weeks, 7 out of the 10 patients showed marked to moderate improvement and 4 out of 5 patients on prednisone were able to reduce their daily dose.

In 2005, Meister et al. showed that in vitro treatment of colon biopsies from IBD patients with omega-3 fatty acid reduced inflammation.⁸  Omega-3 fatty acid supplementation in addition to amino-salicylic-acid (5-ASA) was effective in maintaining remission of pediatric CD, concluded Romano et al in their randomized placebo-controlled study.⁹ Furthermore, omega-3 fatty acid supplementation with antioxidants significantly modulated the eicosanoid levels and attenuated their proinflammatory activity.¹⁰

Another randomized study showed that omega-3 fatty acids supplementation reduced the secretion of proinflammatory cytokines decreased the inflammatory process in patients with active CD as compared to omega-6 fatty acids.¹¹ A short-term study involving patients with active CD showed that an intravenous administration of 0.6 g EPA could improve the clinical symptoms of the disease even after a short period of just 2 weeks.¹²

Omega-3 fatty acids also have the potential to decrease colonic damage and inflammation, weight loss and mortality due to IBD.^3,13 An omega-3 fatty acid rich diet is very important for the maintenance of remission and treatment of IBD.  All these studies indicate the therapeutic potential of omega–3 fatty acids in the therapy of CD and UC.

Epacor from Synergy Therapeutics Rx offers the highest quality, most potent enteric coated formulation of omega-3 fatty acids, containing 660 mg of EPA and 340 mg of DHA per serving, which ensures purity and safety along with a healthy gastrointestinal system.

References:
1.    Karlinger K, Gyorke T, Mako E, et al. The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol 2000;35(3):154-67. (PUBMED Abstract)
2.    Amre DK, D'Souza S, Morgan K, et al. Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn's disease in children. Am J Gastroenterol 2007;102(9):2016-25. (PUBMED Abstract)
3.    Calder PC. Polyunsaturated fatty acids, inflammatory processes and inflammatory bowel diseases. Mol Nutr Food Res 2008;52(8):885-97. (PUBMED Abstract)
4.    Ruggiero C, Lattanzio F, Lauretani F, et al. Omega-3 polyunsaturated fatty acids and immune-mediated diseases: inflammatory bowel disease and rheumatoid arthritis. Curr Pharm Des 2009;15(36):4135-48. (PUBMED Abstract)
5.    Gil A. Polyunsaturated fatty acids and inflammatory diseases. Biomed Pharmacother 2002;56(8):388-96. (PUBMED Abstract)
6.    Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study. Am J Gastroenterol 1992;87(4):432-7. (PUBMED Abstract)
7.    Salomon P, Kornbluth AA, Janowitz HD. Treatment of ulcerative colitis with fish oil n--3-omega-fatty acid: an open trial. J Clin Gastroenterol 1990;12(2):157-61. (PUBMED Abstract)
8.    Meister D, Ghosh S. Effect of fish oil enriched enteral diet on inflammatory bowel disease tissues in organ culture: differential effects on ulcerative colitis and Crohn's disease. World J Gastroenterol 2005;11(47):7466-72. (PUBMED Abstract)
9.    Romano C, Cucchiara S, Barabino A, et al. Usefulness of omega-3 fatty acid supplementation in addition to mesalazine in maintaining remission in pediatric Crohn's disease: a double-blind, randomized, placebo-controlled study. World J Gastroenterol 2005;11(45):7118-21. (PUBMED Abstract)
10.    Geerling BJ, Badart-Smook A, van Deursen C, et al. Nutritional supplementation with N-3 fatty acids and antioxidants in patients with Crohn's disease in remission: effects on antioxidant status and fatty acid profile. Inflamm Bowel Dis 2000;6(2):77-84. (PUBMED Abstract)
11.    Nielsen AA, Jorgensen LG, Nielsen JN, et al. Omega-3 fatty acids inhibit an increase of proinflammatory cytokines in patients with active Crohn's disease compared with omega-6 fatty acids. Aliment Pharmacol Ther 2005;22(11-12):1121-8. (PUBMED Abstract)
12.    Ikehata A, Hiwatashi N, Kinouchi Y, et al. Effect of intravenously infused eicosapentaenoic acid on the leukotriene generation in patients with active Crohn's disease. Am J Clin Nutr 1992;56(5):938-42. (PUBMED Abstract)
13.    Nieto N, Torres MI, Rios A, Gil A. Dietary polyunsaturated fatty acids improve histological and biochemical alterations in rats with experimental ulcerative colitis. J Nutr 2002;132(1):11-9. (PUBMED Abstract)