Fatty Acids: Omega-3s in the Treatment of Lupus
- Introduction; The 20-second Overview
- What exactly are omega-3’s?
- What are the health benefits of omega-3’s?
- Sources of Omega-3
- Krill Oil in the Treatment of Lupus
- In conclusion
Introduction: The 20-second Overview
Lately, there have been a growing number of research studies, which highlight the possible role of certain fatty acids in slowing that kind of overactive immune responses that are seen in lupus patients.
- In 2018, one study highlighted the discovery of a totally new group of molecules called “nitro-fatty acids” that showed anti-inflammatory properties.
- A 2022 study found that out of the 25,871 participants who took marine omega-3 supplements over the course of five years, the incidence of autoimmune disease decreased by 15% compared to those who took a placebo. This study was not specific to lupus, but it showed promise and a basis for future studies.
- In 2022, a study described in greater detail the positive effects of omega-3’s on specific lupus symptoms and the reduction of some lupus biomarkers.
In this blog, I will take the opportunity to explore fatty acids as a group – particularly the popular omega-3’s – and how they may aid in symptom management for those of us with lupus.
Omega-3 fatty acids reportedly help in many ways, such as improve heart-health, lower cholesterol, provide the foundation for brain tissue development and may possibly decrease inflammation in conditions like lupus and other autoimmune diseases such as rheumatoid arthritis and fibromyalgia. In this article, we’ll look at the health benefits of this nutrient-rich supplement and provide the information you may need as an individual with lupus to start talking with your healthcare provider about ways in which you can add it safely to your diet in order to potentially reap the rewards of this potent natural element.
What exactly are omega-3s?
First, a quick overview of the science of fats and oils! Fats, oils and waxes are all different types of lipids – those chemicals that are great at the long-term storage of energy as well as insulating and protecting our bodies as well as a multitude of other functions. In general, oils (like olive oil) are lipids that are a liquid at room or ambient temperatures, while fats (like butter) tend to solidify at those same temperatures. All fats (usually called triglycerides in your medical reports) and oils are made up of long chains of carbons called fatty acids. The good and bad kinds of fats and oils really depend upon what fatty acids they contain. This is where you hear about “trans-fats” or “polyunsaturated” fats; what they really refer to are different kinds of fatty acids. So, enough of the biology lecture; what does this mean for lupus research? Well, let’s talk fish.
Ever wonder how fish can survive in the harshest of climates? It seems nothing short of miraculous that even the iciest rivers and oceans are teeming with life. As it turns out different fish need different kinds of fatty acids. Fish like albacore, salmon, herring, and – before you turn up your nose – anchovies – are “oily” fish that are loaded with the kinds of fats that not only insulate them from the cold, but also keep them from solidifying like a cube of butter at very low temperatures.
As it turns out, some of the fatty acids that help cold-water fish survive frigid conditions are same ones that are often very beneficial to human health – specifically, the omega 3 fatty acids. This is why, for example, salmon has more of the omega 3’s than a warm-water fish, like tilapia might have.
As it turns out, there are three kinds of omega-3s to consider:
- Alpha-linolenic acid (ALA) – an essential fatty acids that our bodies don’t generate and we have to get them from the foods we eat, primarily found in plant oils including flaxseed.
- Elcosapentaenoic acid (EPA) – fatty acids found in fish and other seafood.
- Docosahexaenoic acid (DHA) – fatty acids found in fish and other seafood.
You don’t need to remember their names, but just know this – the last two, EPA and DHA, are the most beneficial and though our bodies are capable of converting some ALA into EPA and then DHA, it is usually not enough to help much. In order to have enough, you may need to take DHA and EPA supplements or make sure the foods we eat contain DHA and EPA. So, check the labels if you are using these supplements.
Also, it may be easy to confuse these fatty acids with their omega-6 cousins, but omega-6s can actually be responsible for inflammation in the body – omega-6s can be found in a lot of the bad fats and refined sugars we eat. If you are an individual with lupus, one of the things you may have been asked by your healthcare practitioner to limit or remove bad fats and sugars from your diet in order to try to decrease inflammation throughout your body naturally. Omega-3’s, on the other hand, maybe something you and your healthcare practitioner choose to include to boost your overall well-being.
What are some of the health benefits of omega-3s?
Researchers are still investigating ways in which omega-3s can improve and protect our health. They include:
- Lowering triglyceride levels through the consumption of foods containing EPA and DHA.
- Lowering the risk of developing certain types of cancer such as breast and colorectal cancer.
- Lowering the risk of developing cognitive ailments such as Alzheimer’s and dementia.
- Lowering the risk of developing age-related macular degeneration (AMD).
- Relieving symptoms of dry eye disease specifically by DHA and EPA.
- Managing symptoms of rheumatoid arthritis (RA).
Potential Health Benefits of Omega-3s in the Treatment of Lupus
To be honest, the clinical trials and research on omega-3 fatty acids from fish oil for lupus have sometimes been contradictory. However, the most recent studies have demonstrated that specific benefits have been seen for specific symptoms – if not actual reduction in overall autoimmunity. Secondarily, there are almost no adverse effects associated with omega-3 fatty acid supplements, so it is definitely worth trying!
Here are some of the most important studies and their findings:
In 2017, the University of Michigan received a $2.5 million grant from the National Institutes of Health (NIH) to study the effects of omega-3 fatty acids on stopping lupus triggers. Previous studies conducted by researchers at the University of Michigan showed that individuals with lupus who had a higher dietary intake of omega-3s reported experiencing better sleep, fewer depressive episodes, and a decrease in the presence of comorbid fibromyalgia. While more research is needed, these results are significant.
Studies have also shown that omega-3s are beneficial in managing inflammation. A 2012 article published by the British Journal of Clinical Pharmacology refers to a study in which patients who had RA who took fish oil supplements reported a decrease in severity of pain and joint inflammation symptoms and “…improvements in several clinical outcomes including reduced duration of morning stiffness, reduced number of tender or swollen joints, reduced joint pain, reduced time to fatigue, [and] increased grip strength.”
A 2015 study conducted by the University of Texas in Dallas and the University of Houston also shows evidence of the benefits of omega-3s in the treatment of lupus symptoms. Individuals with lupus who participated in the study and who took a fish oil supplement reported experiencing less fatigue, increased emotional well-being, and a decrease in global disease activity. These individuals also reported a significant decrease in systemic inflammation.
A 2020 study of 136 patients who took daily doses of less than 3 g of omega-3 fatty acids, showed reduced ALD activity based on the SLE Disease Activity Index (SLEDAI) scale.
A 2022 study of ten trials found significant improvement in Systemic Lupus Activity Measure-Revised (SLAM-R) scores after 12 and 24 weeks of taking omega-3 supplements.
Sources of Omega-3
I’ve mentioned some of the best sources of omega-3s earlier, but here is a more detailed list, including both animal and plant-based sources:
- Natural fish oils from fish such as salmon, sardines, and cod liver.
- Processed fish oils which are more concentrated and more purified (less risk of mercury contamination) – you’ll find these in the majority in the market.
- Krill oil – extracted from the shrimp-like creatures found in the waters of Antarctica. We’ll discuss krill oil more in-depth later in this article.
- Green-lipped mussel oil.
- Mammalian oil from seal blubber.
- Flaxseed, chia seeds, and hemp seed
- Brussel sprouts
- Flaxseed oil, soybean oil, canola oil, perilla oil, and algal oil
- Various brands of eggs, dairy, juice, soy beverages, and infant formulas – check labels closely for omega-3 inclusion
Your healthcare practitioner may ask that you take an omega-3 supplement. Don’t fear – there are many supplements today that are burpless, odorless, and even have added flavors to make them more palatable. You’ll want to discuss which supplements are best for you, paying close attention to the following:
- Type of omega-3 – it should contain DHA or EPA; many do not contain either.
- How much omega-3 is in each capsule – make sure to read the back label for specific amounts.
- Form of omega-3 – look for supplements containing free fatty acids, TG (triglycerides), rTG (reformed triglycerides), and PL (phospholipids). Avoid ethyl esters.
- Freshness – check the date and check the smell; they can go rancid sitting on the store shelf.
- Purity and authenticity – look for supplements marked “GOED Standard for Purity” or other third-party tested stamps.
- Sustainability – look for supplements certified by the MSC, Environmental Defense Fund, or similar organizations to make sure they are obtained in a responsible manner!
Krill oil in the Treatment of Lupus
One of the best sources for omega-3s is found in krill oil – they have incredibly high levels of DHA and EPA. Krill oil also contains phospholipid-derived fatty acids (PLFA) which may aid in greater absorption. It can also contain astaxanthin, an antioxidant that may neutralize free radicals and improve overall health and prevent disease. As you may know, krill are a small, shrimp-like crustaceans that – a cording to National Geographic, krill are “are essentially the fuel that runs the engine of the Earth’s marine ecosystems.” They are the main food source for whales, penguins, and other animals that inhabit our oceans, especially in the waters of the Antarctic where they are particularly plentiful.
The Lupus Research Alliance (LRA), Lupus Therapeutics and Aker-BioMarine have partnered Aker-BioMarine to explore how krill oil may be beneficial in the treatment of lupus. Aker-BioMarine is a “biotech innovator” whose “core business consists of
harvesting, production, sales and marketing of krill-based products.” Aker-BioMarine began trials this past summer that will conclude in 2020 to assess the outcomes of individuals with lupus given krill oil as a supplement. According to Scienceforlupus.com, the primary goal of the study, “is to determine if a concentrated form of krill oil can restore normal omega-3 levels in people with lupus, therefore reducing flare-ups and debilitating symptoms like joint pain, fatigue, and more.”
To read more about the study and to stay up-to-date on its progress, visit Science for Lupus.
Environmental Impact of Krill Fishing
As wonderful as the health benefits of krill may potentially be for individuals with lupus, we can’t ignore the potential environmental impact of krill fishing. Coolantarctica.com suggests that krill fishing is “sustainably exploited” so far. Krill fishing is closely monitored in the Antarctic, and as of 2013, various groups including NGOs, scientists, commercial fishers all around the globe have agreed to track how many tons of krill are fished and when it begins to have a global impact. Historically, krill fishing significantly decreased in the 1990’s after the fall of the Soviet Union – the USSR basically had cornered the market on krill fishing – but it is expected to steadily increase as new uses for krill oil – including medicinal uses become more profitable.
Notably, Greenpeace disagrees with this assessment of responsible krill fishing, and contends “krill fishing is taking place in areas which have been put forward as ocean sanctuaries. Such protected areas will help these marine ecosystems to build resilience to the combined impacts of climate change, pollution and fishing.” They monitor areas heavily populated with penguins and other animals that rely on krill for food and whose populations are endangered from the increase in industrial krill harvesting and climate change.
It is ultimately up to you to decide whether or not using krill oil supports your particular values as well as your health needs. We’ve listed our resources below so you can read more about the pros and cons of krill fishing.
Good fatty acids – omega-3s – show promise in not only general health and well-being but specifically in symptom management in the treatment of lupus. However, it is always advisable to speak with your healthcare professional to determine whether or not omega-3s may be right for you and from what source. If it’s determined that omega-3s in the form of fish oil is right for you, you will then need to make the personal decision of where to source your supplements as this decision may impact your individual set of values and even the global environment.
Aarhus University. (2018, September 20). Fatty acids can slow down an overheated immune system. ScienceDaily. Retrieved October 17, 2023 from www.sciencedaily.com/releases/2018/09/180920101101.htm
Aker Biomarine Antarctic AS. (2021, October, 12). Omega-3 replacement with krill oil in disease management of SLE. ClinicalTRials.gov. https://clinicaltrials.gov/study/NCT03626311
Arriens, C. Hynan, L.S., Lerman, R.H., Karp, D.R., & Mohan, C. (2015). Placebo-controlled randomized clinical trial of fish oil’s impact on fatigue, quality of life, and disease activity in systemic lupus erythematosus. Nutrition Journal, 14(82). DOI 10.1186/s12937-015-0068-2
Calder, P.C. (2012). Omega-3 polyunsaturated fatty acids and inflammatory processes: Nutrition or pharmacology? British Journal of Clinical Pharmacology, 75(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575932/pdf/bcp0075-0645.pdf
Cool Antarctica. (n.d.). Human Impacts on Antarctica and Threats to the Environment – Fishing. Coolantarctica.com. https://www.coolantarctica.com/Antarctica%20fact%20file/science/threats_fishing.php
Duarte-García, A., Myasoedova, E., Karmacharya, P., Hocaoğlu, M., Murad, M. H., Warrington, K. J., & Crowson, C. S. (2020). Effect of omega-3 fatty acids on systemic lupus erythematosus disease activity: A systematic review and meta-analysis. Autoimmunity reviews, 19(12), 102688. https://doi.org/10.1016/j.autrev.2020.102688
Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. Retrieved from https://www.bmj.com/content/376/bmj-2021-066452
Ramessar, N., Borad, A., & Schlesinger, N. (2022). The effect of omega-3 fatty acid supplementation in systemic lupus erythematosus patients: A systematic review. Lupus, 31(3), 287–296. https://doi.org/10.1177/09612033211067985
Pestka, J.J., Akbari, P., Wierenga, K.A., Bates, M.A., Gilley, K.N., Wagner, J.G., Lewandowski, R.P., Rajasigne, L.D., Chauhan, P.S., Lock, A.L., Li, G-Z., & Harkema, J.R. (2021). Omega-3 polyunsaturated fatty acid intervention against established autoimmunity in murine model of taxicant-triggered lupus. Frontiers in Immunology, 12. https://doi.org/10.3389/fimmu.2021.653464
Author: Liz Heintz (Updated 2023)
Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.
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