Since the operation to have my elbow fracture repaired, I don’t think it’s an over statement to say that pain has been a prominent factor in my life. Especially whilst in physiotherapy, everything is about pushing just about as far as you can go. That is going to leave you a little sore. However in addition to the paracetamol and codeine pain killers, I’ve also used Omega 3 to help me deal with inflammation.
Now I say omega 3. What I am NOT talking about is SevenSeas or Holland and Barratts bottles of cod liver oil. I am talking as close to pharmaceutically pure as you can get without a prescription – That makes it sound almost like something from Breaking Bad!
What I mean is that cod liver oil, specifically omega 3 – of which there are two components EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid respectively).
SO a few or these (Read many) of these articles as a little behind the actual timeline of my injury. I’m currently 8 weeks today away from the fracture date. However I recently ran out of my omega 3 supply about 2 weeks ago and haven’t ordered any more yet. The reason why this has triggered a post, is that over the last week things have begun to ache a little bit more. Specifically the fracture site.
Two days ago was the first time in about 3 weeks I’ve needed any co-codamol. Not pain per say, but just a deep ache. What really triggered me to think about the Omega 3 was I have noticed from a run, and recently on the turbo, my knees are beginning to become sore again.
Omega 3 in clinic
I was discussing a joint pain issue with a patient this morning, and it triggered me to remember I hadn’t ordered any more Omega 3, particularly as I discussed the merits with her.
Now let me be very clear on something. If you are going to make medical recommendations to a patient, you’d better be able to back it up with SOLID documented fact and evidence. Omega 3 as an anti-inflammatory measure has a large body of evidence behind it. There is even a prescription version used by the cardiologists, for its anti-inflammatory and anti-platlet function. Regrettably, because of the pricing, we are not able to prescribe it in GP for its anti-inflammatory properties, but since it is available over the counter, people can still get the benefit.
To take a line from “Me and My Shadow”….now to repeat what I said at the start. All Omega 3 is not SOLD equally. Just because you can buy it easily, doesn’t mean it is all of the same quality or concentration.
A little bit like cars. They are available over all the place. However, that doesn’t mean your Kia Picanto is going to be able to hold up to a Ferrari La Ferrari when it comes to a drag race!
Careful what you buy
This loops me back to the EPA and DHA in Omega 3. Lets take Seven Seas Omega 3 Maximum Strength Capules – available in Lloyds. The box states 1105mg of Fish Oil, and 697mg of Omega-3 Nutrients. Thats a little bit like saying This Vehicle is made of 100% Car with a 2.0Litre engine. You can infer a lot of information from this. But crucially like the car analogy, not the right information. Is the car a saloon or estate. That 2.0L engine, is it diesel or petrol. Possibly even gas! The correct information when buying Omega 3 really matters.
We have the same issue at Chemist Direct . Holland and Barrett have changed in the last few years and begun not only to tell people the amount of CONSTITUENTS in their omega three, but also at a strength sufficient to make a discernable medicinal effect
Omega 3 – the Science
EPA and DHA are two polyunsaturated fatty acids. These are the two chemicals which make up Omega 3 that produce the anti-inflammatory effect.
Higher doesn’t mean better
Whilst Omega 3 has been shown to be protective of inflammatory processes, Omega 6 works at the other end of the spectrum. It is actually a PRO inflammatory molecule, and activates the immune system. Whilst the immune system does protect us from bugs etc, it is also the immune system that causes inflammation, so in this particular case, dealing with painful joints etc, we want to try and keep the immune system quiet to reduce the level of inflammation.Omega 3 – specifically EPA and DHA components decrease the production of certain prostaglandins, which are needed to drive the inflammation. A little like stopping the coal man bringing fuel. Its not directly affecting the fire burning, but will stop it getting any bigger, and hopefully mean it will eventually burn out.
The following journal articles discuss how Omega 3 has its anti-inflammatory effect:
- Singer, Pierre, et al. “Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrative perspective.” Intensive care medicine 34.9 (2008): 1580-1592.
- Adam, Olaf, et al. “Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis.” Rheumatology international 23.1 (2003): 27-36.
- Rupp, Heinz, et al. “Risk Stratification by the “EPA+ DHA Level” and the “EPA/AA Ratio”.” Herz 29.7 (2004): 673-685.
- Stanford University also have a very nice explanation of the background science behind omega 3
The most crucial take home from these two papers is shown in the bottom paper by Olaf – Patients on omega 3 supplementation had their swollen joints improve by 14%, and reduced inflammatory markers in the blood by 26% compared to people NOT on the supplements.
This brings me back to EPA and DHA. We don’t know how much is needed. But we know its a fair amount. To an effect on the inflammation of joints, it is thought between 1-3grams of EPA and 0.5-2grams of DHA is needed, for about 10days before levels in the body reach an effective level. Similarly however, that level is lost, after about 10days without. Which is just about where I am currently, hence the increase in discomfort
It is estimated that once daily oily contains approximately 100-200mg of EPA/DPA per 100gram. So you’d not be able to reach even remotely effective levels of EPA/DPA to reduce discomfort in the joints by eating fish alone. Well not if you wanted to have friends anyway!
So if we look at the Holland and Barratt label above, that is suggesting you’d be needing two capsules a day just to hit the minimal levels seen to be effective in experimental studies.
MEDICAL DISCLAIMER – I AM NOT ADVOCATING BUYING OMEGA 3 – ANY SUPPLEMENT YOU TAKE MAY INTERACT WITH OTHER MEDICATION YOU TAKE OR HAVE SIDE EFFECTS. ANY CHANGES TO YOUR MANAGEMENT PLANS SHOULD NOT BE MADE WITHOUT DISCUSSING WITH YOUR GP/DOCTOR
Ultimately, this whole blog is set up for me to explain my story of recovery, and point out things I have found effective so that others also might help. There is plenty of evidence to suggest that Omega 3 is an effective anti-inflamatory in its own right. I’m using the supplements to get high concentration EPA/DHA, and have found a very positive effect. Remember, just because you want to top up your Omega 3 doesn’t mean you only have to use fish oils. I also have seeds I throw in with smoothies. Although it is harder to avoid the inflammation producing Omega 6 in a seed form, so frankly use it only if you like the taste!
I’d love to hear any comments, so drop me a line