Dr. Richard Firshein

CHAPTER 4. FISH OIL: Firefighter of the High Seas

Because fish oils quench inflammation, I like to call them nature's fire fighters. Fish oils have shown dramatic benefits in an astounding range of conditions, many of which are triggered by some form of chronic inflammation. Here are some examples:

ARTHRITIS: I have seen fish oil turn around many cases of arthritis, as well as related conditions like lupus and Still's disease, a form of juvenile arthritis. A study in The Annals of Rheumatology found that patients treated with fish oil or primrose oil showed a significant improvement in their symptoms, and by the end of a year they had dramatically reduced the level of their medications.

ASTHMA: A recent study in the International Archives of Allergy and Applied Immunology examined the effect of fish oil on asthmatics over a one year period. After nine months, the lung function of the subjects taking fish oil increased by 23 percent, while those given placebos saw no discernible improvement.

INFLAMMATORY BOWEL DISEASE Fish oils are beneficial in ulcerative colitis and Crohn's disease (when the patients are not too ill to absorb fats). A recent Italian study showed that coated fish oil capsules passed through the stomach without being dissolved and reach the gut fully preserved, produced significant improvement in symptoms of inflammatory bowel disease. There were also improvements in the cells of the colon. Bleeding diminished, as did abdominal distention and pain, and bowel movements were more fully formed.

HEART DISEASE: Fish oil has a profoundly beneficial effect on heart disease. A recent study showed that when men who otherwise ate a standard American diet ate fish twice a week, their death rates plummeted by 50 percent. A study in the Archives of Internal Medicine showed that fish oils in moderate amounts reduced triglycerides and harmful cholesterol, both shown to be risk factors for heart disease.

BLOOD PRESSURE: Fish oil can lower high blood pressure. A 1990 study in the American Journal of Hypertension showed that in patients with hypertension, fish oil supplements reduced blood pressure, lowered triglyceride levels and increased the amount of time the body takes to form a blood clot.

CANCER: I consider fish oils an absolutely essential supplement for my patients with a history of cancer. Cancer cells can grow and spread by creating inflammation. Research suggests essential fatty acids slow down cancer growth, impairing the malignant cells' ability to function efficiently. In one study, increasing the proportion of red-blood cell omega 6 fatty acids significantly reduced the risk of prostate cancer. Another study showed fish oil may protect against colon cancer. A study reported in the Journal of the National Cancer Institute, suggests that a diet rich in omega-3 fatty acids can suppress breast cancer cell growth.

DIABETES: Fish oils can help prevent the damage to blood vessels that is so common in diabetes, and is actually the underlying cause for many of the devastating complications of the disease from kidney failure to gangrene to heart disease. A 1980 study published in Germany found that essential fatty acids improved the action of insulin and reduced the development of blood clots.

PMS: I often prescribe fish oils, among other nutrients, to treat symptoms of PMS. A study in the European Journal of Clinical Nutrition looked at 181 healthy Danish women between the ages of 20 and 45. Menstrual pain was significantly higher in those who did not include omega-3s in their diet, or whose bloodwork showed unfavorable ratios of omega-3 and omega-6. The study concluded that marine fatty acids are linked to reduced symptoms of PMS.

An Inflammatory Issue

How can something as simple as an essential fatty acid change someone's life so profoundly? How can it work better than a powerful drug? What could possibly be occurring in the body?

The answers will teach you about more than fish oils, or their plant counterpart, flaxseed oil. They will help you understand how to stay healthy. For in understanding the importance of these oils, one must fully comprehend inflammation and its effect on the body.

Inflammation is a chemical fire. That's why it causes redness, swelling, tenderness and pain. Some fires burn fast and furious, and then burn out. That's the kind of inflammation caused by an acute febrile illness, where your fever spikes high and then breaks; or by an accident, where a bruise or injury swells and then heals. Other fires are like a hot bed of ashes, always releasing heat, never quite dying, never bringing down the whole house. That's the kind of response caused by chronic auto-immune diseases like arthritis or asthma.

Inflammation is actually a complex response to some kind of damage to the body, whether it's from bacteria, viruses, toxins, or the waste products of the body's own chemical reactions. And it involves a sequence of reactions and chemicals. The inflammatory process attracts cells called platelets, white blood cells and macrophages, which are designed to kill bacteria by actually eating them up.

Our immune system needs inflammation in order to help heal wounds and fight illness. However, sometimes the process becomes disregulated or goes awry. This is where the essential oils, and fish oil in particular, come into play. These oils contain essential fatty acids called omega-3s. In the last 10 years, nearly five thousand studies have been conducted on omega-3 acids alone. These studies have researched the benefits of omega-3 fatty acids on everything from heart disease to cancer, psoriasis, autoimmune disorders, and even kidney disease. It has long been known that Eskimos suffer very little cancer and auto-immune disorders, because their diet is so high in fish, which is a great source of omega-3 fatty acids.

How Can Fats Be Essential?

Fish oils and their chemical cousins found in plants are among the greatest nutritional stories of our time. The oils in specific plants and fish are so important that they are called essential fatty acids. Specific fatty acids modify inflammation and help treat such conditions as diabetes, asthma, hypertension, and arthritis. They are even crucial for the development of nerve and brain function in infants. Fish oils are actually absorbed directly into the outer fatty layer of every cell, where they act as a kind of cellular cushion or barrier, protecting each cell from the outside environment, like a moat around a castle.

Recently, fat has become a dirty word, but in truth, fats are life's lubricants and energy powerhouses. We need fats for optimal health, and women in particular need fats to build their hormones. However, there are a variety of fats, some good, some bad. Here's a brief guide:

Saturated fats are either derived from animal sources or have been artificially saturated by the food industry. They can promote free-radical damage and clog the arteries. In saturated fats, such as those found in meat and cheese, every carbon atom is completely saturated with all the hydrogen it can carry. It is a solid, thick fat, like the yellowy fat you find in chickens and beef. This fat is known to be a major risk factor in raising cholesterol levels.

Trans-saturated fats do not exist in nature, but are artificially produced. In America, margarine contains trans-saturated fats (in Europe, this is not the case; the trans-saturated fats have been eliminated). Oil is manufactured to harden at room temperature and have a long shelf life, but in the body it is harmful. It actually blocks your cells' use of essential fatty acids. This fat should be avoided whenever possible.

Unsaturated fats are found in most oils. They are called unsaturated or polyunsaturated because many of the carbon atoms are 'empty' and don't carry hydrogen. Corn oil is a common unsaturated fat, along with safflower, soybean, and other vegetable oils. When used in cooking, they easily become oxidized and create free radicals. High amounts of unsaturated fats were once thought to be healthy, but they are now believed to contribute to a variety of illnesses, including heart disease and cancer.

Mono unsaturated fats such as olive oil are good for your health. They contain the fatty acid known as oleic acid. It has 18 carbon atoms and only 16 hydrogen atoms, which makes the fat less solid. It flows easily at room temperature.

Omega-3 and omega-6 fatty acids are unsaturated; they are so important to health that I have put them in their own category.

As you can see, overconsumption of the wrong type of fat can cause serious damage within the body, by blocking your body's ability to access essential fatty acids. Eating the right amount of fat is a delicate balancing act.

Remember These Numbers: Three and Six

The body uses omega oils to regulate a wide variety of cellular functions and substances, including the level of prostaglandins, active hormone-like substances that regulate almost every bodily function, including the work of the heart and kidneys, the constriction of blood vessels, healing and repair, immune function, allergy defense, digestion, inflammation, menstrual cramps, body temperature, and pressure in the eyes, ears and joints.

There are three important classes of prostaglandins: each is made from different fatty acids and is influenced almost entirely by our diet.

The first class, Class 1, quench inflammation, and are derived from a fatty acid called dihomogammalinolenic acid (DGLA). This is found in only one substance known to man: mother's milk. However, our body can make its own DGLA from GLA, a healthy omega-6 fatty acid. In turn, our bodies can make GLA from linoleic acid, which is found in nuts and seeds. Many women's problems are triggered or worsened by a single deficiency in GLA or DGLA, and the resulting deficiency in Class 1 prostaglandins.

Class 3 prostaglandins are also anti-inflammatory agents. They are derived exclusively from omega-3 fatty acids, which primarily come from fish oils. (Our bodies can make EPA [eicosapentaenoic acid] from the oil in flaxseed, which is good news for vegetarians.)

Class 2 prostaglandins are powerfully pro-inflammatory fire starters. Our bodies make them from meat or from vegetable oils that contain omega-6 fatty acids. Many of these omega-6s are an important linchpin in the inflammatory avalanche.

Our body needs all three classes of prostaglandins, but it needs them in a proper balance. Too many class 2 prostaglandins, fueled by an unhealthy diet, may be an important factor in many chronic, inflammatory illnesses.

Where Do I Get My Good Fats?

Two important forms of Omega-3 fatty acids come in fatty fish like salmon and mackerel. (Other fish, though offering a healthy form of protein, are not high in omega-3s. These less fatty fish, such as flounder, simply do not provide beneficial amounts). They are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Symptoms of EPA and DHA deficiency often include allergies, inflammation, and dry skin. Prolonged deficiencies can lead to serious autoimmune diseases.

Omega-6s have a wide variety of effects. They can trigger or inhibit inflammation, depending on the individual, his or her genes and diet. Unhealthy omega-6 oils permeate every portion of the typical American diet, in corn oil and saturated fat.

An important and healthy omega-6 oil is gamma linolenic acid (GLA), which has been found helpful in menstrual disorders. This omega-6 oil is found in evening primrose oil and blackcurrant oil. I recommend evening primrose because it is very stable, and doesn't degrade as easily while sitting in capsules on the shelf.

These days, the dietary availability of omega-3 fatty acids in America is only 20 percent of what it was a century ago. This precipitous plunge is cause for concern. Studies in Eskimos show that they eat an excess of omega-3s and that they lack the enzymes that convert omega-6s into inflammatory substances. Their genes are protecting them from the potentially harmful by-products of omega-6s, and their high-fish diet is protecting them as well. That's probably why their rates of heart disease are negligible.

Why are omega-3s and 6s so important? Simply because many of the chemical signals that stimulate a cell to act do so by metabolizing and changing the fatty layer of the cell's membrane. The signals that can impact that layer range from adrenaline to histamine as well as powerful neurotransmitters such as serotonin and dopamine. If the fatty layer is deficient or impaired, chemical signals don't have the proper effect, and the body's functions are impaired.

How important are omega-3s? A study was conducted in 1970 in which eight monkeys were placed on a laboratory diet with every essential nutrient and only one fat, corn oil. Within two years, the monkeys all became sick and developed patchy hair loss. Two suffered from severe intestinal inflammation, two began to gnaw obsessively at their own bodies, and four died. That's of particular concern to me because corn oil is such a commonly used oil in the American diet, and is often used to deep-fry fast foods.

FISH OIL AS A BLOOD THINNER

Fish oil not only inhibits excessive inflammation, it can actually thin the blood and work like a kind of natural aspirin, only better. Fish oils inhibit the clumping-together of cells called platelets. Platelets have a complex array of functions, including the ability to bind together and help the body heal wounds by clotting blood. When a blood vessel is injured, platelets adhere to the exposed part of the blood vessel, secreting a veritable fountain of chemicals that help promote inflammation. The inflammation seals the wound, and keeps bacteria from spreading. It's like when firefighters build a ring of fire around a raging blaze, sealing it off, and preventing it from spreading.

Are we getting enough omega-3s? Think of the huge increase in autoimmune and inflammatory diseases today. Half a million people die of heart disease each year. Two million are diagnosed with cancer. More people go to their doctor for joint pains than any other condition. Asthma is now recognized as a national epidemic. Why are these diseases on the rise? Our typical American diet is not that different from the diet of the sick monkeys that were studied many years ago.

Individuals who live in cold climates seem to need higher levels of omega-3 fatty acids. Individuals who suffer from atopic eczema often have a poorly functioning enzyme that makes it hard for them to convert their essential fatty acids into anti-inflammatory prostaglandins. If they are given evening primrose oil, their eczema may clear up.

If your diet is high in nuts and seeds, and in flaxseed oil, and you still suffer from inflammatory disease, consult your nutritionist about eating fish and taking fish oil capsules. But remember, fish oil capsules inevitably become oxidized, or rancid, causing free radical damage. A study of 20 smokers and 22 nonsmokers given 10 grams of fish oil daily found that after four weeks, peroxide damage to cholesterol increased by as much as 50 percent in both groups. (oxidized cholesterol can be harmful to health). The antioxidant vitamin E, which is fat soluble, can provide partial protection, but it can't entirely solve the problem. Therefore, first try eating fish high in omega-3s three or four times a week, then add fish oil capsules if necessary, and be sure to take vitamins C and E as well.

If Fish is Not for You

Vegetarians may wonder what dietary option they have if they don't eat fish. Flaxseed oil is a plant counterpart to fish oil and an excellent alternative for most vegetarians. It contains the essential omega-3 fatty acids which, when converted by an enzyme in the body, turn into the active form found in fish oil. However, I find that most vegetarians eat too little of these essential oils, concentrating instead on the polyunsaturated fats such as those found in corn oil and safflower oil, which can ultimately promote inflammation.

Fish for All

Fish oils are helpful in combating most inflammatory conditions. Asthma, lupus, arthritis and other rheumatic diseases, scleroderma (where the skin and organs harden), Raynaud's disease (where the fingers turn purple whenever exposed to cold), and autoimmune thyroiditis (where the thyroid becomes inflamed). In these illnesses, a tremendous amount of inflammation is produced by the body, and it ends up fighting itself. Nobody knows quite what triggers these illnesses, although viruses are possible culprits. Whatever the cause, studies have shown that essential fatty acid levels in patients with autoimmune illnesses are depressed. I recommend fish and/or flaxseed oil in any of the above conditions, and have found the results extremely encouraging.

WHERE AND HOW TO GET YOUR OILS

Nature is an abundant source of vitamins, minerals and nutrients needed for good health, including essential fatty acids, so unless you are trying to combat an ongoing inflammatory illness or heart condition, there's no need to rush to the health food store for these supplements. Three servings of fish a week should be adequate for most people. Fish high in EFAs are tuna, salmon, halibut, bluefish, red snapper and mackerel. However, you must also eliminate the unhealthy fats that compete with fish oils. You can't continue eating fatty, fried foods and meats every day.

Different diseases require different amounts of EFAs. Inflammatory bowel disease can require as much as 6,000 milligrams per day, partly because the inflamed gut cannot absorb oils as well. Arthritis may require 2,000 to 6,000 milligrams of fish oil a day, perhaps because of the many different sites of inflammation involved in arthritis. Treatments for asthma and lupus generally require 1,000 to 2,000 milligrams of fish oil a day. Most other conditions, such as PMS, skin conditions, or Raynaud's, will usually improve with 2,000 milligrams a day, higher doses may be necessary with Raynaud's.

Flaxseed oil can be used as a supplement to fish oil, especially for vegetarians. I recommend three grams a day in most illnesses. Otherwise, flaxseed oil can be a healthful addition to salads and can be used instead of butter on baked potatoes, squash or other vegetables. However, it should not be cooked, as it easily turns rancid, and it should always be refrigerated, with the cap closed tightly.

Our bodies have an almost effortless ability to absorb omega-3s. Every other fat requires enzymes to activate it. This is not the case with fish oils.

However, the secret of omega-3s is that they concentrate and accumulate over time. If your diet has been rich in omega-3s for years, you will have an equally rich store of essential fatty oils in your cells. If, however, your diet has been deficient, and your body has been forced to use other fats (and to utilize precious enzymes in an attempt to convert them), you will need time in order to bring yourself back into balance.

Understanding fish oils helps us to peer into the very inner workings of each cell in our body. I feel there is a certain ancient mystery about omega-3s, they are a link in the vast arc of time, a reminder of the change that occurred eons ago when we moved from sea to land, and yet retained this very important need for this essential oil. Omega-3s are indeed the firefighters from the ancient oceans, they can work marvels, and the only thing they ask of you is patience and time.

HOW MUCH SHOULD I TAKE?

For General Health
2-3 6-oz. Servings of fish per week, or 1 tablespoon of flaxseed oil daily in salad dressing

Special Conditions
Arthritis 3,000-4,000 mg/day
Inflammatory bowel disease 3,000-4,000 mg/day
Heart disease 3,000-4,000 mg/day
Blood pressure 3,000-4,000 mg/day
Diabetes 3,000-4,000 mg/day
PMS 3,000-4,000 mg/day
Asthma 3,000-4,000 mg/day
Eczema/Seborrhea 3,000-4,000 mg/day
Raynaud's disease 3,000-4,000 mg/day

The above dosages are based on a fish oil formulation containing at least 500 mg of EPA, 310 mg of DHA, and 190 mg of other omega-3 fatty acids.

by Dr. Richard Firshein