Alpha Linolenic Acid (ALA) : An Underappreciated Omega-3

The inclusion of omega-3 fatty acids from flax oil and fish oil are increasingly popular as food manufacturers seek to improve the nutrient value of their products. Flax contains the omega-3 fatty acid alpha-linolenic acid (ALA). Fish oils are sources of the longer-chain omega-3s eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Despite the positive attributes expounded for the category, and omega-3s’ increasing presence in the marketplace, there is also confusing messaging around the health effects of the specific omega-3s, in particular the physiological significance of ALA vs. fish-based EPA and DHA. Recent headlines have warned consumers not to “confuse” the benefits of these omega-3s and have downplayed the significance of ALA for health. However, ALA has an important role in reducing chronic disease through conversion to EPA and DHA, as well as through its own unique metabolic activities. Additionally, what many fail to understand is the critical need for both plant- and fish-based omega-3s, especially considering the increasing predominance of omega-6 fatty acids in the diet.

ALA is the true “essential” omega-3 fatty acid, because it is the parent fatty acid of the omega-3 family and must be obtained from foods.  ALA’s essential nature is reflected in the federal government’s dietary recommendations. The current recommended Adequate Intake (AI), which represents the average usual intake of a nutrient by healthy people, is based on ALA, not EPA or DHA. Diets deficient in ALA result in impaired vision in monkeys, learning deficits in rats and, in humans, very low levels of omega-3 fatty acids in plasma and red blood cells, as well as nervous system abnormalities such as numbness, weakness and pain in the legs.

Fast conversion facts
ALA and its counterpart omega-6 essential fatty acid, linoleic acid (LA), are converted to longer-chain fatty acids by a series of alternating desaturations and elongations. Conversion is dependent upon a number of factors. Estimates of the amount of ALA converted to EPA range from 0.2% to 8%, with young women showing a conversion rate as high as 21%.  Conversion of ALA to DHA appears limited in humans, with most studies showing a conversion rate of about 0.05%, although one study reported a figure of 4%, and a conversion rate of 9% was reported in young women.   The large differences in the rates of ALA conversion reflect major differences in study methodologies.

The impact that LA has on reducing ALA’s health benefits is often overlooked. Diets rich in LA can reduce the conversion of ALA to EPA and DHA. For example, in a study of 22 healthy men, an LA-rich diet reduced the EPA content of plasma phospholipids significantly after four weeks compared to a low-LA diet, even though both diets contained the same amount of ALA.
The absolute amounts of ALA and LA in the diet also affect ALA conversion. Decreasing the intake of LA has been found to increase the proportion of dietary ALA converted into EPA, while increasing ALA intake can increase the absolute amount of DHA synthesized.

Healthy discoveries
Research indicates ALA consumption may reduce the risk of heart disease and other inflammatory diseases by reducing inflammatory compounds called cytokines and eicosanoids. LA is converted to longer-chain omega-6 fatty acids, in particular, arachidonic acid (AA), the precursor of eicosanoids, several of which promote blood platelet aggregation, the clotting of blood within blood vessels (thrombosis) and inflammatory reactions. ALA dampens inflammation by blocking the formation of the compounds that promote it. Inflammation is a feature of many chronic diseases, such as heart disease, type 2 diabetes, metabolic syndrome, obesity, cancer and Alzheimer’s disease. In addition, ALA interferes with the conversion of LA to AA—acting as a “nutritional brake” to block further synthesis of AA to its pro-inflammatory eicosanoids.
For example, in a study of healthy men who consumed 1.75 tablespoons of flax oil daily for four weeks, the TXB2 (an inactive metabolite of TXA2) concentration in immune cells decreased by 30%. TXA2 is one of the most-potent known promoters of both inflammation and platelet aggregation. Similarly, concentrations of the pro-inflammatory cytokines TNF-α and IL-1β in immune cells decreased 26% and 28%, respectively. In another study, serum levels of TNF-α decreased by 43%, and the production by immune cells of TNF-α and IL-1β decreased between 18% and 22% in 23 people with high cholesterol levels who consumed a diet rich in ALA compared with the average American diet, further supporting the anti-inflammatory aspects of ALA.

ALA, EPA and DHA have all been shown to prevent sudden death from arrhythmias in animals and reduce the risk of sudden cardiac death in humans. Arrhythmias are abnormal rhythms of the heart muscle that can lead to sudden death. ALA assists in achieving a normal heart rhythm by decreasing the heart muscle recover time after a heart beat and by maintaining a steady heart beat.13 In the Nurses’ Health Study, women who consumed as little as 1.2 grams of ALA daily (the amount found in less than 1 teaspoon of flax oil) had a 40% lower risk of sudden cardiac death than women with a low-ALA diet.

Epidemiological studies and, increasingly, clinical work support the beneficial effects of ALA in minimizing the risk of heart disease and for anti-inflammatory effects. ALA is the main, if not only, omega-3 in the diet of at least one billion vegetarians worldwide; despite not consuming fish, vegetarians do not have a higher prevalence of chronic diseases than nonvegetarians.

There is no doubt that EPA and DHA are beneficial, as these fatty acids have been the subjects of thousands of clinical trials. In Sept. 2004, FDA approved a qualified health claim for reduced risk of coronary heart disease on conventional foods that contain EPA and DHA. This claim, however, does not extend to ALA, because ALA was not a part of the petition process. The FDA has never assessed nor denied a qualified health claim for ALA.

Assessing intake
The current AI of ALA for men is 1.6 grams of ALA per day; for women who are not pregnant or breastfeeding, it is 1.1 grams of ALA per day. Of these amounts, about 10%—160 mg per day for men and 110 mg per day for women—can come from a combination of EPA plus DHA.²
Canadian children consume 1.2 grams of ALA and 92 mg of EPA plus DHA on average every day. Although their average omega-3 intake appears to be adequate, only 61% of the children met the AI for ALA and only 22% met the AI for EPA plus DHA.

Some experts believe higher intakes of omega-3 fatty acids are needed for health: an intake of 2.2 grams per day for ALA; an EPA plus DHA intake of 500 mg per day to decrease the risk of coronary heart disease; and an EPA plus DHA intake of 1,000 mg (or 1 gram) per day for adults with diagnosed heart disease. Clinical studies suggest that 3.6 grams of ALA (found in less than 1.5 teaspoon of flax oil) can be converted by the body to 500 to 540 mg of long-chain omega-3s, bringing current intakes closer to that recommended for reducing the risk of heart disease.

It is unfortunate that in the “omega-3 debate” there are those who choose to downplay the importance of ALA in the diet and simply ignore the omega-6 side of the metabolic equation. The typical North American diet is “deficient” in omega-3 fatty acids and overly rich in omega-6 fatty acids. The omega-6 to omega-3 ratio may be as high as 17:1 in some Western diets. In the Women’s Health Study, some women ate diets with a ratio of 33:1. The omega-6 to omega-3 ratio recommended by international nutrition agencies ranges from 4:1 to 10:1. The best route to improving one’s omega-6 to omega-3 ratio is by decreasing the intake of omega-6 fats and increasing the intake of the omega-3 fats ALA, EPA and DHA in whole foods, flax, fortified foods and supplements.

Dietary sources

Seed oils are the richest sources of α-linolenic acid, notably those of rapeseed (canola), soybeans,walnuts, flaxseed (linseed oil), perilla, chia, and hemp. α-Linolenic acid is also obtained from the thylakoid membranes of the green leaves of broadleaf plants (the membranes responsible for photosynthesis).

Common name	Alternate name	Linnaean name	% ALA
Chia	chia sage	Salvia hispanica	64%
Kiwifruit seeds	Chinese gooseberry	Actinidia chinensis	62%
Perilla	shiso	Perilla frutescens	58%
Flax	linseed	Linum usatissimum	55%
Lingonberry	cowberry	Vaccinium vitis-idaea	49%
Purslane	portulaca	Portulaca oleracea	35%
Sea buckthorn	seaberry	Hippophae rhamnoides L.	32%
Hemp	cannabis	Cannabis sativa	20%
Rapeseed	canola	Brassica napus	10%
Soybean	soya	Glycine max	8%

Flax Shown to Be Effective Against Cancers of the Colon and Breast

Flax oil and flax seeds have been shown to lower blood cholesterol and triglycerides, and to help reduce damage to cell membranes. Flax is also important in the body's ability to reduce inflammation and prevent the many degenerative diseases associated with it. Studies have shown that women with a high intake of flax oil and flax lignans are at much lower risk of developing breast cancer. Research is now documenting the benefits of flax oil, lignans, and flax meal in preventing and treating cancer in the gastrointestinal tract and colon, and breast cancer metastasis.

Recent studies and results
In a study published in the journal Food and Chemical Toxicology researchers noted that flax seed oil and flax seed meal are good sources of omega-3 fatty acids. Their objective was to investigate the feeding of flax seed oil and flax meal to groups of rats with induced precursors of colon cancer. These precursors form in the lining of the colon and rectum prior to the appearance of colorectal polyps.

The groups of rats were fed either a controlled diet alone, controlled diet plus soybean oil, controlled diet plus flax oil, or controlled diet plus flax meal. The rats were examined after 17 weeks. Those fed the flax seed oil and the flax seed meal showed reduced incidence of colon cancer precursor by 84% and 87.5% respectively. Glutathione-S-transferase (GST) activity rates were significantly higher in the rats fed flax seed oil and flax seed meal compared to those fed soybean oil. The enzymes in GST play a significant role in the detoxification of such substances as carcinogens, therapeutic drugs, and products of oxidative stress.

In the Journal of Nutrition and Cancer researchers note that fatty acid composition of dietary fat plays a vital role in colon tumor development in animal models. Fats containing omega-3 fatty acids, such as flax oil, and those containing omega-6 fats, such as corn oil, reduced chemically induced colon tumor development in rats. Lignans have also been shown to prevent colon tumor development in animal studies. These researchers investigated the effects of dietary flaxseed meal, a source of both omega-3 fatty acids and lignans, on colon tumor development and compared them with the effects of dietary corn meal.

One group of cancer induced rats ate a controlled diet supplemented with corn meal, while another ate the controlled diet supplemented with flaxseed meal. After 35 weeks, the gastrointestinal tract was isolated, and the site, size, and number of tumors were recorded and the tumors were evaluated. Tumor incidence in the corn meal group was 82.6% vs. 29.4% in the flax meal group. Tumor multiplicity was 1.3 for the corn meal group vs. 0.3 for the flax meal group. And tumor size was 44.4 mm for the corn meal group vs. 5.3 mm for the flax meal group. Researchers attributed these amazing statistics to the increased omega-3 fatty acids levels ingested by the flax meal group.

A third study, from the International Journal of Cancer reports that previous studies have shown dietary flax seed was able to reduce the growth and metastasis of human estrogen receptor negative breast cancer in mice. Researchers for this study sought to determine whether the tumor inhibitory effect of flaxseed was due to its oil, lignan secoisolariciresinol diglycoside (SDG), or both, and whether the effect on tumor growth was related to increased oxidative degradation of lipids.

Rats were injected with estrogen receptor negative breast cancer cells and after 8 weeks were fed either the basal diet, or basal diet supplemented with flax seeds, SDG, flax oil, or a combination.

Compared to the basal diet group, the tumors in all supplemented groups showed decreased cell proliferation and increased apoptosis. These results did not significantly relate to lipid peroxidation. Lung metastasis incidence was reduced by 16 to 70 percent by all treatments, and most significantly in the flax seed, SDG, and flax oil groups. Distant lymph node metastasis was significantly decreased (52%) only in the flax oil group. Total metastasis incidence was lowered significantly (42%) only in the SDG plus flax oil group.

What these studies may mean for you
The studies show both flax oil and flax meal to be highly effective against cancers of the gastrointestinal tract and colon. Flax oil was clearly the most effective at preventing lymph node metastasis, while the impact on total body metastasis was greatest when SDG, the active compound from lignans, was included with flax oil.

It is the omega-3 fatty acids in flax that are the active agents producing these results. Omega-3 fatty acids are electron rich, and are able to enter the cells to provide them with the electrical energy needed for the healthy completion of cellular processes.

Our bodies produce over 500 million new cells daily. When these cells divide, the old cell and the new cell must contain enough electron rich fatty acids to divide off completely from each other. When this process is not completed due to a lack of electron rich highly unsaturated fat, the course of growth and division is altered and the maturing and shedding process is never fully completed. This may lead to the formation of tumors.

Unless you frequently eat omega-3 rich foods such as salmon or walnuts, supplementing your diet with lignan rich flax oil may be one of the best choices for your health that you ever make.

Using flax oilFlax oil is highly unstable and begins to oxidize quickly after processing. If you are going to use flax oil, you will want only the freshest, best quality organic oil. Fresh flax oil has a nutty taste that is good. Although results from study number three indicate that even when the oil has oxidized it will still do its job in the body, most health experts say that any oil that does not taste good is oil you should not use. Any trace of bitterness means the oil is oxidizing.

Most flax oil on the market is rancid to some degree, particularly the capsules. Taste one and you will be appalled. The maker of the capsules is counting on you swallowing them whole and never tasting the rancid oil that is in them. Oil that is bought from a drugstore, supermarket, or discount center is usually quite oxidized and bitter. Even house brands from online supplement stores are usually oxidized. Just because it's organic doesn't mean it isn't rancid.

There are two brands which produce organic flax oil that is usually fresh and good-tasting. These are Spectrum and Barleans. Spectrum is the more consistent of the two brands. These oils are available at health food stores, and grocery stores that cater to the health conscious. They are sold in the refrigerator section, and should be refrigerated again immediately after purchase.

If you do not have access to these oils where you live, they can be ordered from the online supplement stores. When it's relatively cold outside, the oil can be shipped to you without a problem. In the warm months or if you live in a place where it is warm all year, you will need to have them shipped in a cold pack. Not all online stores offer cold packs, but several do.

Taste the oil when you bring it home or have it delivered. If it does not taste fresh and good, if you detect bitterness, return it or call the online store and ask for a refund. Retailers seem to be quite used to people returning rancid flax oil, and they will give you a refund or replacement.

The amount of oil you need per day to keep yourself healthy is one tablespoon for each 100 pounds of body weight. If you have had cancer and are trying to prevent a recurrence you may want to double that amount. If you are actively fighting cancer or other serious disease, you will need to take the oil throughout the day, building up to an amount of 8 ounces or more as you are able to tolerate it.

Never heat flax oil. Always shake the bottle before using.

Using flax lignansSpectrum and Barleans as well as others produce flax oil with lignans added. They usually settle to the bottom requiring you to give the bottle a hard shaking every time you use it.

If you don't want to take flax oil with lignans but want to get the benefits of lignans, you can get one of the capsule forms on the market containing SDG. The best known of these is Brevail, made by the Barleans company. There are others that are equally as effective.

Flax Seed Health Benefits

The flax seed has long been known as a great non-animal source of omega-3 fatty acids, and recent research has found that this tiny nutritional powerhouse may reduce inflammation and provide skin health benefits.


Flaxseed and other plant-based foods including walnuts, canola oil, and soybeans are rich in an omega-3 fatty acid called ALA. But flaxseed lacks the omega-3 fatty acids EPA and DHA, which have shown cardiovascular benefits in past studies.

Flaxseed is high in:

• Vitamins and minerals, including most of the B vitamins, magnesium, and manganese
• Fiber, both soluble and insoluble
• Phytochemicals, including many powerful antioxidants such as lignans. In fact, because it’s a plant, flaxseed is one of the best sources of lignans around.
• Omega-3 fatty acids, key to fighting inflammation. Flaxseed is a mega-source of the plant version of omega-3 called alpha-linolenic acid (ALA). Flaxseed oil is about 50 percent ALA — five times more than walnut oil or canola oil, which are the next highest sources of ALA.

Healthy postmenopausal women who ate a low-fat muffin enriched with flax seed daily for six weeks saw a 15% reduction in the inflammatory marker, C-reactive protein, according to a study published in Nutrition, Metabolism and Cardiovascular Diseases.

In addition to these flax seed health benefits, German and French researchers also suggest that flax seed oil supplements may protect skin against reddening and improve overall skin health. According to findings published in the British Journal of Nutrition, the omega-3-rich flax seed oil can decrease skin roughness and scaling. Subjects who took flax seed oil supplements for 12 weeks saw an increase in blood levels of ALA (alpha linolenic acid), an omega-3 fatty acid. When an irritant was applied to the subjects' skin, the researchers noted a 45% decrease in reddening of the skin in the flax seed oil group.

The ALA found in flax seed oil has been shown to be beneficial for preventing heart disease and arrhythmia. Studies have also found that taking flax seed oil may prevent atherosclerosis (hardening of the arteries) by reducing inflammation and increasing arterial elasticity.

The Anti-Aging Bottom Line: Flax seeds are among the best plant sources of omega-3 fatty acids, and they are easy to incorporate into tasty foods like muffins and other baked goods. Recent research has revealed some unique flax seed health benefits. Among the most notable of recent discoveries is the finding that the ALA flax seeds contain can improve skin health and help prevent cardiovascular disease.

Flaxseed is the most potent plant source of omega-3 fats. Studies indicate that adding flaxseed to your diet can reduce the development of heart disease by 46%—it helps keep red blood cells from clumping together and forming clots that can block arteries. It may also reduce breast cancer odds. In one study, women who ate 10 g of flaxseed (about 1 rounded tablespoon) every day for 2 months had a 25% improvement in the ratio of breast cancer-protective to breast cancer-promoting chemicals in their blood. Sprinkle 1 to 2 tablespoons of flaxseed a day on your cereal, salad, or yogurt. Buy it preground, and keep it refrigerated.

But don’t take flaxseed supplements. Plant estrogens, like human hormones, are not always benign. At high doses—and no one knows how much is too much—lignans might turn into cancer promoters.

Why Omega-3 Fatty Acids Are so Important

Recommended:

• walnuts and walnut oil
• flax seed and oil
• chia seeds

Omega-3 fatty acids are considered essential fatty acids. They are essential to human health but cannot be manufactured by the body. For this reason, omega-3 fatty acids must be obtained from food. Omega-3 fatty acids can be found in fish, such as salmon, tuna, and halibut, other marine life such as algae and krill, certain plants (including purslane), and nut oils.

Omega-3s, as they're known for short, are "good" polyunsaturated fats. They are important for growth and brain function as well as heart health because they help lower triglycerides and total cholesterol.

A diet full of omega-3s also has been linked to improved immunity and a reduced risk of high blood pressure, Alzheimer's disease and rheumatoid arthritis.

There are three types of omega-3 fats. EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are most commonly found in cold-water fish. ALA (alpha-linolenic acid) is the omega-3 fat found in plants.

Good sources of EPA and DHA are cold-water fish such as salmon, tuna and sardines (salmon and sardines are typically low in mercury as well).

ALA is found in canola oil, soy products such as soybean oil and tofu, flaxseeds, walnuts and in some leafy green veggies (for example, kale).

Omega-3 supplements are also an option; they are made from fish oil, flaxseed or marine algae oil.

When considering a supplement, remember these guidelines: Take with food to avoid a fishy aftertaste or digestive problems, avoid mega-doses unless prescribed by a doctor and remember that supplements will not provide you with the other nutrients found in omega-3-rich foods.

Eat a diet rich in all three types of omega-3 fats.

Experiment with healthy salmon recipes and try to get two servings of omega-3-rich fish per week. An example of a serving would be 170 grams of raw or 110-140g of canned or cooked salmon.
To get some ALA, cook with canola oil, top oatmeal with ground flaxseed, add tofu to stir-fries or sprinkle walnuts on yogurt or salads.

Uses:
Clinical studies suggest that omega-3 fatty acids may be helpful in treating a variety of health conditions. The evidence is strongest for heart disease and problems that contribute to heart disease, but the range of possible uses for omega-3 fatty acids include.

High cholesterol 
Those who follow a Mediterranean-style diet tend to have higher high density lipoprotein (HDL or “good” )cholesterol levels. Similar to those who follow a Mediterranean diet, Inuit Eskimos, who consume high amounts of omega-3 fatty acids from fatty fish, also tend to have increasedHDL cholesterol and decreased triglycerides (fatty material that circulates in the blood). In addition, fish oil supplements containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been reported in several large clinical studies to reduce low density lipoprotein (LDL or “bad”) cholesterol and triglyceride levels. Finally, walnuts (which are rich in alpha linolenic acid or ALA) have been reported to lower total cholesterol and triglycerides in individuals with high cholesterol levels.

High blood pressure 
Several clinical studies suggest that diets or supplements rich in omega-3 fatty acids lower blood pressure significantly in individuals with hypertension. An analysis of 17 clinical studies using fish oil supplements found that supplementation with 3 or more grams of fish oil daily can lead to significant reductions in blood pressure in individuals with untreated hypertension.

Heart disease 
One of the best ways to help prevent and treat heart disease is to eat a low-fat diet and to replace foods rich in saturated and trans-fat with those that are rich in monounsaturated and polyunsaturated fats (including omega-3 fatty acids). Clinical evidence suggests that EPA and DHA found in fish oil help reduce risk factors for heart disease including high cholesterol and high blood pressure. There is also strong evidence that these substances can help prevent and treat atherosclerosis by inhibiting the development of plaque and blood clots, each of which tends to clog arteries. Clinical studies of heart attack survivors have found that daily omega-3 fatty acid supplements dramatically reduce the risk of death, subsequent heart attacks, and stroke. Similarly, people who eat an ALA-rich diet are less likely to suffer a fatal heart attack.

Strong evidence from population-based clinical studies suggests that omega-3 fatty acid intake (primarily from fish) helps protect against stroke caused by plaque buildup and blood clots in the arteries that lead to the brain. In fact, eating at least 2 servings of fish per week can reduce the risk of stroke by as much as 50%. However, people who eat more than 3 grams of omega-3 fatty acids per day (equivalent to 3 servings of fish per day) may be at an increased risk for hemorrhagic stroke, a potentially fatal type of stroke in which an artery in the brain leaks or ruptures.

Diabetes

Individuals with diabetes tend to have high triglyceride and low HDL levels. Omega-3 fatty acids from fish oil can help lower triglycerides and apoproteins (markers of diabetes), and raise HDL, so people with diabetes may benefit from eating foods or taking supplements that contain DHA and EPA. ALA (from flaxseed, for example) may not have the same benefit as DHA and EPA because some people with diabetes lack the ability to efficiently convert ALA to a form of omega-3 fatty acids that the body can use readily. There have been slight increases reported in fasting blood sugar levels in patients with type 2 diabetes while taking fish oil supplements.

Weight loss 
Many individuals who are overweight suffer from poor blood sugar control, diabetes, and high cholesterol. Clinical studies suggest that overweight people who follow a weight loss program that includes exercise tend to achieve better control over their blood sugar and cholesterol levels when fish rich in omega-3 fatty acids (such as salmon, mackerel, and herring) is a staple in their low-fat diet.

Arthritis 
Most clinical studies investigating the use of omega-3 fatty acid supplements for inflammatory joint conditions have focused almost entirely on rheumatoid arthritis. Several articles reviewing the research in this area conclude that omega-3 fatty acid supplements reduce tenderness in joints, decrease morning stiffness, and allow for a reduction in the amount of medication needed for people with rheumatoid arthritis.

In addition, laboratory studies suggest that diets rich in omega-3 fatty acids (and low in the inflammatory omega-6 fatty acids) may benefit people with other inflammatory disorders, such as osteoarthritis. In fact, several test tube studies of cartilage-containing cells have found that omega-3 fatty acids decrease inflammation and reduce the activity of enzymes that destroy cartilage. Similarly, New Zealand green lipped mussel (Perna canaliculus), another potential source of omega-3 fatty acids, has been reported to reduce joint stiffness and pain, increase grip strength, and enhance walking pace in a small group of people with osteoarthritis. In some participants, symptoms worsened before they improved.

An analysis was conducted of 17 randomized, controlled clinical trials assessing the pain relieving effects of omega-3 fatty acid supplementation in patients with rheumatoid arthritis or joint pain caused by inflammatory bowel disease (IBS) and painful menstruation (dysmenorrhea). The results suggest that omega-3 fatty acids are effective treatment, along with conventional therapies such as anti-inflammatory drugs, for joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea.

Osteoporosis 
Clinical studies suggest that omega-3 fatty acids such as EPA help increase levels of calcium in the body, deposit calcium in the bones, and improve bone strength. In addition, studies also suggest that people who are deficient in certain essential fatty acids (particularly EPA and gamma-linolenic acid [GLA], an omega-6 fatty acid) are more likely to suffer from bone loss than those with normal levels of these fatty acids. In a study of women over 65 with osteoporosis, those given EPA and GLA supplements experienced significantly less bone loss over 3 years than those who were given a placebo. Many of these women also experienced an increase in bone density.

Depression 
People who do not get enough omega-3 fatty acids or do not maintain a healthy balance of omega-3 to omega-6 fatty acids in their diet may be at an increased risk for depression. The omega-3 fatty acids are important components of nerve cell membranes. They help nerve cells communicate with each other, which is an essential step in maintaining good mental health. In particular, DHA is involved in a variety of nerve Cell processes.
Levels of omega-3 fatty acids were found to be measurably low and the ratio of omega-6 to omega-3 fatty acids were particularly high in a clinical study of patients hospitalized for depression. In a clinical study of individuals with depression, those who ate a healthy diet consisting of fatty fish 2 – 3 times per week for 5 years experienced a significant reduction in feelings of depression and hostility.

Bipolar disorder 
In a clinical study of 30 people with bipolar disorder, those who were treated with EPA and DHA (in combination with their usual mood stabilizing medications) for 4 months experienced fewer mood swings and recurrence of either depression or mania than those who received placebo. Another 4-month long clinical study treating individuals with bipolar depression and rapid cycling bipolar disorder did not find evidence of efficacy for the use of in EPA in these patients.

Schizophrenia 
Preliminary clinical evidence suggests that people with schizophrenia experience an improvement in symptoms when given omega-3 fatty acids. However, a recent well-designed study concluded that EPA supplements are no better than placebo in improving symptoms of this condition. The conflicting results suggest that more research is needed before conclusions can be drawn about the benefit of omega-3 fatty acids for schizophrenia. Similar to diabetes, individuals with schizophrenia may not be able to convert ALA to EPA or DHA efficiently.

Attention deficit/hyperactivity disorder (ADHD) 
Children with attention deficit/hyperactivity disorder (ADHD) may have low levels of certain essential fatty acids (including EPA and DHA) in their bodies. In a clinical study of nearly 100 boys, those with lower levels of omega-3 fatty acids demonstrated more learning and behavioral problems (such as temper tantrums and sleep disturbances) than boys with normal omega-3 fatty acid levels. In animal studies, low levels of omega-3 fatty acids have been shown to lower the concentration of certain brain chemicals (such as dopamine and serotonin) related to attention and motivation. Clinical studies that examine the ability of omega-3 supplements to improve symptoms of ADHD are still needed. At this point in time, eating foods high in omega-3 fatty acids is a reasonable approach for someone with ADHD. A clinical study used omega-3 and omega-6 fatty acid supplementation in 117 children with ADHD. They study found significant improvements in reading, spelling, and behavior in the children over the 3 months of therapy. Another clinical study found that omega-3 fatty acid supplementation helped to decrease physical aggression in school children with ADHD. More studies, including comparisons with drug therapies (such as stimulants), should be performed.

Eating disorders 
Clinical studies suggest that men and women with anorexia nervosa have lower than optimal levels of polyunsaturated fatty acids (including ALA and GLA). To prevent the complications associated with essential fatty acid deficiencies, some experts recommend that treatment programs for anorexia nervosa include PUFA-rich foods such as fish and organ meats (which include omega-6 fatty acids).

Burns 
Essential fatty acids have been used to reduce inflammation and promote wound healing in burn victims. Animal research indicates that omega-3 fatty acids help promote a healthy balance of proteins in the body — protein balance is important for recovery after sustaining a burn. Further research is necessary to determine whether omega-3s benefit people in the same way.

Skin disorders 
In one clinical study, 13 people with a particular sensitivity to the sun known as photo dermatitis showed significantly less sensitivity to UV rays after taking fish oil supplements. Still, research indicates that topical sunscreens are much better at protecting the skin from damaging effects of the sun than omega-3 fatty acids. In another study of 40 people with psoriasis, those who were treated with medications and EPA supplements did better than those treated with the medications alone. In addition, many clinicians believe that flaxseed (which contains omega-3 fatty acids) is helpful for treating acne.

Inflammatory bowel disease (IBD)
When added to medication, such as sulfasalazine (a standard medication for IBD), omega-3 fatty acids may reduce symptoms of Crohn’s disease and ulcerative colitis — the 2 types of IBD. More studies to investigate this preliminary finding are under way. In animals, it appears that ALA works better at decreasing bowel inflammation than EPA and DHA. Plus, fish oil supplements can cause side effects that are similar to symptoms of IBD (such as flatulence, belching, bloating, and diarrhea).

Asthma
Clinical research suggests that omega-3 fatty acid supplements (in the form of perilla seed oil, which is rich in ALA) may decrease inflammation and improve lung function in adults with asthma. Omega-6 fatty acids have the opposite effect: they tend to increase inflammation and worsen respiratory function. In a small, well-designed clinical study of 29 children with asthma, those who took fish oil supplements rich in EPA and DHA for 10 months had improvement in their symptoms compared to children who took a placebo pill.

Macular Degeneration 
A questionnaire administered to more than 3,000 people over the age of 49 found that those who consumed more fish in their diet were less likely to have macular degeneration (a serious age-related eye condition that can progress to blindness) than those who consumed less fish. Similarly, a clinical study comparing 350 people with macular degeneration to 500 without the eye disease found that those with a healthy dietary balance of omega-3 and omega-6 fatty acids and higher intake of fish in their diets were less likely to have this particular eye disorder. Another larger clinical study confirms that EPA and DHA from fish, 4 or more times per week, may reduce the risk of developing macular degeneration. Notably, however, this same study suggests that ALA may actually increase the risk of this eye condition.

Menstrual pain
In a clinical study of nearly 200 Danish women, those with the highest dietary intake of omega-3 fatty acids had the mildest symptoms, such as hot flashes and increased sweating, during menstruation.

Colon cancer 
Consuming significant amounts of foods rich in omega-3 fatty acids appears to reduce the risk of colorectal cancer. For example, Eskimos, who tend to follow a high-fat diet but eat significant amounts of fish rich in omega-3 fatty acids, have a low rate of colorectal cancer. Animal studies and laboratory studies have found that omega-3 fatty acids prevent worsening of colon cancer while omega-6 fatty acids promote the growth of colon tumors. Daily consumption of EPA and DHA also appeared to slow or even reverse the progression of colon cancer in people with early stages of the disease.

Clinical studies have reported that low levels of omega-3 fatty acids in the body are a marker for an increased risk of colon cancer.

However, in an animal study of rats with metastatic colon cancer (in other words, cancer that has spread to other parts of the body such as the liver), omega-3 fatty acids actually promoted the growth of cancer cells in the liver. Until more information is available, it is best for people with advanced stages of colorectal cancer to avoid omega-3 fatty acid supplements and diets rich in this substance.

Breast cancer 
Although not all experts agree, women who regularly consume foods rich in omega-3 fatty acids over many years may be less likely to develop breast cancer. In addition, the risk of dying from breast cancer may be significantly less for those who eat large quantities of omega-3 from fish and brown kelp seaweed (common in Japan). This is particularly true among women who substitute fish for meat. The balance between omega-3 and omega-6 fatty acids appears to play an important role in the development and growth of breast cancer. Further research is still needed to understand the effect that omega-3 fatty acids may have on the prevention or treatment of breast cancer. For example, researchers speculate that omega-3 fatty acids in combination with other nutrients (namely, vitamin C, vitamin E, beta-carotene, selenium, and coenzyme Q10) may prove to be of particular value for preventing and treating breast cancer.

Prostate cancer 
Laboratory and animal studies indicate that omega-3 fatty acids (specifically, DHA and EPA) may inhibit the growth of prostate cancer. Similarly, population based clinical studies of groups of men suggest that a low-fat diet with the addition of omega-3 fatty acids from fish or fish oil help prevent the development of prostate cancer. Like breast cancer, the balance of omega-3 to omega-6 fatty acids appears to be particularly important for reducing the risk of this condition. ALA, however, may not offer the same benefits as EPA and DHA. In fact, one recent clinical study evaluating 67 men with prostate cancer found that they had higher levels of ALA compared to men without prostate cancer. More research in this area is needed.