Fish oil update

[Guest guest]

Dear All;

This paper indicates that the combination of mesalazine (I believe

that this is the same as Asacol) and omega-3 fatty acids (fish oils)

shows promise in maintaining remission in pediatric Crohn's disease:

______________________

World J Gastroenterol. 2005 Dec 7;11(45):7118-21.

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.

Romano C, Cucchiara S, Barabino A, Annese V, Sferlazzas C.

Pediatric Department, University of Messina, Italy. romanoc@...

AIM: To assess the value of long-chain omega-3 fatty acids (FAs)

supplementation in addition to amino-salicylic-acid (5-ASA) in

pediatric patients with Crohn's disease (CD). METHODS: Thirty-eight

patients (20 males and 18 females, mean age 10.13 years, range 5-16

years) with CD in remission were randomized into two groups and

treated for 12 mo. Group I (18 patients) received 5-ASA (50 mg/kg/d)

+ omega-3 FAs as triglycerides in gastro-resistant capsules, 3 g/d

(eicosapentanoic acid, EPA, 400 mg/g, docosahexaenoic acid, DHA, 200

mg/g). Group II (20 patients) received 5-ASA (50 mg/kg/d)+olive oil

placebo capsules. Patients were evaluated for fatty acid

incorporation in red blood cell membranes by gas chromatography at

baseline 6 and 12 mo after the treatment. RESULTS: The number of

patients who relapsed at 1 year was significantly lower in group I

than in group II (P<0.001). Patients in group I had a significant

increase in the incorporation of EPA and DHA (P<0.001) and a

decrease in the presence of arachidonic acids. CONCLUSION: Enteric-

coated omega-3 FAs in addition to treatment with 5-ASA are effective

in maintaining remission of pediatric CD.

PMID: 16437657

______________________

The full text of this article is available at:

http://www.wjgnet.com/1007-9327/11/7118.pdf

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)

[Guest guest]

Thank you . I wonder if fish oils would also help UC. One more

thing to ask at the next check-up! I'm going to forward this to the

Mom's group.

Dana

(Mom of Josh, UC 3/04, PSC 4/04)

>

> Dear All;

>

> This paper indicates that the combination of mesalazine (I believe

> that this is the same as Asacol) and omega-3 fatty acids (fish oils)

> shows promise in maintaining remission in pediatric Crohn's disease:

[Guest guest]

and others,

In your opinion(s), how generalizable are

these findings to Ulcerative Colitis? Or any research for that matter? I do not

understand the differences enough (between Crohn’s and UC) to even begin

to have confidence that the findings are or are not generalizable. It seems to

me that research usually begins with Crohn’s and if found successful the

next phase is to test the treatment (or theory) with UC. I wonder if there are

treatments that have not been studied with people with UC because it was found

to be ineffective with people with Crohn’s. And then there is always the indeterminate

IBD group, which Suzanne still may be a part of. In terms of Suzanne’s

treatment, I am not sure it matters whether she officially has Crohn’s or

UC; her treatments are based on her symptoms not her dx.

Another observation … is seems that

there is some type of relationship with IBD and rheumatoid arthritis because

some of the same medications are used (Remicade, Cyclosporine, Methotrexate

etc.) Or is the relationship that both diseases are inflammatory and autoimmune

which is why there is overlap?

Just my wandering mind . . .

LINDA

(Mom of Suzanne,

16; IBD 1/04; PSC 3/04)

From: [mailto: ] On Behalf Of

Sent: Tuesday, February 28, 2006

10:44 AM

To:

Subject: Fish oil

update

Dear All;

This paper indicates that the combination of

mesalazine (I believe

that this is the same as Asacol) and omega-3 fatty

acids (fish oils)

shows promise in maintaining remission in

pediatric Crohn's disease:

______________________

World J Gastroenterol. 2005 Dec 7;11(45):7118-21.

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.

Romano C, Cucchiara S, Barabino A, Annese V,

Sferlazzas C.

Pediatric Department, University of Messina, Italy.

romanoc@...

AIM: To assess the value of long-chain omega-3

fatty acids (FAs)

supplementation in addition to

amino-salicylic-acid (5-ASA) in

pediatric patients with Crohn's disease (CD).

METHODS: Thirty-eight

patients (20 males and 18 females, mean age 10.13

years, range 5-16

years) with CD in remission were randomized into

two groups and

treated for 12 mo. Group I (18 patients) received

5-ASA (50 mg/kg/d)

+ omega-3 FAs as triglycerides in gastro-resistant

capsules, 3 g/d

(eicosapentanoic acid, EPA, 400 mg/g, docosahexaenoic

acid, DHA, 200

mg/g). Group II (20 patients) received 5-ASA (50

mg/kg/d)+olive oil

placebo capsules. Patients were evaluated for

fatty acid

incorporation in red blood cell membranes by gas

chromatography at

baseline 6 and 12 mo after the treatment. RESULTS:

The number of

patients who relapsed at 1 year was significantly

lower in group I

than in group II (P<0.001). Patients in group I

had a significant

increase in the incorporation of EPA and DHA

(P<0.001) and a

decrease in the presence of arachidonic acids.

CONCLUSION: Enteric-

coated omega-3 FAs in addition to treatment with

5-ASA are effective

in maintaining remission of pediatric CD.

PMID: 16437657

______________________

The full text of this article is available at:

http://www.wjgnet.com/1007-9327/11/7118.pdf

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)

[Guest guest]

Dear ;

There are reports that dietary fish oils are modestly beneficial in

ulcerative colitis, and other inflammatory diseases, including

arthritis. I can point you to references if you are interested. In

general the omega-3 fatty acids in fish oils seem to suppress the

production of pro-inflammatory molecules, and increase the production

of anti-inflammatory molecules. One of the most important pro-

inflammatory molecules in both IBD and arthritis is Tumor Necrosis

Factor alpha (TNFalpha) [this is the target of inhibition by

Remicade, which is a TNF-antibody]. As shown in the following paper,

higher plasma omega-3 fatty acids seem to be associated with lower

TNFa levels:

______________________

J Clin Endocrinol Metab. 2006 Feb;91(2):439-46.

Relationship of plasma polyunsaturated fatty acids to circulating

inflammatory markers.

Ferrucci L, Cherubini A, Bandinelli S, Bartali B, Corsi A, Lauretani

F, A, Andres-Lacueva C, Senin U, Guralnik JM.

Longitudinal Studies Section, Clinical Research Branch, National

Institute on Aging, National Institutes of Health, Harbor Hospital,

5th Floor, 3001 Hanover Street, Baltimore, MD 21225, USA.

ferruccilu@...

AIMS: Persons with high intake of polyunsaturated fatty acids (PUFAs)

have lower cardiovascular morbidity and mortality. The protective

effect of PUFAs is mediated by multiple mechanisms, including their

antiinflammatory properties. The association of physiological PUFA

levels with pro- and antiinflammatory markers has not been

established. METHODS AND RESULTS: In 1123 persons (aged 20-98 yr), we

examined the relationship between relative concentration of fatty

acids in fasting plasma and level of inflammatory markers. Adjusting

for age, sex, and major confounders, lower arachidonic and

docosahexaenoic acids were associated with significantly higher IL-6

and IL-1ra and significantly lower TGFbeta. Lower alpha-linolenic

acid was associated with higher C-reactive protein and IL-1ra, and

lower eicosapentaenoic acid was associated with higher IL-6 and lower

TGFbeta. Lower docosahexaenoic acid was strongly associated with

lower IL-10. Total n-3 fatty acids were associated with lower IL-6 (P

= 0.005), IL-1ra (P = 0.004), and TNFalpha (P = 0.040) and higher

soluble IL-6r (P < 0.001), IL-10 (P = 0.024), and TGFbeta (P =

0.0012). Lower n-6 fatty acid levels were significantly associated

with higher IL-1ra (P = 0.026) and lower TGFbeta (P = 0.014). The n-6

to n-3 ratio was a strong, negative correlate of IL-10. Findings were

similar in participants free of cardiovascular diseases and after

excluding lipids from covariates. CONCLUSIONS: In this community-

based sample, PUFAs, and especially total n-3 fatty acids, were

independently associated with lower levels of proinflammatory markers

(IL-6, IL-1ra, TNFalpha, C-reactive protein) and higher levels of

antiinflammatory markers (soluble IL-6r, IL-10, TGFbeta) independent

of confounders. Our findings support the notion that n-3 fatty acids

may be beneficial in patients affected by diseases characterized by

active inflammation. PMID: 16234304

_____________________

What intrigued me the most about the Crohn's paper that I posted

earlier today, was that they tested fish-oils with mesalazine, a 5-

aminosalicylic acid, and the combination seemed to be superior.

There are reports that the most potent anti-inflammatory molecules

(Resolvins) derived from omega-3 fatty acids, come from the

combination of omega-3 fatty acids with aspirin (also known as

acetylsalicylic acid):

______________________

Prostaglandins Other Lipid Mediat. 2004 Apr;73(3-4):155-72.

Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived

mediators, and their aspirin-triggered endogenous epimers: an

overview of their protective roles in catabasis.

Serhan CN, Gotlinger K, Hong S, Arita M.

Department of Anesthesiology, Perioperative and Pain Medicine, Center

for Experimental Therapeutics and Reperfusion Injury, Brigham and

Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.

cnserhan@...

The molecular basis for the beneficial impact of essential omega-3

fatty acids is of considerable interest. Recently, novel mediators

generated from eicosapentaenoic acid (EPA) and docosahexaenoic acid

(DHA) that displayed potent bioactions were first identified in

resolving inflammatory exudates [J. Exp. Med. 192 (2000) 1197; J.

Exp. Med. 196 (2002) 1025] and in tissues enriched with DHA [J. Exp.

Med. 196 (2002) 1025; J. Biol. Chem. 278 (2003) 14677]. The trivial

names Resolvin (resolution phase interaction products) and

docosatrienes were introduced for the bioactive compounds belonging

to these novel series because they demonstrate potent anti-

inflammatory and immunoregulatory actions. The compounds derived from

eicosapentaenoic acid carrying potent biological actions (i.e., 1-10

nM range) are designated E series, given their EPA precursor, and

denoted as Resolvins of the E series (Resolvin E1 or RvE1), and those

biosynthesized from the precursor docosahexaenoic acid are Resolvins

of the D series (Resolvin D1 or RvD1). Bioactive members from DHA

with conjugated triene structures are docosatrienes (DT) that are

immunoregulatory [J. Exp. Med. 196 (2002) 1025; J. Biol. Chem. 278

(2003) 14677], and neuroprotective [J. Biol. Chem., 278 (2003) 43807;

Proc. Natl. Acad. Sci. U.S.A. [submitted for publication]] and are

termed neuroprotectins. The specific receptors for these novel

bioactive products from omega-3 EPA and DHA are abbreviated Resolvin

D receptors (i.e., ResoDR1), Resolvin E receptor (ResoER1; RER1), and

neuroprotectin D receptors (NPDR), respectively, in recognition of

their respective cognate ligands. Aspirin treatment impacts

biosynthesis of these compounds and a related series by triggering

endogenous formation of the 17R-D series Resolvins and docosatrienes.

These novel epimers are denoted as aspirin-triggered (AT)-RvDs and -

DTs, and possess potent anti-inflammatory actions in vivo essentially

equivalent to their 17S series pathway products. Here, we provide a

syntomy overview of the formation and actions of these newly

uncovered pathways and products as well as highlight their role(s) as

endogenous protective mediators generated in anti-inflammation and

catabasis. PMID: 15290791

______________________

I've been trying to find out if 5-aminosalyclic acid also promotes

the production of these anti-inflammatory mediators from omega-3's,

but without success yet. I might have to write to the Serhan group to

see if they have tested whether 5-aminosalicylic acid is effective as

aspirin in promoting the production of these " resolvins " ?

The combination of aspirin and omega-3 fatty acids provides

protection against experimental colitis in mice:

____________________

Proc Natl Acad Sci U S A. 2005 May 24;102(21):7671-6.

Resolvin E1, an endogenous lipid mediator derived from omega-3

eicosapentaenoic acid, protects against 2,4,6-trinitrobenzene

sulfonic acid-induced colitis.

Arita M, Yoshida M, Hong S, Tjonahen E, Glickman JN, Petasis NA,

Blumberg RS, Serhan CN.

Center for Experimental Therapeutics and Reperfusion Injury, Brigham

and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

Resolvin E1 (RvE1; 5S,12R,18R-trihydroxyeicosapentaenoic acid) is an

antiinflammatory lipid mediator derived from omega-3 fatty acid

eicosapentaenoic acid (EPA). At the local site of inflammation,

aspirin treatment enhances EPA conversion to 18R-oxygenated products,

including RvE1, which carry potent antiinflammatory signals. Here, we

obtained evidence for reduced leukocyte infiltration in a mouse

peritonitis model, where the administration of EPA and aspirin

initiated the generation of RvE1 in the exudates. Similar results

were obtained with the administration of synthetic RvE1, which

blocked leukocyte infiltration. RvE1 also protected against the

development of 2,4,6-trinitrobenzene sulfonic acid-induced colitis.

The beneficial effect was reflected by increased survival rates,

sustained body weight, improvement of histologic scores, reduced

serum anti-2,4,6-trinitrobenzene sulfonic acid IgG, decreased

leukocyte infiltration, and proinflammatory gene expression,

including IL-12 p40, TNF-alpha, and inducible nitric oxide synthase.

Thus, the endogenous lipid mediator RvE1 counter-regulates leukocyte-

mediated tissue injury and proinflammatory gene expression. These

findings show an endogenous mechanism that may underlie the

beneficial actions of omega-3 EPA and provide targeted approaches for

the treatment of intestinal inflammation.

PMID: 15890784

_______________________

It would seem logical to check if mesalazine and fish oils is

superior to mesalazine alone in ulcerative colitis.

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)

[Guest guest]

Dear

I wonder if you could answer a couple of questions, and apologies

if you already have or they were the text of the research articles.

1. Can u confirm that the omega 3 is also helpful for adults with

UC / PSC. I am already on asacol.

2. What is the required dose? I understand also that the quality

varies in brands.

3. I have read elsewhere that it is not much use taking Omega 3

without Omega 6 as well. I am not sure what Omega 6 is in, or if

this means a further tablet / capsule?

Your thoughts would be much appreciated.

Thanks

Tim (UK) PSc etc c.01

[Guest guest]

Dear Tim;

This article gives a good summary of fish oils:

Go to:

http://www.gettingwell.com/drug_info/index.html

Then click on " Nutritional Supplements A-Z " and then scroll down to

Fish Oils under " F " .

Under " Indications " it states:

" Fish oils may primarily be indicated to lower triglyceride levels

in those with hypertriglyceridemia. Another important indication may

be to prevent death in those who have suffered myocardial

infarctions. Fish oils are used to decrease clotting tendencies of

the blood. They may also be indicated for lowering blood pressure,

for preventing restenosis following coronary angioplasty, for

alleviating some of the symptoms of rheumatoid arthritis and

ulcerative colitis and for helping to prevent relapse in Crohn's

disease. They may help stabilize mood in bipolar disorder and may

have beneficial effects in IgA nephropathy. There is evidence they

may help prevent rejection in renal transplant patients, and they

are used in enteral feeding of various patient categories. "

and goes on to say:

" A one year double-blind trial of subjects with Crohn's disease

randomized these subjects into two groups. One group received a

mixture of 2.7 grams of EPA and DHA daily. The fish oil was in the

form of enterically coated free fatty acids and provided 1.8 grams

of EPA and 0.9 grams of DHA daily. It was noted that the subjects

taking the fish oil supplement had a significantly reduced relapse

rate. No significant adverse effects were reported.

Supplementation of fish oils in subjects with ulcerative colitis has

shown some encouraging trends. In one study, six patients with

active ulcerative colitis were given 3 to 4 grams of a mixture of

EPA and DHA daily in the form of natural triacylglycerols for a

period of 12 weeks. Significant results were reported regarding the

subjects' symptoms and histological appearance of the rectal mucosa

by the end of the 12 weeks. "

Important precautions are:

" PRECAUTIONS

Fish oil supplements should be used by children, pregnant women and

nursing mothers only if recommended and monitored by a physician.

Because of the possible anti-thrombotic effect of fish oil

supplements, hemophiliacs and those taking warfarin (Coumadin)

should exercise caution in their use. Fish oil supplements should be

stopped before any surgical procedure. Conflicting results have been

reported regarding the effects of fish oil supplements on glycemic

control in those with glucose intolerance including type 2

diabetics. Some early studies indicated that fish oil supplements

might have detrimental effects in those groups. Recently, better

designed studies have not reported these adverse effects. There is

no evidence that fish oil supplements have detrimental effects on

glucose tolerance, insulin secretion or insulin resistance in non-

diabetic subjects. Diabetics should discuss the use of these

supplements with their physicians and note if the supplements affect

their glycemic control. Diabetics who take fish oil supplements

should be monitored by their physicians.

ADVERSE REACTIONS

There have been no reports of serious adverse events in those taking

fish oil supplements, even up to 15 grams daily for prolonged

periods of time. Those side effects that have been reported include

mild gastrointestinal upsets such as nausea and diarrhea, halitosis,

eructation and " fishy " smelling breath, skin and even urine. The

blood-thinning effects can cause occasional nosebleeds and easy

bruising. "

The doses used in these studies vary hugely; they " ranged from 0.5

grams to 25 grams daily " . My son is taking 2 x 1000 mg capsules of

Super Omega-3 daily; each capsule contains 300 mg EPA and 200 mg DHA.

http://www.carlsonlabs.com/product_detail.phtml?prodid=10012879

We chose this brand because of its high purity.

ly, we don't know whether this is the optimum dose!

As I understand it, the Western diet is already rich in omega-6

fatty acids, and the goal of omega-3 supplementation is to try to

bring down the ratio of omega-6/omega-3:

_______________________________

Biomed Pharmacother. 2002 Oct;56(8):365-79.

The importance of the ratio of omega-6/omega-3 essential fatty acids.

Simopoulos AP.

The Center for Genetics, Nutrition and Health, Washington, DC 20009,

USA. cgnh@...

Several sources of information suggest that human beings evolved on

a diet with a ratio of omega-6 to omega-3 essential fatty acids

(EFA) of approximately 1 whereas in Western diets the ratio is 15/1-

16.7/1. Western diets are deficient in omega-3 fatty acids, and have

excessive amounts of omega-6 fatty acids compared with the diet on

which human beings evolved and their genetic patterns were

established. Excessive amounts of omega-6 polyunsaturated fatty

acids (PUFA) and a very high omega-6/omega-3 ratio, as is found in

today's Western diets, promote the pathogenesis of many diseases,

including cardiovascular disease, cancer, and inflammatory and

autoimmune diseases, whereas increased levels of omega-3 PUFA (a low

omega-6/omega-3 ratio) exert suppressive effects. In the secondary

prevention of cardiovascular disease, a ratio of 4/1 was associated

with a 70% decrease in total mortality. A ratio of 2.5/1 reduced

rectal cell proliferation in patients with colorectal cancer,

whereas a ratio of 4/1 with the same amount of omega-3 PUFA had no

effect. The lower omega-6/omega-3 ratio in women with breast cancer

was associated with decreased risk. A ratio of 2-3/1 suppressed

inflammation in patients with rheumatoid arthritis, and a ratio of

5/1 had a beneficial effect on patients with asthma, whereas a ratio

of 10/1 had adverse consequences. These studies indicate that the

optimal ratio may vary with the disease under consideration. This is

consistent with the fact that chronic diseases are multigenic and

multifactorial. Therefore, it is quite possible that the therapeutic

dose of omega-3 fatty acids will depend on the degree of severity of

disease resulting from the genetic predisposition. A lower ratio of

omega-6/omega-3 fatty acids is more desirable in reducing the risk

of many of the chronic diseases of high prevalence in Western

societies, as well as in the developing countries, that are being

exported to the rest of the world. PMID: 12442909

_______________________________

So I don't think it would be necessary to take " extra " omega-6 fatty

acids.

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)

>

> Dear

>

> I wonder if you could answer a couple of questions, and apologies

> if you already have or they were the text of the research articles.

>

> 1. Can u confirm that the omega 3 is also helpful for adults with

> UC / PSC. I am already on asacol.

>

> 2. What is the required dose? I understand also that the quality

> varies in brands.

>

> 3. I have read elsewhere that it is not much use taking Omega 3

> without Omega 6 as well. I am not sure what Omega 6 is in, or if

> this means a further tablet / capsule?

>

>

> Your thoughts would be much appreciated.

>

> Thanks

>

> Tim (UK) PSc etc c.01

>