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Alert Number 141

Omega-3 Fats in Fish Oil Combat Pulmonary Inflammation

  — and Improve Lung Function

Date: December 14, 2005

Airway and lung inflammation is one of the serious problems faced by CLL patients. As we have described in previous articles, pulmonary complications are the major cause of hospitalization in CLL patients. More CLL patients die of pneumonia and related pulmonary problems than any other cause. If you have CLL, chances are you will face pulmonary problems at some point in your life. You are more likely to die of pneumonia and related complications than the CLL itself.

Even when we are not sick enough to go to the hospital or emergency room, sinusitis and COPD (chronic obstructive pulmonary disease) are major quality of life issues for our patients. At the root of this and many of the other problems we face is chronic inflammation. Inflammatory diseases have reached epidemic levels in the general population as well: diseases such as asthma, rheumatoid arthritis, psoriasis, ulcerative colitis, Crohn’s disease, etc., are a lot more common now than they used to be. There is mounting evidence that our modern diet may have something to do with this, specifically the increased consumption of omega-6 fatty acids (such as corn oil) and dramatically reduced consumption of omega-3 fatty acids. Long chain omega-3 fatty acids (n-3 PUFAs) are present in fish oils, and almost no other source of food provides these beneficial fatty acids.

The Medscape article below describes an important paper published in the prestigious journal “Chest”, and this randomized clinical trial confirms what we have been preaching for a long time on our website. Fish oils are essential for good pulmonary health! If you are in the habit of eating cold water fish such as salmon, tuna, etc., several times a week, good for you. If this is not your favorite food, or you are a vegetarian like me, I strongly urge you to consider daily intake of good quality fish oil capsules. (Please be aware that fish oil is not the same as fish liver oil. Liver oils have high levels of fat soluble vitamins A and D, and overdosing on these vitamins can be quite toxic). Fish oils are also excellent in protecting cardiac health; the American Heart Association is on record recommending daily consumption of fish oil. The active ingredients in fish oil are EPA (eicosapentanoic acid) and DHA (dodecahexanoic acid). The present recommendation is about 1 gram of combined EPA+DHA each day for the general population. PC and I take double this amount, with no adverse effects. One of the nice bonus effects of fish oil consumption: smoother and softer skin and hair.

Here are several articles on our website that you can read to refresh your memory.

Omega 3 Fatty Acids;
Role of Pulmonary Inflammation in CLL;
CLL, Chronic Inflammation and What You Can Do About It;
Our Research Proposal to the CLL Global Research Foundation.

Be well,


Medscape CME

Omega-3 Fatty Acids May Improve Lung Function in COPD CME

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

Dec. 13, 2005 — Omega-3 fatty acid supplementation improved lung function in patients with chronic obstructive pulmonary disease (COPD), according to the results of a randomized study reported in the December issue of Chest. Even though the study was small, the investigators suggest that the findings are sufficient to warrant recommending an omega-3 polyunsaturated fatty acid (PUFA)-rich diet as a safe, practical method for treating COPD.

'COPD, the fifth-leading cause of death worldwide, is characterized by chronic inflammation,' write Wataru Matsuyama, MD, PhD, from Kagoshima University Hospital in Japan, and colleagues. 'However, no available agent can effectively cure this inflammation. A dietary supplement containing omega-3 PUFAs has anti-inflammatory effects.'

In this prospective study, 64 patients with COPD were randomized to receive 400 kcal/day of an omega-3 PUFA-rich supplement (n-3 group) or a supplement lacking n-omega-3 PUFA (n-6 group) for 2 years.

The n-3 group significantly improved in 6-minute walk testing, the dyspnea Borg scale, and arterial oxygen saturation measured by pulse oximetry. Although leukotriene B4 (LTB4) levels in serum and sputum and tumor necrosis factor–alpha (TNF-alpha) and interleukin 8 (IL-8) levels in sputum decreased significantly in the n-3 group, there was no significant change in these inflammatory markers in the n-6 group.

Adverse effects included mild diarrhea in 2 patients in the n-3 group and in 3 patients in the n-6 group and nausea in 3 patients in each group. However, these symptoms were easily managed, and they improved with treatment. Multiple regression analysis showed that the omega-3 PUFA-rich diet significantly contributed to the observed change in cytokine levels.

Study limitations include small sample size and limited duration.

'We suggest nutritional support with an omega-3 PUFA-rich diet as a safe and practical method for treating COPD,' the authors write. 'The dosage of omega-3 PUFAs in our study is smaller than the standard dose used to treat cardiovascular diseases.... Further studies on the effects of high doses of omega-3 PUFAs in the treatment of COPD might be interesting.'

The Foundation for Total Health Promotion supported this study.

Chest. 2005;128:3817-3827

Clinical Context

COPD is the fifth-leading cause of death worldwide, and there is no cure for this progressive illness. The hallmark of COPD in terms of its pathology is inflammation of the small airways. Inflammatory mediators in these airways include IL-8, TNF-alpha, and LTB4. Inflammation can persist even after cessation of smoking, and this inflammation produces fibrosis, which replaces normal lung parenchyma.

Diets that are high in fat but not high in carbohydrate have been recommended for the treatment of COPD, as these diets may help maintain weight and reduce airway inflammation. The authors of the current study performed a randomized trial comparing supplementation of a standard diet with omega-3 PUFAs with a control diet among patients with COPD.

Study Highlights

Patients with COPD and a body mass index of less than 25 kg/m2 were eligible for study participation. The forced expiratory volume in 1 second of all subjects was less than 60% of predicted value. Patients who smoked in the 6 months prior to the study, along with those who had an exacerbation of COPD or had received antibiotics or nonsteroidal anti-inflammatory drugs in 4 weeks prior to the study, were excluded from study participation. Excluding the diagnosis of COPD, study participants were generally healthy.

Patients' regular dietary intake was monitored prior to randomization. They were then assigned to a control diet, containing 0.07 g in total calories of omega-3 PUFAs and 0.93 g in total calories of omega-6 PUFAs, or a diet rich in omega-3 PUFAs, containing 0.6 g in total calories of omega-3 PUFAs and 0.4 g in total calories of omega-6 PUFAs. Participants in the control and omega-3 PUFA diet groups were followed up for 24 months for blood gas analysis, pulmonary function testing, a 6-minute walk test, symptom evaluations of COPD, and the concentration of inflammatory mediators in the serum and sputum.

64 subjects participated in the study. The mean age was 66 years old. Baseline demographic, disease, and diet data were similar between the 2 groups. During the 24-month follow-up, participants in both treatment groups gained a mean of approximately 5 kg. The mean serum levels of albumin and protein increased in both diet groups as well. The 2 diet groups were similar with regard to blood gas analysis and pulmonary function testing for the study period.

Symptom scores for COPD improved to a greater degree in the omega-3 PUFA group vs the control group, although this result just missed statistical significance. Performance in the 6-minute walk was significantly improved from baseline in the omega-3 PUFA group at 24 months, particularly in terms of perceived dyspnea and arterial oxygen saturation. No such improvement was seen in the control group. The sputum neutrophil count decreased to a greater degree in the omega-3 PUFA group than the control group. The omega-3 PUFA group also a showed trend toward less use of bronchodilators and supplemental oxygen when compared with the control group.

Serum levels of LTB4 decreased in the omega-3 PUFA diet group compared with the control group, but serum levels of IL-8 and TNF-alpha were similar between groups. Sputum levels of all of these proteins were reduced in the course of the trial in the omega-3 PUFA group compared with the control group. There was evidence of improvement of sputum cytokines by 6 months in the omega-3 PUFA group. The main study results remained valid after multiple regression analysis.

Both diets were fairly well-tolerated.

Pearls for Practice

COPD is characterized by chronic inflammation of the small airways, which is mediated in part by IL-8, TNF-alpha, and LTB4. Inflammation can persist even after cessation of smoking, and this inflammation produces fibrosis, which replaces normal lung parenchyma.

The current study demonstrates that a diet supplemented with omega-3 PUFAs can improve 6-minute walk performance, sputum markers of inflammation, and, possibly, symptoms of COPD and use of COPD treatment when compared with a control diet.

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