Omega-3 Fatty Acids and Multiple Sclerosis

Omega-3 fatty acids are on many people’s radar, as pretty much everyone has heard that we need to eat more fatty fish (such as salmon), primary for cardiovascular health. However, then comes a parade of warnings about mercury contamination, as well as high levels of pesticides and antibiotics found in farm-raised fish.

Combine this danger with information about fish being put on the endangered lists, as well as practical facts that it is fairly expensive and not everyone knows how to turn a slab of raw salmon into something tasty. All of these obstacles start really standing in the way of many people getting adequate dietary omega-3 fatty acids.

Of course, some people rely on supplements, but these can also be confusing to many people.

For those of us with multiple sclerosis (MS), our ears perk up when we hear about omega-3 fatty acids contributing to “brain health.” There are even some books and experts that claim that omega-3s can reverse our MS disease progression and lessen our MS symptoms. So, what is the deal?

Why Should People with MS Care About Omega-3 Fatty Acids?

In some studies, low levels of omega-3 fatty acids were found in people with MS. While this does not automatically mean that these low levels have anything to do with our MS symptoms or disease, some small studies have suggested that maybe omega-3 fatty acids can help us.

What Are Omega-3 Fatty Acids For and How Do They Work?

Omega-3 fatty acids contain two compounds eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Among other things, these may work to decrease certain immune reactions, reducing inflammatory responses. In very simple terms, they work to regulate the pro-inflammatory effects of omega-6 fatty acids, which many people (especially in the United States, Canada and Europe) get too much of in their diets.

How Effective Is It?

In the Nurses’ Health Study, there was no association between the intake of omega-3 fatty acids from fish and developing MS.

However, a couple of studies have shown positive effects. In very small studies of 10 and 16 participants, people with MS that were treated with omega-3 supplementation had a reduced relapse rate and improved expanded disability status scale (EDSS) scores. In a larger placebo-controlled study, therapeutic effects (fewer relapses and less disability progression) were seen in the treatment group, although these were not statistically significant.

Usual Dosage/How Taken

Total daily dosages of up to 3 grams are recommended.

Dietary sources of omega-3 fatty acid include:

• Flaxseeds and flaxseed oil
• Nuts, such as walnuts
• Avocados
• Fatty fish, such as salmon, tuna, mackerel, sardines, anchovies
• Some dark, leafy greens (such as kale, spinach, purslane, collard greens, mustard greens)

While fish are the best source of omega-3s, it is important not to eat too much of certain fish, due to mercury concentrations. Check out the Consumer Guide to Mercury in Fish by the National Resources Defense Council, which tells you levels of mercury in different types of fish and how much of each type you can safely consume each month.

Side Effects

At dosages over 3 grams of EPA and DHA a day, the following side effects were noted:

• Increased risk of bleeding complications
• Gastrointestinal symptoms
• Increased LDL cholesterol levels
• Elevated blood sugar in patents with diabetes (although in normal dosages, blood sugar levels are lowered slightly in healthy people)

Potential Interactions and Warnings

In one seven-year study, no serious adverse effects were observed in people taking a total of less than 3 grams of EPA and DHA.

Omega-6 fatty acid supplements may interact with the following medications:

• Blood-thinning medications, such as warfarin (Coumadin), copidogrel (Plavix) or aspirin, as omega-3 intake could increase the risk of bleeding
• Medications for diabetes and high blood pressure may need to be adjusted (doses lowered), as omega-3 fatty acids naturally lower blood pressure and blood sugar
• In addition, serum cholesterol levels should be monitored. Omega-3 can work to lower triglyceride levels, but actually may worsen levels of LDL cholesterol. People on drugs to lower triglycerides (such as niacin, Lopin or Questran) may need to lower these dosages, and people on statins (such as Lipitor or Mevacor) may need to increase these dosages.

Of course, all adjustment to medication should be done under the supervision of your doctor.

Costs

Fresh fish can be expensive, with wild Alaskan salmon costing as much as $20 a pound (or more). Supplements of fish oil range in price from $10 for a one-month supply to as much as $50 for some brands.

My Bottom Line

Like many people with MS, I tend to focus my health efforts (and thoughts about health) almost entirely on my MS. However, I am also aging, along with everyone else, and I certainly have lifestyle factors around diet and exercise that could use improvement. This is a long way of saying that I probably will start taking an omega-3 supplement. I am not expecting miracles in terms of impact on my MS disease progression or symptoms, but I think that it certainly couldn’t hurt anything.

_Sources:

Schwarz S, Leweling H. Multiple sclerosis and nutrition. Mult Scler. 2005 Feb;11(1):24-32.

Bowling, Allen C. Complementary and Alternative Medicine and Multiple Sclerosis. 2nd ed. Demos Publishing: New York. 2007.

Omega-3 fatty acids, fish oil, alpha-linolenic acid. MedlinePlus.

Bates D, Cartlidge NE, French JM, Jackson MJ, Nightingale S, Shaw DA, Smith S, Woo E, Hawkins SA, Millar JH, et al. A double-blind controlled trial of long chain n-3 polyunsaturated fatty acids in the treatment of multiple sclerosis. J Neurol Neurosurg Psychiatry. 1989 Jan;52(1):18-22.