Utilizing Nutraceuticals in the Clinic: Omega 3 Fatty Acids

By Sara M. Wilchowski, MS, PA-C

INTRODUCTION
The global market for the use of nutraceuticals, or supplements, is expected to rise 7.5 percent in the next five years as patients seek out selfcare treatments as a result of the COVID-19 pandemic.1 Such products can aid in a variety of health benefits, including protection against disease and promotion of overall health.1 It is important as astute clinicians to be equipped with the changes in the healthcare landscape to provide adequate advice on supplements. Here, we will examine the use of omega 3 fatty acids in the dermatology clinic.

OMEGA 3 FATTY ACIDS AND INFLAMMATION
There are three main types of omega 3 fatty acids; alpha-linolenic acid, which is found in plants, and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are found in mostly fish. There have been a number of clinical studies examining the effects of these fatty acids on systemic inflammation.2 While these acids can aid in dampening various inflammatory cytokines, they also give rise to pro-resolving lipid mediators. Both EPA and DHA promote pro-resolving related compounds via the cyclooxygenase and lipoxygenase enzymatic pathways.3 These enzymes act by inhibiting transendothelial migration of neutrophils, thus preventing neutrophilic infiltration at sites of inflammation, which can inhibit TNF-alpha and IL-1 beta production and limit the inflammatory process reducing tissue damage.3,4 Systemic inflammation can manifest as a number of different phenotypic expressions ranging from acne to psoriasis.

RELATION TO SKIN DISEASE
Utilizing omega 3 supplementation extends beyond its use for cardiovascular disease. There are several chronic inflammatory diseases that we encounter daily in dermatology, some of which are more common, such as acne and psoriasis. In non-Westernized societies with higher ratios of omega 3 intake from diet alone, acne vulgaris is relatively rare.4 This relationship allows a further understanding that diet plays a role in inflammatory disease as well as balancing the immune system. Several studies have also shown benefit for psoriasis; however, higher doses of EPA and DHA ranging from 4 to 14 grams daily are needed in these patients.5 Additionally, EPA and DHA supplementation had positive impacts on joint pain and severity of lesions in hidradenitis suppurativa.5,6 Limited studies are available for the use of atopic dermatitis, however, supplementation has been reported to decrease severity of symptoms in adults.6 It is important to note that intake of 2 grams or more of EPA and DHA has been determined to downregulate the inflammatory process.3

CONCLUSION
Overall, inflammation is a primary driver in many disease states which can lead to tissue damage and diet and nutrition need to be utilized in the clinic. The role of supplementation with omega 3 fatty acids may be important in decreasing disease severity by dampening inflammatory cytokines. Utilizing alternative methods to decrease inflammation can not only lead to improvement in disease states but also promote overall wellness.

References

1. Global Nutraceuticals Market Size, Share, Trends, Growth (2022-27). Accessed March 10, 2022. https://www.mordorintelligence.com/industry-reports/global-nutraceuticals-market-industry
2. Ramirez JL, Gasper WJ, Khetani SA, et al. Fish oil increases specialized pro-resolvin lipid mediators in PAD (The OMEGA-PAD II Trial). J Surg Res. 2019;238:164-174. doi:10.1016/j.jss.2019.01.038
3. Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010;2(3):355-374. doi:10.3390/nu2030355
4. Khayef G, Young J, Burns-Whitmore B, Spalding T. Effects of fish oil supplementation on inflammatory acne. Lipids Health Dis. 2012;11:165. doi:10.1186/1476-511X-11-165
5. Kiefer D, Pantuso T. Omega-3 fatty acids: An update emphasizing clinical use. Agro Food Ind Hi-Tech. 2012;23(4):10-13.
6. Balić A, Vlašić D, Žužul K, Marinović B, Bukvić Mokos Z. Omega-3 Versus Omega-6 polyunsaturated fatty acids in the prevention and treatment of Inflammatory skin diseases. Int J Mol Sci. 2020;21(3):741. doi:10.3390/ijms21030741

Sara M. Wilchowski, MS, PA-C, is a PA specializing in dermatology in Michigan. She holds two certifications from the Society of Dermatology Physician Assistants as a Diplomate and Diplomate Fellow. Sara has completed all coursework from the Institute for Functional Medicine and is a candidate for certification. She has held numerous appointed and elected roles with the SDPA, spanning over a decade. She is past president of the Michigan Dermatology PAs and 2016 Michigan Dermatology PA of the year.

Disclosures: The author has disclosed no potential conflicts of interest, financial or otherwise, relating to the content of this article.