At some point you've probably reached for NSAIDs (Advil, Motrin, Aleve, aspirin) in the hopes of eliminating - or at least dulling - that constant, nagging pain. And maybe it worked. And maybe you're still using them. But what if there was something you could add to your diet that targeted the same pain-causing inflammatory pathway and functioned in a similar manner?
The use of omega-3 fats (namely, EPA and DHA) in the treatment of pain can be dated back to as early as the late 18th century - in the form of cod liver oil for the treatment of muscular, skeletal, and vertebral disc-related diseases - but it's only recently that we elucidated the mechanism by which they work (and they actually do work).
The Pathway Behind the Pain
In most cases, regardless of cause, the origin of pain is inflammatory. It's the ability of NSAIDs to interfere with the inflammatory pathway that is the major mechanism associated with their success in treating pain.
A major player in this pathway is arachidonic acid, an omega-6 polyunsaturated fat. When a cell is damaged, it releases arachidonic acid from its membrane. This omega-6 fat is readily transformed into mediators of inflammation known as prostaglandins, thromboxanes, and leukotrienes through the action of two enzymes, known as COX and LOX (not to be confused with the brined salmon that goes deliciously with a bagel and cream cheese).
In the event of trauma or chronic damage, inflammatory mediators do exactly what you'd expect - induce fever, pain, and increase the inflammatory response. NSAIDs act by blocking the action of the COX enzyme (a COX blocker, if you will...SORRY, I had to) in order to reduce the production of those inflammatory mediators, thereby reducing the pain that you experience.
NOW, this all sounds well and good, except for the fact that you can't just disable an enzyme and expect a singular response. No, no, no - that enzyme affects many more things than just pain... such as protecting the gastrointestinal mucosa, for one. (This is why you've probably heard that nonselective NSAIDs cause GI upset, hemorrhage, gastritis, ulceration, and even death.....no thanks). In fact, NSAIDs have a lot more issues than just that particular example, but we'll save that for another article, since I should stay on track and focus on omega-3's today...
Omega-3 Fats and Competitive Inhibition
So, how do omega-3's fit in, you ask?
First, let me clarify that not all prostaglandins, thromboxanes, and leukotrienes are pro-inflammatory. There are different classes of these molecules, some pro-inflammatory and some anti-inflammatory. The differentiator is the substrate from which these molecules are derived.
Remember arachidonic acid and how it exists in the cell membrane? OF COURSE YOU DO, that was just 3 paragraphs ago. Well, dietary intake can ALTER the fatty acid composition of these cell membranes. YES - what you eat does in fact change things inside you (contrary to what we'd all like to believe Friday night when we don't immediately say no to the drink or dessert menu).
Turns out that if you eat more omega-3 fats, there will be more in your cell membrane. More omega-3 fatty acids in your cell membrane means less omega-6 arachidonic acid. Here's the real kicker: the molecules that are derived from omega-3 fatty acids through COX and LOX activity are less potent inducers of inflammation, and in fact will competitively inhibit the effects of the arachidonic acid conversion to pro-inflammatory molecules.
The anti-inflammatory mediators derived from omega-3s also inhibit the synthesis of other highly inflammatory substances (TNF-alpha, IL-1b, and pro-inflammatory leukotrienes).
So what does this all mean?
If you incorporate more omega-3 fats in your diet, you will likely decrease the inflammatory response on a cellular level, resulting in less pain....and less risk for chronic disease! (Side note: omega-3 fats have a whole host of benefits when it comes to preventing and treating chronic disease, but for the purpose of this article these weren't addressed. Be sure to stay tuned for more!!).
In fact, before we even understood this mechanism, plenty of studies already showed the potential for omega-3 fats to reduce chronic pain and symptoms associated with inflammatory auto-immune diseases, like rheumatoid arthritis and SLE.
The question is, are you getting enough?
Sources of Omega-3's
When possible, get your omega-3 fats from FOOD. The easiest way is to eat fish high in omega-3 derivatives EPA and DHA at least 2-3 times per week.
Fish High in EPA and DHA:
Choose WILD-CAUGHT fish, as they will often have a higher ratio of omega-3 to omega-6 fats AND less contaminants.
You can also consume foods high in an omega-3 called ALA (alpha-linoleic acid), as it may be converted into EPA and DHA in the body. HOWEVER, this conversion isn't very efficient, so it's recommended that your primary source of omega-3s be from fish.
Foods high in ALA:
Walnuts and walnut oil
Flaxseed and flaxseed oil
Soybeans and soybean oil
Your final option is to take a supplement (AKA the easy way out).
Be sure your supplement contains both EPA and DHA - READ LABELS
Shoot for ~1 g total of omega-3s…no need for omega-6s or omega-9s
Look for molecularly distilled fish oils, as this method protects the oils from oxidation and rancidity
CAUTION if you have a bleeding condition or are taking medications that make bleeding more likely
Speak with us or a qualified healthcare professional before you begin taking any supplement
Brands we like: Nordic Naturals, Barlean's, Carlson Labs
Got questions? Comment below or shoot us an email at contact@ViTLnutrition.com!
Some things I looked at besides using the knowledge in my brain...
Curtis CL, Hughes CE, Flannery CR, Little CB, Harwood JL, Caterson B. n-3 Fatty Acids Specifically Modulate Catabolic Factors Involved in Articular Cartilage Degradation. Journal of Biological Chemistry 2000;275(2):721–724.
Calder PC. n−3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases. American Journal of Clinical Nutrition 2006;83(6):1505–1519.
Bost J, Maroon A, Maroon J. Natural anti-inflammatory agents for pain relief.Surgical Neurology International Surg Neurol Int 2010;1(1):80.
Guy RA. The History Of Cod Liver Oil As A Remedy. Arch Pediatr Adolesc Med Archives of Pediatrics & Adolescent Medicine 1923;26(2):112.
Essential Fatty Acids. Micronutrient Information Center. Available at: http://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids#sources. Accessed February 12, 2016.
Omega-3 Fatty Acids: An Essential Contribution. The Nutrition Source. Available at: http://www.hsph.harvard.edu/nutritionsource/omega-3-fats/. Accessed February 12, 2016.