Is DHA the same as fish oil

Omega-3 fatty acids (EPA, DHA)

Omega-3 fatty acids have antiarrhythmic, anti-inflammatory, antihypertensive and endothelial protective effects. If they are given in addition to a CSE inhibitor, they strengthen and expand its cardioprotective effect profile (Tab. 1).

In the JELIS study (Japan EPA Lipid Intervention Study), Japanese researchers were able to show that the adjuvant administration of omega-3 fatty acids during therapy with statins significantly reduces the rate of coronary events [1]. This current study enrolled over 18,645 patients with hypercholesterolemia who were treated with a low-dose statin. Over 9000 study participants received an additional 1800 mg of eicosapentaenoic acid (EPA) daily in the form of capsules. After an average treatment duration of 4.6 years, the rate of cardiac events was 3.5 percent in the statin-only group and 2.8 percent in the EPA group. However, it was important for the risk reduction whether the patients already had coronary disease or not. In the EPA subgroup of patients with no evidence of CAD (n = 14,981), the reduction was not significant. In contrast, the EPA subgroup of CHD patients (n = 3664) benefited from a 19% reduction in the rate of coronary events (Fig. 1).

Ω-3 fatty acids

The essential long-chain polyunsaturated Ω-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have high therapeutic potential in the prevention and treatment of numerous chronic degenerative and inflammatory diseases.

Functions
  • Brain / eye function (DHA): Development of brain and nerve cells, cell membranes of the retina.
  • Eicosanoid metabolism (EPA: competitive displacement of arachidonic acid): synthesis of anti-inflammatory, antithrombogenic, antichemotactic and vasodilatory prostanoids and leukotrienes.
  • Blood rheology: fibrinogen level ↓, platelet aggregation ↓ (TXA2), NO synthesis ↑.
  • Vascular endothelium: NO-mediated vascular relaxation ↑, expression of adhesion molecules ↓ (e.g. VCAM-1) and inflammation markers ↓ (e.g. E-selectin), leukocyte adhesion ↓, synthesis of proinflammatory cytokines ↓ (e.g. TNFα, IL- 1), PAF release ↓, cell proliferation ↓.
  • Hemodynamics / blood pressure: blood pressure ↓ (diastolic / systolic), renal blood flow ↑, microcirculation ↑, blood rheology ↑, blood viscosity ↓.
  • Heart: anti-arrhythmic, antiatherogenic, anti-thrombotic, endothelial, cardioprotective.
  • Lipid metabolism: triglycerides (TG) ↓, hepatic synthesis of TG and VLDL ↓, activity of lipogenic enzymes ↓.

Recommended intake: 0.5 to 1.0 g EPA / DHA per day. Fish oil contains around 30 to 35% (3 g fish oil = 1 g omega-3 FA), high concentrates up to 85% EPA / DHA.

Omega-3 FS status: Normal range (serum): α-linolenic acid: 15 - 30 mg / l, EPA: 20 - 55 mg / l, DHA: 50 - 110 mg / l. Material / method: fasting serum / GC. Note: FS distribution is subject to considerable diet-related fluctuations (better: membrane lipids of the erythrocytes).

Deficiency / increased need:Increased need: Pregnancy / lactation, growth, age; nutrition: little sea fish, extreme Ω-6-FS intake, TPN; Diseases / malabsorption: IBD, hypertriglyceridemia, biliary and liver diseases, chronic pancreatitis, inflammatory, chronic degenerative diseases (e.g. allergies, Alzheimer's, MS, psoriasis, rheumatism), dry eye.

Possible symptoms of deficiency / consequences: Generally: increased tendency to atopy, cachexia, lipid abnormalities, behavioral disorders; eye: Inflammation, blurred vision, dryness; skin: dry, scaly, eczema; Cardiovascular system: increased cardiovascular morbidity / mortality; immune system: Inflammatory reactions, susceptibility to infection; Children / adolescents: Concentration, learning, behavior, growth disorders; Neurological disorders: Senility of old age, depression, muscle weakness, neuropathies, CNS development ↓.

Ingestion: Omega-3 fatty acids should be taken with meals. Only long-term and regular intake makes sense! The therapeutic dose range is around 30 to 40 mg / kg body weight and can initially be up to 90 mg / kg body weight. In general, the combination with antioxidants is recommended (→ lipid peroxidation: limiting factor for biological effectiveness).

Contraindications: Acute and subacute pancreatitis, acute pancreatic necrosis, acute to chronic liver intoxication, liver cirrhosis, acute to chronic gallbladder inflammation, acute coagulation disorders.

Side effects: Fish taste (belching). Bleeding time can be increased. At doses> 3 g / d, regular monitoring of blood coagulation, LDL cholesterol and glucose tolerance should be considered.

Interactions:Cyclosporine: EPA / DHA reduce ciclosporin-induced side effects (nephrotoxicity, hypertension, hypertriglyceridaemia);

Corticoids / NSAID: EPA / DHA reduce therapeutic need and NW of anti-inflammatory drugs; CSE inhibitors / statins: EPA / DHA expand the therapeutic profile of statins; Warfarin, ASS: Bleeding time can be extended, thrombocyte aggregation can be reduced (possible reduction of anti-coagulant drugs after consultation with a doctor!).

literature

[1] Yokoyama, M., et al .: Effects of eicosapentaenoic acid in major coronary events in hypercholesterolaemic patients (JELIS): a randomized open-label, blinded endpoint analysis. Lancet 2007: 369 (9567); 1090-1098. Author:Pharmacist Uwe Gröber, [email protected]