With each passing medical and scientific study the benefits of fish oil and fish oil supplements, are finding their way into the spotlight. Many studies have shown a correlation between reducing the possibility of heart failure, heart attack and different vascular diseases, but it has only been recently that a connection between Omega-3 fatty acids and helpful benefits for patients suffering from Irritable Bowl Diseases (IBDs) such as ulcerative colitis and Chrohn's disease.
Many of these studies are double-blind studies that are further validated with cultural studies of Inuit and Eskimo populations that have a diet high in fish that contains Omega-3 fatty acids and a very low occurrence of ulcerative colitis and Chrohn's disease. As the evidence mounts, further studies will be needed to pinpoint with any accuracy how much the dietary intake of Omega-3 fatty acids can help in patients suffering from these gastrointestinal diseases, but on the surface the smaller studies that have been done are very promising.
Ulcerative Colitis and Chrohn's Disease Overview
Ulcerative Colitis and Crohn's disease are two types of inflammatory bowel diseases. These diseases are believed to be caused by several factors. First, genetic and non-genetic causes are believed to be the culprit in many cases. The other possible cause is environmental factors such as infections that cause an immune reaction in the gastrointestinal area. The body then generates a large amount of white blood cells in the intestinal lining. These white blood cells release chemicals in the process of fighting the infection that inflame the intestinal tissue. It should be noted, though, that the exact causes of IBDs, such as ulcerative colitis and Crohn's disease, are currently unknown.
In general, an ulcerative colitis attack or Crohn's disease attack will consist of severe intestinal inflammation, which can cause bloody diarrhea, stomach cramps, fever, loss of appetite, weight loss, anemia, bleeding from the ulcers, rupture of the bowel, obstructions and strictures, fistulae, toxic megacolon and malignant cancer. In the last instance, the risk of colon cancer in patients that have had ulcerative colitis or Crohn's disease rises significantly. Generally, after an attack, the disease will go into a remission stage that can last weeks or even years. If you are suffering from these symptoms you should see your physician immediately for a proper diagnosis.
Until recently, the treatment for ulcerative colitis and Crohn's disease was, first and foremost, a healthy diet. If symptoms require it, physicians will ask their patients to limit their intake of dairy and fiber. While it is true that diet has relatively little to no influence on the actual inflammation process within ulcerative colitis, it could have influence on the different symptoms associated with it. On the other hand, diet does have an impact on the inflammatory activity in Crohn's disease and one of the main ways of treating these symptoms is a diet that consists of predigested food. It should also be noted that in both diseases, stress has been shown to be a factor in causing flare-ups. Because of this, physicians will also emphasize the importance of stress management.
Secondarily, medical treatment for these two diseases involves suppression of the high level of inflammatory response mechanisms of the immune system within the intestinal tract. By suppressing this response, the intestinal tissue can heal and the symptoms of abdominal pain and diarrhea can be relieved. After the symptoms have been controlled, further medicinal treatment helps to decrease flare-ups and lengthen or maintain remission periods.
Conventional methods of medicating these two diseases involve a stepped approach. Initially, the least harmful of medications are given in as low a dosage as possible and are taken for a short time period. If these medications provide little or no relief, the dosages are either increased or the medications are changed.
The lowest levels of medications, or Step I, are aminosalicylates and antibiotics. Corticosteroids make up the set of Step II drugs. Step III drugs involve the use of immune modifying medications or a drug called Infliximab for patients suffering from Crohn's disease. These medications are not used, however, during acute flare-ups due to the length of time that a flare-up can last. Only after Step III medications fail completely are Step IV drugs introduced because at this time, they are experimental.
A final alternative in treating ulcerative colitis is surgery. Because ulcerative colitis is limited to the colon, surgery can completely cure it. Crohn's disease, unfortunately, is not restricted to the colon and can exist anywhere in the digestive tract. Because of this, surgery will often complicate matters more.
Limitations of Medical Treatment
Nearly one-quarter of all patients diagnosed with some form of IBD, either Crohn's disease or ulcerative colitis, will not respond to medical treatment. In about three-quarters of cases of Crohn's disease, surgery (even though it is not curative) will be required. Regardless of current medical treatment, a person suffering from ulcerative colitis will have a 50% chance of having remission end within a two-year period after the last flare-up. Even if the initial diagnosis of ulcerative colitis is limited to the rectum there is a 50% probability of the disease becoming more extensive over a twenty-five year period. If a patient has ulcerative colitis that involves the entire colon, that patient stands a 60% chance of requiring a colectomy and most patients will require surgical intervention within the first year after diagnosis of the disease.
It's obvious that Intestinal Bowel Disease can be debilitating. Continued treatments with progressively harsher medications and surgeries that may help in some cases but not others become the norm for these patients. Further, the complications like strictures and fistulas associated with IBDs, can ultimately lead to colon cancer. Many times, these complications create a feeling of hopelessness among those who suffer from ulcerative colitis or Crohn's disease.
There is hope, though. New studies are presenting strong evidence for the use of Omega-3 fatty acids (fish oil and fish oil supplements) in the prevention and treatment of IBDs. These studies are shedding new light on the multi-faceted health benefits of Omega-3 fatty acids and ultimately may present new methods for the treatment of these painful diseases.
The Case for Omega-3 Fatty Acids
Traditionally, the Inuit populations of Alaska have existed on diets high in fatty fish, specifically, types of fish that are high in Omega-3 fatty acids. Past studies of these cultures have shown that the large majority of these groups do not suffer from heart problems, heart disease or other forms of vascular disease. Less known, however, was the fact that the majority of people within these cultures also do not suffer from any form of Inflammatory Bowel Disease. This has led some scientists to postulate that there is a strong connection between the dietary intake of fish oil or fish oil supplements and the prevention of IBDs.
Take, for instance, one example of a symptom of both Crohn's disease and ulcerative colitis: inflammation. Fish oils high in Omega-3 fatty acids have anti-inflammatory properties, which can help reduce its occurrence in patients suffering from IBDs. The reason for this is that when Omega-3 fatty acids are introduced into the body it suppresses the production of leukotriene B4. Omega-3s have also been shown to inhibit interleukin 1Beta. Both leukotriene B4 and interleukin 1Beta are major players in the inflammation of mucosa lining the gastrointestinal tracts.
With regular dietary intake of fish oil supplements high in DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), inflammation can be reduced by up to 50% in the intestinal tissues of patients who suffer from ulcerative colitis. Fish oils that have anti-inflammatory properties are only effective in reducing inflammation, but not preventing it. Results in patients with Crohn's disease haven't been quite as promising, but this area of research is still in its infancy.
Recent studies show tremendous promise in fish oil's effectiveness in preventing and reducing the effects of IBDs. These studies show that there is an increase in the manufacture of less powerful prostaglandins at the sacrifice of the more potent ones. Patients with active ulcerative colitis who were given fish oil supplements have also shown significant improvement versus patients who were given placebos. Further study with larger control groups is needed, though, in order for more accurate data to be gathered.
As further evidence of the link between Omega-3s and relief from the symptoms and inflammation of IBDs, a 12-week study involving patients who knew they were taking fish oil supplements showed a significant decline in the disease. This study was further bolstered by the results from samples of the intestinal mucosa that were found to have increased amounts of eicosapentaenoic acid. These results increase when the supplement given to the patients is encased with an enteric coating, which allows the fish oil to be released lower into the intestinal tract. This further alleviates side effects such as fishy breath, burping and flatulence related to taking fish oil supplements. Because of the fewer side effects associated with these supplements, treatment over the long-term is more tolerable.
A Worldwide Phenomenon
With more notice being taken of the effects of Omega-3 fatty acids on the health of people who take them on a consistent basis, the worldwide scientific community has opened up more to the idea of this supplement being used for effective treatment of IBDs. For instance, in Italy, a study was conducted using enteric-coated fish oil supplements and a notable reduction in the rate of relapse in Crohn's disease remission was noted. The patients involved in this study showed evidence of inflammation at the beginning of the study and were suffering from the symptoms related to Crohn's. In this study, patients suffering from the disease received either three fish oil capsules three times per day or a placebo three times per day. Those patients receiving fish oil supplements showed a significant reduction in the inflammation.
Among 39 patients in the placebo group, almost 70% of the patients who were in remission, relapsed. Out of the 39 patients supplementing their diet with fish oil capsules, only 28% relapsed. Further, after a year, nearly 60% of the 39 patients being given fish oil supplements were still in remission while only 25% of the patients given the placebo were in remission.
Given the small size of the study group it is only possible to speculate on the efficacy of treatment for Crohn's disease patients, however, the results of this study are promising. If scientists are given the opportunity to produce a study with a much larger group of patients, better and more accurate data could be gathered which could lead to even more positive results. More research would also allow scientists and doctors to understand the ways in which the EPA works to help increase time of remission.
There is strong speculation that patients suffering from IBDs lack a particular enzyme found in Omega-3 pathways and that when this enzyme is present, remission and even prevention of IBDs is possible. In a sense, adding an Omega-3 supplement to the diet of a patient suffering from Crohn's disease or ulcerative colitis appears to be a type of enzyme replacement therapy.
In Japan, medical researchers at Shiga University of Medical Science conducted a study in which the diet of Crohn's disease patients was altered to include a meal of rice, cooked fish and soup. Prior to the establishment of this diet, the occurrence of relapse within one year was 90%. After implementation of the diet the occurrence of relapse dropped to 40% within one year. Results like this are encouraging other countries to do similar studies.
In the United States, research conducted at Boston University Medical Center shows that patients with chronic IBD have unusual fatty acid profiles that were generally lower than control subjects who did not suffer from any type of chronic intestinal disorder. Because of this lack of fatty acids, it is believed that these patients are more prone to these problems. The study also suggests that the addition of Omega-3 fatty acids via a diet that adds fish oil or fish oil supplements can help reduce and correct this shortage.
Another study in San Francisco that involved patients with ulcerative colitis showed that there is an increase in leukotriene B4 in the colonic lining. The hypothesis in this study is that an increase in fish oil supplements in patients suffering from ulcerative colitis could inhibit the synthesis of the leukotrienes. If this is possible, fish oil supplements would be responsible for a reduction or elimination of the symptoms associated with inflammation of the bowels in this disease.
The final results of the study show that the hypothesis was accurate. Patients in the study were randomized and placed into two different groups. The study group received regular daily doses of fish oil containing 2.7 grams of eicosapentaenoic acid and 1.8 grams of docosahexaenoic acid. The second set of patients were placed into a control group and given placebo capsules filled with olive oil. Over a three-month period, patients receiving the fish oil supplements showed marked improvement in the severity of the symptoms of the disease. In fact, 72% of the study group taking the supplements was able to reduce or completely terminate their anti-inflammation and steroid medication schedules. The final outcome of the study was that fish oil supplements were integral to the improvement of patients suffering from ulcerative colitis.
A similar study done at Mount Sinai School of Medicine shows that the regular use of fish oil supplements in patients suffering from ulcerative colitis diminishes the severity of the disease. Fully 70% of the patients involved in the study showed moderate to significant improvement and 80% of the patients in the study were able to reduce their intake of prednisone, an anti-inflammatory used to help alleviate symptoms of the disease, by up to 66%.
Taking the Next Steps
Studies are showing positive results and it's obvious that the Omega-3 fatty acids inherent to fish oil supplements are beneficial to our intestinal health. The obvious thing to do is find out what types of fish oil supplements are the best. Personal research will aid you in finding the correct supplements and additionally, if you suffer from Crohn's disease or ulcerative colitis, you should consult with your physician about the benefits of adding a fish oil supplement to your diet and what dosage you should take. There is, however, some basic information about fish oil supplements that you need to know.
First of all, not all fish oil supplements are created equal. Cod liver oil is, by far, the most inexpensive form of fish oil that contains Omega-3 fatty acids. However, it does not contain the highest amounts and in most cases it cannot be taken in high doses because of impurities such as mercury that are left in it. It also has an extremely powerful taste that most have trouble tolerating.
A much better choice for supplementing your diet with fish oil is a health food grade supplement. These supplements have been purified using a process called molecular distillation. This process eliminates nearly all of the impurities and is very safe when taken in the doses necessary to help alleviate the symptoms associated with IBDs.
The purest form of fish oil supplements is pharmaceutical grade. These supplements have also been processed using molecular distillation, however, at a much higher level. The process used in filtering out the impurities gets rid of all of them down to the particulate level. These supplements, of course, are also the most expensive, but will have the greatest impact on your ulcerative colitis or Crohn's disease.
The benefits of Omega-3 fatty acids are proving to be phenomenal and it is anyone's guess as to the limits of what these supplements can do for our health. With few side effects that are relatively minor, fish oil supplements are a good choice to help you improve your overall health. The fact that they can be used to inhibit the relapse of the symptoms of Crohn's disease and ulcerative colitis is even more exciting. Omega-3 fatty acids are carving out a healthy niche in the diets of individuals worldwide and everyone is all the better for it.
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