Kottke TE, Wu LA, Brekke LN, et al. Preventing Sudden Death with n-3 (Omega-3) Fatty Acids and Defibrillators. Am J Prev Med.,2006;31(4):316-323.

BACKGROUND: Because interventions that prevent and treat events due to cardiovascular disease are applied to different, but overlapping, segments of the population, it can be difficult to estimate their effectiveness if formal calculations are not available.

METHODS: Markov chain analysis, including sensitivity analysis, was used with a hypothetical population resembling that of Olmsted County, MN, aged 30 to 84 in the year 2000 to compare the estimated impact of three interventions to prevent sudden death: (1) raising blood levels of n-3 (omega-3) fatty acids, (2) distributing automated external defibrillators (AEDs), and (3) implanting cardioverter defibrillators (ICDs) in appropriate candidates. The analysis was performed in 2004, 2005, and 2006.

RESULTS: Raising median n-3 fatty acid levels would be expected to lower total mortality by 6.4% (range from sensitivity analysis=1.6% to 10.3%). Distributing AEDs would be expected to lower total mortality by 0.8% (0.2% to 1.3%), and implanting ICDs would be expected to lower total mortality by 3.3% (0.6% to 8.7%).
Three fourths of the reduction in total mortality due to n-3 fatty acid augmentation would accrue from raising n-3 fatty acid levels in the healthy population.

CONCLUSIONS: Based on central values of candidacy and efficacy, raising n-3 fatty acid levels would have about eight times the impact of distributing AEDs and two times the impact of implanting ICDs.
Raising n-3 fatty acid levels would also reduce rates of sudden death among the subpopulation that does not qualify for ICDs.

Mickleborough TD, Murray RL, et al. Fish Oil Supplementation Reduces Severity of Exercise-induced Bronchoconstriction in Elite Athletes.
Am. J of Resp & Critical Care Med, 2003;168: 1181-1189

In elite athletes, exercise-induced bronchoconstriction (EIB) may respond to dietary modification, thereby reducing the need for pharmacologic treatment.

Ten elite athletes with EIB and 10 elite athletes without EIB (control subjects) participated in a randomized, double-blind crossover study.

Subjects entered the study on their normal diet, and then received either fish oil capsules containing 3.2 g eicosapentaenoic acid and 2.2 g docohexaenoic acid (n-3 polyunsaturated fatty acid [PUFA] diet; n = 5) or placebo capsules containing olive oil (placebo diet; n = 5) taken daily for 3 weeks.

Diet had no effect on preexercise pulmonary function in either group or on postexercise pulmonary function in control subjects.

However, in subjects with EIB, the n-3 PUFA diet improved postexercise pulmonary function compared with the normal and placebo diets. FEV1 decreased by 3 2% on n-3 PUFA diet, 14.5 5% on placebo diet, and 17.3 6% on normal diet at 15 minutes postexercise. Leukotriene (LT)E4, 9, 11-prostaglandin F2, LTB4, tumor necrosis factor, and interleukin-1, all significantly decreased on the n-3 PUFA diet compared with normal and placebo diets and after the exercise challenge.

These data suggest that dietary fish oil supplementation has a markedly protective effect in suppressing EIB in elite athletes, and this may be attributed to their antiinflammatory properties.

AM Hill, JD Buckley, KJ Murphy, et al. Combined effects of omega-3 supplementation and regular exercise on body composition and cardiovascular risk factors. Asia Pac J Clin Nutr, 2005; 14 Suppl: S57.

Background - Regular exercise and inclusion of n3 fatty acids in the diet can improve cardiovascular (CV) health.

Objectives - We examined whether the combination of both could reduce CV and metabolic risk factors more than either treatment alone.

Design - Volunteers with metabolic syndrome characteristics (mean BMI=34 kg/m(2); TG=1.82 mM) were randomly assigned to take 6 g/day of HiDHA(R) tuna fish oil or sunflower oil (provided in blinded capsules by NuMega Ingredients) and to undertake regular exercise (walking for 45 min, 3 days/wk at 75% of age-predicted maximal heart rate) or remain relatively sedentary.

Fasting plasma lipids, blood pressure and measures of arterial function and respiratory exchange ratio (RER) during exercise were assessed at baseline and after 6 and 12 weeks of intervention. Body composition was assessed by Dual Energy X-ray Absorptiometry at baseline and 12 weeks only.

Outcomes - Fish oil supplementation lowered plasma triglycerides, increased HDL cholesterol and tended to improve endothelium dependent vasodilation (P =0.06), while exercise independently improved arterial compliance (P <0.01).

The combined treatment, however, caused a 5% loss of body fat (P < 0.05) - a benefit not seen with either treatment alone. The loss of fat correlated with increased fat oxidation (RER) during exercise (P < 0.01).

Conclusion - Fish oil and exercise appear to have a synergistic effect on body fat, indicating that omega-3 supplementation may be a useful adjunct to exercise programs aimed at improving body composition and CV risk.

Buckley JD, Burgess S, Murphy KJ, Howe PR. Effects of omega-3 polyunsaturated fatty acids on cardiovascular risk, exercise performance and recovery in Australian Football League (AFL) players. Asia Pac J Clin Nutr. 2005;14 Suppl:S57.

Background:
Long chain omega-3 polyunsaturated fatty acids (LCn-3) can improve cardiovascular (CV) function and reduce the risk of CV disease.
Studies have investigated the potential for these CV benefits to improve athletic performance without success, but none have investigated effects on recovery.

Objectives:
To examine the effect of LC n-3 on exercise performance, recovery, and CV risk in AFL players.

Design:
Twenty-five AFL players completed a five week training program during which they were randomised, double-blind, to consume six g/day of fish oil (FO; n=12, HiDHA(R), Numega Ingredients Pty Ltd) or sunflower oil (C; n=13).

At baseline and after five weeks erythrocyte (RBC) membrane LCn-3 content and fasting serum triglyceride (TG) concentrations were assessed, and players performed two treadmill runs (R1 and R2) to exhaustion separated by five min of recovery.
Heart rate (HR) was monitored throughout each treadmill run. R1 assessed running performance while R2 assessed recovery (expressed as % of R1).

Outcomes:
After five weeks, RBC LCn-3 content had increased 47.4 +/- 11.2% in FO (P <0.001) and TG had decreased significantly compared with C (FO, -25.4 +/- 4.9%, C, 4.9 +/- 7.0%; P =0.002).

HR during steady-state submaximal exercise decreased significantly in FO compared with C (FO, -8 +/- 2 bpm, C -2 +/- 2 bpm; P =0.05).

Time to exhaustion during R1 increased in both groups (P <0.001) but by similar amounts (FO, 10.2 +/- 2.2%, C 17.3 +/- 4.3%; P =0.18).

Recovery did not change in either group (FO, -2.6 +/- 10.9%, C -13.5 +/- 6.0%; P =0.87).

Conclusion:
Five weeks of supplementing AFL players with LCn-3 reduced HR during submaximal exercise and fasting TG, reflecting improved CV function and decreased CV risk, but did not enhance endurance exercise performance or recovery.

PMID: 16326521

Mickleborough TD, Lindley MR, Ionescu AA, Fly AD. Protective Effect of Fish Oil Supplementation on Exercise-Induced Bronchoconstriction in Asthma. Chest, 2006;129:39-49.

Background:
Previous research has demonstrated that fish oil supplementation has a protective effect on exercise-induced bronchoconstriction (EIB) in elite athletes, which may be attributed to its antiinflammatory properties.

Since EIB in asthma involves proinflammatory mediator release, it is feasible that fish oil supplementation may reduce the severity of EIB in asthmatic subjects.

Study objectives:
To determine the efficacy of fish oil supplementation on severity of EIB in subjects with asthma.

Design:
Randomized, double-blind, crossover study.

Setting:
Lung function and exercise testing in a university research laboratory.

Patients and measurements:
Sixteen asthmatic patients with documented EIB entered the study on their normal diet and then received either fish oil capsules containing 3.2 g of eicosapentaenoic acid and 2.0 g of docohexaenoic acid (fish oil diet, n = 8) or placebo capsules (placebo diet, n = 8) daily for 3 weeks.

At the beginning of the study (normal diet) and at the end of each treatment phase, the following pre-exercise and postexercise measures were assessed: (1) pulmonary function; (2) induced sputum differential cell count percentage and proinflammatory eicosanoid metabolite (leukotriene C4 [LTC4]-leukotriene E4 [LTE4] and prostaglandin D2 [PGD2]) and cytokine (interleukin [IL]-1 and tumor necrosis factor [TNF]-) concentrations; and (3) eicosanoid metabolites leukotriene B4 (LTB4) and leukotriene B5 (LTB5) generation from activated polymorphonuclear leukocytes (PMNLs).

Results:
On the normal and placebo diet, subjects exhibited EIB. However, the fish oil diet improved pulmonary function to below the diagnostic EIB threshold, with a concurrent reduction in bronchodilator use.
Induced sputum differential cell count percentage and concentrations of LTC4-LTE4, PGD2, IL-1 and TNF- were significantly reduced before and following exercise on the fish oil diet compared to the normal and placebo diets.
There was a significant reduction in LTB4 and a significant increase in LTB5 generation from activated PMNLs on the fish oil diet compared to the normal and placebo diets.

Conclusion:
Our data suggest that fish oil supplementation may represent a potentially beneficial nonpharmacologic intervention for asthmatic subjects with EIB.

Mickleborough TD, Rundell KW. Dietary polyunsaturated fatty acids in asthma- and exercise-induced bronchoconstriction. Euro J Clinical Nutrition, 2005;59:1335?1346. doi:10.1038/sj.ejcn.1602250; published online.

Despite progress that has been made in the treatment of asthma, the prevalence and burden of this disease has continued to increase.

While pharmacological treatment of asthma is usually highly effective, medications may have significant side effects or exhibit tachyphylaxis.

Alternative therapies for treatment that reduce the dose requirements of pharmacological interventions would be beneficial, and could potentially reduce the public health burden of this disease.

Ecological and temporal data suggest that dietary factors may have a role in recent increases in the prevalence of asthma.

A possible contributing factor to the increased incidence of asthma in Western societies may be the consumption of a proinflammatory diet.

In the typical Western diet, 20- to 25-fold more omega (n)-6 polyunsaturated fatty acids (PUFA) than n-3 PUFA are consumed, which promotes the release of proinflammatory arachidonic acid metabolites (leukotrienes and prostanoids).

This review will analyze the evidence for the health effects of n-3 PUFA in asthma- and exercise-induced bronchoconstriction (EIB).

While clinical data evaluating the effect of omega-3 fatty acid supplementation in asthma has been equivocal, it has recently been shown that fish oil supplementation, rich in n-3 PUFA, reduces airway narrowing, medication use, and proinflammatory mediator generation in nonatopic elite athletes with EIB.

These findings are provocative and suggest that dietary fish oil supplementation may be a viable treatment modality and/or adjunct therapy in asthma and EIB.

Walser B, Giordano RM, Stebbins CL. Supplementation with omega-3 polyunsaturated fatty acids augments brachial artery dilation and blood flow during forearm contraction. Eur J Appl Physiol. 2006 [Epub ahead of print]

Omega-3 polyunsaturated fatty acids such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have beneficial effects on the heart and vasculature.

We tested the hypothesis that 6 weeks of dietary supplementation with DHA (2.0 g/day) and EPA (3.0 g/day) enhances exercise-induced increases in brachial artery diameter and blood flow during rhythmic exercise.

In seven healthy subjects, blood pressure, heart rate and brachial artery diameter, blood flow, and conductance were assessed before and during the last 30 s of 90 s of rhythmic handgrip exercise (30% of maximal handgrip tension). Blood pressure (MAP), heart rate (HR), and brachial artery vascular conductance were also determined. This paradigm was also performed in six other healthy subjects who received 6 weeks of placebo (safflower oil).

Placebo treatment had no effect on any variable. DHA and EPA supplementation enhanced contraction-induced increases in brachial artery diameter (0.28 +/- 0.04 vs. 0.14 +/- 0.03 mm), blood flow (367 +/- 65 vs. 293 +/- 55 ml min-1) and conductance (3.86 +/- 0.71 vs. 2.89 +/- 0.61 ml min-1 mmHg-1) (P < 0.05). MAP and HR were unchanged.

Results indicate that treatment with DHA and EPA enhances brachial artery blood flow and conductance during exercise. These findings may have implications for individuals with cardiovascular disease and exercise intolerance (e.g., heart failure).

PMID: 16636858

Fish oil rich in omega-3 fatty acids has been shown to have a range of mental-health and cardiovascular advantages, but a fat is a fat - surely, one might think, the more one consumes, the more weight one will gain.

But in a study of overweight and obese dieters with cardiovascular problems, researchers at the University of South Australia found that tuna oil, rich in omega-3's, actually helped them lose more weight with exercise.

Sixty-eight overweight and obese people were divided into four groups: one took small daily doses of fish oil, another was given sunflower oil (which contains no omega-3's) and both groups undertook moderate exercise programs of a 45-minute run or walk three times a week. Two other groups received fish or sunflower oil but did no exercises. None of the groups' participants changed any other of their normal eating habits.

Those who took the fish oil and exercised lost an average of 4.5 pounds over three months, while those in the other three groups lost no weight.

The study was presented at the International Society for the Study of Fatty Acids & LipidsCongress in Cairns, Australia, on July 25, 2006.
It's just one small study, but take it as one more reason - as if one were needed - to increase your intake of these vital fatty acids.

And bear in mind that for maximum benefit, you should also lower your intake of omega 6 fatty acids, which are abundant in seed oils such as soybean oil.

Source: http://www.drweil.com/drw/u/id/WBL02002

Curtis CL, Rees SG, et al. Effects of n-3 fatty acids on cartilage metabolism. Proc Nutr Soc, 2002;61(3):381-389

Although the clinical benefits of dietary supplementation with n-3 polyunsaturated fatty acids (PUFA) has been recognised for a number of years, the molecular mechanisms by which particular PUFA affect metabolism of cells within the synovial joint tissues are not understood.

This study set out to investigate how n-3 PUFA and other classes of fatty acids affect both degradative and inflammatory aspects of metabolism of articular cartilage chondrocytes using an in vitro model of cartilage degradation.

Using well-established culture models, cartilage explants from normal bovine and human osteoarthritic cartilage were supplemented with either n-3 or n-6 PUFA, and cultures were subsequently treated with interleukin 1 to initiate catabolic processes that mimic cartilage degradation in arthritis.

Results show that supplementation specifically with n-3 PUFA, but not n-6 PUFA, causes a decrease in both degradative and inflammatory aspects of chondrocyte metabolism, whilst having no effect on the normal tissue homeostasis.

Collectively, our data provide evidence supporting dietary supplementation of n-3 PUFA, which in turn may have a beneficial effect of slowing and reducing inflammation in the pathogenesis of degenerative joint diseases in man.

Yates A, Bradley JP, Maroon J, et al. Evaluation of lipid profiles, inflammatory markers and the use of Omega-3 EFA in Professional Football Players. Initiation: 2006

Introduction: The risk of cardiovascular disease becomes significant in males at age 30. Because many professional football players carry a large amount of weight and are required to exert extreme bursts of maximal physical effort, they make up a unique class of individuals that may have a higher risk for adverse cardiac events such as heart attacks and death.

Family heart history, obesity and other diet and lifestyle factor also play a major role. Cardiac risk assessment is critical to ensure the health of these premier athletes.

The Pittsburgh Steelers have undertaken a rigorous health screening program using both conventional physical exams and now state of the art blood test to assess these risks.

This same physical contact often results in painful joints which are often treated with NSAIDs. The recent withdrawal of Vioxx and the concern of serious side effects make long term use of the COX-2 family of NSAIDs a significant risk factor.

For this evaluation we plan to evaluate the use of Omega-3 EFAs for both their cardiovascular protective effect, by reducing vascular inflammation and plaque stabilization and their ability to relieve joint tissue inflammation and the associated pain.

Materials and Methods: The study will recruit a total of 40 players of which 20 will be given 2,800 mg of omega-3 EFA (EPA/DHA) at the start of the pre-season for the duration of the season. The other 20 players will be the control group. Both groups will be asked to complete questionnaires, diary logs, NSAIDs usage and pain assessments. Routine pre-, mid- and post season cardiac risk assessment blood work and history and physical exams data will also be collected and results used for this analysis.

With this pilot analysis of 40 NFL players we hope to assess any potential beneficial affects of omega-3 EFA on both reducing cardiac risk by improved blood inflammation and lipid markers and by quantifying any reduction in NSAIDs use and improved pain scores in the treatment group.