Lupus & Omega-3s
By Patricia Weinstein, PhD, ARNP, NP-C ©2014
Many claims have been made about the value of omega fatty acids in the treatment of lupus. Until recently, most of the evidence has been anecdotal or based on studies involving mice or small numbers of human participants, but researchers are increasingly conducting human studies.
Research
Studies during the 1980s and 1990s investigating fatty acid supplementation in patients with lupus nephritis found decreased platelet stickiness, triglycerides and very low density lipoproteins cholesterol (VLDL-C) and increased high density lipoprotein cholesterol (HDL-C, often referred to as “healthy cholesterol”) but no significant effect on immune complexes, anti-dsDNA, proteinuria, disease activity or prednisone dose.1,2
The results of more recent studies in patients with lupus nephritis have been more encouraging. One study found that flaxseed was effective in decreasing serum creatinine levels, an indication of improved renal function.3 However, the study involved a relatively small number of participants. Another larger study of omega-3 fish oils in participants with SLE showed a significant decline in disease activity.4 One study of lupus patients showed that low omega-3 and high carbohydrate intake was associated with worse disease activity, unfavorable lipid levels, and the presence of atherosclerotic plaques. Findings of another study suggested that omega-3s have a protective effect on the kidneys in people with lupus.5 Most recently, research showed that dietary flaxseed oil altered the expression of genes involved in inflammation in white blood cells in dogs6 and contributed to antihypertensive effects in patients with peripheral arterial disease.7 Furthermore, omega-3s may protect against bone loss8 It is important to also note the benefit of fatty acids on lipid levels, since lupus increases the risk of atherosclerosis. Flaxseed has been shown to be more effective than soy in reducing lipids, although the lipid lowering effect of either is not large. Research also has shown that omega-3 fatty acids decrease the risk of stroke and coronary artery disease in women in general. Most of the benefit derived from omega-3s is most likely due to their anti- inflammatory effects.
Effect on Estrogens
Flaxseed also may benefit people with lupus because of its effect on estrogen. When estrogen is metabolized, it is broken down into two compoun
ds, 2-hydroxyestrone and 16-alpha-hydroxyestrone. 16-alpha-hydroxyestrone exerts a more prolonged estrogen effect than does 2-hydroxyestrone. Women with lupus tend to breakdown their estrogen into more16-alpha-hydroxyestrone than 2-hydroxyestrone. Men with lupus also favor metabolism of estrogen toward 16-alpha- hydroxyestrone. (The hormones estrogen and testosterone are found in both men and women although at different levels.)
Indole-3-carbinol (I3C), a compound found in cruciferous vegetables (broccoli, cabbage, cauliflower, Brussels sprouts, greens) and flax, directs estrogen metabolism toward 2- hydroxtyestrone, thus decreasing 16-alpha-hydroxyestrone and reducing some of estrogen’s effects. In a 3-month study, women with lupus who were given I3C showed a significant increase in 2-hydroxyestrone and a modest non-significant decrease in disease activity.9 Although more research is needed, I3C may benefit some women with lupus. In order to interpret the research findings and make nutritional decisions, a basic understanding of fatty acids is helpful.
ESSENTIAL FATTY ACIDS
Fatty acids are organic molecules made of a carbon chain. They are the key building blocks of all fats and oils in our food and our body. They perform vital functions in the construction and maintenance of all healthy cells and are stored in fat tissue for future use. Fatty acids can be saturated or unsaturated, which refers to the bonds between the carbon molecules in the chain. Fatty acids whose carbons are joined by a single bond, like a row of friends joined together holding hands, are saturated.
Unsaturated fatty acids have double bonds, which are like friends holding both hands. Saturated fats have no double bonds, monounsaturated fatty acids have one double bond, and polyunsaturated fatty acids have two or more double bonds. The small difference in structure between saturated and unsaturated fatty acids drastically changes a fatty acid’s properties. The fats that heal contain unsaturated fatty acids, which also make them liquid oils at room temperature.
Fatty acids are identified by the families to which they belong. The unsaturated fatty acid family is called omega. The family name also has a number designation, such as omega-3, omega-6 or omega-9, which identifies the location of the first double bonds on the carbon chain. The two most important unsaturated fatty acids with more than one double bond are known as essential fatty acids (EFAs). They are linoleic acid and alpha-linoleic acid. When a fatty acid is referred to as essential, it means that it is necessary for vital functions but is not manufactured by the body. It must be obtained from dietary sources. Linoleic acid is known also as omega-6 and found in abundance in safflower oil and in sunflower, corn, sesame, soy and other vegetable oils. Alpha-linoleic acid, also known as omega-3, is most abundant in flax oil and also found in walnut oil, wheat germ oil and cold-water fish. Olive oil is an omega-9 fatty acid but not an essential fatty acid since the body can produce it.
Some important functions of EFAs are energy production, oxygen transfer, hemoglobin production, cell division, cell membrane construction, and recovery of fatigued muscles after exercise. Omega-3 speeds healing, reduces inflammation and is required for brain development. In order to perform someof their functions, omega-3s must be converted into prostaglandins, a compound that lowers blood pressure, relaxes coronary arteries, inhibits platelet stickiness, and blocks the effects of “bad” prostaglandins that cause inflammation.
Converting omega-3s to prostaglandins requires vitamins B3, B6, and C and the minerals magnesium and zinc. Omega-3 conversion to prostaglandins involves several steps that include the conversion of eicosapentanoic acid (EPA) to docosahexanoic acid (DHA) before omega-3 becomes a prostaglandin. Prostaglandins can be formed from EPA and DHA sources, thus bypassing the requirement of alpha-linoleic acid. EPA and DHA are found primarily in cold-water fatty fish such as mackerel, sardines, salmon and orange roughy. Fish oil capsules most often contain both EPA and DHA. Sometimes degenerative diseases impair the body’s ability to make EPA and DHA from alpha-linoleic acid. Oil supplements of EPA and DHA (fish oils) can allow prostaglandin production to take place. Dietary supplements of prostaglandins are not effective because they are destroyed during digestion.
FLAX
Flax is one of the oldest known cultivated plants grown both for its fiber, which was woven into linen, and for its seeds, which provides omega-3 rich oils for food (flax oil) and paint (linseed oil). References to flax’s healing powers date back to 650 B.C. Flax grows in every part of the world except the tropics and the arctic. The seeds come in golden or brown varieties and both are nutritious. Flax is not considered a wheat grain and therefore contains no gluten.
In addition to alpha-linoleic acid, flaxseed contains lecithin, carotene, vitamins E, B1, B2, and C (when oil is refined, lecithin and vitamins are removed), protein, fiber, minerals (potassium, phosphorous, magnesium, calcium and sulphur), and lignans. Lignans are present in very small amounts if at all in flax oil.
Lignans are phytoestrogens, naturally occurring plant compounds that are structurally similar to estrogen. Flaxseed lignans have anti-viral, anti-fungal, anti-bacterial and anti- cancer properties, lower glucose and insulin levels, improve mild menopausal symptoms, and have protective effects on the kidney. Flaxseed contains 100 times the amount of lignans as the next best source,
bran. Flax is the richest source of alpha-linoleic acid (the body converts alpha-linoleic acid to omega-3), but a poor source of linoleic acid (omega-6). This usually does not pose a problem since most Amer
ican diets are low in omega-3s but abundant in omega- 6s. A balanced diet contains both omega-3 and omega-6 fatty acids (see omega-6/omega-3 ratio).
OMEGA-6/OMEGA-3 RATIO
Experts disagree on what is the ideal ratio of omega-6 to omega-3 fatty acids in our diet. Current consumption of omega-3s in the typical American diet is one sixth of that found in our food in 1850. It is speculated that today’s imbalance of omega-6 to omega-3 fatty acids contributes to an increased incidence of heart disease and inflammatory disorders.10 Inuits (native Alaskans), who follow a traditional native diet with an omega-6/omega-3 ratio of 1:2.5, have virtually no heart disease. Nutritionists generally recommend that a healthy diet contains no more than 2 omega-6 for each omega-3 or a 2:1 ratio of omega-6 to omega-3.1
CARING FOR ESSENTIAL FATTY ACIDS
Both EFAs, omega-3 and omega-6, are easily destroyed by air, light and heat. Nature packages these oils in seeds that protect them for extended periods of time. Light speeds up the oxidation of EFAs 1000 times. This not only destroys the vital biological properties of EFAs but also breaks them down into potentially toxic compounds. Oxygen, even without the presence of light, breaks down EFAs resulting in rancid oil. Heat destroys EFAs by twisting their molecules into trans-fats.
Fresh omega-3 should be pressed and packaged in the dark, in the absence of oxygen and with minimal heat, and then stored in shelf-dated opaque containers,
preferably refrigerated. The lignans in flaxseed will settle to the bottom of the container, so be sure to shake before pouring. Once they are opened, omega-3 fatty acids should be kept refrigerated and used within 4 weeks even if the shelf-date has not expired. As you can see, flax oil capsules deteriorate quickly and should be replaced with freshly ground flax seeds or flax oil in dark bottles. Do not buy oil that is not refrigerated in the store.
HOW MUCH
Unless you follow a totally fat free diet, there is usually no need to supplement your diet with omega-6 fatty acids. Omega-6s are found in liquid vegetable oils and are the fat source of most commercially prepared foods. Commercial vegetable oils contain very little omega-3s and large amounts of omega-6s. For instance, canola oil contains 23% omega-6 and 10-15% omega-3. This isn’t too bad but canola oil goes rancid easily, and omega-3s are transformed into trans fatty acids during the deodorizing process of oil refinement. Efforts to increase omega-3s in commercially prepared foods are underway but not to the extent that adequate amounts can be consumed without dietary supplementation. Olive oil, an omega-9 fatty acid, is more stable when heated and is a good choice for cookin
g at moderate temperatures.
Fresh/wild or farm-raised salmon provides omega-3. Omega-3 rich fish should be eaten 1 to 2 times per week and use of oils heavy in omega-6s should be minimal. If you prefer fish oil capsules, 1000–1500mg/day is recommended. If your choice is flaxseed, begin with one teaspoon per day and work up to 3-6 tablespoons. If you swallow flaxseeds whole, your body will not absorb the nutrients because they are protected by a tough seed coat. The best way to get the most nutritional value from flaxseeds is to grind the seeds in a small grinder, such as a coffee bean grinder, and consume them within 15-20 minutes of grinding. One tablespoon of flaxseeds equals one teaspoon of flax oil. Because of its instability, flax oil should not be used for cooking, but it works well in salad dressings or as a topping on cooked vegetables. Ground flaxseeds can be added to cold cereal or hot cereal after it has been cooked, yogurt or smoothies, sprinkled on top of salads, or mixed with peanut butter or other nut spreads. Whole flaxseeds can be stored at a cool temperature for up to a year. Some people have difficulty with flax because of its high fiber content. Be sure to take plenty of fluid with freshly ground flax because it absorbs water in your intestine. It is recommended you drink 5 times the volume of the flax eaten. Whatever your source of omega-3, it will take 6-8 weeks to restore healthy levels in your body before you see the benefits.
References
1. Clark WF, Parbtani A. (1994). Omega-3 fatty acid supplementation in clinical and experimental lupus nephritis. American Journal of Kidney Diseases, 23(5):644-647.
2. Clark WF, Parbtani A, Huff MW, Reid B, Holub BJ, Falardeau P. (1989), Omega- 3 fatty acid dietary supplementation in systemic lupus erythematosus. Kidney International, 36(4):653-660.
3. Clark WF, Kortas C, Heidenheim AP, Garland J, Spanner E, Parbtani A. (2001). Flaxseed in lupus nephritis: a two-year nonplacebo-controlled crossover study. Journal of the American College of Nutrition, 20(2 Suppl):143-148.
4. Duffy EM, Meenagh GK, McMillan SA, Strain JJ, Hannigan BM, Bell AL. (2004). The clinical effect of dietary supplementation with omega-3 fish oils and/or copper in systemic lupus erythematosus. Journal of Rheumatology, 31(8):1551-1556.
5. Pestka JJ. (2010). n-3 polyunsaturated fatty acids and autoimmune-mediated glomerulonephritis. Prostaglandins, Leukotrienes and Essential Fatty Acids, 82(4-6), 251-8.
6. Purushothaman D, Brown WY, Vaneslow BA, Quinn K and Wu SB. (2014). Flaxseed oil supplementation alters the expression of inflammatory-related genes. Genetic and Molecular Research, 13(3):5322-32.
7. Caligiuri SP et al. (2014). Flaxseed consumption reduces blood pressure in patients with hypertension by altering circulating oxylipins via an linoleic acid-induced inhibition of soluble epoxide hydrolase. Hypertension, 64(1):53-9.
8. Elkan AC et al. (2012). Diet and fatty acid pattern among patients with SLE: associations with disease activity, blood lipids and atherosclerosis. Lupus, 21(13), 1405-11.
9. McAlindon TE, Gulin J, Chen T, Klug T, Lahita R, Nuite M. (2001). Indole-3- carbinol in women with SLE: effect on estrogen metabolism and disease activity. Lupus, 10(11):779-783.
10. Fallon S, Enig MG. (2001). Nourishing Traditions. Washington, DC: New Trends Publishing.
Additional resources:
Enig, Mary G. (2000). Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils, and Cholesterol. Silver Springs, MD: Bethesda Press.
Erasmus, Udo. (1993). Fats That Heal, Fats That Kill. Barnaby, Canada: Alive Books.