Omega-3 Fatty Acids: Effects, Benefits, and Safety

Omega-3 fatty acids have numerous functions in your body. They help regulate your blood pressure, inflammatory processes, and your nervous system, just to mention a few vital functions. In addition, they are responsible for maintaining cell structure and signaling, as well as cell membrane fluidity. You wouldn’t survive without them.

For the athlete, omega-3 fatty acids have the potential to influence the functional response to training, as well as stimulate muscle protein synthesis. In addition, they have both anti-inflammatory and antioxidant properties, making them an attractive supplement for health and performance.

Potential does not automatically mean actual benefits in practical application. In this article, we will take a look at omega-3 supplements and see if they are worth your money and whether or not they will help or hinder your efforts in the gym. Of course, we will also review potential health benefits.

Introduction to Omega-3 Fatty Acids

There are two major classes of polyunsaturated fatty acids:

  • Omega-3
  • Omega-6

Unlike saturated and monounsaturated fatty acids, they have at least two double bonds between the carbons of the long chain of carbon atoms they are made of. This article is all about the first class, omega-3.

There are several types of omega-3, but three in particular have been the focus of much health-related research:

  • ALA – alpha-linolenic acid
  • EPA – eicosapentaenoic acid
  • DHA – docosahexaenoic acid

Lately, more and more interest has been focused on the potential of omega-3 fatty acids to increase exercise performance and even enhance muscle hypertrophy.

Your body can make most of the types of fat it needs on its own, but not omega-3. Omega-3 is an essential fat, which means that you have to provide it through your diet. Actually, if we are to be completely correct, the body can make two of the omega-3 fatty acids if you provide the ALA. The body can’t synthesize ALA, but it can convert ALA into EPA and then into DHA. However, this conversion is very inefficient. The conversion rate is below 15%, which makes consuming all three major omega-3 fatty acids the only way to actually increase the levels in the body in any meaningful way.

Important and plentiful sources of ALA include various nuts and seeds, while the richest and most well-known sources of EPA and DHA are fatty fish like salmon and mackerel.

Omega-3 supplements come in many varieties, and you cannot count on them being equal. If you buy 1000 mg fish oil capsules, chances are it won’t contain 1000 mg of EPA and DHA.

Make sure your supplement contains EPA and DHA in the amounts you want. For example, if you want 3 grams of EPA + DHA per day, 3 x 1000-mg fish oil capsules will not be enough, since it won’t all be EPA and DHA.

Omega-3 and Health

Heart Health and Cardiovascular Disease

A common reason for taking omega 3 supplements is because they are said to be good for the heart. Supposedly, they also protect against cardiovascular disease. While omega-3 fatty acids perform many important functions in the body, their effects on heart health are probably the most well-known and widely believed. Everyone knows that omega 3 fats are good for the heart, right? Let’s check out what the science says.

There is a huge amount of research on the subject of omega-3 in relation to cardiovascular disease and risk factors for cardiovascular disease. EPA and DHA in particular. This research dates back to the 1970s, when observational studies documented stand-out low rates of cardiovascular disease among populations that traditionally consume a lot of fish, like the Inuit population of Greenland.

Since then, many epidemiological studies observing the same association have been published. In addition, several reviews and meta-analyses have confirmed the association between a high fish or omega-3 fatty acid intake and a lower incidence of heart disease and heart failure.1 2

Recent clinical research has discovered that omega-3 in the form of supplements might not offer the same protective benefits as eating a lot of seafood, including fatty fish. Large studies where the participants consumed a gram a day of omega-3 fat in the form of supplements have failed to show any consistent effect on cardiovascular disease.3 4

A 2018 meta-analysis of 10 trials involving more than 77 000 individuals found no association between omega-3 fatty acids and heart disease or vascular events.5

In 2018, a giant Cochrane report analyzing 79 randomized controlled trials with more than 112 000 participants found no support for claims that increasing dietary EPA or DHA has any effect on mortality or cardiovascular health.6

The story doesn’t end there, however. Very recently, a new meta-analysis found a significant association between marine omega-3 fatty acid intake and lower cardiovascular disease risk. This meta-analysis built on the previous ones, but increased samples sized by including 3 new trials. This had a big influence on the evidence, and showed that omega-3 decreases the risk of most cardiovascular disease outcomes, including heart attack, death from coronary heart disease, and death from cardiovascular disease. The researchers also showed a dose-dependent effect, where larger intakes of omega-3 further reduced these risks.7

Why have the epidemiological findings gone from hailing omega-3 fatty acids as the heart’s best friend to finding no effects at most recent studies? Maybe the answer lies in the way dietary habits have changed over the last 40 years. The benefits of eating more fatty fish and omega-3 fats could have influenced the dietary habits of the population, increasing the average intake. There might very well be a level of omega-3 intake beyond which further supplementation offers little or no benefits. If that is the case, a diet lacking in omega-3 rich foods could still benefit from omega-3 supplementation. The most recent meta-analysis showing a dose-dependent effect of omega-3 fatty acids on cardiovascular disease risk does suggest that maybe all that was needed was more evidence and larger doses for the benefits to become apparent.

Cancer

Omega-3 fatty acids might have the capacity to inhibit cell growth.8 Along with the anti-inflammatory effects of omega-3, this has led to the hypothesis that high intakes of omega-3 fat, either through food or supplements, might help reduce the risk of cancer. However, observational studies do not fully support this theory. While some studies have found an association between omega-3 and reduced risk of breast cancer and colorectal cancer, other studies have not found any association at all. A few studies have even found an association between high intakes of omega-3 fatty acids and an increased risk of cancer, prostate cancer in particular.

Overall, there is no consistent evidence pointing in any one direction. There is some limited moderate-quality evidence indicating that omega-3 fatty acids might decrease the risk of some cancer types, in particular breast cancer. However, the largest clinical trial yet, with more than 25 000 participants, found that supplementation with omega-3 fatty acids did not result in a lower incidence of cancer than placebo.9

In summary, at the moment we don’t really know if and how omega-3 influences overall cancer risk. More research is needed, since right now, the available evidence is too inconsistent for any conclusions to be made.10

Alzheimer’s Disease, Dementia, and Cognitive Function

Omega-3 fatty acids are very important for the function of our brain, but this does not automatically mean that supplementing with omega-3 in the absence of any deficiency actually leads to better brain function.

Several observational studies have found an association between fish and/or omega-3 fatty acid intake and a decreased risk of cognitive decline or dementia, but others have found no such association.11

There are not many clinical studies on omega-3 fatty acids on their own, and the ones available are often fairly small. Generally, they suggest little to no effect. This suggests that eating fish in general is probably good for the brain, but that there is no conclusive evidence that supplementing with omega-3 will have any substantial effect.

It could just be that people who eat a lot of fish simply lead an overall healthier lifestyle than people who don’t, thus decreasing their risk of dementia and Alzheimer’s.

Cochrane reviews have concluded that available trials show no effect of omega-3 fatty acids on cognitive function in healthy individuals. In addition, there is no evidence that supplementation with omega-3 fatty acids offer any benefits in mild to moderate dementia. On the other hand, it doesn’t seem to hurt either.12

Depression

Major depression affects one tenth of the US population and is a leading cause of disability. There is ample evidence that omega-3 polyunsaturated fatty acids have antidepressant effects. An expert panel organized by the International Society for Nutritional Psychiatry Research recently concluded that omega-3 fatty acids should be recommended as adjuvant treatment for major depression in pregnant women, children, and the elderly, and as prevention in high-risk populations.13

Omega-3 and Your Muscles

Dietary omega-3 might be important for optimal health, but what about your gains? Can you expect any benefits by supplementing with omega-3 to increase strength and muscle mass?

The short answer is: maybe. The available data is limited, which makes it hard to come to any conclusions. However, there is some evidence that omega-3 supplements can increase muscle protein synthesis. When combined with resistance training, they could possibly augment training adaptations.

Omega 3 and Muscle Protein Synthesis

The combination of sufficient amounts of protein and calories stimulate resting muscle protein synthesis. Adding omega-3 fatty acids to this equation results in even greater rates of muscle protein synthesis.14 15

At least it does under conditions of a so-called hyperaminoacidemic-hyperinsulinemic clamp. This means that the same might not hold true in a real-world setting.

In young people, this additive effect of omega-3 is not evident when protein is provided in ample amounts. However, consuming omega-3 along with post-exercise protein elavates anabolic signaling acitivity for a longer period of time. This could mean that the addition of omega-3 may enhance the anabolic effect of protein. Less protein would then be required to elicit the same anabolic effect as a higher dose. This theory is based on limited data and remains to be tested in a controlled setting.

In the elderly, there is evidence that omega-3 can increase the anabolic response to protein intake both without resistance training in the picture and following a strength-training session.16 17

These studies provide evidence of such an effect even in a real-world scenario, following a training session and a regular meal, not just in an artificial laboratory setting. If the previously mentioned theory, where omega-3 allows a smaller protein intake to have the same anabolic effect as a larger one, this could be especially valuable to the elderly. When we get old, our muscle develop so-called “anabolic resistance”. More protein is required to maintain a high anabolic response to a meal. If omega-3 could rescue this anabolic sensitivity to protein intakes, it would mean that older people wouldn’t have to double their protein portions to maintain high levels of muscle protein synthesis.

The mechanisms by which omega-3 could help stimulate muscle protein synthesis are not fully understood. Possible mechanisms include increased incorporation of omega-3 fatty acids into cell membranes. Proteins that are tethered to the cell membrane are associated with the stimulation of muscle protein synthesis, and omega-3 might enhance their activity.18

In summary, omega-3 supplements could help promote muscle protein synthesis when taken with a protein-rich meal, at least when the protein content of said meal is sub-optimal. Omega-3 also seems to prolong the anabolic signaling following protein ingestion. These effects are more prominent in the elderly compared to the young.

Omega-3 and Muscle Mass

While muscle protein synthesis is the main driver of muscle hypertrophy, increased rates of muscle protein synthesis do not automatically translate into hypertrophy. There are too many factors involved for such a simple cause-and-effect scenario.

Young Adults

In young adults, there are only two studies investigating the effects of omega-3 supplements on muscle mass when used as part of an exercise protocol. Both have severe limitations. One does not use resistance training as the exercise mode. The other one might be too short for measurable effects on muscle mass to become evident.

In the first of these studies, overweight adults below the age of 65 were randomly assigned to 1 of 4 groups.19 The first received fish oil but didn’t exercise, the second combined fish oil with exercise, the third received sunflower oil, and the last group combined sunflower oil and exercise as part of the intervention.

The exercise groups walked for 45 minutes at 75% of their max heart rate 3 days per week for 12 weeks. The participants who exercised and supplemented with fish oil lost more body fat than the group supplementing with sunflower oil. However, neither group increased their lean body mass. Not surprisingly, since walking hardly provides the anabolic stimulus necessary for muscle growth.

The second of the two studies did employ resistance training as the mode of exercise.20 Unfortunately, it was only 4 weeks in duration. Four weeks is enough time too see the effects of strength training in previously untrained subjects, but not enough for minor interventions like omega-3 fatty acids to make a difference.

In any case, twenty-eight young females, randomly assigned to one of three groups followed a resistance training program for four weeks. The first group received no dietary intervention, while the second and third were put on a higher-protein diet and a supplement in the form of omega-3 fatty acids. The third group also added creatine monohydrate to the equation.

All three groups increased their lean body mass and lost body fat as a result of the training. However, there were no additive effects from the omega-3 fatty acids.

Older Adults

If we look at older adults, we have a larger sample of studies to draw conclusions from. Sadly, the ones that don’t have any particular limitation in design are also the ones with null findings.

Let’s take a look at the two studies showing increased muscle mass when omega-3 fatty acids are used in conjuction with resistance training in the elderly first.21 22

Both of these studies are well designed, long-term studies with plenty of participants. They both show that resistance training combined with a healthy diet improves body composition and adds muscle more than resistance training alone. The problem here is actually the healthy diet, as strange as that might sound. The thing is, these two studies didn’t look at the effects of omega-3 fatty acids per se. They altered the ratio of other fatty acids as well, which makes it hard, if not impossible, to single out any effects of the omega-3 fatty acids.

The rest of the studies featuring elderly subjects have failed to find any particular benefits when it comes to muscle mass from the combination of omega-3 and strength training.

Back in 2009, 51 older adults with an average age of 65 years, completed a 12-week resistance-training program while consuming either alpha-linolenic acid (ALA) in the form of flax oil or placebo. Both groups increased their strength, muscle mass, and muscle thickness during the study, but there were no differences in muscle mass between the ALA and placebo groups.23

In 2017, a study examined the effects of long-term fish oil supplementation on strength training adaptations in elderly men and women. This is a strange one. There were no differences in muscle mass, measured as changes in muscle anatomical cross-sectional area, between those who used fish oil supplements and those who did not. That’s not the strange part, though. Neither of the groups experienced any significant increases in muscle mass from the resistance training intervention, which consisted of 2 training sessions per week for 18 weeks. That goes against all other research. It is well established that untrained elderly individuals will respond quite well to regular strength training with increased muscle mass.24

The most recent study, from 2018, randomized eldely men (≥65 years old) into either an omega-3 supplementation group or a placebo group. Both groups performed whole-body resistance training thrice weekly for 12 weeks. During this time, both groups lost significant amounts of body fat, gained strength, and increased their muscle mass. The omega-3 supplementation, however, did nothing to improve the results of that group compared to placebo.25

In summary, most studies that examine the potential effect of omega-3 fatty acids on muscle mass and hypertrophy when used as part of a strength training program are of pretty low quality. In young people, there are also very few of them. This makes it quite hard to draw any valid conclusions. That being said, you probably shouldn’t expect any noticable gains by using an omega-3 supplement.

Effects of Omega-3 on Strength and Physical Function

Can omega-3 supplements help you get stronger? Again, the answer is maybe. However, any effects seem to be most prominent in the elderly, so don’t expect too much before retirement age.

Omega-3 has been associated with improved strength and physical function. The mechanisms behind these effects are not completely known, but we know enough to at least partially explain them.

Our central nervous system contain DHA and EPA, which maintain nerve-cell membranes and increase nerve conduction velocity. Omega-3 fatty acids help improve muscle contractile capacity by increasing synaptic transmission speed, membrane fusion, and neurotransmitter turnover (both uptake and release).

Several studies have examined the effects of omega-3 supplementation in combination with resistance training on strength gains.

Older Adults

In one study, older women supplemented their diet with 2 grams of fish oil a day for 90 days while engaging in strength training 3 times per week. A control group trained the same way, but without any supplement. The fish oil supplement provided about 0.4 grams of EPA and 0.3 grams of DHA per day. The women who supplemented their diet with omega-3 increased both their strength and their functional capacity more than the control group.26

Another study also showed that supplementing with omega-3 might enhance the effects of resistance training on strength gains in the elderly. However, this study also demonstrated that this effect could be more prominent in women than in men.

Fifty elderly men and women participated in a resistance training program, working out twice weekly for 18 weeks. Twenty-three of them supplemented their diet with 3 grams of fish oil per day, while the rest received a placebo. The participants taking fish oil increased their strength, muscle quality and functional capacity more than the ones who received placebo. However, this additive effect was only observed among the women, not the men.27

Another recent randomized controlled trial showed that a diet rich in omega-3 fatty acids enhanced strength gains in elderly women engaging in resistance training over the course of 24 weeks. This study had 3 groups, one that performed strength training without dietary adjustments, one that adjusted their omega-6/omega-3 ratio to “healthy” levels through supplementation, and one control group. The group that improved their diet through omega-3 supplementation improved their strength, peak power, and physical function significantly more than the other groups.28

One study examined the effects of alpha-linolenic acid (ALA) supplementation during a resistance training program. Fifty-one elderly men and women received either flax oil or placebo while participating in a strength training program 3 days a week for 12 weeks. Both groups increased their leg press and chest press strength, their muscle thickness and their lean body mass as a result of the training. Supplementing with ALA had very minor benefits. A somewhat greater increase in knee flexor muscle thickness could be observed in the ALA group, but overall, the effects were minimal.29

Young Adults

As you can see, the studies so far all have older participants. What about young people? Unfortunately, to date, only one study has examined the effects of omega-3 on physical function in young, resistance training individuals.

Twenty-eight females were randomized into 3 groups and completed 4 weeks of strength training. Two of the groups followed a supplement protocol consisting either of 50 grams of whey protein plus 900 mg of omega-3 fatty acids per day or these supplements plus 5 grams of creatine per day. The third group performed the same training program, but without any dietary intervention. Both lean mass and strength increased in all three groups, but neither of the groups who received the omega-3 supplement improved their strength more than the non-supplement group.30

Does Omega-3 Improve Physical Function Even Without Exercise?

Even without strength training as part of the picture, omega-3 fatty acids improve muscle function and strength in the elderly.

Older Adults

Sixty 60 to 85-year old men and women consumed either an omega-3 fatty acid supplement or corn oil in addition to their usual diet over the course of 6 months. Compared to the corn oil group, the participants who received omega-3 improved their isokinetic power, 1RM muscle strength, and increased their thigh muscle volume. Unfortunately, neither diet nor the physical activity of the participants were controlled. This makes it hard to say if the improvements were caused by the fatty acid supplement or a better diet and physical activity in general.31

In another study, 126 postmenopausal women received either fish oil or olive oil every day for six months in addition to their normal diet. The women who consumed fish oil improved their walking speed significantly compared to the olive oil group.32

Yet another study showed that 3 grams per day of DHA and EPA in supplement form improved exercise capacity by 13% compared to pre-study testing in elderly females. A placebo group showed no improvements at all. It is important to note that this study did not control the physical activity of the participants. Again, this makes it very hard to say whether or not the improvements were the result of the supplement or of undocumented physical activity.33

Young Adults

There is only one study examining the effects of omega-3 fatty acids on physical function in young people outside of any strength training intervention. Twenty-six soccer players were randomized to receive either an omega-3 supplement or a placebo supplement during 4 weeks of soccer training. Only the participants of the omega-3 group increased their anaerobic endurance. However, omega-3 supplementation did not affect strength, power or speed assessments.34

In summary, there is some evidence that omega-3 can improve muscle strength in the elderly, both on its own and when used in conjunction with strength training. However, the evidence is not conclusive. In young people, there simply is not enough research available to say anything for sure. The limited data that exist does not support any claims that omega-3 supplements increase strength.

Safety of Omega-3

There are a number of commonly reported side effects from omega-3 supplements. While these might be unpleasant, they are usually harmless. They include nausea, gastrointestinal discomfort, fishy breath, a bad taste in the mouth, diarrhea, headaches, and smelly sweat.

These side-effects can certainly both be uncomfortable and embarrassing, but they don’t actually harm you. They are usually caused by taking too much omega-3. In some instances, like the fishy breath, they can also be the result of old, rancid, or badly produced supplements.

The solution to alleviate or eliminate these symptoms is simple. Reduce the amount of omega-3 you take, or get a new bottle if the ones you have are past their expiration date. Also, avoid no-name, suspiciously cheap products. They might be cheap for a reason and not of the highest quality.

High doses of omega-3 fatty acids over longer periods of time might reduce immune function because of the anti-inflammatory effects. This could happen through a prolonged use of 900 mg per day of EPA plus 600 mg per day of DHA, according to a report from the Institute of Medicine, Food and Nutrition Board.35

In addition, the same report also states that 2 to 15 grams per day of EPA and/or DHA might reduce platelet aggregation, thus increasing the risk of bleeding and bleeding time.

However, according to the European Food Safety Authority, or EFSA, you can combine EPA and DHA supplements up to a total dose of 5 grams per day, long-term, without any safety risks. They state that a daily dose of 5 grams has not been shown to have any negative effects on immune function, lipid peroxidation, or the risk of bleeding.36

Yet another authority, the U.S. Food and Drug Administration (FDA) recommends that you limit your total EPA and DHA combined intake to a maximum of 3 grams. Of this amount, not more than 2 grams should come from supplements.

If you use medications with anticoagulant properties, like Warfarin, you should be aware that omega-3 supplements can interact with them. This could potentially prolong clotting time, which in turn could increase the risks of bleeding. However, a recent review concluded that this risk is not clinically significant, a sentiment that is echoed by the FDA.37

A dose of up to 6 grams of omega-3 fatty acids per day seems to be safe even if you use Warfarin. If you take more than that, you are exceeding general safety recommendations anyway.

In summary, different authorities offer different recommendations. Up to 5 grams daily does not seem to be dangerous, although as mentioned above, you might experience some unpleasant, if harmless, side effects at high doses.

Omega-3 and Inflammation

Inflammations are not inherently bad. When your body’s tissues are threatened or harmed by bacteria, toxins, or some other kind of trauma, the damaged cells release chemicals that cause inflammation. This isolates the harmful substances and prevents them from spreading. In addition, the inflammatory response attracts white blood cells that consume dead and damaged cells. In summary, inflammation is necessary to protect your body from injury. You don’t want to eliminate inflammations.

That being said, chronic systemic inflammation is anything but good. When you have chronic inflammation running rampant in your body without any acute injury or infection, it affects you negatively in a number of ways, including increasing the risk of heart disease and cancer.

When it comes to the regulation of muscle mass, chronic inflammations are something you want to avoid at any cost. They cause muscle proteolysis (breakdown of muscle protein), and especially in the elderly, inflammation is an underlying cause of muscle mass loss.38

Omega-3 fatty acids, in high enough amounts, decrease inflammatory mechanisms and inhibit the production of inflammatory cytokines and eicosanoids.39 40

A number of placebo-controlled trials have demonstrated a significant benefit from fish oil supplementation in chronic inflammatory diseases. Omega-3 might even be an alternative therapeutic method to treat and prevent age-related sarcopenia.41 42 43 44

In young people, acute inflammation as a response to a training session is essential to induce gains in muscle mass. This is not necessarily the case in the elderly. With rising age, low-grade inflammations become more common, and adding an acute inflammatory response on top of that might be too much. Evidence from this comes from the fact that anti-inflammatory medications inhibit muscle growth after resistance training in young people, but actually enhance it in the elderly.45

Especially in the elderly, supplementing with omega-3 fatty acids might be a way to reduce systemic inflammations and limit their negative effects on skeletal muscle mass. There is no real evidence that young, healthy adults will benefit in the same way, seeing as chronic inflammation is less common at a younger age.

Dosage

There are no absolute recommendations on how much omega-3 will fit one and all, but global, generalised recommendations land somewhere around 1 gram of omega-3 fatty acids per day.46

For athletes seeking to counteract exercise-induced inflammation and to maximize health benefits, 1 to 2 grams of EPA and DHA combined, with a ratio of EPA to DHA of 2:1, seem beneficial.47

Most of the studies hinting at benefits from omega-3 supplementation for muscle and strength gains have used dosages ranging from 2 to 4 grams total of EPA and DHA. Seeing as the FDA and EFSA safety recommendations limit omega-3 consumption to 3 to 5 grams per dag, it might be prudent to supplement for a total daily intake somewhere in that interval. This would not only make sure you get any potential benefits from the supplements, but also ensure that you avoid negative side effects.

Conclusion and Recommendations

Are omega-3 supplements worth your money if you only plan on taking them to gain muscle mass and increase your strength? Probably not. There are too many mights and maybes. While there are some promising studies, especially in the elderly, the research is quite equivocal when it comes to hypertrophy, strength, and physical function. If you do get any benefits in the gym from omega-3, they will not be eye-opening or something you can actually notice.

Now, if you add potential health benefits to the equation, the answer might be yes, possibly. Especially if you don’t eat a lot of fatty fish. Food regulatory agencies and organizations will always recommend that you eat more fish instead. Nothing wrong with fish. Fish is an excellent protein source, with plenty of health benefits, and the fatty variants are filled with natural omega-3. Most of us would benefit from increasing our fish intake.

However, what if you don’t want to or can’t eat fish? Then taking a quality omega-3 fatty acid supplement wouldn’t be a bad idea at all. You’d get the recognized positive health effects, and who knows, future research might offer more insight into potential benefits for training adaptions as well.


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References

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