Capsules - Omega 3 Information
"You are what you eat!"
Much has been said and written about how changing diets
in developed countries over recent decades are having
a significant impact on health. Two recent reports 1
have focused on how diet may affect mental health but
there are implications too for cardiovascular disease,
rheumatoid arthritis, inflammatory bowel disease and
a range of cancers, including bowel cancer.
One aspect of diet that receives particular attention
is the consequence of reduced consumption of oily fish.
Why is that important? Oily fish contain particular
types of fat, called long chain polyunsaturated fatty
acids (PUFAs) that are essential to good health. They
are essential because they playa key role in metabolism
but cannot be made readily by the body and so must be
consumed in as part of the diet. They originate in the
plankton which fish ingest and are retained in various
organs. Oily fish such as mackerel, herring, sardines
and salmon contain the highest amounts. These PUFAs
include the so-called omega-3 fatty acids, such as eicosapentaenoic
acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic
acid (DHA). Many diets have adequate or even excess
amounts of the omega-6 group of PUFAs but are deficient
in the omega-3 group.
There is mounting evidence to suggest that omega-3 PUFAs,
in particular EPA, can prevent the promotion and progression
of certain cancers. These effects are believed to result
from changes in the immune response, changes in metabolism,
cell growth and differentiation and in apoptosis. Apoptosis
is a normal physiological process of programmed cell
death and is important in maintaining normal levels
of healthy cells, for example those in the mucosa lining
Bowel cancer is thought to develop as a result of an
imbalance between the production of new cells and programmed
cell death in the lining of the gut. This leads to the
formation of polyps (small growths projecting into the
gut) and an increased likelihood of cells having faulty
DNA. Some of these polyps may then develop into cancer.
A number of studies have shown that supplementing the
diet with fish oil can redress this imbalance in patients
with occasional (sporadic) polyps, who have an increased
risk of bowel cancer compared to the general population.
Government bodies are keen to encourage greater consumption
of oily fish to increase the intake of omega-3 PUFAs
but we are advised also to limit the amount to about
two portions per week. The reason for these mixed messages
is that, whilst fish are good at accumulating the essential
PUFAs, they also accumulate potentially harmful environmental
pollutants such as pesticides, dioxins and heavy metals
such as mercury.
How can we resolve the dilemma of increasing the intake
of essential omega-3 PUFAs and concerns over environmental
contaminants in fish? There is increasing interest in
supplementing the diet with fish oils. However, many
of these contain mixtures of PUFAs and care must be
taken to ensure that the contaminants are removed. Also,
as mixtures of fatty acids, it is necessary to take
large numbers of capsules in order to absorb sufficient
amounts of the important PUFAs such as EPA in order
to make a difference.
S.L.A. Pharma AG is addressing these problems by developing
a pure form of EPA (ALFA). This is extracted from high
quality fish oils and contains 99% EPA which is converted
to the free fatty acid. This free fatty acid is very
much more readily absorbed than the naturally-occurring
forms (ethyl ester or triglyceride) found in most fish
oil supplements. Furthermore, it contains very low levels
of environmental contaminants. It is taken in specially
designed capsules which release their contents
in the small intestine, avoiding the fishy aftertaste
and abdominal discomfort experienced with some fish
S.L.A. Pharma is currently investigating the potential
benefits of ALFA in patients with sporadic polyps. In
a recent study in patients with a history of sporadic
polyps, EPA 99% taken for a period of 3 months produced
marked reductions in cell proliferation and an increase
in apoptosis in the lining of the colon2. This effect
would be expected to reduce the likelihood of formation
of polyps (and hence cancer) in the large bowel. Importantly,
this response was achieved with ALFA in 3 months. This
contrasts with results from a similar study in Japan
in which a mixture of EPA and DHA, taken as 8 capsules
per day for 2 years, caused an increase in apoptosis
after 24 months but not after 12 months3. This suggests
that ALFA may have a much more rapid effect.
The next steps will be to find the optimal dose to produce
these changes and then to see whether ALFA reduces the
development of polyps in patients with Familial Adenomatous
Polyposis (FAP). Given the large numbers of polyps that
form in gastrointestinal tract in this condition there
is a well recognised high risk of developing bowel cancer.
Whilst colectomy remains the most effective preventative
measure, any additional intervention that prevents or
reduces the rate of development of polyps would be welcome.
Readers may be familiar with the group of drugs called
COX-2 inhibitors, such as celecoxib and rofecoxib, which
showed considerable promise in preventing the development
of polyps in patients with FAP. Unfortunately, they
were found subsequently to be associated with an increased
risk of heart problems and so their use is now restricted.
EPA 99% offers the possibility of achieving similar
benefits but with a greatly reduced risk of undesirable
effects in patients at risk of bowel cancer and we await
the outcome of further clinical trials with interest.
1 Feeding Minds - the impact of food on mental health
(The Mental Health Foundation; January 2006) Changing
Diets, Changing Minds: how food affects mental well
being and behaviour (Sustain; January 2006).
2 Courtney, Matthews, Finalyson,
di Pierro, Belluzzi, Roda, Kang & Leicester (submitted
3 Cheng, Ogawa, Kuriki
et a/., (2003) Cancer Letters; 193:17-24.