For Protection Against Liver Disease, Some Omega-3 Oils Are Better Than Others

Article Date: 08 Feb 2013 - 0:00 PST

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Research at Oregon State University has found that one particular omega-3 fatty acid has a powerful effect in preventing liver inflammation and fibrosis - common problems that are steadily rising along with the number of Americans who are overweight.

The American Liver Foundation has estimated that about 25 percent of the nation's population, and 75 percent of those who are obese, have nonalcoholic fatty liver disease. This early-stage health condition can sometimes progress to more serious, even fatal diseases, including nonalcoholic steatohepatitis, or NASH, as well as cirrhosis and liver cancer.

The study, published online in the Journal of Nutrition, was one of the first to directly compare the effects of two of the omega-3 fatty acids often cited for their nutritional value, DHA and EPA.

In research with laboratory animals, it found that EPA had comparatively little effect on preventing the fibrosis, or scarring, that's associated with NASH. However, DHA supplementation reduced the proteins involved in liver fibrosis by more than 65 percent.

"A reduction of that magnitude in the actual scarring and damage to the liver is very important," said Donald Jump, a principal investigator with the Linus Pauling Institute at OSU and a professor in the College of Public Health and Human Sciences.

"Many clinical trials are being done with omega-3 fatty acids related to liver disease," Jump said. "Our studies may represent the first to specifically compare the capacity of EPA versus DHA to prevent NASH. It appears that DHA, which can also be converted to EPA in the human body, is one of the most valuable for this purpose."

The issues have taken center stage as the weight of Americans continues to rise, with a related increase in the incidence of fatty liver disease and liver damage.

NASH is a progressive form of liver disease that is associated with chronic inflammation and oxidative stress, resulting from excess fat storage in the liver. Chronic inflammation can eventually lead to fibrosis, cirrhosis, or even liver cancer. While management of lifestyle, including weight loss and exercise, is one approach to control the onset and progression of fatty liver disease, other approaches are needed to prevent and treat it.

About 30-40 percent of people with nonalcoholic fatty liver disease progress to NASH, which in turn can result in cirrhosis, a major risk factor for liver cancer. While this research studied the prevention of fatty liver disease, Jump said, ongoing studies are examining the capacity of DHA to be used in NASH therapy.

The levels of omega-3 oils needed vary with the health concern, officials say.

"Omega-3 fatty acids are typically recommended for the prevention of cardiovascular disease," Jump said. "Recommended intake levels of omega-3 fatty acids in humans for disease prevention are around 200-500 milligrams of combined DHA and EPA per day."

Levels used in therapy to lower blood triglycerides, also a risk factor for cardiovascular disease, are higher, about 2-4 grams of combined EPA and DHA per day. The OSU studies with mice used DHA at levels comparable to the triglyceride therapies.

"DHA was more effective than EPA at attenuating inflammation, oxidative stress, fibrosis and hepatic damage," the researchers wrote in their conclusion. "Based on these results, DHA may be a more attractive dietary supplement than EPA for the prevention and potential treatment of NASH in obese humans."

http://www.medicalnewstoday.com/releases/255960.php

[stef2011]

thank you so much for your post, we have a research that finally indicates doses for liver which are about 2-4g, i already used these high dosages.most products on the market have no such doses, i have found only two with such high doses

puritans "one per day formula", i take 3 pills per day, they contain EPA 625mg and DHA 244mg.3 pills equal epa 1.87g dha 0.7g about 2,6g daily.180pills 25usd and 450pills 50usd

this is expensive but has the highest epa dha content, only in liquid form:
5ml, epa 1.8g dha 0.9g equal to 2.7g.the cost is 35€ (47usd) and once open it must be consumed by about 30-40days and kept in fridge

please post if you find better products, of course these oils must be purified from metals

[aberdeen577]

Hello Stef, hope you are keeping well. I have been taking the Italian long life fish oil for about 6 months now and have just ordered more. Very encouraging to read this and all of us HBVers should really be taking this especially those like me who have fibrosis with a fs reading of 8.7kpa. Btw, u go back to doctor in London at end of march to have hbs checked again to see if it has dropped below 12.80 iu/ml. Will ask about trial of tdf and ifn in uk when i am there.

[stef2011]

if your hbsag is so low as 12.8iu/ml you alreadyhave an immune response going on and tdf add on will probably make it weaker in your case, so i d go for peginterferon possibly plus ezetimibe or nitazoxanide but even peg alone will clear in your case

only if your hbvdna is very high tdf add on makes sense, otherwise go for peg intf alone

[Rome70]

Is it a good idea to add  polyenylphosphatidylcholine (EPA, DHA) as supplements when on INF treatment or when hbsag goes down on alt flare?

Can not find any research on it.  Only found that it normalize alt but no info on what it does with hbsag.

Alt reduction only is not a goal isnt it?

[stef2011]

i think not, during a flare you need inflammation

Alt reduction only is not a goal isnt it?

no, alt normalization is a goal only after hbsag und or in case of severe liver damage, the aim of damaged liver/cirrotic livers is reduce damage to zero

[Rome70]

Found a study on Omega-3 and HCC

Consumption of n-3 fatty acids and fish reduces risk of hepatocellular carcinoma.

Abstract
BACKGROUND

Fish is a rich source of n-3 polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA). Although consumption of fish and n-3 PUFA has been reported to protect against the development of some types of cancer, little is known about its association with hepatocellular carcinoma (HCC).
METHODS:

We investigated the association between fish and n-3 PUFA consumption and HCC incidence (n = 398) in a population-based prospective cohort study of 90,296 Japanese subjects (aged, 45-74 y). Hazard ratios and 95% confidence intervals (CIs) for the highest vs the lowest quintile were estimated from multivariable adjusted Cox proportional hazards regression models. We also conducted subanalyses of subjects with known hepatitis B virus (HBV) or hepatitis C virus (HCV) status, and of subjects who were anti-HCV and/or hepatitis B surface antigen positive. All tests of statistical significance were 2-sided.
RESULTS:

Among all subjects, consumption of n-3 PUFA-rich fish and individual n-3 PUFAs was associated inversely with HCC, in a dose-dependent manner. Hazard ratios for the highest vs lowest quintiles were 0.64 (95% CI, 0.42-0.96) for n-3 PUFA-rich fish, 0.56 (95% CI, 0.36-0.85) for EPA, 0.64 (95% CI, 0.41-0.98) for DPA, and 0.56 (95% CI, 0.35-0.87) for DHA. These inverse associations were similar irrespective of HCV or HBV status.
CONCLUSIONS:

Consumption of n-3 PUFA-rich fish or n-3 PUFAs, particularly EPA, DPA, and DHA, appears to protect against the development of HCC, even among subjects with HBV and/or HCV infection.

[Rome70]

there is another study that confirms effectiveness of EPA, DHA against HCC

Hepatocellular Carcinoma and Other Liver Diseases Among Greenlanders Chronically Infected With Hepatitis B Virus: A Population-Based Study

http://jnci.oxfordjournals.org/content/early/2012/08/21/jnci.djs361.extract#

Cannot copy from there.

[Rome70]

Blackadar raises the question whether high intake of marine products containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may partly explain the low incidence rate of hepatocellular carcinoma (HCC) found among HBsAg-positive individuals in our population-based cohort study in Greenland.

Although EPA and DHA appear to have protective effects against cardiovascular disease (1), firm evidence of protective effects against cancer is lacking (2). Conflicting results have been published on the association between n-3-fatty acids and HBV/HCC. However, recently Sawada et al. concluded that consumption of n-3 fatty acids (in particular, EPA, docosapentaenoic acid [DPA].....

[lema2210]

Hi Stef,

Can you confirm this is the product you are refering to?

Puritan's Pride
One Per Day Fish Oil 1360 mg
950 mg / 90 Softgels

http://www.puritan.com/fish-oils-056/one-per-day-fish-oil-1360-mg-032948

Or if you know other brands that are more effective that you can recomend.

Thanks a lot

[aberdeen577]

This is what I use, very high in EPA and dha.
http://www.pho.it/popup.asp?prodottoID=202

[aberdeen577]

Stef, do you know is high EPA and dha can actually regress fibrosis?

[stef2011]

yes it is, it is the only puritan with dha and epa quantity with enough quantity for us but you have to take 3 pills per day to reach enough

[stef2011]

i can t say it  regresses fibrosis but i think all these supplements do help.the results of several studies indicate:
effect fatty liver, cardiovascular health, sugars/lipids so this can also reflect on less fibrosis development