Historically, research investigating female-specific nutrition strategies to maximize physical performance and recovery is limited. Yet, with the significant expansion of women in professional sports since the 1990s following the formation of the WNBA and the iconic U.S. Soccer Women’s World Cup triumph, global interest and participation in women’s sports continues to rise, calling for more peer-reviewed research and evidence-based performance recommendations.
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Omega-3 fatty acids have also gained popularity recently for their numerous health and performance benefits. Do these benefits apply to the female athlete?
Omega-3s in Review
Omega-3 polyunsaturated fatty acids (PUFAs) have unique structural, signaling, and anti-inflammatory properties. The most well-known omega-3s are alpha-linoleic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). ALA is a plant-derived PUFA, which acts as a precursor for EPA and DHA. However, endogenously synthesizing EPA and DHA from ALA is limited in humans, with <10% of ALA being converted to DHA.
Therefore, EPA and DHA are considered essential and should be obtained directly through food or supplement sources. DHA and EPA are found primarily in marine food sources, including fatty fish and other seafood (salmon, mackerel, tuna, herring, and sardines) and marine microalgae.
Interestingly, no Recommended Dietary Allowance (RDA) guidelines for omega-3 fatty acids have been established. However, several professional organizations have published their recommendations, such as the Academy of Nutrition and Dietetics, which recommends 500 mg of EPA + DHA daily. Similarly, the European Food Safety Agency (EFSA) advises between 250-500 mg daily or ~2 servings of oily fish per week, whereas the Institute of Medicine recommends a bit more at 1.2 g of EPA + DHA per day.
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While monitoring the dietary intake of omega-3s is a good place to start, the actual omega-3 status of an individual is best gauged through blood analysis represented by the Omega-3 Index. TheOmega-3 Index measures the EPA and DHA as a percentage of total fatty acids in the red blood cell membranes.
Omega-3 Index recommendations are based on coronary heart disease (CHD) literature. Reports have also published recommendations for the Omega-3 Index after concluding that an Omega-3 Index of less than 4% indicates high risk, 4-8% is moderate risk, and 8% or higher is low risk. Therefore, the recommendation for both athletes and the general population is to achieve an optimal Omega-3 Index of 8% or higher.
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Female Athletes and Omega-3 Levels: Overview of Current Studies
Previous research conducted on a global scale has identified that <20% of people of both sexes achieve the recommended daily intake of >250 mg of EPA + DHA daily. But collegiate and professional athletes must be different, right? Not in this case.
A look at the recent evidence reveals that the majority of female (and male) athletes present with suboptimal Omega-3 Index levels. For example, a 2020 study assessed athletes from nine NCAA Division I institutions throughout the U.S., including over 1,500 participants, 49% of which were female. Every athlete completed a food frequency questionnaire to assess omega-3 intake, and the Omega-3 Index was evaluated in 229 of the participants, 45% of whom were female.
The researchers found that only 6% of athletes met the Academy of Nutrition and Dietetics recommendation of consuming 500 mg of EPA and DHA daily. Furthermore, the Omega-3 Index average was 4.33%, with no participants meeting the 8% benchmark.
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Another study published in 2021 that examined dietary omega-3 intake and Omega-3 Index in elite male and female Canadian Rugby players found that the average score was 4.54%, which only slightly increased when the supplemented athletes were separated out (4.82%).
Furthermore, the researchers determined that dietary intake in the non-supplemented athletes did not meet daily dietary recommendations and that despite supplementation, the Omega-3 Index score remained in the high-risk category in a proportion of athletes (even though they were meeting recommended intakes). This outcome suggests that athletes may require more than the current recommendations to increase Omega-3 Index to desirable levels.
Even more recently, a 2023 study from Ireland was the first to combine omega-3 dietary and blood FA analyses with perceived barriers in elite female athletes. The researchers assessed 35 elite international-level female athletes participating in team-based sports. The study was a cross-sectional, observational study where the participants were asked to complete an online questionnaire and provide dried whole blood samples for v analysis. The researchers concluded that elite-level, team-based female athletes do not meet current dietary omega-3 intake guidelines and no athletes reached the current Omega-3 Index target of 8%.
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Factors Influencing Omega-3 Status in Female Athletes
Numerous factors contribute to variability in the Omega-3 Index, including sex, age, body weight, and training status. However, dietary intake, specifically of EPA and DHA, is the most direct way to influence omega-3 levels.
The 2023 study of elite female athletes found that only 8 of 35 female athletes met the EFSA guidelines for a combined intake of EPA and DHA >250 mg. Yet, the athletes who consumed more than 2 servings of fish and seafood per week and/or took supplements had a significantly greater Omega-3 Index than those who consumed less than 2 servings of fish and seafood per week and/or did not consume a supplement. This demonstrates that increased intake of EPA and DHA does increase Omega-3 Index. Still, athletes may require amounts greater than current recommendations to meet target Omega-3 Index levels.
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Similarly, a 2017 study evaluated the Omega-3 Index response to supplemental EPA and DHA intake in elite athletes of both sexes. Twenty-four athletes were randomized into two groups and provided either 2 grams or 3 grams EPA and DHA per day for four months and were compared to a control group of athletes and training staff. At the end of 4 months, supplementation with omega-3s increased the Omega-3 Index in a dose-dependent manner.
However, the Omega-3 Index was still below the desired 8% target in over 93% of the athletes. Other studies have demonstrated improved omega-3 status with increased EPA and DHA intake, displaying that every additional weekly serving of fish or seafood is associated with an absolute Omega-3 Index increase of 0.27%. Most experts believe more research on the athletic population is required to determine optimal intake levels to hit optimal Omega-3 Index recommendations.
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Another critical aspect of the 2023 study on female athletes was the revelation of perceived barriers to omega-3 intake in the population, which included sensory (42%), cooking skills (38%), and lack of knowledge of health and performance benefits (27%). Considering the main barrier reported refers to the taste or smell of fish, the recommendation to increase fish and seafood intake would not be effective, and alternatives must be considered. In these cases, supplementation could support increased omega-3 intake.
Unfortunately, skepticism over supplement quality and safety is often reported in athletic populations due to stringent anti-doping regulations in sports. Therefore, comprehensive education around cooking, safe supplementation, and omega-3 health and performance benefits may be required to increase female athlete acceptance of omega-3 recommendations.
Benefits of Optimal Omega-3 Intake for Female Athletes
Because they are integral components of cell membrane phospholipids, the benefits of EPA and DHA span wide, ranging from the development, plasticity, and functionality of the central nervous system to the treatment and prevention of inflammatory chronic conditions.
Regarding physical performance outcomes, collective omega-3 literature provides evidence that higher omega-3 intake may positively affect cognitive functions, physical performance, and management of exercise-induced muscle damage.
Some specific performance-based outcomes demonstrated in healthy athletes with omega-3 supplementation include improved neuromuscular function, muscle activation, complex reaction time, and reduced muscular fatigue.
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Furthermore, studies in amateur athletes reported improved endurance capacity, delayed onset of muscle soreness, and improvements in markers related to enhanced recovery and immune modulation. Omega-3 fatty acids have also been identified as a potential therapeutic aid for the recovery from mild traumatic brain injury (TBI), a topic of concern in sports around the globe.
Additionally, more specifically in the female athlete population, higher omega-3 intake has been linked to reduced severity of premenstrual syndrome symptoms, improved response to inflammation following exercise, and reduced symptoms of depression and anxiety.
Summary
Current evidence suggests that female athletes of all levels are under-consuming omega-3 fatty acids. Furthermore, barriers to optimal omega-3 intake have been identified and reported in the literature, including sensory challenges, lack of cooking skills, lack of education, and distrust of supplements in general.
Although more research is required, evidence to date has identified several potential performance benefits for female athletes who consume adequate amounts of EPA and DHA, such as improvements in neuromuscular function, muscle activation, complex reaction time, immune response, and muscle recovery after exercise.
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To maximize the intake of omega-3s in female athlete populations, perceived barriers must be individually overcome, likely through increased education and exposure.
Omega-3 supplementation is a good alternative for those who struggle with the smell or taste of seafood, and female athletes should be educated on supplementation variables such as dose, duration, baseline Omega-3 Index, training status, omega-3 form, and omega-3 composition. This article can provide more information on how to choose the proper omega-3 supplement for your needs.
