COVID-19 is wreaking havoc on our immune systems. A healthy immune system is supported by a diet that provides the necessary nutrition and limits what is detrimental. Exercise, good sleep and decreasing stress are all also important for a well-functioning immune system. This information is not new but it seems to hold more weight these days.
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In this blog, we are going to discuss the rapidly evolving research developments with regards to treating COVID-19 symptoms with omega-3s, as well as recommendations and trends regarding omega-3s supporting immune health.
Companies Initiating Omega-3/COVID-19 Research
There’s been a lot of news lately on the potential relationship between omega-3s EPA and DHA and COVID-19. But before we talk about how omega-3s relate to COVID-19, it is important to point out that this research in very much in its infancy and can only be considered interesting at this stage.
Most recently, German omega-3 company, KD Pharma, initiated a clinical trial to examine the effects of its drug, EPAspire, in COVID-positive patients in the early stages of the illness. The Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK has approved the trial and late-stage discussions are ongoing with authorities in other European countries. Additionally, an application has been submitted to the FDA in the US. It is expected that the first patients in the trial will be enrolled shortly and additional hospital sites are being recruited for the trial.
Eligible patients with a positive COVID-19 test result will be able to participate in the trial and, after enrollment, will be given the product within a day of hospitalization and continue treatment for one month with a two-week follow-up. They will be monitored for progression to more serious outcomes and markers of inflammation, with the aim that EPAspire could help reduce the risk of mortality in severely ill patients.
Also, Iceland-based Kerecis and the National Hospital of Iceland are conducting a randomized, controlled, double-blind clinical study to evaluate the effectiveness of the Kerecis Omega3 Viruxide system on COVID-19 patients. The trial follows successful off-label use on Italian patients with COVID-19 symptoms.
Omega3 Viruxide is a virucidal and bactericidal system used in the Kerecis Primary Wound Spray, which has been on the market for several years in multiple countries. Among other benefits, the product helps control infections. Recognizing this benefit, Italian doctors are using the product off-label to spray into the oral and nasal cavities of patients believed to have early onset of COVID-19, for the purpose of preventing the progression of the disease.
“I have been using the spray to treat wounds for years here in Italy and have been impressed with its ability to protect wounds from infections. We were confronted by the lack of therapeutic solutions to treat COVID-19 and were inspired to use the spray. Our observations after treating more than 70 patients are very promising,” said Professor Giuseppe Noschese, M.D., who is Acting President of the International Disaster Medicine Association, Scientific Consultant to the Italian Navy in Naples, Coordinator of the Trauma Center Unit at Ospedale Del Mare in Naples and the COVID-19 task force leader.
Omega-3s & ARDS Studies
One of the most serious symptoms of COVID-19 is Acute Respiratory Distress Syndrome (ARDS), which is what requires people to be put on ventilators or oxygen to survive. Adding omega-3s to a “tube-feeding” diet have been tested in ARDS patients with mixed, but potentially positive, results.
A 2014 meta-analysis that included data from seven randomized controlled trials (RCTs) concluded, “Among patients with ARDS, enteral supplementation of omega-3 fatty acids seemed ineffective regarding all-cause 28-day mortality, ventilator-free days, and ICU-free days. Routine use of enteral n-3 FA cannot be recommended based on the available evidence.”
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A more recent meta-analysis of 12 RCTs on omega-3 and ARDS was more encouraging. Here is the conclusion: “In critically ill patients with ARDS, omega-3 PUFAs in enteral immunomodulatory diets may be associated with an improvement in early and late PaO2-to-FiO2 ratio*, and statistical trends exist for an improved ICU length of stay and mechanical ventilation duration. Considering these results, administering omega-3 fatty acids appears a reasonable strategy in ARDS.”
*PaO2-to-FiO2 ratio is the arterial pressure of oxygen divided by the inspired fraction of oxygen and is the preferred tool to quantify the severity of the ARDS.
Are Omega-3s In General Recommended for ‘Immune Health’?
In March, top researchers in the field of nutrition and immunology provided guidance on how nutrition could play a significant role during the pandemic of COVID-19. Their main suggestions were:
1) supplementation with certain micronutrients [such as vitamins A, B6, B12, C, D, E, folate, zinc, iron, selenium, magnesium, and copper] and omega-3 fatty acids is a safe, effective and low-cost strategy to help support optimal immune support.
2) Supplementation above the Recommended Daily Allowance (RDA) but within recommended upper safety limits, for specific nutrients such as vitamins C and D is warranted.
3) Public health offices are encouraged to include nutritional strategies in their recommendations to improve public health.
Their specific recommendation for omega-3 fatty acids was 250 mg per day as per international guidelines. Our recommendation would be to eat a diet with enough EPA and DHA to reach and maintain an Omega-3 Index of between 8-12%. (For guidance on dosage, please use our Calculator).
PODCAST: Optimal Nutritional Status for a Well-Functioning Immune System as an Important Factor to Protect Against Viral Infections
A review published earlier this year examined data representing the research on prominent intervention agents such as omega-3 fatty acids, micronutrients (zinc, vitamins D and E), and functional foods including probiotics and tea components (in particular epigallocatechin gallate) for their immunological effects, working mechanisms, and clinical relevance.
The researchers said many of these nutritive and non-nutritive food components are related in their functions to maintain or improve immune function including inhibition of pro-inflammatory mediators, promotion of anti-inflammatory functions, modulation of cell-mediated immunity, alteration of antigen-presenting cell functions, and communication between the innate and adaptive immune systems.
They concluded that while both animal and human studies have presented promising findings suggesting a clinical benefit of vitamin D, omega-3s and EGCG in chronic inflammatory conditions, omega-3s and EGCG in autoimmune disorders, and vitamin D, vitamin E, zinc and probiotics in protection against infection. “However, the discrepancy in results from many studies adds the challenge and complexity of nutritional immunology research; as the result, there is no clear consensus at this time regarding the clinical relevance of these dietary components,” they said.
Further, particularly for zinc, vitamin E, omega-3s and probiotics, clearly there is need to establish the optimal doses for maximum clinical benefits, which may likely differ depending on the age, genetic background, and nutritional and health status of the population of study.
People Are Increasing Their Supplement Use During COVID-19
People tend to take stock of their health and create their own nutrition strategies as a means to weather the storm of cold and flu season. But these are not ordinary times and this was no ordinary cold and flu season. Since the emergence of the COVID-19 pandemic, there has been a relative stampede for immune support products, as well as those that support general wellness like vitamins and minerals, herbs and botanicals, and omega-3 fatty acids.
In times similar to COVID-19, such as the economic downturn of 2007-09, nutritional supplements and health products faired very well. Some of the standouts during that period were vitamin D, probiotics, melatonin, fish oil and sports nutrition powders. Omega-3s in particular grew an average of 23% back then. And now, forecasters believe we’re riding a similar wave.
A survey of 1000 U.S. consumers fielded March 30, 2020 showed that 36% of consumers reported their use of supplements had increased compared to the previous month. This isn’t surprising, according to Nutrition Business Journal, which conducted the survey, as it coincides with record sales of immunity supplements throughout February and March.
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However, according to Claire Morton Reynolds, an analyst with Nutrition Business Journal, the more telling number is the 39% of consumers who expect to increase their supplement use three months from now, signaling a potential halo effect for supplements beyond the immunity category. And Perhaps most notably, she said, 20% of consumers who “never” use supplements reported an expected increase in supplement usage in three months, indicating that the health threat is bringing in new consumers.
“It will be interesting to see if the overall percentage of users grows with some permanence,” said Morton Reynolds, predicting that immunity supplement sales will grow 25% this year.
Testing your Omega-3 Index is the only way to know if you are getting enough EPA+DHA for your needs and getting what you want out of your supplements.