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Omega-3 Fatty Acids

Guidelines
Treatment
Wellness
Risk
Cautions
Dosing
Integrative
Programs
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Information

Omega-3 fatty acids are a type of polyunsaturated fatty acid (PUFA) found naturally in these foods and supplements:

Expand list

The three main omega-3 fatty acids are docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA). DHA and EPA generally show greater benefits in cancer, but are found only in animal sources. ALA from plant sources is converted to DHA and EPA in our bodies, but with a low conversion efficiency. ALA is not recommended as your sole source of omega-3s.²

Clinical Practice Guidelines

2013 evidence-based clinical practice guidelines from the American College of Chest Physicians recommended oral nutritional supplementation with omega-3 fatty acids to improve the nutritional status for lung cancer patients with sarcopenia (loss of muscle tissue).³

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Clinical Evidence

Findings in colorectal cancer:

• A diet rich in omega-3 fatty acids is associated with higher survival⁴
• Improved overall survival in patients undergoing liver resection surgery for colorectal cancer liver metastases taking eicosapentaenoic acid (EPA) supplements⁵
• Lowered the magnitude of inflammatory responses and modulated the immune response in patients undergoing radical colorectal cancer resectionL⁶
• Compared with a placebo, eicosapentaenoic acid (EPA) either with or without aspirin did not reduce the proportion of patients with at least one colorectal adenoma in patients with sporadic colorectal neoplasia.⁷

A group of men with prostate cancer combining omega 3 supplements with a low-fat (15 percent of calories from fat) diet for four to six weeks before prostatectomy was compared to a control group consuming the standard American diet with 40 percent of calories from fat and no fish oil supplementation. At prostatectomy, the group supplement had smaller prostates (both benign and malignant components), lower proliferation index, and plasma that inhibited growth of prostate cancer cells in vitro more than the plasma from the control patients.⁸ Other effects in prostate cancer:

• Decreased prostate cancer proliferation and decreased prostate tissue omega-6:omega-3 ratios, but no change in serum insulin-like growth factor I (IGF-1) in a small study of men undergoing radical prostatectomy⁹
• Some evidence of decreased inflammatory markers in clinical trials¹⁰
• Increased resistance to chemotherapy; not recommended on the days surrounding chemotherapy¹¹

Conflicting interactions with chemotherapy have been reported:

• Improved outcomes with DHA added to chemotherapy in a small trial of metastatic breast cancer patients¹²
• No adverse side effects and possible improved anthracycline-based chemotherapy outcome were found in a small uncontrolled trial of group patients with rapidly progressing visceral metastases.¹³
• Rise in plasma levels after supplementation in healthy volunteers to levels capable of causing chemoresistance to cisplatin in mice; use is not recommended on the days surrounding chemotherapy.¹⁴

Lab and Animal Evidence

Read more

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Results related to patient body weight and composition:

• Omega-3 fatty acid (EPA and DHA) capsules or supplements with EPA have been associated with weight stabilization, gain in lean body mass, and improvement in quality of life markers in patients losing weight as a result of advanced pancreatic and head and neck cancers.²¹
• The weight of patients with gastrointestinal cancer (anal, colorectal, esophageal, stomach) increased significantly with EPA supplementation.²² EPA and DHA ameliorated muscle loss and myosteatosis (the presence of intermuscular and intramuscular adipose tissue) in clinical studies.²³
• In patients with colorectal cancer, EPA supplements increased weight and improved scores of health-related quality of life, with a trend toward fewer interruptions of chemotherapy treatment in a small study.²⁴
• A small study involving cancer patients receiving chemotherapy after surgical tumor (mainly gastrointestinal) removal found that fish oil supplementation reduced weight loss and improved the function of blood neutrophils.²⁵
• Omega-3 supplements improved outcomes, especially body composition, in patients undergoing chemotherapy and/or radiotherapy.²⁶

High-dose EPA inhibited bone resorption in breast cancer survivors taking aromatase inhibitors.²⁷²⁸

Omega-3s reduced paclitaxel-induced peripheral neuropathy in a small clinical study of breast cancer patients.²⁹

Dietary omega-3 fatty acids combined with guarana extract and a diet rich in whole foods, fruits and vegetables can treat cancer-related fatigue in patients with breast cancer.³⁰

Nutritional supplementation with omega-3 fatty acids, arginine and nucleotides resulted in a marked improvement of immune functions in cancer patients undergoing surgery and a reduction in infectious complications, hospital stay and co-morbidities.³¹

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Clinical Evidence

Substantial data support the importance of omega-3 fatty acids for colorectal cancer prevention.³² A decreased risk colon cancer was found, primarily in men, from using fish oil supplements.³³

Higher omega-6 to omega-3 ratios are associated with higher risk of breast cancer,³⁴ while higher consumption of dietary marine omega-3 polyunsaturated fatty acids is associated with a lower risk of breast cancer.³⁵ Higher levels from combined diet and supplements are associated with reduced risks of breast cancer.³⁶ No impact of supplements on breast cancer recurrence and improved overall mortality in patients were found with early stage breast cancer, but marine omega-3s from food were associated with reduced risk of additional breast cancer events and all-cause mortality.³⁷

Higher levels from combined diet and supplements are associated with reduced risks of breast cancer.³⁸ No impact of supplements was found on breast cancer recurrence and improved overall mortality in patients with early stage breast cancer, but marine omega-3s (DHA and EPA) from food were associated with reduced risk of additional breast cancer events and all-cause mortality.³⁹

Data on omega-3 fatty acid supplementation for prostate cancer prevention are inconclusive. A 2017 review of the literature showed no clear relationship between fish-derived omega-3 fatty acids and risk of prostate cancer,⁴⁰ but a separate review found that consumption of omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and "an omega-6/omega-3 ratio of 2-4:1 are associated with a reduced risk of breast, prostate, colon and renal cancers."⁴¹

Lab and Animal Evidence

Read more

Cautions

A few cautions are noted. Please see the Memorial Sloan Kettering Cancer Center’s About Herbs website for information.

• High blood concentrations of omega-3s are associated with increased risk of prostate cancer (see the Foundation for Alternative and Integrative Medicine for an analysis of the study that found this).
• A type of omega-3 fatty acid, 16:4(n-3), can reduce the activity of the chemotherapy drug cisplatin.⁴³
• A 2018 review conclusions:⁴⁴
  • Four grams of supplementation may impair clotting; patients may want to eliminate omega-3 supplements before and immediately after surgery.
  • A few adverse reactions and interactions with prescription and other drugs have been observed.

Dosing

BCCT does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated. Levels of active ingredients of natural products can vary widely between and even within products. See Quality and Sources of Herbs, Supplements and Other Natural Products.

Dosage recommendations are available from these sources:

• Solutions 4 Health:
• Breast Cancer Wellness Plan
• Colorectal Cancer Wellness Plan
• Endometrial Cancer Wellness Plan
• Lung Cancer Wellness Plan
• Prostate Cancer Wellness Plan
• Natural Medicines Database (requires purchase)
• Also see the protocols listed below.

Integrative Programs, Protocols and Medical Systems

• Programs and protocols
• Alschuler & Gazella complementary approaches⁴⁵
• Breast cancer
• Colon cancer
• Lung cancer
• Pancreatic cancer
• Prostate cancer
• Block program⁴⁶
  • Breast cancer case study
  • Lung cancer case study
  • Prostate cancer case study
  • Core diet plan
  • Remission support diet
  • Chemotherapy coupler
  • Radiation therapy coupler
  • Normalizing coagulation
  • Blocking inflammation
  • Blocking tumor-fueling enzymes
  • Boosting immune surveillance
  • Self-care program for stress chemistry and circadian rhythm
• Chang strategies⁴⁷
• Lemole, Mehta & McKee protocols⁴⁸
• Breast cancer
• Colorectal cancer
• Endometrial cancer
• Lung cancer
• Prostate cancer
• MacDonald breast cancer program⁴⁹
• McKinney protocols⁵⁰
  • General cancer
  • Breast cancer
  • Leukemia amd myelodysplastic syndrome
  • Melanoma
  • Prostate cancer
  • Sarcoma
  • Thyroid cancer
  • Depression
  • Fatigue
  • Weight loss
• Traditional systems
  • Ayurveda
  • Traditional Chinese medicine

Written by Nancy Hepp, MS, and reviewed by Laura Pole, RN, MSN, OCNS; most recent update on August 21, 2019. Note: BCCT has not conducted an independent review of research of Omega-3 fatty acids. This summary draws from the Memorial Sloan Kettering Cancer Center’s About Herbs and other sources as noted.

1. WebMD. The Facts on Omega-3 Fatty Acids. Viewed December 1, 2017.
2. Linus Pauling Institute. Essential Fatty Acids. Oregon State University. Viewed May 14, 2019.
3. Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
4. Volpato M, Hull MA. Omega-3 polyunsaturated fatty acids as adjuvant therapy of colorectal cancer. Cancer Metastasis Reviews. 2018 Sep;37(2-3):545-555; Song M, Ou FS et al. Marine omega-3 fatty acid intake and survival of stage III colon cancer according to tumor molecular markers in NCCTG Phase III trial N0147 (Alliance). International Journal of Cancer. 2019 Jul 15;145(2):380-389.
5. Cockbain AJ, Volpato M et al. Anticolorectal cancer activity of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid. Gut. 2014 Nov;63(11):1760-8.
6. iang B, Wang S, Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients. World Journal of Gastroenterology. 2008 Apr 21;14(15):2434-9.
7. Hull MA, Sprange K et al. Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial. Lancet. 2018 Dec 15;392(10164):2583-2594.
8. Abrams DI. An integrative approach to prostate cancer. Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
9. Aronson WJ , Kobayashi N et al. Phase II prospective randomized trial of a low-fat diet with fish oil supplementation in men undergoing radical prostatectomy. Cancer Prevention Research (Phila). 2011 Dec;4(12):2062-71.
10. Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62.
11. Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8.
12. Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62.
13. Bougnoux P, Hajjaji N et al. Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial. British Journal of Cancer. 2009 Dec 15;101(12):1978-85.
14. Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8.
15. Serna-Thomé G, Castro-Eguiluz D et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Revista de Investigación Clínica. 2018;70(3):136-146.
16. VanderSluis L, Mazurak VC, Damaraju S, Field CJ. Determination of the relative efficacy of eicosapentaenoic acid and docosahexaenoic acid for anti-cancer effects in human breast cancer models. International Journal of Moleculat Sciences. 2017 Dec 4;18(12). pii: E2607.
17. Tanaka A, Yamamoto A et al. Polyunsaturated fatty acids induce ovarian cancer cell death through ROS-dependent MAP kinase activation. Biochemical and Biophysical Research Communications. 2017 Nov 4;493(1):468-473.
18. Hopkins MM, Meier KE. Free fatty acid receptor (FFAR) agonists inhibit proliferation of human ovarian cancer cells. Prostaglandins, Leukotrienes and Essential Fatty Acids. 2017 Jul;122:24-29.
19. Wan XH, Fu X, Ababaikeli G. Docosahexaenoic acid induces growth suppression on epithelial ovarian cancer cells more effectively than eicosapentaenoic acid. Nutrition and Cancer. 2016;68(2):320-7.
20. Khadge S, Sharp JG et al. Immune regulation and anti-cancer activity by lipid inflammatory mediators. International Immunopharmacology. 2018 Dec;65:580-592.
21. Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
22. Lavriv DS, Neves PM, Ravasco P. Should omega-3 fatty acids be used for adjuvant treatment of cancer cachexia? Clin Nutr ESPEN. 2018 Jun;25:18-25.
23. Ewaschuk JB, Almasud A, Mazurak VC. Role of n-3 fatty acids in muscle loss and myosteatosis. Applied Physiology, Nutrition, and Metabolism. 2014 Jun;39(6):654-62.
24. Trabal J, Leyes P, Forga M, Maurel J. Potential usefulness of an EPA-enriched nutritional supplement on chemotherapy tolerability in cancer patients without overt malnutrition. Nutricion Hospitalaria. 2010 Sep-Oct;25(5):736-40.
25. Bonatto SJ, Oliveira HH et al. Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids. 2012 Apr;47(4):383-9.
26. de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
27. Hutchins-Wiese HL, Picho K et al. High-dose eicosapentaenoic acid and docosahexaenoic acid supplementation reduces bone resorption in postmenopausal breast cancer survivors on aromatase inhibitors: a pilot study.
28. Nutrition and Cancer. 2014;66(1):68-76.
    
29. Ghoreishi Z, Esfahani A et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled trial. BMC Cancer. 2012 Aug 15;12:355.
30. Pereira PTVT, Reis AD et al. Dietary supplements and fatigue in patients with breast cancer: a systematic review. Breast Cancer Research and Treatment. 2018 Oct;171(3):515-526.
31. Soldati L, Di Renzo L et al. The influence of diet on anti-cancer immune responsiveness. Journal of Translational Medicine. 2018 Mar 20;16(1):75; Adiamah A, Skořepa P, Weimann A, Lobo DN. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Annals of Surgery. 2019 Feb 26.
32. Song M, Chan AT. Environmental factors, gut microbiota, and colorectal cancer prevention. Clinical Gastroenterology and Hepatology. 2019 Jan;17(2):275-289.
33. Kantor ED, Lampe JW, Peters U, Vaughan TL, White E. Long-chain omega-3 polyunsaturated fatty acid intake and risk of colorectal cancer. Nutrition and Cancer. 2014;66(4):716-27.
34. Serna-Thomé G, Castro-Eguiluz D et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Revista de Investigacion Clinica. 2018;70(3):136-146.
35. Zheng JS, Hu XJ, Zhao YM, Yang J, Li D. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies. BMJ. 2013 Jun 27;346:f3706.
36. Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62.
37. Patterson RE, Flatt SW et al. Marine fatty acid intake is associated with breast cancer prognosis. Journal of Nutrition. 2011 Feb;141(2):201-6.
38. Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62.
39. Patterson RE, Flatt SW et al. Marine fatty acid intake is associated with breast cancer prognosis. Journal of Nutrition. 2011 Feb;141(2):201-6.
40. Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62.
41. Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine. 2017 Dec;6(1):25.
42. Serna-Thomé G, Castro-Eguiluz D et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Revista de Investigacion Clinica. 2018;70(3):136-146.
43. Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8.
44. Abrams D. An integrative approach to prostate cancer. The Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
45. Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
46. Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
47. Chang R. Beyond the Magic Bullet: The Anti-Cancer Cocktail. New York: Square One Publishers. 2012.
48. Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
49. MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. (self-published, Amazon, 2016).
50. McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.

View All References

More Information

• Memorial Sloan Kettering Cancer Center’s About Herbs website: Omega-3
• Deng G, Gubili J. Omega-3 Fatty Acids. ASCO Post. March 10, 2019.
• American Institute for Cancer Research website: more than 100 articles and scientific reports on omega-3 fatty acids and cancer
• TRC Natural Medicines website (subscription is required): in-depth information, ratings of effectiveness and safety and evaluation of specific omega-3 fatty acid products   
• Consumer Labs: Product Review (subscription required): Fish Oil and Omega-3 and -7 Fatty Acids Supplement Review
• Moss Reports (purchase required): Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.
• Harvard Health Publishing: Should you be taking an omega-3 supplement?
• Linus Pauling Institute, Oregon State University: Essential Fatty Acids
• Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
• Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
• Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
• Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
• Lone Star Medical Group: Natural Alternative Treatments
• National Cancer Institute: Office of Cancer Complementary and Alternative Medicine
• Ted Schettler, MD, MPH: The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing
• Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
• Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
• Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
• Keith Block and others: A Broad-Spectrum Integrative Design for Cancer Prevention and Therapy
• Block KI, Block PB, Gyllenhaal C: Integrative Treatment for Colorectal Cancer