Omega 3 for Dry Eyes, Blepharitis and MGD with Dr. Alice Epitropoulos

Omega-3 is an essential fatty acid that has been a topic of conversation in the dry eye space for the last few years. Many eye care practitioners recognize the importance of taking omega-3s, but there has recently been a study (the DREAM study) stating that there was no benefit to taking it. However, most of the peer reviewed research out there does indicate a benefit to taking omega-3s, not only for dry eye disease but also for cardiovascular health and improvement of cholesterol, triglycerides, joints and other muscular disorders. Recently, the American Heart Association came out with a report showing that the risk of cardiovascular events was reduced by about 25% when taking omega-3s.

Fish oil is just that. It is oil extracted from fish, but not just any fish. It is extracted from fatty fish such as mackerel, tuna, anchovies and sardines. The fish don't actually make the oil themselves, they absorb the oil from other fish who get it from algae and plankton. The oil thus goes up the food chain and is found in large quantities in fish that are higher on the food chain. The oil can be received directly from fresh fish that contain oil, but the freshness is necessary. If the fish is not fresh, then the quantity and quality of the oil that it has diminishes and thus is not as beneficial as it would be. That's where supplements come in.

Supplements are useful for a variety of reasons. The first being that it can be hard to get the quantity of fish oil in such a high dose with just one meal. It requires eating fatty fish at least twice a week to give you the recommended dosage of fish oil, which can be exhausting both palate and pocket wise. There is also the fact that there are a lot of people that cannot stand seafood. Lobster and clams are one thing, but eating fish twice a week can be off-putting for many. That's why people prefer to use supplements. All it takes is a few pills per day, and you can get the recommended daily dosage in a matter of seconds.

There are, of course, different dosage amount recommendations depending on your weight, age, gender, etc. but we'll get into that a little later. Let's first discuss what fish oil actually contains and why it is healthy. Fish oil contains two types of omega-3 fatty acids that are helpful for the human body. The first is an acid known as Eicosapentaenoic acid, or EPA for short. The second is docosahexaenoic acid, known as DHA. Both of these fatty acids are linked to reducing inflammation in the human body and are the reason why fish oil is one of the most popular supplements on the market. You might be thinking to yourself that Omega-3 fatty acids aren't only found in fish, they can be found in plants as well. That is true, but the varieties found in plant matter have been shown to be less effective than those found in fish because they must be converted by the body into the correct form.

EPA and DHA are not only linked to reducing inflammation throughout the body, but they also help with a condition known as hypertriglyceridemia, which may sound really complicated, but it’s essentially when the quantity of fatty molecules in the blood reaches extremely high quantities, quantities that are dangerous to the human body.

This condition is often the reason why people face cardiovascular diseases, and it can easily prove to be fatal. That’s why this supplement is so important, because it can actually help prevent heart disease and fatal heart conditions that are caused because of the following reasons:

• Overeating
• Obesity
• Kidney Failure
• Excess Alcohol Consumption
• Diabetes

There are other, rarer causes of heart disease which are genetic in nature which can also be alleviated through the intake of EPA and DHA. But that’s not all that these two can help with. There is so much more that fish oil is useful for. 

Blood Pressure

DHA lends support for blood flow and also improves endothelial function. This contributes to the ability of your blood vessels to dilate.

A review of 20 studies revealed that DHA and EPA do help lower blood pressure. However, the rates at which they do so may differ. DHA reduced diastolic blood pressure at an average of 3.1 mmHg. EPA, on the other hand, reduced systolic blood pressure at an average of 3.8 mmHg.

Fish oil has been linked to improving blood flow and reducing blood pressure in individuals that are at a risk of high blood pressure. It actively works to reduce blood pressure and thus can work wonders in people that have high blood pressure. 

Plaque Buildup

Plaque buildup in the arteries is a common problem, especially as you get older. Plaque is a combination of fat, cholesterol, calcium, and other substances that harden over time and manage to block certain arteries, thus increasing blood pressure as well as the risk of a stroke. Fish oil can help prevent the build-up of plaque. It can also prove to be beneficial in cases where plaque has already built up. It can prevent further build up and keep the blood flowing normally.

Fatal Arrhythmia

Arrhythmia is a condition in which the heart has an abnormal rhythm. That can be potentially fatal, but fish oil has actually shown promise in reducing the risk that is associated with arrhythmia, especially in the elderly. 

As you can see, omega-3 fats are highly valuable for your heart health. The majority of studies conducted tend to examine DHA and EPA in combination rather than individually. Some studies seem to suggest that DHA is more effective than EPA for the improvement in several heart-related risks, but both are valuable.

A research study on 154 obese adults who were given 2700 mg of DHA for 10 weeks showed that their exposure to heart-disease had reduced by 5.6%. The same dose of EPA helped increase the omega-3 index of the same participants only 3.3%. DHA also reduced blood triglycerides more than EPA. Omega-3 fatty acids also help increase the ‘good’ HDL cholesterol in your body.

Mental Health Disorders

Fish oil has been linked to improving the condition of mentally ill patients primarily because of our brain. Roughly 60% of the brain is made up of fat, and most of that fat is omega-3 fatty acids. It stands to reason then, that an increase in omega-3 fatty acids could lead to better mental conditions. There are some studies that state that mental disorders are accompanied with a reduced amount of omega-3 fatty acids in the blood and in some cases, fish oil has been shown to lower the chance of psychotic disorders in people that are at risk of them.

There is also the fact that high dosages of omega-3 fatty acids have shown to lower the symptoms of bipolar disorder as well as schizophrenia. This means that fish oil is not just a treatment of mental disorders. It can also be used to reduce the chances of facing one. That means that if you have a family history of mental disorders, it would be wise to supplement yourself with fish oil so that you can potentially shield yourself from mental disorders.

Weight Loss

It might seem strange that fatty acids can actually help in weight loss, but it does so because it is good fat. There is pretty good evidence that consuming fish oil with a proper diet, accompanied by exercise, can reduce the waist-to-hip ratio as well as waist circumference. That being said, there is little evidence to suggest if fish oil can actually help with reducing weight in obese individuals. It might be able to help, and it might not, but the problem is that there aren’t enough studies to actually find out whether it’s helpful or not. Since fish oil is so great at decreasing inflammation, it is likely that it can aid in weight disorders as well.

Inflammation

Omega-3 fats such as DHA contain high anti-inflammatory effects. An increase in DHA intake helps to bring balance to the excess of inflammatory omega-6 fats that you may often consume. These fats are typically found in abundance in Western diets rich in soybean and corn oil. When you eat fried and processed foods, you’re eating unhealthy omega-6 fats.

DHA has effective anti-inflammatory properties which may lower the risk of chronic diseases that come with old age. In addition, it may save you from heart and gum diseases and improve autoimmune conditions. Using DHA can also help relieve joint pain.

A study was conducted for 10 weeks in which 38 people with rheumatoid arthritis took part. A daily intake of 2100 mg of DHA reduced the number of swollen joints by 28%! Those in the placebo group did not experience this.

Despite previous successful studies, this one was the first to indicate that DHA alone could help reduce inflammation. In short, an increase in DHA intake may reduce inflammation. It also balances excess inflammatory omega-6 fats typical in Western diets. Because of these properties, DHA may help counteract heart disease and rheumatoid arthritis symptoms.

Inflammation is your body’s natural response to certain predators, and it’s your body’s way of fighting back. Inflammation is used to fight injuries and fight off infections. There are cases, though, when inflammation is not a good thing. One such case is chronic inflammation that happens when the body is faced with obesity, diabetes, depression, or heart disease. Fish oil can help in such cases, as it has been known for a long time now that fish oil has anti-inflammatory properties. It can thus help in cases where the body is faced with chronic inflammation and reduce its effects on the body. 

Skin Health

The skin may be the largest user of omega-3 fatty acids. It covers the whole area of your body and is the single largest organ that you have. It is also one of the many organs that declines with age. It is highly susceptible to environmental pressures and can deteriorate very quickly if it is not taken care of. Fish oil has been shown to have tremendous effects on the skin and can help keep it healthy. The omega-3 fatty acids in fish oil can not only help keep the skin in a healthy condition but can also prove to be useful when the skin faces certain conditions such as psoriasis and dermatitis. It can help combat the symptoms of these diseases and return the skin to its normal and healthy self. 

Pregnancy and Fetal Development

Omega-3 fatty acids are crucial for proper fetal development and growth. As discussed before, a major portion of the brain is made of omega-3 fatty acids, and getting enough of them is necessary for proper mental development. Studies have shown that an intake of omega-3 fatty acids during pregnancy can improve hand-eye coordination in children, although there hasn't been enough correlation between an improvement in IQ or learning ability and ingesting omega-3 during pregnancy. That doesn't mean that there isn't though, it's just that there aren't enough proper studies to verify either of the claims. There is evidence, however, that ingesting fish oil during pregnancy and breastfeeding can reduce the risk of the child developing allergies later on.

Also, any baby delivered before 34 weeks is vulnerable to several health diseases, and omega-3 fatty acids may help prevent pre-term birth. There have been two large studies on the effects of fish oil supplements on pregnant women. These studies revealed that women who consumed 600-800 mg DHA had their pre-term birth risk reduced. These results stood in sharp contrast to those women placed in the placebo group.

Hence, it is imperative that you get sufficient amounts of DHA when you are pregnant. You can consume these fatty acids either through diet or supplements, and most obstetricians and midwives will recommend taking omega-3 supplements while pregnant.

Liver Fat

The accumulation of liver fat on its own is known as non-alcoholic fatty liver disease (NAFLD) and is one of the most common diseases that can happen in the liver. It occurs naturally because the liver is the organ that is responsible for processing all the fat that builds up in the body. As this happens, fat remnants end up in and around the liver causing it to become coated in fat and thus reducing its efficiency as an organ.

Fish oil supplements can actually help in this case, as they can improve liver function and deal with the inflammation, reducing the symptoms of NAFLD and reducing the amount of fat that is in the liver. It is most effective if taken preemptively but has also shown promise in helping once the disease sets in and the fat starts to build up at an alarming rate. 

Depression

Even though mental illnesses have been discussed before, the topic of depression is too important to not touch on itself. Science made huge strides when it classified depression as an actual illness, and it has now become the most common mental illness in the world, affections millions of people each year. Studies have shown that depressed individuals actually have lower levels of omega-3 in their blood than healthy individuals, which causes scientists to think that a correlation exists. Studies have shown that fish oil supplements that are high in EPA can reduce the effects of depression and can actually alleviate the symptoms that occur when faced with depression.

Attention Disorders and Hyperactivity in Children

There are two main disorders that affect children nowadays. These two are hyperactivity and attention disorders. They may be caused by a number of variables, both environmental and genetic, and there is no set cure yet, but studies have shown that fish oil supplements might help to alleviate some of the symptoms associated with these problems such as inattention, impulsiveness, and aggression.

This, in turn, allows children to focus much more easily and gain as much knowledge as possible. As is the case with many of the benefits, it is best to take fish oil supplements as early as possible if there is a deficiency in the diet of such children. There has also been promising evidence to show that fish oil supplements can actually reduce hyperactivity in children and improve their focus.

ADHD normally begins in childhood but may well persist into adulthood. Omega-3 plays an important role in your brain health and helps increase blood flow during mental activities. Researchers indicate that children and adults with ADHD have comparatively lower levels of DHA.

Seven out of nine studies showed that the effects of DHA supplements in children with ADHD did exhibit improvement.  For example, these kids’ attention and behavior showed positive changes.

Mental Decline

Mental decline is something that many of us eventually have to deal with. It is a side effect of growing older, and there is nothing we can do as of yet to completely stop it. There are, however, ways we can slow down the process and retain most mental functions even when we grow old. One such way is through the use of fish oil supplements. Fish oil supplements cannot only reduce mental decline in the golden years but may also improve your memory. There is scientific evidence to support this, but keep in mind that this is true only in healthy, older adults. Whether that is also the case in younger members of society is still up for debate.

Asthma and Allergies

Asthma and allergies go hand in hand and are becoming more and more common in both infants and toddlers. There have been multiple studies done to see if fish oil actually helps in such cases, and the results are quite positive. In one study, it was shown that fish oil can reduce the effects of asthma, especially in younger years whereas in another study it was shown that omega-3 intake during pregnancy severely reduced the risk of asthma in the child. It has also come to light that fish oil intake during pregnancy may severely reduce the risk of children developing allergies, although more research still needs to be conducted. In any case, fish oil has proven to be beneficial during pregnancy and breastfeeding.

Bone Health and Muscle Recovery

Bone health may seem like a weird topic for fish oil because bones are made of calcium, and Vitamin D helps make them strong, but it is now believed that fish oil can actually help maintain bone mineral density. It can improve the sturdiness of bones, reducing the risk of breakage and fractures. In one study, it has also been shown that fish oil can actually help in preventing bone diseases such as osteoporosis and osteoarthritis. 

Also, if you follow a rigorous exercise routine, then it is likely to trigger muscle inflammation and soreness for you. DHA-either on its own or in combination with EPA-can provide efficient help in reducing muscle soreness after exercise. That’s because it has an impactful anti-inflammatory effect.

27 women who took 3000 mg of DHA daily for seven days showed a 23% reduction in muscle soreness. These results were in sharp contrast to the ones shown by those placed in the placebo group.

Similarly, 24 men received 260 mg of DHA supplements and 600 mg of EPA supplements on a daily basis. The study was conducted for 8 weeks. At the end of this study, there was no decrease in their range of motion after elbow-stretching exercises. On the other hand, men placed in the placebo group had an 18% decrease.

Even though these studies looked at only a few people, it does illustrate that DHA plays a role in reducing muscle soreness and limitations in motion range after exercise. That happens because of the anti-inflammatory effects of omega-3 fatty acids.

Eye Health

Much like the brain, the eyes are primarily made up of omega-3 fatty acids. That is why there exists evidence that people that lack omega-3 fatty acids in their diet have a greater tendency to develop eye diseases. There is also the fact that the eyes deteriorate as we age. 

There have been two recent studies suggesting that DHA may provide effective help in decreasing discomfort from contact lenses. A 12-week study  was recently performed with contact lens wearers. At the end of that study, it was concluded that 600 mg of DHA and 900 mg of EPA daily did actually help in the reduction of eye discomfort by 42%! This effect was similar to the improvements noticed when patients were on steroid eye drops.

In addition to these benefits, a daily dose of 500 mg of DHA and 1000 mg of EPA for three consecutive months brought on a decrease in eye pressure by 8%. You should know that elevated eye pressure is a risk factor for glaucoma, which is a disease which slowly takes away your vision.

To put it briefly, the use of DHA may offer improvement for certain eye conditions, including dry eyes, diabetic retinopathy, and glaucoma. It also helps reduce contact lens discomfort, which is so important for those of you with dry, irritated eyes.

What is Dry Eye?

Dry eye happens when the body fails to produce enough tears and essential oils to keep the eyes moist. This is not a one-time thing, though. The disease known as dry eye continuously happens and irritates the eyes so much that it can even become difficult to see. It is accompanied by the following symptoms:

Stinging, burning, or scratching sensation in the eyes: Dry eye causes severe irritation of the eyes. It often makes it painful to keep the eyes open for long because they can’t be lubricated by the body. It literally dries out the eyes, hence the name.

Mucus in or around the eyes: The disease can be accompanied by mucus that exists in or around the eyes which can irritate the eye, as well as lower the self-confidence of many individuals.

Sensitivity to Light: Sensitivity to light is a huge determiner of dry eye. As you know, light cannot exist without heat and any form of light will start drying out the eyes. Also, those with dry eyes often have dry patches on their eyes that scatter light. That’s why people with dry eye may prefer to wear sunglasses, even when indoors, so that they can shield their eyes from bright light. 

Eye Redness: One of the surest signs of dry eye. If you suffer from dry eye, your eyes will likely get red. That happens because of the increased blood flow to the eyes as they are being irritated (a result of inflammation).

Blurred Vision: The eyes are heavily dependent on moisture to see clearly. If they are not lubricated well enough, they will actually lose efficacy in how well they can understand visual stimuli. That means that it makes the world blurry or foggy for people suffering from dry eye. It may come and go, but this is a symptom that often affects people with dry eye. 

Watery Eyes: This symptom may seem strange but is actually one of the most common ones. The body starts over producing tears when it senses that the eyes are being irritated. This happens because the body believes that there is something in the eyes, and the tears can get that something out. This doesn’t help lubricate the eyes, though, because the eyes rely on both tears and oils. Aqueous tears alone will not help much.

Feeling Something in Your Eyes: When faced with dry eyes, the eyes are constantly being irritated. That forces the brain to send reflex impulses to the rest of the body to remove the irritation, even when something is not there. That is why most people with dry eyes feel like they have something in their eyes, even when they don’t. The mind is trying to trick them into removing the irritation even when it’s not there. 

Irritation With Contact Lenses: Contact lenses are irritating enough on their own but dry eyes can really aggravate the problem. Contacts cause irritation in the eyes because they need moisture to sit well on the eyes. If they don’t have that moisture, they become a nuisance and start irritating the eyes. 

Problems Driving in the Night: This is not night blindness per se, as night blindness occurs for a different reason, but the result is pretty much the same. It makes it difficult to recognize fast moving objects at night, because the eyes are not well lubricated enough to keep up with all that is happening. 

There are many causes of dry eyes but the most common are:

• The most common cause of dry eyes has to be aging because as you age your eyes deteriorate. That can lead to a decreased production of tears and essential oils that usually keep the eyes moist.
• There are certain medical conditions that can often cause dry eyes. The most common of these are lupus, diabetes, and rheumatoid arthritis. These medical conditions can affect your body in such a way that it stops performing the normal functions that it needs to, which can result in dry eyes.
• There are also certain medical procedures that can cause dry eyes. One such example is laser eye surgery, or LASIK, which can temporarily affect the glands that produce tears and oil. This often goes away on its own, so if you have dry eyes after laser eye surgery you should wait a bit and see if it goes away on its own naturally. In the majority of cases, patients ill notice improvement in dry eye symptoms within 6 months.
• Any damage to the tear glands can also affect the production of tears and oils. This happens if the glands are affected by either inflammation or radiation. The causes of these two can be numerous and are unique to the patients that face dry eyes in this way.
• There are also certain medications that can cause dry eye. These include antihistamines, antidepressants, as well as any drugs for hormone replacement therapy, acne, birth control, Parkinson’s disease, and high blood pressure. 

Risk Factors for Dry Eye

There are certain conditions that can put you at risk for dry eye. These include:

• Being older than 50. If you’re older than 50 years, then your tears might start drying up or your ducts may stop producing enough oil. This can put you at risk for dry eye. 
• Contact lenses. If you use contact lenses then you are at risk for developing dry eye. The lenses can irritate your eyes and lower the amount of tears, oil, and mucus that they get.
• Being female. Being female puts you at risk of dry eyes because of the hormonal changes that are associated with being female. Hormonal changes occur during pregnancy, menopause, and also because of birth control measures. All of these can change the way your body behaves and can leave you at risk of developing dry eye.
  
• Your diet. Your diet contributes hugely to any of your body’s functions. A diet that is low in vitamin A can lead to your eyes deteriorating early, whereas a diet that is low in omega-3 fatty acids can cause a lessened production of essential oils that are necessary to keep your eyes moist. 

Complications of Dry Eye

Dry eye can often be easily managed, at least in mild cases. Complications can, of course, occur if the disease is left untreated or if there are underlying systemic conditions. There are three main complications that can occur if dry eye is left untreated. These are:

• Eye Infections. Your eyes are at more of a risk for developing an infection if you have dry eye disease. The lack of lubrication gives germs a better area to spread, and infections like pink eye have more of a chance of developing. 

• Severe damage to the eyes. If dry eye is left untreated, the lack of lubrication can actually damage the eyes and reduce the effectiveness of them. It can reduce your vision, make your vision blurry, and lower your overall visual capabilities. 

• Degradation of the quality of your life. As said before, dry eye is irritating rather than painful but it can severely reduce the quality of your life. It can hinder you when driving, reading, or doing any activity that is strenuous on the eyes.

Prevention of Dry Eyes

There are a lot of things that you can do to prevent dry eyes. Before we get into how fish oil can help, let’s discuss some other things you can do to prevent yourself from getting the disease. There are a lot of small things that can help you in preventing the disease and these include:

• Protecting your eyes from direct air: This means that you should keep in mind that any air that is blown directly into your eyes can be harmful to you. This includes air from air conditioners, fans, heaters, and blow dryers. These can quicken the evaporation of moisture that helps your eyes and thus lead to dry eyes.

• Moisturizing your environment: If the environment that your eyes are in is dry, you are at more of a risk for developing dry eye. Make sure to use a humidifier, especially in the winter when the weather is dry. 

• Wear protective eyewear: Make sure to wear protective eyewear when going outside or into any dry or hot area. They can block the wind and heat and make sure that your eyes remain in their optimal environment. Polarized, wrap around  sunglasses are often helpful.

• Take regular visual breaks: Activities that require the full and concentrated use of your eyes can negatively impact your eyes if carried on for long periods of time. Activities such as reading, watching TV, looking at a computer screen can severely negatively impact your eyes if carried on for hours on end, especially if the surrounding conditions are darker than the screen. 

• Smoking: Smoking is obviously bad for your lungs, but it is also terrible for your eyes. The smoke can irritate your eyes and increase inflammation in your body, so if you smoke you should talk to your medical caregiver about quitting. In addition to this, keep your distance from smokers, at least when they are smoking. 

• Keep your eyes lubricated: This should take top priority. If you already have dry eyes and are treating it yourself, you should keep on moisturizing your eyes with non-preserved artificial tears regularly. It keeps your eyes moist and prevents you from facing the disease’s symptoms. We recommend Oasis Tears Plus PF.

• Keep your eyelids clean: Blepharitis and meibomian gland dysfunction (MGD) can wreak havoc on your eyes, so make sure you’re cleaning your eyelids twice daily with a hypochlorous acid solution, such as Heyedrate Lid and Lash Cleanser.

Patient Selection for Omega-3 Supplements

Dry eye disease is a very common reason for patients to enter their eye doctor’s office today, and 85+% of all dry eye disease patients have a component of meibomian gland dysfunction (MGD), which results in dysfunctional lipid production and evaporative dry eye disease. MGD may also be a sign of hypercholesterolemia, and omega-3 supplementation has been recommended for nearly all dry eye patients according to many dry eye algorithms. Oral supplementation of omega-3s changes the composition of the oil component of the meibomian gland secretions and the tears. This means that, instead of hardened oil, you’re going to get an increase in the amount of unsaturated fatty acids which are in a liquid state at body temperature. This prevents blockage and stagnation of the meibum in the glands. Omega-3s may reduce tear evaporation in this way, since a healthy oily layer of the tear film prevents evaporation.

There are not many contraindications to taking an omega-3 supplement, however they do have the ability to thin the blood (especially if the supplement contains vitamin E). Some surgeons will have their patients stop supplements such as this before surgery. If a patient is predisposed to gout or has gout, a liquid form of omega-3 may be recommended because the outer coating of omega-3 supplements can sometimes be problematic for these people. However, the most common reason people cannot take omega-3s is due to issues with the GI tract.

It’s important to take a medical grade omega-3 supplement, which are re-esterified triglyceride omega-3 supplements. This means that an extra process has been taken to remove the alcohol from the substance, making it more tolerable and more bioavailable. As a note, the majority of the omega-3 supplements on the market are ethyl ester vs. triglyceride based, meaning they may not be absorbed as well as triglyceride based supplements (and they have a greater likelihood of disrupting the GI tract). 

An omega-3 index level test is available as a quick finger prick test which can check a patient’s omega-3 level in their blood. An omega-3 index level of 8 or higher has been shown to give benefits, and those with lower index levels will likely not be experiencing as great of a benefit. 

NERD ALERT → So why do companies use ethyl ester fish oil?  The primary reason is that companies can concentrate it more easily and put more into each capsule.  Ethyl ester fish oil is formed by processing the glycerol backbone of triglyceride-based fish oil and adding ethyl esters.

Dosage for Healthy Adults

There are different recommended dosages for women and men. The recommended dosage for omega-3 fatty acids for women is 1100 mg for women and 1600 mg for men. Omega-3 isn’t limited only to fish, because it can also be found in vegetative sources such as flax seeds, walnuts, and soybeans but there is one problem with these sources. They contain omega-3 fatty acids in the form of ALA. ALA is Alpha Linolenic Acid and cannot be processed by the body as well as EPA or DHA and also cannot perform the functions that EPA and DHA can do. The body can convert some ALA into DHA and EPA but not enough to satisfy all the demands of the body. That is why it is important to take fish oil supplements, because they are high in EPA and DHA which are the more useful omega-3 fatty acids. 

We recommend the Heyedrate Omega-3 for Eye Health, whether you have dry eyes or not. It contains additional vitamins and minerals that your eyes need to maintain optimal health and reverse inflammation. If you happen to be vegan or vegetarian, we recommend checking out Nested Naturals Vegan Omega-3. Sourced from marine algae, this omega-3 will hit all the bases when you don’t wish to have fish in your diet.

Dosage for Pregnant Women

Both EPA and DHA are vital for proper fetal development. DHA is especially useful because it forms the most part of the brain during the third trimester. That’s why the recommended doses for pregnant women are higher than others. Typically 3000 mg of omega-3 is safe for adults but what matters, in this case, is the DHA and EPA content rather than the omega-3 content.

During pregnancy, you should be taking fish oil supplements that have at least 300 mg of DHA. Since DHA is more important than EPA, this is the dosage that is recommended by the WHO. You should keep in mind, though, that you should check the vitamin A content of fish oil supplements. You should try to avoid cod liver oil because it has high values of vitamin A which can impair fetal development. You should stick with supplements that are purely EPA and DHA. 

Dosage for Kids

The dosage for children is obviously different depending on how old they are. The recommended dosage for children of 1 year is 500 mg which goes to the normal adult recommended dosage as soon as they hit 14 years. The EPA and DHA recommended dosage are also different. At 4 years a child requires a 100 mg of both DHA and EPA combined. At 8 years the dosage simply doubles. For the best advice, you should consult your child’s pediatrician and you should purchase supplements that specifically say that they are for children. We love Nordic Naturals Ultimate Omega Junior.

Dr. Epitropoulos recently published a study assessing the effect of oral re-esterified omega-3 supplementation on tear osmolarity, MMP-9, tear break-up time, OSDI score, corneal staining, Shirmer score, Omega-3 index, and other indices in subjects with dry eye and confirmed MGD. This was a multi-center, prospective, interventional, placebo-controlled, double-masked study.

Subjects were randomized to either 4 softgels containing 1680 mg of eicosapentaenoic acid/560 mg of docosahexaenoic acid (the omega-3) or a control of 3136 mg of linoleic acid (omega-6), daily for 12 weeks. 3:1 ratio of EPA:DHA has been shown to help with dry eye disease and was used in this study. After completion of the study, a statistically significant difference was shown in tear osmolarity, omega-3 index levels, tear break-up time, MMP-9, and OSDI symptom scores. This is great because omega-3s were shown to improve nearly all areas studied.

What about the DREAM Study?

Despite the negative results of the DREAM study, patients in both the omega-3 (3 grams) and olive oil placebo (5 grams) group had improvement in OSDI symptom scores. 61% of the omega-3 group noticed improvement of OSDI by greater than 10 points, compared with an improvement of 54% in the placebo group. However, this was not considered statistically significant. Basically, both the omega-3 and olive oil worked well in these patients. 

There has been a lot of debate around the design and interpretation of this study, and many other variables in this study were uncontrolled. Study subjects were able to add, delete, or change their dry eye therapy during the study. Olive oil is also known to be a natural anti-inflammatory, so this may not have been the best placebo oil to choose.

A recent meta-analysis was done looking at 17 qualifying, randomized trials including the DREAM study and Dr. Epitropoulos’s study and the mean indices looked at were greatly improved in the omega-3 group vs. placebo groups. 

The foods with healthy oils listed below help rebuild your cells into healthier cells able to transfer oxygen and reduce inflammation and disease.  These healthier oils can also cross the blood/brain and blood/eye barriers, which means they will benefit both the brain and eye, helping with dry eye.

When using an oil in cooking (it is never recommended to heat an oil above its smoking point), use either an organic, extra virgin, cold-pressed coconut oil; organic, extra virgin olive oil; or organic avocado oil.  The key thing with cooking is to not let the oils get above their smoking point.  Once an oil is smoking it has been damaged, and damaged oil causes damage to your body.  When an oil is damaged, the healthy fat molecules are broken down and they form free radicals, which are cancerous.

  

If you are already a healthy individual (be honest), you should be getting a 2:1 ratio of healthy omega-6 to healthy omega-3.  However, if you suffer from numerous diseases, are overweight, or eat terribly, you should start by shifting your diet first (which we’ll discuss more in later sections) and start with a ratio of 4:1 healthy omega-6 to healthy omega-3 (some suggest even 8:1 to combat all that “bad” fat you have been eating).

If you start to pay attention to this ratio and you can get it to 4:1, then you will be more than doubling the amount of oxygen that moves from your blood to your cells, which will decrease pain, inflammation, and disease.  

The key with this ratio is to make sure the sources of omega-6 are healthy, which are listed below.  The typical North American diet consists of up to 50:1 UNhealthy omega-6 to omega-3. This causes increased inflammation, heart disease, blood vessel blockage, stroke, diabetes, and more. 

This is NOT a short term fix, though, and requires a lifestyle change.  What you are doing now is not working and causing you a tremendous amount of pain... FIX IT.  It is not up to a doctor to fix your problem, it is on you! Below I list examples of healthy omega fatty acids for you to include in your diet.

Healthy Vegetarian Omega-6’s

• Avocado (15:1 omega-6 to omega-3 ratio)
• Flaxseed oil (or ground)
• Chia seeds
• Evening primrose oil
• Black currant seed oil
• Walnuts
• Almonds (Almond butter)
• Sunflower seeds (Sunflower seed butter)
• Sesame seeds
• Pine nuts
• Brazil nuts
• Pecans
• Pumpkin seeds
• Hemp seeds

Healthy Vegetarian Omega-3’s

• Avocado (15:1 omega-6 to omega-3 ratio)
• Flaxseed oil (or ground flaxseed)
• Chia seeds
• Evening primrose oil
• Black currant seed oil
• Walnuts
• Almonds (Almond butter)
• Sunflower seeds (Sunflower seed butter)
• Sesame seeds
• Pine nuts
• Brazil nuts
• Pecans
• Pumpkin seeds
• Hemp seeds
• Fresh basil
• Dried oregano
• Cloves
• Canned grape leaves

Healthy Meat Omega-6

• Organic, free-range eggs
• Organic cheese - try to stick to WHITE cheese such as cottage cheese, parmesan, goat cheese, gruyere
• Organic whole milk
• Organic, grass-fed butter
• Organic, grass-fed, free-range beef
• Organic, grass-fed, free-range poultry

Healthy Meat Omega-3

• High quality wild caught fish (make sure it’s wild)
• Wild mackerel
• Wild Alaskan salmon 
• Wild herring
• Wild caught tuna
• Wild caught sardines

There are minimal side effects of fish oil supplements at the recommended doses, but if you are exceeding the recommended dosage you’ll start noticing some side effects. Make sure to discuss any of these with your doctor. These may include:

High Blood Sugar

This is only for the people that suffer from diabetes, which makes up a huge portion of the population. In some cases, it has been noticed that people with diabetes have elevated blood sugar levels because of fish oil. This only occurred in cases where the patients consumed more than the recommended dosage, so if you have diabetes and notice that your blood sugar levels are rising more than normal, you should cut down the number of fish oil supplements that you are taking.

Bleeding Gums and Nosebleeds

Even though there can be any number of causes for bleeding gums and nosebleeds, they have been called as the trademark of too much fish oil. If you have started taking omega-3 supplements and notice that your gums are bleeding and that you are getting nosebleeds, you should immediately lower your intake and see your doctor for more advice on how to proceed with the supplements. You should also not take this supplement before any surgery or if you are on blood thinners, because that can cause more aggravated bleeding. In addition to bleeding, easy bruising may also be noticed by those taking high amounts of fish oil.

Lower Blood Pressure

It is widely known that fish oil supplements contain ingredients that help in lowering blood pressure. That is both a boon and a curse. In patients with high blood pressure, it is an incredibly useful supplement but in people with low blood pressure, it can be a dangerous addition. In either case, fish oil supplements can tangle with the medications that you are on and reduce the efficacy of them. Make sure to consult your doctor if you have either high or low blood pressure before you start taking this particular supplement. 

Diarrhea

Diarrhea is the most common side effect of taking fish oil supplements. It can mess with the body’s bowel movements and increase the frequency as well as the magnitude of bowel movements. The case gets worse with an increase in dosage so, if you notice any changes in your bowel movements after taking the supplement, you should alert your doctor and think about reducing the dosage of the supplements.

19:30 - Fabian Cappetta - Options to unclog meibomian glands if Lipiflow and IPL don’t work?

20:38 - Brian Lee - Difference between systemic vs topical application aka consuming from wholefood/supplements vs eye drops with omega 3 for dry eyes and inflammation

21:50 - Becca McCarty - How effective is omega 3 for dry eyes vs GLA?

22:50 - Vanessa Hofheins - What are they doing to find a cure for this disease?

24:14 - Ali Ali - Best omega 3’s they recommend?

25:23 - Sylvie Morin - Does the source of Omega 3 make a difference? (ie: krill? salmon? mackerel? herring? anchovies? cod? plants?)

26:21 - Nadine Nehme - What’s your experience treating people with accutane? Do you typically see improvement?

27:25 - Tina Capello-Silvestri - If your glands are atrophied, do omegas help?

28:35 - Karen L. Torgerson - How do you know if you're absorbing Omega-3, and how can I go about trying to absorb it if I'm not?

29:35 - Sarah Wes - Is fish oil, flaxseed or sea buckthorn best, or a combination of all 3?

If you’d like to contact Dr. Epitropoulos, visit her website or give their Columbus office a call at 614-221-7464. 

About Dr. Epitropoulos

Dr. Alice Epitropoulos is a Columbus, Ohio, native passionate about improving the vision of her Columbus neighbors. Her highly personal, hands-on approach to preoperative evaluation and measurement enables her to provide an unmatched level of care, and unusually low re-treatment rate. She is proud to be one of the cofounders of The Eye Center of Columbus, an innovative affiliation of more than 70 ophthalmologists.  The Eye Center is one of the largest dedicated Eye Care Centers in the United States and is located in the Arena District of downtown Columbus.

Alice T. Epitropoulos is a board certified ophthalmologist who specializes in refractive and cataract surgery.

She has been performing laser vision correction since 1995 with excellent results. She is also offering femtosecond laser cataract surgery with premium lens surgery for her cataract patients.  In addition to operating a private practice, Dr. Epitropoulos serves as a clinical assistant professor at the Ohio State University. Currently Dr. Epitropoulos has a patent of a medical device known as the EpiGlare Tester to measure visual disability from oncoming headlights in cataract patients. There was a multicenter clinical trial to validate the device, and recently signed a license agreement to manufacture, market and distribute the device.

Dr. Epitropoulos received her bachelor and medical degrees with Honors from The Ohio State University. She completed her internship at Riverside Methodist Hospital and returned to The Ohio State University for her residency in ophthalmology where she served as Chief Resident. She is a Diplomat of the American Board of Ophthalmology.  Several of Dr Epitropoulos' articles have been published in ophthalmic journals, and she has presented numerous papers at prominent national eye meetings.

You can read more about her study on omega-3s for dry eye disease here.

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