Omega 3's and Endometriosis
The omega 3’s EPA and DHA are delicate, polyunsaturated fats found most abundantly in cold water fatty fish and seafoods. They are renowned for their anti-inflammatory effects and fertility support, associated with brain health, immune function, and healthy aging.
They’re also an “essential nutrient”, which means that if you’re not eating them, you won’t have any. This is why so many of us are deficient, leading to symptoms ranging from dry skin and joint pain to clinical depression and inflammatory diseases. And, of course, endometriosis.
Today let’s talk about why they’re important and, something more, how to test, reverse deficiency, and be part of my cool new club!
EPA, DHA, and Endo oh-my!
The connection between EPA, DHA, and endo has been shown through quite a few studies. In fact, it’s one of the best studied nutrients in relation to endo. That’s because EPA and DHA are absolutely essential to combat inflammation.
Simply put, no EPA/DHA = lots of endo inflammation.
Or, lots of EPA/DHA = less endo inflammation.
Cool equations, huh? Here are a few studies to back this up (note that many of them are done in the lab rather than on people) : [1-7]
Supplementing with EPA suppressed the local sites with active endo inflammation while an additional five markers of systemic inflammation were reduced.
Supplementing with DHA and EPA significantly decreased inflammatory markers within the peritoneal fluid and reduced endometriosis lesion size.
Animals with more omega 3’s had less than half the endometriosis lesion size and quantity than controls.
Researchers in one study concluded EPA and DHA were so helpful they may be “useful in the management of endometriosis by reducing the inflammatory response and modulating cytokine function.”
Women eating the most omega-3s were less likely to be diagnosed with endometriosis or have painful periods.
Here’s something perhaps even more important: sufficient levels of EPA and DHA may also help prevent endo lesion progression. This is thanks to its ability to stop something called an arachidonic acid cascade overreaction, something that may cause intense endo pain as well as support the creation of new endo lesions and endo progression. Yikes! To prevent such an overreaction, you need to increase the amount of DHA and EPA you consume. When these omega-3s are increased, the overreaction is halted. [8,9]
Even more, omega 3’s act like microbiome gold. They’ve been shown to increase families of bacterium that produce butyrate, an anti-inflammatory compound, maintain intestinal wall integrity, increase bacterial diversity, and support mucosal health. A 2019 analysis found so many positive correlations between omega-3s and the gut that it noted omega-3s could be considered a “prebiotic” in their own right, acknowledging the well-known combination of prebiotics and probiotics to correct dysbiosis. The problem is, well, nearly all of us may be deficient.[10-12]
Are we all deficient?
Probably, yes.
A recent worldwide analysis found the majority of the world to be in the low range for EPA and DHA, with North Americans all in the very low category.[13]
How low is very low? Turns out 99% of us are in the intermediate to high-risk deficiency category! This even included those of us who believed we were eating enough—demonstrating you may need a lot more than you think, especially to reverse an existing deficiency.[14]
Just how deficient are … you?
Since EPA and DHA deficiency is associated with endometriosis as well as symptoms (depression, brain fog, joint pain, menstrual pain, and more), it becomes a very important nutrient deficiency to address. The 2 big questions are:
Just how deficient are you?
How much DHA and EPA do you need to reverse this deficiency fully?
Because yes, you want to reverse your deficiency completely! You don’t want to eat a little more salmon here or there and pop a bottle of fish oil just to remain in the severely deficient category, right? Right. You want to know your status, understand you may need something like 3,500 mg a day for three months (that’s a lot of EPA/DHA people!) to get yourself out of the red and into the green.
The cool thing is, there is a clearer way to answer both questions. And, you can actively work to reverse deficiencies in 3-4 months so that you (yes YOU) can see the differences in your symptoms as your tissue levels are saturated with cool, anti-inflammatory effects of omega-3’s.
Meet: The OmegaQuant Test
Testing the blood for EPA/DHA levels can be challenging because often the level will coincide with how much you recently ate. Take fish oils the test morning, and your levels may look really good! Yah, a little misleading…
If your red blood cells are low in EPA and DHA, your uterus, eyes, mouth, and everywhere else will be too. Image by OmegaQuant
The better way to know your levels of EPA and DHA is by checking your Omega-3 Index, how much EPA and DHA you have making up your body composition (not blood level) in comparison to all other fats. OmegaQuant discovered this could be done by examining the cellular membrane of red blood cells to measure the levels of all 64 fatty acids, and what percentage of those are EPA and DHA. It’s incredible just how easy it is to uncover your tissue levels of fatty acids without an invasive biopsy.
The OmegaQuant test is so legit it’s the go-to for just about all research involving omega 3’s. They are the Global Leader in Fatty Acid Research, working with such institutions as Duke, Harvard, Colombia, National Institutes for Health, and more. If there’s a researcher who wants to investigate fatty acid levels, OmegaQuant is the place to go since
This is why it’s so cool they offer testing to the general public as well! Like, really cool. And it’s not expensive, only $50 bucks.
To test, all you need is a test kit, which you can get here, and some … blood
If this doesn’t make you queasy, you too can test.
Which test is best? There are 3 varieties of tests, with the most affordable offering a straightforward measurement of your omega 3 levels ($50 plus 5% off with code I7IC1C3VSN). This is perfect if you just want to know how low your omega-3 status is so you can work on bringing it up. The low price is also nice so that you can more easily repeat the test in a few months after liberal supplementation and cold-water fatty fish eating.
The other two options offer extra information about your other fatty acid balance. This may be helpful is you’re a nerd (like me) and want the info, or if you’re working with a nutritionist. Otherwise, you’ll be OK with the cheapest, most straightforward option for now.
What do I do with the results? Your results will show just how deficient you are. Now you can use this cool calculator to find your unique “prescription” dose of omega’s to bring you up to sufficiency in 3-4 months! For example, if you tested at 3% (low) and
How does it work? You just need to poke yourself with the fingerpick test to get a wee-drop of blood. Follow the instructions, send back, and you’ll get your results in 2-4 weeks.
[Heads up, I am an affiliate for the OmegaQuant Test! I reached out to them, not the other way around (so they’re not using me for marketing), because I’m so psyched on this test and wanted to get a discount for everyone. This is a bad-ass test.]
Meeting your New (Much Higher) Needs
For those of us who are really deficient (i.e., probably everyone reading this), it’s not hard, per se, to reverse a deficiency. But following the usual recommendations of a few servings of fish per week will definitely not be enough. Here is your new formula for reversing deficiency:
Supplement big, supplement wise
Eat liberal amounts of cold water fatty fish
Reduce all consumption of Omega 6’s in the form of veggie oils.
1) Supplement Wisely
Here again is the free calculator you can use to determine your EPA/DHA needs for the next 3-4 months (in addition to eating EPA/DHA)
To use it you put in your own Omega 3 level, followed by your target level (8-12%). For this image I input an example of someone with a test value of 3% (which is super low, but normal for Americans), and said my target was 10%. Voila! This person needs to supplement with 3200 mg/day.
This is quite a lot of EPA and DHA over what we’re recommended to eat (around 200-300/day). Do you see how someone deficient will remain deficient if they follow this lower recommendation?
Before you run out and buy crappy poor quality fish oil, know that fish oil is notorious for being rancid. Just like veggie oils, this oil is delicate and easily oxidized, so the processing, shipping, and storage techniques become essential. To avoid this, you will have to spend more money on quality supplementation. There is no cheap way around it. If it’s cheap (orin a clear bottle) it’s not for you. So budget for 3-4 months (if you can), and see if you can make a dent in your endo-provoking deficiency with the quality stuff.
My best recommendation is Nordic Naturals, which is third-party certified for freshness, purity, and integrity. All good things. They also have EPA/DHA concentrates, so you take fewer pills for more gold. For example, their product Ultimate Omegas offers 1280mg EPA/DHA combined in 2 pills, so you would take 2 pills per meal (6/day total) for 3-4 months rather than 6 pills per meal via other brands.
If you are vegan, they also offer a product called Algae Omega, which offers plant-based EPA and DHA. To be honest, I’m not sure how effectively it reverses deficiency, BUT YOU CAN TEST! This is why OmegaQuant is so cool. Meet your extra-high vegan omega needs and re-test in 3-4 months to see if you’re making a dent in your deficiency.
If you’d like 15% off, click here to create a FREE account with Fullscript, a company I fully trust for high-quality supplementation, and items will be shipped directly to you.
2) Eat Liberally
While you’re supplementing, you also want to be eating Omega 3s. Yes, really, this is how we actively reverse a deficiency! And then keep it at bay after we stop supplementing.
The best source for EPA and DHA by far are cold-water fatty fish and seafood, including salmon, herring, mackerel, sardines, anchovies, fish roe, or oysters. Affordable options include canned salmon, sardines, anchovies, and smoked oysters. Other seafood and shellfish options also have beneficial amounts, although you’ll want to avoid any larger fish that bioaccumulate toxins and heavy metals, such as shark, swordfish, tuna (except for skipjack), king mackerel, or marlin.
Unfortunately, for exclusively plant-based eaters, you may not be getting enough because you need the real deal to keep your levels optimal: EPA and DHA. While ALA is the plant-based form of omega 3 (all those omega-rich flax seeds and walnuts you hear about), your body must convert it into EPA or DHA in order to use it. To do so, it must navigate an intense chemical reaction - perhaps why humans appear to convert no more than 6% ALA to EPA, or 3.8% ALA to DHA (1). This is why we must focus on ingesting EPA and DHA directly from animals who’ve already done the conversion for us (the one exception is an algae-based supplement, which should be a must if you’re vegan).
If you’re actively supplementing, aim to consume these foods 2-3x a week. If you’re not supplementing, I recommend 5-7x a week for our endo-increased needs.
If seafood makes you queasy and you want to supplement exclusively, first hear me out. If you exclusively supplement, you’ll be missing out on the myriad of the nutrients included within seafood, such as selenium, zinc, vitamin D, and iodine, all nutrients I can assertively say you need more of. As an intermedium, I ask you to try to begin waking up those atrophied taste buds, even if it’s just 1-2 bites a week to grow accustomed to new flavors. I have a toddler learning to like new foods, and if it works for him, it will work for you.
3) Avoid Veggie Oils
Vegetable oils contribute 13x more omega-6’s to the American diet than meat, eggs, and dairy combined (30). This is the reason why our cellular membranes are saturated with the stuff. Since the 60’s, our levels of lineoleic acid, the predominate omega 6 in veggie oils, has tripled. This is really bad news on many levels. It not only triples the inflammation-supportive properties omega 6’s offer, but it kicks omega 3s to the curb in the storage department.
That’s right, even if you’re eating a healthy dose of omega 3’s, if you’re also eating excessive veggie oils the omega 6s will kick your omega-3’s to the curb.
This is why you should really avoid veggie oils and all foods that contain them (barely processed refined foods). Honestly, if it’s packaged at a store in box or bag, frozen or warm, check the ingredients. Put it back if you see:
Canola oil
Rapeseed oil
Safflower oil
Sunflower oil
Corn oil
Soy oil
Grapeseed oil
Vegetable oil
If you currently cook with them, throw those buggers out. Replace with 100% olive oil (not blends, which have veggie oils), coconut oil, avocado oil, butter, ghee, pastured lard, or cold-pressed nut/seed oils (found in the refrigerated section, use these for salad dressings) like flax or walnut.
Do you want to be part of my club?
Much endo research is done on lab animals, in vitro, or using observational studies. There are few studies available on people with testing included. That’s why I’m interested in finding out more information about nutrients and how they affect endo on the endo-population themselves.
Meet The Endo-Naught Club, an incredibly informal “research club” where we can track impactful information about diet, lifestyle, and endo to get some (hopefully) neat information to share with the broader endo community. For example, few of us know if we have an omega-3 deficiency, how severe it is, or if reversing the deficiency would make an impact on endo symptoms.
So, if you’re an endo nerd like me and interested in sharing your omega status information, tracking your symptoms for 3-4 months as you reverse your deficiency, and retesting, reach out! I will send you the symptom-tracking information and also virtually high-five you for being a part of the solution!
Your privacy is secure, and no names will be shared, but I would love to hear about your journey reversing your omega-3 deficiency so we can help others with endo understand just how beneficial it can be.
[There will be more endo-naught discovery challenges in the future too (only if you’re interested). From testing for SIBO with the Food Marble to stool sample with the Thorne DNA test.]
Yes, I want to join the Endo Naught Discovery Club! Click the button below for your download
Want to learn more about your most pressing endometriosis diet and lifestyle questions? Make sure to check out my book, Heal Endo: An Anti-Inflammatory Approach to Healing From Endometriosis, available now
1. Netsu, S., Konno, R., Odagiri, K., Soma, M., Fujiwara, H., & Suzuki, M. (2008). Oral eicosapentaenoic acid supplementation as possible therapy for endometriosis. Fertility and sterility, 90(4 Suppl), 1496–1502. https://doi.org/10.1016/j.fertnstert.2007.08.014
2. Covens, A. L., Christopher, P., & Casper, R. F. (1988). The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit. Fertility and sterility, 49(4), 698–703. https://doi.org/10.1016/s0015-0282(16)59842-2
3. Akyol, A., Şimşek, M., İlhan, R., Can, B., Baspinar, M., Akyol, H., Gül, H. F., Gürsu, F., Kavak, B., & Akın, M. (2016). Efficacies of vitamin D and omega-3 polyunsaturated fatty acids on experimental endometriosis. Taiwanese journal of obstetrics & gynecology, 55(6), 835–839. https://doi.org/10.1016/j.tjog.2015.06.018
4. Tomio K, Kawana K, Taguchi A, Isobe Y, Iwamoto R, Yamashita A, Kojima S, Mori M, Nagamatsu T, Arimoto T, Oda K, Osuga Y, Taketani Y, Kang JX, Arai H, Arita M, Kozuma S, Fujii T. Omega-3 polyunsaturated Fatty acids suppress the cystic lesion formation of peritoneal endometriosis in transgenic mouse models. PLoS One. 2013 Sep 10;8(9):e73085. doi: 10.1371/journal.pone.0073085. PMID: 24039864; PMCID: PMC3769312.
5. Gazvani, M. R., Smith, L., Haggarty, P., Fowler, P. A., & Templeton, A. (2001). High omega-3:omega-6 fatty acid ratios in culture medium reduce endometrial-cell survival in combined endometrial gland and stromal cell cultures from women with and without endometriosis. Fertility and sterility, 76(4), 717–722. https://doi.org/10.1016/s0015-0282(01)01991-4
6. Missmer, S. A., Chavarro, J. E., Malspeis, S., Bertone-Johnson, E. R., Hornstein, M. D., Spiegelman, D., Barbieri, R. L., Willett, W. C., & Hankinson, S. E. (2010). A prospective study of dietary fat consumption and endometriosis risk. Human reproduction (Oxford, England), 25(6), 1528–1535. https://doi.org/10.1093/humrep/deq044
7. Deutch B. (1996). Menstruationssmerter og lavt indtag af n-3-fedtsyrer [Painful menstruation and low intake of n-3 fatty acids]. Ugeskrift for laeger, 158(29), 4195–4198.
8. Wu, M. H., Lu, C. W., Chuang, P. C., & Tsai, S. J. (2010). Prostaglandin E2: the master of endometriosis?. Experimental biology and medicine (Maywood, N.J.), 235(6), 668–677. https://doi.org/10.1258/ebm.2010.009321
9. Lands B. Omega-3 PUFAs Lower the Propensity for Arachidonic Acid Cascade Overreactions. Biomed Res Int. 2015;2015:285135. doi: 10.1155/2015/285135. Epub 2015 Aug 2. PMID: 26301244; PMCID: PMC4537720.
10. Costantini L, Molinari R, Farinon B, Merendino N. Impact of Omega-3 Fatty Acids on the Gut Microbiota. Int J Mol Sci. 2017 Dec 7;18(12):2645. doi: 10.3390/ijms18122645. PMID: 29215589; PMCID: PMC5751248.
11. Menni C, Zierer J, Pallister T, Jackson MA, Long T, Mohney RP, Steves CJ, Spector TD, Valdes AM. Omega-3 fatty acids correlate with gut microbiome diversity and production of N-carbamylglutamate in middle aged and elderly women. Sci Rep. 2017 Sep 11;7(1):11079. doi: 10.1038/s41598-017-10382-2. PMID: 28894110; PMCID: PMC5593975.
12. Parolini C. Effects of Fish n-3 PUFAs on Intestinal Microbiota and Immune System. Mar Drugs. 2019 Jun 22;17(6):374. doi: 10.3390/md17060374. PMID: 31234533; PMCID: PMC6627897.
13. Stark, K. D., Van Elswyk, M. E., Higgins, M. R., Weatherford, C. A., & Salem, N., Jr (2016). Global survey of the omega-3 fatty acids, docosahexaenoic acid and eicosapentaenoic acid in the blood stream of healthy adults. Progress in lipid research, 63, 132–152. https://doi.org/10.1016/j.plipres.2016.05.001
14. Thuppal SV, von Schacky C, Harris WS, Sherif KD, Denby N, Steinbaum SR, Haycock B, Bailey RL. Discrepancy between Knowledge and Perceptions of Dietary Omega-3 Fatty Acid Intake Compared with the Omega-3 Index. Nutrients. 2017 Aug 24;9(9):930. doi: 10.3390/nu9090930. PMID: 28837086; PMCID: PMC5622690.