Spotlight on Omega-3s and Women’s Health

Spotlight on Omega-3s and Women’s Health

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Omega-3 fatty acids play a critical role in women’s health and disease prevention across the lifespan. We often think of them in terms of cardiovascular health, which is a concern for women, especially post-menopause. However, omega-3s offer so much more. Today’s article will dive into the science behind omega-3 fats, their foundational role in women’s health, and how to optimize your intake from an integrative perspective.

Keep reading as we explore:

• What are omega-3 fatty acids?
• The omega-6-to-3 ratio, and why it matters
• Omega-3s for women’s health
• An integrative approach to dietary omega-3s and supplements

What Are Omega-3s?

Omega-3 fatty acids are polyunsaturated fatty acids, which are long chains of carbon molecules with double bonds beginning in the omega-3 position. Fatty acids are most often found in nature as triglycerides, where three fatty acids are combined with a glycerol molecule. (This is precisely what we measure when we measure your blood triglyceride levels.)

The chemical structure is important because it dictates how the fatty acids act in the body. They make up a portion of the fatty acids in every cell membrane, providing membrane fluidity and aiding cellular communication.

The three primary omega-3 fatty acids are:

• Alpha-linolenic acid (ALA) – Humans cannot synthesize ALA, and we must obtain it from the diet. It’s the essential omega-3 fat with a chain of 18 carbons. It’s found in plants, including flaxseed, soybeans, walnuts, and chia seeds.

• Eicosapentaenoic acid (EPA) – Cells can turn EPA, which has 20 carbons, into messengers called eicosanoids. EPA is responsible for the anti-inflammatory effects of omega-3s throughout the body.

• Docosahexaenoic acid (DHA) – DHA is a 22-carbon chain and is concentrated in the brain and eyes.

The body can synthesize some EPA and DHA from ALA, but the conversion, which happens in the liver, is quite low. Only about 5-10% of ALA converts to EPA, and only about 2-5% to DHA. Genetic factors can influence conversion rates, and some people are very low converters. Because of this, some advocate that EPA and DHA also be considered essential, to shift the focus towards consuming dietary sources to optimize levels in the body.

EPA and DHA are primarily found in cold-water fatty fish and seafood, including:

• Wild salmon
• Sardines
• Mackerel
• Anchovies
• Herring
• Cod
• Trout
• Oysters
• Scallops
• Crab
• Lobster
• Fish eggs (caviar)
• Fish oil and cod liver oil

Other sources include algae oil, omega-3 eggs (where chickens are fed flax or algae), and small amounts in grass-fed beef and dairy.

The Omega 6:3 Ratio

Omega-6 fatty acids are the other primary category of polyunsaturated fatty acids. Like omega-3s, they are incorporated into cell membranes and used to produce messenger molecules. Where omega-3 messages tend to be more anti-inflammatory, omega-6s are more pro-inflammatory. It’s not that one is better than the other; we need both, but in balance.

Despite total fat decreasing in the Western diet over the last 30 years, omega-6 fats have increased, while omega-3s have decreased. Hunter-gatherer ancestors had close to a 1:1 ratio of omega 6s to 3s, whereas the modern Western diet has a ratio of up to 20:1. Excess omega-6s in the diet primarily come from processed foods and the industrial oils they contain. Eating a balanced, whole-food diet provides a more natural, optimal fatty acid ratio.

Women need at least 1.1 grams of dietary ALA daily (1.4 grams during pregnancy and 1.3 grams during lactation). There is no recommended guidance for EPA and DHA intake, although higher blood and cell membrane levels are protective. The average American has blood or plasma levels (in the phospholipid cell membrane) of 3 to 4%. In Japanese populations with higher fish intakes, the levels are around 8%.

Health Benefits of Omega-3s for Women

Optimal omega-3 status and a healthy omega-6:3 ratio promotes health throughout the body, including the brain, heart, bones, and reproductive system. They are one reason good nutrition helps prevent disease.

Let’s look at some of the connections with women’s health:

• Heart health – Higher levels of omega-3s are associated with lower cardiovascular disease risk.

• PMS and painful periods – More omega-3s in cell membranes help reduce the severity of PMS symptoms. Increasing omega-3 intake can help make periods less painful and more comfortable.

• PCOS – Higher omega-3s in the diet support inflammation reduction and improve metabolic dysfunction in women with PCOS.

• Fertility and ovulation – Omega-3s support healthy ovulation and the menstrual cycle during reproductive years. A higher intake of omega-3s is associated with improved timing of FSH (follicle-stimulating hormone) and estrogen peaks, better progesterone production, and regular ovulation.

• Pregnancy – Omega-3s support uterine and placental blood flow, fetal growth and brain development, and lowers the risk of premature birth and postpartum depression.

• Breastfeeding – Women reserve omega-3s in adipose (fat) tissue and use these fatty acids for fetal support during pregnancy and lactation. Breast milk contains ALA and DHA.

• Perimenopause – In perimenopause, omega-3 fats help reduce inflammatory symptoms, PMS, and hot flashes.

• Post-menopause – After menopause, the risk for breast cancer, dementia, heart disease, osteoporosis, and macular degeneration increases. Maintaining a healthy omega-3 status helps mitigate these risks.

An Integrative Approach

Omega-3 levels can vary widely among individuals due to intake, absorption, genetics, and other factors. At our clinic, we will review your omega-3 intake in your diet, test omega-3 levels in the blood, and put everything into the context of your symptoms and health concerns.

Here are some general omega-3 recommendations based on what we see in clinical practice and the research:

• Eating whole foods with plenty of vegetables, nuts, seeds, olive oil, and high-quality protein, while minimizing processed foods, helps to reduce inflammation. Think: A personalized Mediterranean-style eating pattern.

• Most people benefit from increasing omega-3s in the diet, not just ALA from plant foods, but EPA and DHA too. Since fish can be a source of mercury and other contaminants, we want to focus on small, wild fish from cold water, such as sardines, mackerel, and wild salmon, and avoid large/old and farmed fish that tend to be higher in contaminants.

• Fish oil supplements are supportive throughout the lifespan for women’s health. Again, quality matters. Omega-3s are delicate and easily oxidized by light, heat, and poor transportation, packaging, or storage conditions. Choose practitioner-recommended brands that are third-party tested for quality and purity, like the ones you’ll find here. Keep fish oil in the fridge and don’t take any products that smell rancid. Algae oil is a vegetarian-friendly source of EPA and DHA and also a good option for those with fish allergies.

From an integrative medicine approach, we want to use all the tools in our toolkit to help you address your concerns and prevent disease. Omega-3s are among the most well-studied nutrients and are so beneficial for women from puberty through the reproductive years and into perimenopause and menopause. They help reduce inflammation, support hormone balance, and protect our organs. Work with your TārāMD team to dial in the unique details for you,

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