omega 3 comments

[jackolso]

Hello Martush,

I don't take Restasis because of the side effects.

You mentioned Omega 3. Omega 3 has long chain polyunsaturated fatty acids in it. There are three different LCP's in Omega 3, alpha linolenic acid, elcosapentaenoic acid and docosahexaenoic acid.

When taken as an oral supplement, it appears that the alpha linolenic acid is the main LCP that helps dry eye. It's converted to lipids in the blood and one of those is resolvin e1. Resolvin e1 appears to help dry eye. There are no synthetic forms of resolvin e1, so it can't be taken as a supplement currently.

Here are a few problems with taking Omega 3 for dry eye. Very little Omega 3 actually gets into the blood, ALA is difficult to convert into resolvin e1 and different people need different LCP's to see benefits.

My experience with taking Omega 3, and based on what I know about the research, here are a few suggestions to help it work better. You'll need high daily doses of fish oil, somewhere between 1 gram and 2 grams, and not grams of fish oil but grams of combined EPA and DHA. A lot of people make the mistake of measuring dosage by the grams of fish oil. Krill Oil is a more effective form of omega 3. The molecular structure is slightly different so more of the ALA, DHA and EPA enters the blood stream. The downside is it costs more. I use the Arctic Pure brand which is very good krill supplement. Krill is often taken my women to alleviate monthly cramping and swelling. Krill is very effective for that purpose whereas regular fish oil does not work as well. It looks like Krill has more anti-inflammatory impact.

If you take small amounts of aspirin with the Omega 3, it facilities its conversion to resolvin e1 in the blood.

In addition to the Omega 3 from fish oil, flax seed oil is generally necessary also to see benefits.

If you want to take the one "best" LCP supplement, it's Efalex. Efalex has a complete spectrum of LCP's. It's the most expensive of the three I've mentioned but it's the most effective. The same 1 gram dose applies. GNC used to sell it in the US because of the success it has had in treating ADD, dyslexia and other similar problems, but the volume of sales wasn't high enough for them to sell it in their stores. I buy mine in Canada from Feel Good Natural Health. Most parents of kids with ADD and dyslexia now get theirs through Canada. You can buy it on Amazon. I take it with the Krill and Omega 3. The fish oil in Efalex comes from tuna along with evening primrose oil and thyme oil. The Omega 6 is lower. Omega 6 has not shown any benefits in dry eye so that's not an issue. The three oils in Efalex cover the LCP spectrum.

I think the O3 supplements have helped my dry eye, and it probably has kept it from getting worse. I don't have red eye often, no itching and no burning. But my vision is still blurry as I described in my post on the Trufocals. I take the supplements for a variety of reasons. Dry eye is only one.

It does reduce inflammation and lower triglycerides in the blood. I've had several lab tests confirming the inflammation reduction, etc.

The best application of Omega is a 0.2% solution alpha linolenic acid drops applied directly into the eyes. The results of those studies have shown a variety of benefits including the reduction of inflammation and improved epithelial cell function. It's likely the red eyes, itching and burning are related to epithelial dysfunction.

The problem is no one makes the drops commercially. I've tried to buy them from several compounding pharmacies but it's a lot of trouble to make it in pure 0.2% form and sterile for use in the eyes. So it's very expensive. If you do find a compounding pharmacy that will make it, you'll need a script from an eye doc. They are reluctant to give out the scripts for anything that's put into the eyes they aren't using on regular basis. Eye drops have risks including risk of infection, etc.

I'm guessing that ALA drops will be available either by script or over the counter within 5 years. They'll have to be more studies showing conclusive benefits in double blind trials.

Good luck with your dry eye. I hope this information helps with your Omega 3 usage. Most people taking Omega 3 for dry eye take far too little. They don't understand the digestion and absorption cycle. Another issue is the time it takes to work. You won't see the full benefits of the Omega 3 at the dosages I just mentioned for probably 12 to 20 weeks. That's the amount of time it takes for the cells to fully saturate themselves throughout the body with Omega 3. Omega 3 is not distributed equally around the body. Several key areas of the body like the brain are very high users of LCP's. They get first call on it. So it takes time for it to build up in the cells throughout the body. Omega 3 does not have a half life like a drug. It builds slowly by absorption into the cells and it stays there until it is drawn out when the amount coming in goes down. The body holds it in equilibrium with what is taken in through our diet sources.

The eye drops work much faster because they deliver the Omega 3 to where it is needed and don't depend on the blood to do the distribution. Omega 3 is absorbed directly into the eye's cells.

If you find the drops or if any one else does, let me know the source. ALA

(See notes in "Large Dosages of Fish Oil" Post about Vit A being kept below 3000 IU per day)

[jackolso]

Told to take DHA

It sounds like you've had lasik surgery. I've heard that some eye surgeons are recommending DHA. That comes from a study by Bazan and He that investigated corneal nerve regeneration after surgery.

In the study DHA was given to rabbits along with nerve growth factor or pigment epithelial derived factor. That combination did regrow nerves and regenerate e-cells faster than the norm. EPA increased tear volume and reduced inflammation. So the rabbits were given both. The study was published in the journal of prostaglandins. An earlier version was published in Investigative Ophthalmology. I think that's where the lasik guys read it.

There are a couple of problems with the study. It was done on rabbits and DHA was not tested alone.

Long chain polyunsaturated fatty acid chemistry is very complex. Different ratio's of EPA to DHA to ALA have very different effects. Our diets normally contain 10 to 1 ALA to EPA or DHA. ALA in some forms isn't good for our bodies. It's often found in cooking oils--fried foods. Too much ALA can mess up the brain or cause problems with the blood vessels.

I can't go into the physiological aspects of LCP chemistry on a blog site. It's just too complicated and most people only want to know what they should take and how much of it. One of the most knowledgeable people on EPA, DHA and ALA is Andrew Stoll. He does psychopharmacology research at McLean in Boston and teaches at Harvard Medical School. He has given me reams of information on Omega 3 and the brain. His research on ADD, borderline personality disorder, bi-polar and chronic depression is outstanding. While that is not dry eye particularly, the information still applies to the overall well being of nearly anyone.

For dry eye, somewhere around a gram a day of EPA + DHA is a good level to start with. Flaxseed oil with 500 mg of ALA is good combination with the fish oil.

A lot of people think that alpha linolenic acid and gamma linolenic acid are the same. They are not. ALA is an Omega 3 LCP and GLA is an Omega 6 LCP. It's best to not take supplements with GLA unless someone has a specific shortage of Omega 6 which is very uncommon. Many supplement bottles list linolenic acic without specifying which one it is. It is important to find out. Flaxseed oil has ALA. Borage oil has GLA.

Right now I take fish oil, Krilll oil and Flaxseed oil. I take the fish oil (800 mg EPA+DHA) in the morning, the Krill (500 mg DHA + EPA) at night and the Flaxseed (400 mg ALA) mid-day. That way there is some moving through the digestion tract and into the blood stream all day long. That's important if someone is taking it for heart issues and platelet stickiness, which I do. A small amount of aspirin also prevents platelet stickiness, but it is different from Omega 3 so the two can be used together. Second aspirin also promotes the conversion of ALA into resolvin e1, which appears to benefit the eye the most. A small amount of aspirin like the 80 mg's most docs recommend for heart issues is good. One 80 mg dose of aspirin every other day works great for anyone who can't take aspirin every day. It's half life is much longer than most people, even doctors, understand.

Nothing in here is medical advice. Everyone should talk to the their doctors before adding any supplement to their daily intake. Supplements can interact with meds.

The proper amount and combination of EPA, DHA and ALA vary from person to person and depend on what conditions they have like dry eye, depression, etc. Some need more ALA and others need more EPA and less DHA. It takes a lot of trial and error to find the right amounts and ratios of EPA to DPA to ALA. Most people and almost zero docs have the patience to do the trial and error testing and keep accurate records to know what works and what doesn't. In addition, most docs are skeptical of anything that's not a pharmaceutical they can write a script for. Trial and error testing is expensive when a doctor is charging more than a $100 per ten minute visit. The insurance companies won't pay for the visits and most people won't either. So everyone is mostly on their own. They'll take a little fish oil for a couple of weeks and then say it doesn't work. Whatever ratio of Omega 3 oils is being taken, they have to be used for 20 weeks before their effectiveness will be known.

Since this is a dry eye forum, I don't want to stray off topic much, but I've been involved with a number of families with children that have psych problems like bi-polar and borderline problems. In one case, one of my lawyers had a daughter who was bi-polar. She was in her late twenties, had two kids and lived at home with her parents because she could not function on her own. They had tried every treatment program they could find including a lot of med combinations, but nothing had worked. I gave them Stoll's research, helped them interpret it, and helped them find a psych doc who was willing to use Stoll's program. After 4 months she had progressed so much she was able to return to college, graduated 3 years later with an excellent GPA, has a full time job and takes care of her children and lives on her on. This isn't an isolated case. I've seen this many times. More research comes out every year validating Stoll's work. Stoll contends that dyslexia, ADD, bi-polar, and borderline are all the same issue but simply manifest differently in different people. He's turning out to be more on the money than a lot of psych docs want him to be.

Omega 3 is very important to the functioning of the cells through out the body. It's main benefit is it increases the permeability of the cell walls which helps the body's biochemical functions work more efficiently. It reduces inflammation, and it helps cells to repair themselves faster. It appears that the cell repair and inflammation are the big issues in dry eye.

My guess is during lasik surgery the laser damages the cells in the eye and causes inflammation. Most people get over it because they regenerate the epithelial cells faster and normally. In some people it appears the damage becomes permanent. Eye docs always say if someone develops long term dry eye problems after the surgery they must have had it before the surgery. CYA.

I would never have lasik surgery, but if I were going to, I would be taking those Omega 3 supplements listed above a few months before and after the procedure just to insure rapid cell regen. I would also take the same combination during pregnancy because Omega 3 availability is a major factor in fetal brain development.

Hopefully the ALA eye drops I mentioned in the previous post will be available someday soon. That's the best solution, and it won't require trial and error adjustments. But so far I have not been able to find it.

(See notes in "Large Dosages of Fish Oil" Post about Vit A being kept below 3000 IU per day)

[Rebecca Petris]

The posts above were replies to Martush in this thread in Dry Eye Triumphs.

Please, let's let Dry Eye Triumphs be just that: a place for people to post anything good going on for them and for others to share their triumph.

Thanks for your understanding.

[faithfully]

Thank you Jack for this very informative post. I read all of it in that I have severly dry eyes and have tried everything even the omegas you have written about. I just havent tried the combination nor the long-term usage.
After reading this post I shall try the combination approach believing this could very well be what heals my eyes. It makes since.
Thanks for taking the time.

[magoo]

Thank you so much for the detailed information. I have taken fish oil or krill oil or flaxseed oil. Never a combination. I am going to start the combination you suggested. I already take an aspirin each day. It is very interesting reading about how all these work together.
And for the first time I now understand all the EPA, DHA, ALA etc.
Thanks again,
Lynda

[Aaron77]

Thanks for posting this info. Because of the damage that lasik does to the corneal nerves a naturopath suggested I start taking large doses of DHA rich fish oils this past yr. I was also getting bruised quite easily with the fish oils that were richer in the EPA - this has seemed to be a little less of a problem since starting the super DHA fish oil supplements. Kind of gave up on the ALA well over a yr ago as I figured the fish oil was the way to go. Looks like I'll get back into the flax with ALA along with the EPA and DHA I'm already taking, I think I'll also start taking aspirin again - at some point in time I had been taking aspirin as I thought it might help but never kept it up. Its hard to keep up with all the supplementation - other things I'm currently taking but not consistently include NAC, astaxanthin, MSM, omega-7 and hyaluronic acid. I probably have 50 or so bottles of different supplements in my cupboard.

[jackolso]

Large doses of fish oil

I'm not sure why high doses of DHA are anymore beneficial than smaller doses. You didn't define what a high dose is. Once the cells become fully saturated with Omega 3, which occurs over the 12 to 20 weeks I mentioned, high dosages above 1 gram per day are totally unnecessary. Somewhere between .5 grams and 1 gram, depending on whether it is Krill or regular fish oil, should be sufficient to maintain maximum benefit.

Brain deficiencies of Omega 3 sometimes require dosages as high as 3 grams per day, but that's not average. The ratio of EPA to DHA is normally about 3/2. Sometimes that is adjusted up or down depending on the application.

Dosages around what I mentioned I was taking are a good place to start trial and error testing. If 1 gram of Omega 3 is not working, moving it up to 1.5 grams for a few weeks is okay. Moving it up to 4 grams is not good. If it's not working at 2 grams, it's not a fish oil type of LCP deficiency.

At that point I would take the 1 gram of Omega 3 with 0.5 grams of Flaxseed oil. If that doesn't work, I would move the Flaxseed up to 1 gram. Doses over 1 gram should never be necessary. If that combination of Omega 3 is not working, I would add 80 mg's of aspirin a day, if it doesn't upset the stomach. Again positive results should be seen in a few weeks.

If a gram of Omega 3 and a gram of Flaxseed oil plus the aspirin are not working at all to relieve any dry eye symptoms, I would taper down to half that amount because it good for your health in general.

Sometimes when too many supplements are being taken they have counter active effects. Mixing lots of supplements is tricky business. In my case I only add one at time so I can see what results I get from it. If I can do blood tests to measure the results I do, such as for inflammation, blood thinning, blood clotting, etc.

The problem with taking maximum dosages of Omega 3 and aspirin all at once is if does work, you won't know why or which LCP is the one that's needed. That means you'll have to keep taking maximum dosages. In addition, when you stop taking them any positive benefits associated with them do not stop immediately. In general, the benefits will decline over time at almost the same rate that they ramped up until the cells reach their natural level of Omega 3 saturation from diet, etc. Improvement on Omega 3 is so gradual a lot of people don't recognize that it is taking place. Trying to remember how things were 20 weeks ago as compared to how they are now is difficult. Writing down symptoms in a daily journal helps to measure improvement. Partial improvement is better than none, but it is hard to see without an A to B momentary comparison.

In my case, the Omega 3's didn't eliminate my dry eye symptoms completely. It did get rid of most of the redness, itchy eye, crustiness and sandy feeling. I still have the blurry vision. I also think it has stabilized my dry eye, but that's hard to measure.

Some of my friends get their Omega 3 with cod liver oil. I guess the new flavored cod liver oils aren't too bad tasting. The problem with using cod liver oil is Vit A. No one should take large doses of cod liver oil (if they can stand it) because the high levels of Vit A are toxic. Vit A amounts vary considerably from one brand to another. Daily intake of Vit A shouldn't exceed 3000 IU. Some pharms believe up to 10,000 IU is okay, but that's way above what I would consider safe on a consistent basis. Levels of 20,000 IU are not only toxic, they are deadly. So please read the labels on whatever brand you take and make sure your consumption level is within rational limits.

Good luck! I understand the frustration.

[jackolso]

Cod Liver Oil

Some of the people on this forum use Cod Liver oil as a treatment for dry eye.

There is a risk of infection but it is very small if you use high quality cod liver oil from known quality vendors, and you don't contaminate the bottle. It's best to pour a little oil out of the bottle into a paper plate or some other secondary holder and then put the oil on to a clean piece of tissue. That keeps the bottle clean and lowers the risk of contaminating it. That's just common sense.

I've read that simply putting a little on the eye lids and blinking a few times gets enough into the eyes to gain any benefits from it. I haven't tired it, but I'm thinking about it. If cod liver oil improved my dry eye only a small amount, using it with my Trufocals might improve my vision even more than the Trufocals alone. That would be nice!

If anyone uses cod liver oil be sure to get the triglyceride form and not the ethyl ester (EE) form which has ethanol. Ethanol is not good for the eyes. It’s a by product of the EPA extraction. I believe Carlson’s and Nordic Naturals are TG forms. I don’t take Omega 3 fish oil if it’s been processed with ethyl esters. Putting anything into the eyes carries risk so please be very careful to avoid contaminated products. Everything must be sterile. If you notice any problems or issues stop using whatever you are using immediately.

Here's a link to a 1936 British Journal of Ophthalmology article on using cod liver oil as an eye treatment. Since this link isn't related to Trufocals maybe it can stay up. Interesting. You can download the article in pdf format.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1142681/