Low-grade systemic inflammation linked to omega-3 deficiency is highly prevalent within the UK population and a known risk factor for numerous health conditions for which individuals will approach their practitioner. Some of the key issues facing practitioners are: understanding where fatty acid deficiency may play a role in a client’s symptoms, understanding when supplementing with omega-3 fatty acids can be of benefit and, importantly, knowing how much omega-3 is needed to elicit an improvement in symptoms.
Identifying those individuals who are ‘at risk’ and recognising the potentially higher omega-3 requirements for some health conditions is imperative for advising clients on diet modification and supplementary intervention. The incorporation of omega-3 into red blood cell (RBC) membranes increases in a dose-dependent manner, with individuals with the lowest omega-3 levels shown to respond more favourably (incorporating additional omega-3 at a faster rate) than individuals with higher baseline omega-3 levels, who incorporate additional omega-3 at a slower rate.[1, 2] The Opti-O-3 is a specialist fatty acid biomarker blood test that estimates the dose level of omega-3 required to raise RBCl contents to predetermined levels and is based on two key influencing variables: the individual’s baseline omega-3 level and their body weight. This allows the practitioner to offer a bespoke treatment programme based on individual requirements and, with 6-monthly regular checks, aims to achieve and maintain levels of scientifically established biomarkers within those ranges that are considered to be health positive.
Understanding individual fatty acid requirements for clinical outcomes
The health consequences associated with low intake of the long-chain marine omega-3 fatty acids have become a central issue in nutritional lipid research. Whilst the use of omega-3 fatty acids in clinical practice is common, the ‘dose’ used and the response rates observed in some human trials can often bring about mixed and confusing opinions on the validity of omega-3 treatments. Interestingly, in spite of the importance of the omega-3 fatty acids, relatively few studies have monitored the correlation of supplement intake, subsequent enrichment of these fatty acids and clinical outcomes. Undoubtedly, the ‘one capsule size fits all’ attitude to omega-3 supplements in clinical practice must be improved, and the concept of a more tailored, bespoke dosing, based on individual requirements rather than simple guesswork, should be the way forward to improve the client’s response to treatment. The Opti-O-3 fatty acid biomarker test aims to do just this. By identifying the client’s baseline levels of omega-3 (as defined in the omega-3 index) it is possible to offer a dosing regimen that aims to restore omega-3 levels and balance the omega-6 to omega-3 ratio into healthy target ranges. The Opti-O-3 fatty acid biomarker test differs from standard fatty acid profiling because we do not make recommendations based on levels of individual fatty acids because there are no currently recognised ‘normal’ ranges. Instead, we focus on the following distinct validated biomarkers.
The omega-3 index
Data from epidemiological and dietary intervention studies suggest a desirable target value for the omega-3 index (the content of EPA and DHA in the cell membrane of RBCs, expressed as a weight percentage of total fatty acids and reflects tissue fatty acid composition) of more than 8%, with less than 4% recognised as an undesirable level.  A low omega-3 index is associated with numerous health conditions, including cardiovascular disease and neurodevelopmental and mental health disorders. [4, 5]
The omega-6 to omega-3 ratio and the AA to EPA ratio
In addition to low omega-3, excessive amounts of omega-6 fat acids and a very high omega-6 to omega-3 ratio contribute to the risk and progression of many diseases. The dysfunction in the balance between pro-inflammatory omega-6 arachidonic acid (AA) derived mediators and the anti-inflammatory mediators from eicosapentaenoic acid (EPA) is fundamentally important when addressing chronic systemic low grade inflammation, which is at the core of many typically Western diseases including cardiovascular disease, cancer, neurological disorders, mood disorders, inflammatory and autoimmune disease. As we increase our omega-3 index we see a concurrent decrease in the AA to EPA ratio, which often correlates directly with a reduction in symptom severity. Whilst the omega-6 to omega-3 ratio provides useful information and is a biomarker of health status well recognised by practitioners, the ratio of AA to EPA within cell membranes is a direct biomarker of inflammatory status.
How much omega-3 do we need?
The message that we need to increase our omega-3 intake is far from new. Current recommendations for omega-3 intake are set at 450mg/day, yet it may be that additional intake of long-chain omega-3 fatty acid beyond current recommendation is needed to raise omega-3 levels to predetermined levels known to reduce disease risk. Whilst encouraging clients to consume two portions of fish weekly to increase EPA and DHA levels, the omega-3 index, omega-3 to omega-6 ratio and the AA to EPA ratio can all be manipulated quite simply by increasing EPA intake. The Opti-O-3 is a simple, minimally invasive, (finger prick) blood spot test that can be carried out at home by the client. The dried blood spot is sent for analysis to identify biomarker status derived from individual fatty acid levels and the dose then calculated based on the client’s individual requirements.
Who would benefit from bespoke dosing?
Despite the COMA and SACN recommendation to eat at least two portions of fish per week, the majority of the UK population does not consume enough fish, particularly oily fish.  Identifying deficiencies (which could be defined as a suboptimal omega-3 index) could provide a useful starting ground for practitioner to client guidance. It is becoming clearer that [in some cases] additional intake of long-chain omega-3 fatty acid beyond current recommendations may be needed to achieve an omega-3 index considered to be health protective. For example, a higher dose of at least 1.0 to 1.5 grams per day of omega-3 (as long-chain omega-3 and not the total volume of fish oil) is required for demonstrable beneficial effects on cardiovascular risk factors such as a reduction in triglycerides, blood pressure, platelet aggregation and the inflammatory response. On an international level, health organisations and government agencies are typically recommending relatively low intakes of long-chain omega-3 to ‘maintain’ the status quo, with significantly higher amounts recognised to be necessary for the prevention of cardiovascular disease, the treatment of patients with cardiovascular disease (about 1 gram per day), or the treatment of hypertriglyceridaemia (about 2-4 grams per day). 
The dose of omega-3 adjusted per unit body weight (g/kg) is a strong predictor of change in the omega-3 index; thus, increasing the dose per unit body weight (grams of EPA+DHA per kilogram body weight) results in a greater omega-3 index response, so that those individuals with lower body weight on higher doses will experience the greatest increase in their omega-3 index. For example, a ‘healthy’ 50kg individual with an omega-3 index of 4 would require at least 0.85 g/day of long-chain omega-3 for 5 months to achieve an omega-3 index of 8%, where a 70kg individual would require a minimum of 1.2g/day.
Practitioners will often advise clients on the potential benefits associated with including omega-3 in a treatment programme. With a plethora of products ranging widely in omega-3 content (from simple fish body oil to highly concentrated pure EPA), recommendations are often restricted to the dosing ‘guidelines’ that relate to a ‘one size fits all’ approach to treatment. The introduction of the Opti-O-3 overcomes these constraints by literally taking out the guesswork involved in the treatment. Practitioners can now offer a bespoke treatment programme to their clients for optimal health outcomes; not only will this benefit the client but will also add considerable value to the practitioner service.
- Cao J, Schwichtenberg KA, Hanson NQ, Tsai MY: Incorporation and clearance of omega-3 fatty acids in erythrocyte membranes and plasma phospholipids. Clin Chem 2006, 52(12):2265-2272.
- Flock MR, Skulas-Ray AC, Harris WS, Etherton TD, Fleming JA, Kris-Etherton PM: Determinants of erythrocyte omega-3 fatty acid content in response to fish oil supplementation: a dose-response randomized controlled trial. J Am Heart Assoc 2013, 2(6):e000513.
- Harris WS, Von Schacky C: The Omega-3 Index: a new risk factor for death from coronary heart disease? Prev Med 2004, 39(1):212-220.
- Milte CM, Sinn N, Howe PR: Polyunsaturated fatty acid status in attention deficit hyperactivity disorder, depression, and Alzheimer’s disease: towards an omega-3 index for mental health? Nutr Rev 2009, 67(10):573-590.
- von Schacky C, Harris WS: Cardiovascular risk and the omega-3 index. J Cardiovasc Med (Hagerstown) 2007, 8 Suppl 1:S46-49.
- Simopoulos AP: The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother 2002, 56(8):365-379.
- Food and Agriculture Organization of the United Nations., World Health Organization. Report of the Joint FAO/WHO Expert Consultation on the Risks and Benefits of Fish Consumption : Rome, 25-29 January 2010. Rome: Food and Agriculture Organization of the United Nations : World Health Organization; 2011.
- Harris WS: International recommendations for consumption of long-chain omega-3 fatty acids. J Cardiovasc Med (Hagerstown) 2007, 8 Suppl 1:S50-52.