concussions

Do Omega-3s Benefit Athletes?

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What Do These Recommendations Mean For Non-Athletes?

Author: Dr. Stephen Chaney

fish and fish oilI have been following the research on omega-3s for athletes. But I have been reluctant to review that research in “Health Tips From the Professor” because:

  • Most of the studies are small.
  • Each study measures the effect of omega-3 supplementation on different aspects of exercise and fitness.
  • The dose of omega-3s used in the studies varies widely.
  • To the casual observer, the studies appear to come to conflicting conclusions.

I have been waiting for a respected organization to do an in-depth analysis of the published studies before commenting. The International Society of Sports Nutrition (ISSN) has just published such a study (R Jager et al, Journal of the International Society of Sports Nutrition, Issue 22 (1), 2441775, 2025) and have provided a position statement on the use of omega-3 supplements by athletes and active adults.

I would add that the ISSN is regarded as a trusted source of nutrition information for athletes.

Do Omega-3s Benefit Athletes?

Question MarkThe position of the ISSN is summarized below. What I like is they give the best recommendations based on current data and summarize the strength of the data behind each recommendation.

Statement 1: Athletes may be at higher risk of omega-3 insufficiency, and diets rich in omega-3s, including supplements, are effective for increasing omega-3 levels. In this category, they reported three key findings:

  • Omega-3s (ie EPA and DHA) are conditionally essential nutrients.
  • Fatty fish and omega-3 supplements are both effective in raising omega-3 levels.
  • Athletes belong to the groups at higher risk of omega-3 inadequacy.

My Comments:

    • This conclusion was primarily based on studies with Division I college football players. More research is needed for high-level athletes in other sports.
    • The reason for this omega-3 insufficiency was not discussed. However, I suspect it has to do with the recognition that high-level athletes need extra protein, and that fish is not usually included as a recommended source of additional protein for athletes.
    • The average Omega-3 Index for the football players was 4.4% which is considered at high risk for heart disease. The authors of the ISSN report noted that previous studies have shown that around 1.4 g/day of EPA + DHA is recommended to increase the Omega-3 Index to an optimal 8%.

Statement 2: Omega-3 supplementation, particularly EPA and DHA, has been shown to enhance Sprinterendurance capacity and cardiovascular function during aerobic-type exercise. In this category, they reported three key findings:

  • Omega-3s can improve cardiovascular dynamics during and after exercise as evidenced by enhanced red blood cell deformability, endothelial function, and heart rate recovery after exercise.
  • The incorporation of omega-3s into skeletal muscle membranes has been found to result in changes in muscle omega-3 composition, particularly in the sarcolemma, which is essential for muscle remodeling and/or regeneration after endurance exercise.
  • While these changes may help the heart pump more efficiently during exercise and muscle recover quicker after exercise, their direct impact on endurance performance remains inconsistent. More studies are needed.

My Comments:

    • These studies should be interpreted through the lens of your desired outcome. High-intensity exercise is hard on the heart.
    • If your goal is increased endurance the role of omega-3s is uncertain.
    • If your goal is to have your heart operate more efficiently during aerobic exercise, omega-3 supplementation may be beneficial.

Weight TrainingStatement 3: Omega-3 supplementation in combination with resistance training may improve strength in a dose- and duration-dependent manner. Specifically, they reported.

  • The incorporation of omega-3s into muscle cells may take a minimum of four weeks, and this is dose-dependent. It takes longer to optimize the omega-3 content in muscle cells at lower doses.
  • Once the omega-3 content of muscle cells has been optimized, it may take another three to six months until the improvement in strength plateaus.

My Comment:

    • In short, don’t expect immediate results, but omega-3 supplementation may help increase muscle strength over the long haul.

Statement 4: Omega-3 supplementation may not confer a hypertrophic benefit in young adults. [In plain English they are saying that omega-3s may not stimulate any increase in muscle mass beyond that due to exercise alone for young adults.] They went on to say:

  • More high-quality research is warranted to investigate the effects of omega-3 supplementation on body composition.

My Comments:

    • We need to remember that the ISSN recommendations are for serious athletes and may not apply to the rest of us.
    • For example, the authors state that omega-3 supplementation may enhance an increase in muscle mass…
      • When protein intake is suboptimal.
      • For older adults who are experiencing age-related loss of muscle mass.
      • For people who have previous been inactive and are just beginning an exercise program.
    • In other words, omega-3 supplements may help a lot of us non-athletes who are exercising to retain or increase muscle mass and strength.

Inflammed HeelStatement 5: Omega-3 supplementation may decrease subjective measures of muscle soreness following intensive exercise. In this category, they reported three key findings:

  • Omega-3 supplementation may attenuate indirect measures of muscle damage following intense exercise.
    • For example, when muscles are damaged, they release muscle-specific enzymes such as creatine kinase and lactate dehydrogenase into the blood. Some studies have shown that omega-3s reduce the release of these muscle enzymes following intense exercise.
  • Omega-3 supplementation is equivocal in decreasing subjective measures of muscle soreness following intense exercise.
  • Omega-3 supplementation does not decrease measures of inflammation following exercise-induced muscle damage.

My Comments:

    • Don’t count on omega-3 supplementation for reducing muscle soreness. But if you experience a decrease in muscle soreness, count it as an unexpected side benefit.
    • The lack of an effect of omega-3s at reducing inflammation post exercise may be a good thing. Some experts think that the inflammatory response plays a role in stimulating muscle repair following exercise.

Statement 6: Omega-3 supplementation can positively affect various immune cell responses in athletic populations. In this category, they reported three key findings:

  • Many athletes develop a compromised immune system due to the stress of high training volumes, which can increase the likelihood of developing acute respiratory infections that negatively impact their ability to train and compete.
  • Omega-3 supplementation can affect various immune cell responses in non-athlete, clinical, and athletic populations.
  • Many clinical studies conducted in athletic populations have indicated that omega-3 supplementation can influence the production and regulation of various inflammatory cytokines, which may lead to physiological benefits for the athletes [An example would be a reduction in exercise-induced asthma].

My Comments:

    • These recommendations are based on the effect of omega-3s on blood markers of immune health and inflammation. Clinical studies looking at the effect of omega-3s on exercise-induced respiratory infections or asthma are either nonexistent or conflicting.
    • So, if you experience decreased respiratory infections or exercise induced asthma when you add omega-3s to your exercise regimen, consider it an unexpected side benefit.

Statement 7: Omega-3 supplementation may offer neuroprotective benefits in athletes exposed to repeated head impacts. In this category, they reported three key findings:

  • Omega-3s are crucial for optimal brain development and functioning.
  • Omega-3 supplementation can increase membrane fluidity, neurotransmitter synthesis and release, and cerebral blood flow.
  • In humans, a limited amount of evidence suggests that omega-3 supplementation may offer neuroprotective benefits in athletes following repeated head impacts.

My Comments:

  • This is an important recommendation. Long-term cognitive decline, associated with repetitive traumatic brain injuries, is a serious concern for many high-impact sports. And there are no established protocols to prevent cognitive decline from occurring.
  • I have covered this in more detail in a previous issue of “Health Tips From the Professor”.

Statement 8: Omega-3 supplementation is associated with improved sleep quality. In this category, they reported three key findings:

  • Omega-3 supplementation has been linked to improved sleep quality in some studies.
  • Omega-3 supplementation may help sleep quality due to anti-inflammatory properties and effects on neurotransmitters like dopamine and serotonin, a precursor of melatonin, which helps regulate sleep-wake cycles.
  • However, inconsistency of results indicates more research is needed to fully understand the relationship between omega-3 supplementation and sleep.

My Comment:

  • If you experience improved sleep when you add omega-3s to your exercise regimen, consider it an unexpected side benefit.

Summary Of ISSN Recommendations

A strength of the ISSN recommendations is that they acknowledge where there is good agreement in the studies supporting their recommendations and where the data are scanty or conflicting. Based on the studies behind each recommendation, I would divide their recommendations into three categories.

#1: Recommendations backed by a limited number of strong studies. Confidence in these recommendations can be improved with more studies, but the recommendations are strong. These include:

  • Statement 1: Athletes are at higher risk of omega-3 insufficiency, and diets rich in omega-3s, including supplements, are effective for increasing omega-3 levels.
  • Statement 4: Omega-3 supplementation in combination with resistance training may improve strength in a dose- and duration-dependent manner.

#2: Recommendations where the evidence is weak for athletes, but valuable for non-athletes. I will discuss those in more detail below. These include:

  • Statement 2: Omega-3 supplementation has been shown to enhance endurance capacity and cardiovascular function during aerobic-type exercise.
  • Statement 3: Omega-3 supplementation may not confer a muscle hypertrophic benefit [increase in muscle mass] in young adults.

#3: Recommendations that are weak and/or conflicting. These fall in the category of “don’t count on it. But if you do experience it, consider it an unexpected side-benefit of omega-3 supplementation”. These include”

  • Statement 5: Omega-3 supplementation may decrease subjective measures of muscle soreness following intense exercise.
  • Statement 6: Omega-3 supplementation can positively affect various immune cell responses in athletic populations.
  • Statement 8: Omega-3 supplementation is associated with improved sleep quality.

Finally, the effect of omega-3 supplementation on preventing the cognitive consequences of repeated head trauma (Statement 7) is a very important topic. I have covered this in more detail in a previous issue of “Health Tips From the Professor”.

What Do These Recommendations Mean For Non-Athletes?

confusionAs their name (International Society of Sports Nutrition) suggests, their recommendations are meant primarily for athletes. But what about those of us who are not athletes but work out on a regular basis for fitness, weight management, maintaining muscle mass as we age, or other reasons?

In general, the recommendations apply equally well for athletes and non-athletes with a couple of caveats:

1) Dosage: Some of the studies with athletes were done with 3 to 6 grams/day of omega-3s. However, in most cases similar results were obtained 1-2 grams/day. Since 1-2 grams/day is enough to increase omega-3 levels to optimal for 90% of the population, I would recommend this dosage rather than the higher doses used in some of the studies with athletes.

2) Different Priorities for athletes and non-athletes: As I described earlier, this applies to two of the ISSN recommendations, namely:

  • Statement 2: Omega-3 supplementation has been shown to enhance endurance capacity and cardiovascular function during aerobic-type exercise. As I said above:
    • Young athletes are primarily interested in endurance, and the evidence for an endurance benefit for omega-3 supplementation is weak.
    • However, the rest of us are more interested in how efficiently our heart is functioning during high-intensity exercise, especially as we age. And the evidence for that benefit is strong.
  • Statement 3: Omega-3 supplementation may not confer a hypertrophic muscle benefit [increase in muscle mass] in young adults.
    • That is a true statement for young, high-performance athletes who are consuming high protein diets. For the rest of us, we need to remember the authors of the ISSN report stated that omega-3 supplementation may enhance an increase in muscle mass:
      • When protein intake is suboptimal.
      • For older adults who are experiencing age-related loss of muscle mass.
      • For people who have previous been inactive and are just beginning an exercise program.

The Bottom Line

The International Society For Sports Nutrition (ISSN) is recognized as a trusted source of nutrition advice for athletes. They recently reviewed the literature on the value of omega-3 supplementation for athletes and released a position paper with eight statements (recommendations).

I have divided these recommendations into 3 categories:

  • Recommendations backed by strong data.
  • Recommendations backed by weak data.
  • Recommendations that have different significance for high-performing athletes and the rest of us.

For more details about the ISSN recommendations and what they mean for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

Should Athletes Be Taking Omega-3s?

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Can Omega-3s Protect Your Brain?

Author: Dr. Stephen Chaney 

Contact sports like football and soccer can be an athlete’s ticket to fame and fortune. That is a powerful motivator. But many elite athletes in contact sports pay a terrible price after their playing days are over.

Repeated head trauma can lead to a condition called Chronic Trauma Encephalopathy or CTE. In CTE, a protein called Tau forms clumps that spread through the brain, killing brain cells. Eventually, this can lead to irrational behavior and/or early-onset Alzheimer’s, which is, indeed, a terrible price to pay for their brief moment in the spotlight.

The NCAA is aware of the damaging effects of repeated head trauma and are experimenting with rule changes and improvements to protective head gear to reduce it. But, given the pressures of college teams to win at all costs, it will be impossible to completely eliminate head trauma from contact sports.

So, it is important to ask, “What else we can do?” Several studies have suggested that omega-3s may mitigate the damaging effect of repeated head trauma. For example:

  • The omega-3s DHA and EPA are metabolized to molecules called resolvins and protectins, which protect brain tissue from oxidative stress and help restore damaged brain tissue.
  • DHA and EPA also reduce the inflammation associated with brain injury, so the brain can heal faster.
  • DHA and EPA boost the level of a protein called BDNF in the brain. It helps trigger the production of new brain cells, which also aids in the recovery from brain injury.
  • Finally, some medical clinics have reported that high dose omega-3s help speed the recovery from severe head trauma.
  • This is concerning because omega-3s are largely missing from the diet of college athletes.

This raises the question, “Should athletes be taking omega-3s?”omega 3 supplements

The kinds of studies mentioned above suggest that DHA and EPA might help protect athletes from the damaging effects of repeated head trauma, but it is difficult to prove:

  • If a patient comes into a clinic with severe brain trauma, the symptoms are obvious. And if omega-3s speed recovery it will become apparent in weeks or months. This effect is easy to measure.
  • On the other hand, the effects of repeated, minor head trauma on a highly trained athlete are often not apparent until decades later. Therefore, any protective effects of omega-3s would also not become apparent for decades. Clinical studies don’t last that long.

Because of this, current research focuses on markers of brain damage such as neurofilament light chain or Nf-L. Nf-L is a neuronal protein that is released into the bloodstream by dying neurons. It is widely considered to be an early marker for neurodegenerative diseases such as those seen in former college football players. Previous studies have shown:

  • Nf-L blood levels increase during the season for NCAA-level college football players.
  • College football players have a very low omega-3 index, a measure of omega-3 status.
  • DHA supplementation reduces Nf-L levels in college football players.

With this in mind, the authors of this study (JL Heileson et al, Journal of the International Society of Sports Nutrition 18:65, 2021) looked at the effect of a high-dose, comprehensive omega-3 supplement on Nf-L levels in the blood of NCAA football players during the playing season.

How Was This Study Done?

clinical studyVolunteers from two geographically distinct NCAA football teams were recruited for this study. One team (n=31) was given a daily high-dose omega-3 supplement providing 2,000 mg of DHA, 560 mg of EPA, and 320 mg of DPA starting during pre-season (fall) practices and continuing through the entire season. Compliance with the supplement regimen was 93%.

Volunteers from the other team (n=35) received no supplements and served as a control.

Participants from both teams were advised which foods were high in omega-3s and were asked to limit servings to no more than 2 per week for the duration of the study.

Players were excluded from the study if they:

  • Were on long-term (>20 days) anti-inflammatory therapy.
  • Were using fish oil supplements.
  • Ate more than two servings of fish per week.
  • Were on medications to control blood pressure or blood lipid levels.

Blood samples were drawn 7 days before pre-season practice, at the end of pre-season practice, 3 times during the season, and at the end of the season (a total of 6 blood draws).

The blood samples were analyzed for Nf-L, a marker of brain injury, and Omega-3 Index, a measure of omega-3 status.

Should Athletes Be Taking Omega-3s?

As I stated above, compliance with the supplementation regimen was excellent (93%) and this was reflected in the blood levels of long-chain omega-3s. Between the first and last blood sample drawn:

  • DHA and EPA levels increased 2-fold.
  • DPA levels, on the other hand, decreased slightly.
    • This suggests that the beneficial effects of omega-3 supplementation were primarily due to DHA and EPA. I will discuss the implications of this below.
  • The omega-3 index increased from 4.3%, which is considered poor, to 7.4%, which is considered near optimal.

The effect of omega-3 supplementation on Nf-L levels was striking:

  • In the control team (no supplementation) Nf-L levels increased 1.5-fold during the pre-season practices and remained elevated throughout the regular season.
  • In the team receiving omega-3 supplementation there was no significant increase in Nf-L levels.

The authors of the study concluded, “These findings suggest a…neuroprotective effect of combined EPA+DPA+DHA omega-3 fatty acid supplementation in American-style football athletes.”

The authors went on to say, “Similar elevations of Nf-L have been reported with RHI [repeated head injuries] in other contact sport athletes. These data suggest that those other contact sports athletes may also benefit from omega-3 supplementation…”

So, let’s return to the original question, “Should athletes be taking omega-3s?” Here is my take on the study:

  • The conclusions of the authors are appropriately cautious. This study shows that omega-3 supplementation reduces an indicator of possible brain damage (Nf-L), but the actual symptoms of brain damage don’t appear for decades.
    • Therefore, this study suggests, but doesn’t prove, that omega-3 supplementation may reduce Chronic Trauma Encephalopathy (CTE) for athletes who competed in contact sports during their college years.
  • This study used an omega-3 supplement containing EPA, DHA, and DPA. It resulted in an increase in EPA and DHA levels, but not DPA levels. Thus, there is no evidence that the DPA portion of the supplement was needed. I recommend a supplement with a 4:1 ratio of DHA to EPA for brain health.
  • This study did not establish an optimal dose of omega-3s. Until more information is available, I would recommend around 2,000 mg of DHA and 500 mg of EPA for athletes in contact sports, but the optimal dose may be lower or higher.

Can Omega-3s Protect Your Brain?

If you are not a college athlete competing in contact sports (which would include most of us), you are probably wondering what this means for you. Here are my thoughts.

As Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.”

  • You never know when you may suffer unexpected head trauma. It could be a car accident. It could be a fall. You might be playing a friendly game of softball and get hit in the head by a foul ball. You get the point.
  • And the best time to make sure you have enough omega-3s (specifically DHA + EPA) in your brain is before the trauma occurs.

But how much DHA + EPA is enough? This is where it gets confusing.

  • Recommendations range from 500 mg/day to 3,000 mg/day depending on whether the goal is to reduce death from heart disease, lower blood pressure, or lower triglycerides.
  • This study used 2,500 mg/day to reduce a marker of brain damage in college athletes, but we don’t know whether that is optimal.
  • Finally, these numbers are averages, and none of us are average. We all utilize omega-3s from supplements with different efficiencies.

My recommendation is to use the Omega-3 Index as a gauge. It tells us how much DHA + EPA we have actually accumulated in our tissues.

  • An Omega-3 Index of 8% is considered optimal for heart health, and this study suggests it might be optimal for brain health as well.
  • So, my recommendation is to get your Omega-3 Index measured at 6-month intervals until you have determined the amount of supplemental DHA + EPA you need to attain and maintain an 8% Omega-3 Index.
  • Based on this study, I would recommend a high-purity supplement with an ~4:1 ratio of DHA to EPA if your primary goal is brain health. But other studies suggest that an EPA to DHA ratio of 3:2 may be optimal for heart health.

In short:

  • While the evidence is not definitive, this study suggests that it might be prudent to have accumulated enough DHA and EPA in your neural tissue to help reduce the complications of unexpected brain trauma.
  • This study also suggests that you may wish to aim for an Omega-3 Index of 8%.
    • An Omega-3 Index of 8% likely has side benefits. There is also evidence that it may reduce the rate of cognitive decline as you age, help protect your heart, and reduce inflammation.
  • The ratio of DHA to EPA in the supplement you choose may be different for brain health and heart health. If you are equally interested in brain and heart health, just be sure your supplement provides both DHA and EPA.

The Bottom Line 

Repeated head injuries are a major concern for NCAA football players and college athletes in other contact sports. That’s because repeated head injuries during their playing years are associated with a degenerative brain condition called Chronic Trauma Encephalopathy or CTE, which can lead to irrational behavior and/or early-onset Alzheimer’s.

A recent study looked at the effect of a high-dose, comprehensive omega-3 supplement on Nf-L, a marker of brain injury, in NCAA football players during the playing season. Two teams were selected.

  • In the team receiving no omega-3s, Nf-L increased 1.5-fold during preseason practice and remained elevated throughout the playing season.
  • In the team receiving omega-3 supplementation there was no significant increase in Nf-L levels.

The authors of the study concluded, “These findings suggest a…neuroprotective effect of… omega-3 fatty acid supplementation in American-style football athletes.”

The authors went on to say, “Similar elevations of Nf-L have been reported with RHI [repeated head injuries] in other contact sport athletes. These data suggest that those other contact sports athletes may also benefit from omega-3 supplementation…”

For more information on this study and what it means for all of us who are not college athletes, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

 ____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 

 

Health Tips From The Professor