How to Use Fish Oil Supplements to Treat Ischemic and Ulcerative Colitis

Colitis is a condition of acute or chronic inflammation of the colon. Colitis can be ischemic, which is a kind of inflammation that develops from the inside out. Or colitis can be ulcerative, which is a kind of inflammation that develops from the outside in. Both way, colitis causes a lot of grief, and while fish oil is not an appropriate treatment for colitis, its anti-inflammatory effects can go a long way in helping colitis sufferers get back to normal.

I've had to deal with this health issue myself. A couple of years ago I had two tires blow out on my vehicle while I was driving through the countryside. I had forgotten my cell phone, so I started hiking into the nearest town, a little under 3 miles (5 km) in 108° F (43° C) heat.

On my walk back into town I didn't see another soul. I became seriously dehydrated. The first thing I did was to walk into a Dairy Queen, which is, for those of you visiting this site from outside the United States, the kind of restaurant health experts don't recommend. I wanted something cold and I wanted a lot of it fast.

The kindly proprietor of the Dairy Queen suggested I order something called a Blizzard, which is essentially drinkable ice cream. I almost never eat ice cream, but I was thirsty, tired, and famished. I had a chaser of ice water. A 32-oz (1 L) tumbler of the coldest ice water I could find.

This is something you really should not do if you get dehydrated. I am an expert in this area now. What happened to me is that the combination of dehydration reducing the volume of my bloodstream and a large mass of nearly freezing fluid hitting my stomach cut off circulation through my inferior mesenteric artery to the left side of my colon. About an hour eating the ice cream treat and drinking the ice water, I experienced the worst pain I had ever felt in my life.

You may have experienced what we Americans call a "brain freeze" after eating too much ice cream too fast. A "brain freeze" causes intense migraine-like pain that subsides in a minute or so when the blood vessels warm back up. What I had now was a "colon freeze" that in about an hour was to have me in ER, and in about three hours was to have me chatting with a gastroenterologist about whether I was going to have an emergency colostomy.

The doctors did absolutely everything right, and I didn't have to have emergency surgery to remove a dead colon. Only the outer layer of the wall of my colon wall died that afternoon, and that can grow back. I'll just say it is a very, very unpleasant process, and it took nearly a year for my colon to function normally again-all for the love of a Dairy Queen Blizzard and ice water on a too-hot day. And my bills were nearly a quarter of a million dollars even after insurance, before discounts.

I did use fish oil after I recovered enough to eat solid food and then recovered enough to take capsules-which was more than a month. As I mentioned earlier, fish oil is not emergency treatment for colitis. It's supportive nutrition during recovery.

Frankly, I don't know how much improvement I was making on my own and how much improvement can be attributed to fish oil and other changes in my diet. I can't give fish oil credit for everything. I also lost a lot of weight, for instance, but I think that probably had more to do with not being able to eat solid food! But fish oil definitely helps control colitis and you have more than just my testimony to tell you so.

Clinical Trials of Fish Oil for Treating Colitis

The kind of colitis I experienced was ischemic colitis, inflammation occurring after the lining of the colon stops receiving oxygen. In my case, oxygen deprivation was sudden. This is the sort of ischemic colitis that occurs in athletes who don't drink enough water during long races. (Many of them die as a result, about 90% in some surveys.)

Ischemic colitis can also be gradual. About 25% of people lose circulation through the inferior mesenteric artery by the age of 85. Their colons grow connections to other sources of blood and nutrients, but the left side of the colon becomes "colicky." Sudden ischemic colitis is usually fatal. Gradual ischemic colitis usually is not.

There hasn't been clinical research into using fish for treating acute ischemic colitis, because this condition is so traumatic that (1) most people who get it die and (2) you can't take anything by mouth for several days to several weeks anyway. (Fish oil is not given by intravenous drip.) Similarly, people who have chronic ischemic colitis usually have multiple health issues that make determining the effects and benefits of fish oil, or any other medication or nutritional supplement, murky at best.

There has been some clinical research into using fish oil to treat ulcerative colitis. This is the form of the condition I described early as inflammation from the outside in. By outside, I mean the outer wall of the colon, which comes in contact with digested food. This form of colitis is not caused by poor circulation. It is caused by overactivity of the immune system. Doctors typically treat this form of colitis with steroids to reduce the activity of the immune system.

One way scientists know that fish oil reduces inflammation in the lining of the colon caused by ulcerative colitis is by direct observation of tissues biopsied from colitis patients. (One of the more disagreeable aspects of having colitis is your doctor wanting to snip away little bits of your guts to see how you are doing.) Scientists at the University of Rouen in France have found that cultures of cells taken from healthy colons resist inflammation longer if they are treated with fish oil.

The other way scientists know that fish oil reduces inflammation in the lining of the colon caused by ulcerative colitis is by clinical observation. There have been four clinical trials. They found that colitis sufferers gained muscle mass (colitis usually causes excessive weight loss) and had less abdominal pain. They found that colitis patients who took fish oil need less prednisone to keep pain under control. Taking less of this steroid reduces water weight, allows recovery of the immune system in other parts of the body, and reduces the risk of fractures and broken bones.

The dosage of essential fatty acids needed to make a difference in these trials is about 3200 mg a day. That is 3200 mg of essential fatty acids, not 3200 mg of fish oil. The clinical trials reported in the medical literature used "cheap" fish oil supplements that required taking up to 18 capsules a day, or 18,000 mg of "fish oil" to get 3200 mg of essential fatty acids. The marine liquids that make up much of the rest of the 18,000 mg of "fish oil" the clinical trial participants took can cause allergies, fishy burps, and diarrhea. But you don't have to take 18 capsules of fish oil every day to get 3,200 mg of essential fatty acids.

You just need to use a higher-quality fish oil.

There are several good options in fish oils available to consumers today that were not available to clinical researchers when they were studying fish oil as a treatment for colitis 20 years ago. One of them is Xtend-Life. You would take 7 or 8 capsules of Xtend-Life a day to get the needed 3,200 mg of essential fatty acids; seven being a tiny amount less than was used in clinical trials and eight a tiny bit more.

Or you could take just 5 capsules a day Solgar Omega-3 "950" mg If you have trouble taking larger capsules or you would prefer to get your CoQ10 at the same time you take your fish oil, use Xtend-Life / QH Ultra. If you don't have a problem with larger capsules and you don't take CoQ10, use Solgar. There are other good brands of fish oil. I mention these two to make the process of finding an appropriate product easier. I'd always start off taking just one capsule of any product per day to make sure there are no unexpected reactions, and then build up to the right number of capsules over about a week if there are no problems.

Other Nutritional Supplements for Colitis

There are also other nutritional supplements that are useful for treating specific manifestations of colitis. These supplements are inexpensive, safe, readily available, and often ignored.

Left-Sided Colitis: This is colitis that is caused by poor circulation through the inferior mesenteric artery. People who have left-sided colitis usually benefit from taking a folate supplement because their medications, especially sulfasalazine, interfere with the absorption of folate. The supplement will cost just a few pennies a day, but taking it can prevent future cardiovascular and Alzheimer's-like complications.

Proctitis: This is colitis that is especially severe in the rectum and anus. It is usually treated by regular use of enemas. Every time you take an enema, you stress the blood vessels in the anus, and it's not unusual for them to bleed. Bleeding from the anus is noticed as small amounts of bright red blood; dark blood usually comes from higher up and signals a need for medical diagnosis, and anything more than a few drops of bright red blood also should be referred to a doctor.

To support anal health in proctitis, take vitamin C with citrus bioflavonoids. They help strengthen the blood vessels in the anus so that you don't get bleeding when you withdraw the tip of the enema line. It also helps to eat blackberries, blueberries, and buckwheat, in small servings, at least weekly, as well as cherries and raspberries. These foods provide plant compounds that strengthen the linings of veins.

Pouchitis: Some people who have chronic colitis develop an internal reservoir, or pouch, where the rectum should be. The primary symptom of pouchitis is frequent diarrhea.

It is always important to replace fluids and electrolytes lost during diarrhea. If you have just "mild" diarrhea, your doctor may not remind you of this. If nothing else is available, warm water with a "pinch" of salt and sugar will do. But it's better to replace electrolytes with a product like ElectroMIX, which gives you more electrolytes than just sodium.

If you have pouchitis, at some point your doctor will probably prescribe the antifungal agent metronidazole or, if you don't respond to metronidazole, one of half a dozen antibiotics. After you finish taking the antibiotic, it helps to reestablish the friendly bacteria in your colon by taking probiotics. Because probiotic supplements are coated to dissolve in the small intestine, not in the acid of your stomach, you get more benefit faster from probiotics than you get from eating yogurt with live cultures.

A Reader Asks:

Q. Are there any changes in diet that are good for all kinds of colitis?

A. The way schedules typically work out, you are lying in a hospital bed being fed ice chips about the time a nutritionist comes in to tell you what you will be eating three months later. It's easy to forget even the best advice, because it usually comes when you are not ready for it. Always follow your doctor and nutritionist's guidelines, and here are some basic guidelines that help reduce colitis symptoms.

  • Avoid caffeine not just from coffee but also sodas and diet drinks. This prevents intestinal spasms.
  • Be careful with soy products. If your tofu is made with a stabilizer called carageenan, you can experience cramps.
  • Peppermint tea may help relieve upset stomach. If you take peppermint oil, make sure it is in the form of an enteric-coated capsule. Enteric-coated capsules open in your colon, not in your stomach. Peppermint oil that is not in a protective capsule will reach with stomach acid before it can relieve abdominal pain.
  • Certain hot foods, ironically, can relieve colitis, but you don't want to overdo. Turmeric is helpful, but I personally would take a turmeric supplement rather than loading up on curry. Up to about 2,000 mg of curcumin a day helps relieve inflammation.
  • Slippery elm is useful for treating ulcerative colitis, although it's not especially helpful for ischemic colitis. Eat slippery elm as a porridge rather than drinking it as a tea.
Selected References:
  • Aslan A., Triadafilopoulos G. (1992)Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study, Am J Gastroenterol 87:432-437.
  • Seidner D.L., Lashner B.A., Brzezinski A., Banks P.L., Goldblum J., Fiocchi C. et al. (2005) An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: a randomized, controlled trial, Clin Gastroenterol Hepatol 3:358-369.
  • Stenson W.F., Cort D., Rodgers J., Burakoff R., Deschryver-Kecskemeti K., Gramlich T.L. et al. (1992) Dietary supplementation with fish oil in ulcerative colitis, Ann Intern Me 116:609-614.
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