Omega-3 Fatty Acids Should Not Be Used as Treatment for Ulcerative Colitis
Omega-3 fatty acid supplementation (EPA and DHA) should not be advised for patients with ulcerative colitis, either for treating active disease or maintaining remission. 1
Evidence Against Omega-3 Use in Ulcerative Colitis
Maintenance of Remission - No Benefit Demonstrated
The most recent and authoritative ESPEN guidelines (2017) provide a Grade B recommendation with 100% consensus against omega-3 supplementation for maintenance of remission in inflammatory bowel disease, including ulcerative colitis. 1
Key trial findings demonstrate lack of efficacy:
A 2-year study showed initial improvement in relapse-free survival at 2-3 months, but this effect disappeared and cumulative relapse rates at 2 years were identical to placebo. 1
A 12-month trial using a combination of gamma-linolenic acid, EPA, and DHA actually showed numerically more relapses in the actively treated group compared to placebo. 1
Multiple systematic reviews, including a Cochrane review, concluded that omega-3 supplementation is ineffective for maintaining remission in UC patients. 1, 2
Active Disease - Insufficient Evidence and Potential Harm
For active ulcerative colitis, the evidence is even more concerning:
The 2006 ESPEN guidelines noted that while omega-3 fatty acids improved histological indices and leukotriene ratios, no clinical benefit was proven. 1
One comparative study found that sulfasalazine was superior to omega-3 fatty acids, with omega-3 treatment resulting in greater disease activity as measured by increased platelet count, ESR, C-reactive protein, and fecal nitrogen excretion. 3
The value of omega-3 fatty acids on disease activity remains "controversial and not proven" according to established guidelines. 1
Contradictory Research Findings
While one small crossover trial (n=11) showed a 56% decline in disease activity index with fish oil versus 4% with placebo 4, this finding has not been replicated in larger, more rigorous studies and is contradicted by the systematic review evidence. 1, 2
Clinical Implications
For patients asking about omega-3 supplementation:
Explain that despite theoretical anti-inflammatory properties, clinical trials have failed to demonstrate meaningful benefit for UC. 1
The evidence applies to both adults and children with UC. 1
Standard medical therapy (aminosalicylates, corticosteroids, immunomodulators, biologics) remains the evidence-based approach. 1
Important Caveats
If patients have nutritional deficiencies, these should be corrected with appropriate supplementation (such as iron for anemia), but omega-3 is not indicated specifically for UC management. 1
Omega-3 supplementation for general cardiovascular health in UC patients without IBD-specific benefit is a separate consideration, though even for cardiovascular prevention, evidence is limited. 5
Modified enteral formulae enriched with omega-3 fatty acids are not recommended because no clear benefits have been shown. 1