ONLINE DRIVERS MEDIA

If you want to know how to get of pubertal acne, you got to ask professional pubescents ;-)

The study at hand is not only the first experimental verification of the efficacy of omega-3 + gamma linoleic acid supplementation in acne treatment, its also "paleo approved", because it cites a study by no one else but Loraine Cordaine himself ;-) Dont worry, I am just kiddin around. In spite of the fact that Cordains study "Acne vulgaris: a disease of Western civilization" (Cordain. 2002) is in fact the #1 on the reference list, the scientists from the Seoul National University College of Medicine refrain from (paleolithic) dairy bashing in their evaluation of "the clinical efficacy and safety of omega-3 fatty acids and of GLA for the treatment of mild to moderate facial acne." (Jung. 2014)

If you google "natural acne treatment" it will usually not take long until you find a reference to fish oil and gamma linoleic acid (as in borage or starflower oil). Against that background it is surprising that the Korean scientist are obviously the first to scrutinize the efficacy of 2,000 mg of eicosapentaenoic acid and docosahexaenoic acid and 400 mg ?-linoleic acid (from borage oil) in a parallel design dietary intervention study.

Long-standing "natural acne cure" now scientifically proven

The 45 participants with mild to moderate acne, were allocated to either of the intervention groups for 10 weeks, after which the effect on their skin was evaluated visually and via heamatoxylin, eosin and immunohistochemical staining of the lesions.
And what the scientists observed was ... positive, at least in the omega-3 group, the mean inflammatory acne lesion count was significantly reduced (from 10.1 ± 3.2 in week 0 to 5.8 ± 3.4 in week 10; p < 0.05).

Figure 1: Changes in inflammatory acne lesion counts with time (left, top), noninflammatory acne lesion counts with time (left, bottom), and changes in patients subjective assessment (VAS) with time (right; Jung. 2014)

As you can see in Figure 1, a similar change was observed in the GLA (9.8 ± 5.2 before vs. 8.0 ± 4.6 after 5 weeks vs. 6.6 ± 3.7 after 10 weeks, p < 0.05), but not in the control group (9.9 ± 4.3 before to 10.2 ± 6.2 after 10 weeks).

Figure 2: Before (top) and after (bottom) photos (Jung. 2014)

"Mean non-inflammatory acne lesion counts were also reduced by omega-3 and GLA supplementation (23.5 ± 9.2 to 18.9 ± 8.3, p < 0.05, and 22.8 ± 8.4 to 19.2 ± 7.2, p < 0.05, respectively) at final visits, whereas mean lesion count in the control group was unchanged (from 21.8 ± 9.7 to 22.0 ± 8.6). Significant differences were evident between the treatment groups and the control group after 10 weeks (p < 0.05)." (Jung. 2014)

In the end, there was no no significant difference between the two treatments for any of the measured parameters, so that it is probably up to you, whether you try to control the "fire within your skin" with GLA or DHA + EPA supplements.
References:

• Cordain, Loren, et al. "Acne vulgaris: a disease of Western civilization." Archives of Dermatology 138.12 (2002): 1584-1590.
• Jung, Jae Yoon, et al. "Effect of Dietary Supplementation with Omega-3 Fatty Acid and gamma-linolenic Acid on Acne Vulgaris: A Randomised, Double-blind, Controlled Trial." (2014).
• Wolf, Ronni, Hagit Matz, and Edith Orion. "Acne and diet." Clinics in dermatology 22.5 (2004): 387-393.

Does a (very) high fish oil diet entail the risk of going rancid - in spite of all its short-term health benefits?

Dont worry, I am not addressing the prostate cancer issue, again. In a way, I am still going to resume a discussion, you should be familiar with from my article "Sesame Powered High Omega-6 Diet Boosts Endurance Performance in Rodents - High Omega-3 Diet Sucks" | read more. Its the notion that the extensive incorporation of easily oxidizable (or already rancid) omega-3 fatty acids into metabolically highly active tissues, such as our musculature, will only be beneficial until a certain optimal threshold level is reached. Beyond this point, any further increase of the long-chain PUFA content becomes as problematic as the overabundance of other fatty acids.

This article is about balance!

By now, you should have realized that this post is all about balance, the critical balance of stable saturated and unstable (poly-)unsaturated fatty acids - not in your diet, but in cells & tissue.
Recent evidence of the importance of these numbers comes from a study that was conducted by researchers from the INRA UMR in Montpelier, France (Feillet-Coudray. 2013). It is, as you may have suspected, a rodent study. With a study duration of 12 weeks and the aspiration to investigate the long-term effects of diets containing 50 or 300 g lipid/kg  in the form of either lard or fish oil, this was yet more than a concession to financial constraints.

In the life of a rodent, three months are equivalent to several human years (some sources would say 5 years, but I would not bet on that). A similar study in man would thus take several years - years in the course of which all study participants would have to be locked away in a metabolic ward to ensure that they eat nothing but what the scientists serve them.

Figure 1: Total fatty acid (FA) composition of the LIVER and MUSCLE (mg FA/g tissue; Feillet-Coudray. 2013)

Against that background it is unlikely, but not impossible that we will see similar changes (see Figure 1) in the muscle and liver lipid levels of a human subject within only 3 months, even if he or she would reduce his or her overall fat intake to almost zero while upping the amount of fish oil in the diet into the 50g+ range. For 99% of the existing human studies this means that they are 100% irrelevant in view of the long (and if I write "long", I mean "long" like in years!) term high dose fish oil intakes and the corresponding changes in the fatty acid content and ratios of muscle, liver and other tissue.

No changes in muscle fatty acid make-up. How Come?

Apropos changes! If you look a the data in Figure 1 you will realize that the fatty acid make-up of the musculature in the study by Feillet-Coudray et al. did not change at all. In view of the significant changes in the fatty acid composition of the liver, this appears to be counter-intuitive and if we recall the study design and results of the previously cited study by Ayre et al. (1997) probably a result of the comparatively high omega-6:omega-3 ratio of the purported "fish oil" diet, which contained only 15g of omega-3 fatty acids per kg, and a whopping 21.7g of omega-6s. With an additional 25g of monounsaturated and 27.4g of saturated fats it is thus by no means an "omega-3", let alone "fish oil" diet as the one in the Airy study, which lead to major performance impairments in muscular endurance (and probably strength, which was yet not measured in the Ayre study | learn more).

Figure 2: Fatty acid composition of the test diets (Feillet-Coudray. 2013)

If you take a closer look at Figure 2 you will realize that - compared to the allegedly unhealthy lard diet" - the major difference is not, as people who still believe lard contained almost exclusively saturated fats could believe, the saturated-to-polyunsaturated fatty acid ratio, but simply the absence of significant amounts of omega-3 fatty acids in the mixed control and lard diets (one good reason to supplement a lard only diet with reasonable amounts of fish oil; e.g. 1g per day or 4g twice a week).

Not exactly representative of the contemporary diets, but still meaningful

From a scientific point of view the significant, but still small differences may be a limitation. From a practical point of view, the omega-3 : omega-6 ratios are however more realistic than those of a real fish oil only diet:

• CONTROL & LARD ~ 7:1 vs.  FISH ~ 3:2 
• SAD ~ 15:1 vs. HIGH N3 ~ 1:1 - 3:1

What they are not, however, is representative of the difference between the SAD (standard American) and a high omega-3 diet (HIGH N3).
As close as the FISH diet may be to the often hailed "optimal 1:1" ratio, the CONTROL and LARD diets both contain much more omega-3s / less omega-6s than the SAD diet. Against that background its actually quite astonishing that

Meta-Analysis Says: Fish Oil Does Not Help You Lean Out! Plus: Its Still Worth Having Fatty Fish 1-2x/Week | more

• all rats developed liver steatosis associated with moderate liver injury when fed the 30 % lipid diets
• the rats in both the CONTROL and FISH group did so without getting obese (only the rats "on" the 30% LARD diet became obese; 11% higher body weight, 32% more body fat)
• both FISH (+30%) and LARD (+103%) had elevated insulin levels compared to the rodents on the 30% CONTROL diet; despite higher insulin levels, the effective glucose uptake in the FISH group was normal, while it was already compromised in the LARD group

Its yet not all surprising and unexpected. The FISH diet did produce the expected improvements in total cholesterol and the HDL:LDL ratio. In spite of the -35% (vs. CONTROL; -47% vs. LARD) lower triglyceride levels, "[t]he fish-oil 30 % lipid diet failed to prevent the development of hepatic steatosis" (Feillet-Coudray. 2013) - an effect which may be mediated by concomitant increases in liver lipid oxidation, of which the researchers write that it

Additional Read: "Fish Oil Compromises, Fish Improves Adiponectin Levels in "Overweight, But Healthy" Individuals. Neither Promotes Weight or Fat Loss Within a 4-Week Study Period" | more.

"[...] was increased with the fish-oil diet in comparison with the mixed and the lard diets. Within the 5 % lipid diets, the liver TBARS level was increased by 22 % with the fish-oil diet compared with the mixed diet, whereas within the 30 % lipid diets, the liver TBARS level was increased by 104 % with the fish-oil diet compared with the mixed diet." (Feillet-Coudray. 2013)

It turned out that there was a direct correlation of pathological lipid oxidation and the amount of omega-3 fatty acids in the liver (p < 0·001; r = 0·319). Accordingly, the...

"glutathione peroxidase activity was decreased with the fish-oil 30 % lipid diet in comparison with the lard 30 % lipid diet" (Feillet-Coudray. 2013)

The answer to the the question I raised in the caption of the image in the title of this article, i.e. "Does a (very) high fish oil diet entail the risk of going rancid - in spite of all its short-term benefits?" is "Yes, it does!".
References:

• Ayre KJ, Hulbert AJ. Dietary fatty acid profile affects endurance in rats. Lipids. 1997 Dec;32(12):1265-70 (learn more) 
• Browning, Lucy M., et al. "Compared with Daily, Weekly n–3 PUFA Intake Affects the Incorporation of Eicosapentaenoic Acid and Docosahexaenoic Acid into Platelets and Mononuclear Cells in Humans." The Journal of nutrition (2014): jn-113.
• Feillet-Coudray C, Aoun M, Fouret G, Bonafos B, Ramos J, Casas F, Cristol JP, Coudray C. Effects of long-term administration of saturated and n-3 fatty acid-rich diets on lipid utilisation and oxidative stress in rat liver and muscle tissues. Br J Nutr. 2013 Nov;110(10):1789-802.