Page 101 - JSOM Winter 2022

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a high benefit-to-risk ratio. Interestingly, depression was promotes lean body mass (LBM) gains, preserves LBM during
3
commonly found following head injury. One study reported a weight loss, and/or promotes increased strength. These fac-
threefold increase in the incidence of depression with a greater tors are important to consider given that sustained military
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number of concussions over time. Omega-3 supplements operations and associated training generally result in a loss of
3
may exert antidepressant effects through a variety of possible LBM (2.4–6.1%). Omega-3 supplementation (1–6g/day) may
indirect mechanisms. In one study, after 12 weeks of omega-3 improve performance and recovery from exercise, but results
supplements (2.1g EPA and DHA combined or placebo), the vary by age, supplement dose, duration, genetics, sport, and
omega-3 group had significantly greater improvements in sur- gender. Some evidence suggests performance improvement
8
vey scores for depression, suicidality, and daily stresses than in explosive power, squat and countermovement jumps, 3,40
did the placebo group. Similarly, dietary intakes of EPA and one-repetition maximum, range of motion, and maximal vol-
26
DHA have been inversely associated with chronic depressive untary contraction. 3,8,40 Moreover, improvements in peak and
symptoms in women. Other research studies support the role submaximal heart rate and oxygen uptake in cyclists have
41
27
5
of EPA and DHA in neuropsychological health, 6,26,28 so much been reported. Unfortunately, differences in research methods
so that EPA and DHA supplements are considered by the and performance markers make it difficult to form definitive
American Psychiatric Association to be part of complementary recommendations. Lastly, no controlled studies have been con-
therapies for depressive disorder. 6,29 ducted during rigorous military training. However, based on
the current research, 2–3g/day of omega-3 for at least 8 weeks
Studies of depression often report benefits from both EPA and appears to be the most promising for physical performance
DHA. In some instances, EPA was favored over DHA. Over- improvements.
all, most research studies that supplemented with 1–3g/day of
omega-3 reduced depression and suicidality. Exercise Recovery
Evidence that omega-3 supplementation may affect muscle
Cognitive Performance recovery is growing. Several studies have shown decreased
Results are mixed regarding measures of cognitive performance soreness and pain, 7,38,40,42 decreased swelling, 3,5,8,40 and in-
with omega-3. Some research indicates improved executive creased range of motion when omega-3 supplementation is
function tasks (i.e., memory, flexible thinking, self-control) with provided. 8,43,44 Omega-3 supplementation (0.8–3g/day) has
3,5
a higher omega-3 level, with notable improvements in those produced mixed results on muscle damage. Exercise- induced
30
with reported poor sleep quality. Conversely, another study muscle damage results in inflammation, strength loss, and
did not find benefits on measures of cognitive performance muscle soreness and may cause subsequent exercise avoid-
with omega-3 supplementation among civilians; however, ance. Omega-3 supplementation (2.7g/day) for 30 days prior
39
reduced subjective mental fatigue at times of high cognitive to exercise may reduce perception of pain 72 and 96 hours
demand was noted. Others reported no improvements in mea- postexercise ; however, higher doses (6–8g/day) did not im-
31
36
sured cognitive tests with omega-3 supplementation (2.3g/day) prove exercise-induced muscle damage or enhance muscle
45
in young adult military officers, but poor compliance was a recovery. A recent review reported positive changes on recov-
limitation. 32 ery when supplementation was provided for <8 weeks, with
longer studies (>8 weeks) conferring additional benefits. The
8
Evidence suggests that executive function and cognitive flexi- strongest effects on accelerating muscle recovery with omega-3
bility are positively related to the Omega-3 Index, a measure are evident when following a dietary pattern aligned with Di-
of EPA and DHA in red blood cells. 2,30,33,34 Improvements in etary Guidelines for Americans recommendations (including
reaction time 2,34 and efficiency were noted, thus suggesting adequate intake of fruits, vegetables, and whole grains) and
2
that increasing omega-3 intake may improve neurocognitive additional nutrients known to positively affect skeletal muscle
performance. Omega-3 intake through fish consumption has remodeling (i.e., vitamins D and K). 5,20,37,46 Current evidence
30
been shown to promote brain development and cognitive abil- suggests that EPA and DHA have the potential to decrease
ity. Optimal neurocognitive performance is essential during inflammation and reduce the perception of muscle sore-
33
deployment. Based on several studies, it might be worth im- ness. 3,5,7,8,36,38 Overall, an omega-3 dose of 1–3g/day could be
plementing a strategy to increase omega-3 intake prior to and beneficial for exercise recovery.
during critical deployments.
Injury Recovery and Omega-3
Cognitive benefits have been reported with high doses (3.5g/
day) of omega-3 for short periods of time (4 weeks) and low Preliminary studies support a rehabilitative role of omega-3
doses (fish intake or supplementation of 1–2g/day) for 12 in maintaining muscle mass and minimizing muscle wasting
3
weeks or longer, suggesting benefits of omega-3 from both during a prolonged period of limb immobilization (i.e., leg
fish and dietary supplements. Given challenges with compli- brace or leg cast). Intake of omega-3 enhances anabolic sen-
47
ance, 1–2g/day of omega-3 supplements appears to be superior sitivity to amino acids, which may be beneficial to the injured.
to higher doses (3.5g/day) and/or relying on access to fatty Because of the limited number of studies, varied doses, and
fish. study outcomes, determining an ideal range for injury recovery
is challenging; likely 2–4g/day of omega-3 could be beneficial.
Physical Performance and Recovery With Omega-3
Summary/Recommendations
Performance
Omega-3 supplementation (1–6g/day) may serve a role in Evidence is growing to support the benefits of omega-3 con-
the preservation of strength and recovery of muscle function sumption not only for overall health but also for the mental
after damaging exercise, rigorous training, disuse, or immo- and physical performance of SOF. Table 2 highlights the po-
bilization. 2,3,7,8,35–39 Remaining unclear is whether omega-3 tential benefits of omega-3.

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