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There’s something fishy about Omega

When I ask my patients what they know about omega, most will know that it has something to do with fish or cod liver oil. Some will tell me that regular fish oil supplementation lubricates our joints while others say it is good for our heart. But what actually is Omega and what does it do for our health? Read on to find out.

What is Omega?

The first home truth is that Omega-3 is actually fat. A polyunsaturated fatty acid to be more precise. It is termed an ‘essential fatty acid’, which means that it must be ingested, as the body cannot produce it. There are different types of omega, with the most renowned being Omega-3 and Omega-6. The number refers to where the first double bond occurs in the FA chain. For example with Omega-3, the first double bond occurs 3 carbons into the chain. The placment of the first double bond is important as it changes the chemical nature of the compound and how our bodies react to it.

Why do we need Omega?

Most studies agree that we don’t consume enough Omega-3 in our diets. Omega 3 is needed for the production of hormone like compounds, otherwise known as prostaglandins. Prostaglandins act as anti-inflammatory agents in our bodies with positive health benefits. This anti-inflammatory action is suggested to improve most conditions in the body where ‘inflammation’ is a problem including asthma, inflammatory joint disease, cardiovascular health, certain brain conditions such as Alzheimer’s. However, before you hail Omega is a miracle drug, there is very little evidence from big studies suggesting that this is actually the case. 

Can omega help my health and performance?

In short, yes. There are a lot of the beneficial properties with Omega, particularly Omega-3 are due to the anti-inflammatory affect of prostaglandins. Lets have a look at a few suggested key areas where omega can make a difference:

1. Exercise usually puts your body into a catabolic state, which means that muscles and tissues are being broken down with a degree of inflammation present. Anything that helps the body reduce that inflammation will ultimately help muscle soreness and aid recovery time. There is some suggestion that Omega-3 aids protein synthesis which in turn helps muscle to build.

2. Animal studies have shown that a higher dietary Omega-3/Omega-6 fatty acids ratio is associated with beneficial effects on bone health. This ultimately helps in the prevention of bone stress reaction and fractures. Follow the link to read a systematic review on this. A systematic review of omega-3 fatty acids and osteoporosis – NCBI

3. Symptoms for medical conditions such as exercise induced asthma may also be improved, click on the link for more information!

4. Another key area where Omega can improve our performance is with nerve conduction and neuromuscular control. Fat surrounds the nerve axons in our body acting as an insulator. This insulation increases the rate of transmission of signals and improves its quality. For a performance point of view, this translates into improved control of muscular contraction, speed and reaction times.

Omega-3 and Heart Health

In contrast one area where Omega-3 has a well proven positive benefit to our health is with heart disease. The UK Scientific Advisory Committee on Nutrition suggest a “large body of evidence” suggests that fish consumption, particularly oily fish, reduces the risk of cardiovascular disease. It does this by:

  • Helping to prevent irregular heart beats
  • Reducing the risk of clotting by making the blood less sticky, protecting the walls of blood vessels from damage
  • Helping to improve the cholesterol balance of the blood by increasing levels of good cholesterol (HDL) and decreasing levels of bad cholesterol (LDL)

 Different types of Omega-3
Omega-3 comes in a variety of forms that we should be aware of:

  1. EPA ( eicosapentaenoic acid)
  2. DHA (docosahexanenoic acid)
  3. ALA (alpha-linolenic acid)

Both EPA and DHA are longer chain fatty acids and are found in oils of cold water fish, such as herring mackeral sardines and shellfish. ALA are short chain forms of Omega and are not utilised by the body as well. 

Why Fish?

Why are fish in particular packed out with Omega-3 you may ask? And why cold water fish in particular? Remember, the more double bonds in the fatty acid, the more liquid the fat will be and therefore the less likely it is to freeze at colder temperatures. The cell membrane and other cellular structures in cold water fish therefore remain fluid in a very cold environment due to the number of double bonds.

Recommendations for Omega

Omega-6 fats are found in vegetable oils such as rapeseed, corn, sunflower and some nuts. While most of us get sufficient Omega-6 in our diet, mostly from cooking oil, we’re advised to eat more Omega-3 by eating at least two portions of fish a week, including one of oily fish. To help protect against heart disease everyone should try to eat 1 serving of high Omega-3 fish and 1 serving of white fish a week. Tinned fish is as good a source of Omega-3 as fresh fish, tends to be cheaper, and is convenient as it can be easily stored. The British Heart Foundation endorses the Princes brand of tinned fish as it has a higher Omega-3 content.

Eat at least two portions of fish a week, including one of oily fish.

If you are vegan or vegetarian, there are other foods that contain Omega-3 such as:

  • Dark green leafy vegetables such as spinach and kale
  • Soya beans and tofu
  • Nuts, especially walnuts, pecans, peanuts and almonds
  • Omega-3 enriched foods such as Columbus eggs and supermarket own brand alternatives
  • Rapeseed oil – most oils sold as vegetable oil are rapeseed oil, check the label.
  • Ground flaxseeds or linseeds and their oil.

Is all Omega good Omega?

A word of warning, foods such as flax and chia seeds, nuts, avocado, olive oil contain ALA Omega-3 chains rather than EPA and DHA. This is great but unfortunately the cardiovascular benefits of Omega-3 discussed are more associated with the longer chain Omega-3 FAs. In addition less than 1 percent of ALA is converted to EPA and DHA

Don’t fear though, this is where fish oil supplementation are worth their weight in…well…Omega. Cod liver oil supplementation is great source of Omega-3 which in recent years may have lost flavour due to mercury poisoning scares. With Omega-3 supplements, aim for 0.5 – 1.0g Omega-3 daily (on the active ingredients will be listed as EPA and DHA).

In addition, excessive amounts of Omega-6 polyunsaturated fatty acids and a very high Omega-6/Omega-3 ratio (as is found in today’s Western diets where is can reach 20:1) promote the pathogenesis of many diseases, including cardiovascular disease, cancer, and inflammatory and autoimmune diseases. By increasing levels of Omega-3 (lowering the Omega-6/Omega-3 ratio) exerts suppressive effects. To improve our ratios we need to increase our Omega-3 consumption and reduce Omega-6 as much as possible. This is difficult as we have already discussed Omega-6 is very readily available, especially in cooking oil. We are aiming for an Omega-6:Omega-3 ratio of about 4:1 (The importance of the ratio of omega-6/omega-3 essential fatty acids.). But this is definitely something not to get obsessed about, just bear it in mind. 


In conclusion, Omega and Omega-3 in particular has many potential benefits to help you with your performance and recovery. However, remember that there is still much more scientific evidence required to back this. One area where Omega-3 does make a big difference is with cardiovascular health. It is definitely therefore worth making sure you have having the recommended weekly dose of Omega-3 to ensure you reap all those benefits!

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    Orla Mulligan
    Administration and Social Media Manager
    Administration, LBSM

    Orla Mulligan is the administration and social media manager for LBSM. She has a strong background in sport having herself played netball at an elite standard for the U21s Northern Ireland team in the European Championships as well as the U21s competition for Saracen Mavericks.

    She understands youth sport pathways having herself played and training in the netball Kent regional pathway. She has a keen interest in most sports and a good understanding of how injury and illness can impact on the mind and body, as well as rehabilitation pathways.

    She looks forward to speaking and assisting LBSM patients and gives her best support to them during their treatment pathway.

    A day in the life of Orla involves communicating with patients via phone and email, managing and organising clinics, operations and media management.

    Outside of work, Orla is a gym enthusiast, enjoys tennis and still finds the time for an occasional game of netball.

    Maddie Tait
    BSc, MSc
    Associate, LBSM
    Musculoskeletal and Sports Podiatrist

    Maddie treats and manages complex foot and ankle injuries in London and Surrey.

    She is particularly interested in helping her patients improve their quality of life and achieve their personal goals, working closely with Foot and Ankle Consultants, Sports Medicine Doctors and Physiotherapists.

    Maddie has a sporting background herself having previously represented England in Hockey. She understands the demands of elite sport and the importance of physical and mental health. In her spare time, Maddie continues to enjoy an active lifestyle by running, cycling and attending a Pilates class.

    Having graduated from University of Brighton with a MSc (hons) in Podiatry, Maddie focused her career in Podiatric Sports Injuries and Biomechanics. Previously she completed a BSc (hons) in Sport Science at Loughborough University.

    A day in the life of Maddie involves consulting patients in clinic, performing gait and biomechanical assessments, measuring and fitting orthotics and braces. She also regularly teaches and presents at sports medicine and podiatry conferences.

    Outside of work, Maddie still finds time to play hockey and enjoys running and skiing.

    Mr Prakash Saha
    Consultant Partner, LBSM
    Consultant in Vascular Surgery

    Mr Prakash Saha is a Consultant Vascular Surgeon at LBSM. He takes pride in providing the best possible results for his patients by using the most appropriate non-surgical and surgical methods based on clinical evidence, patient results and satisfaction.

    He treats fit and active people suffering with a range of cardiovascular issues, from painful leg swelling associated with exercise to venous insufficiency, post-thrombotic syndrome and leg ulcers. He also treats people with arterial system problems including poor circulation, compression syndromes and aneurysms. He carries out both endovascular and open aortic repair and has some of the best outcomes in the country.

    Mr Saha studied medicine at the United Medical & Dental Schools at Guy’s and St. Thomas’ Hospitals before completing his higher surgical training in London and the South East. During this time, he was awarded the prestigious NIHR Clinical Lectureship in Vascular Surgery at St. Thomas’ Hospital, giving him comprehensive training in open and endovascular techniques for treating arterial and venous disease. Prakash completed his aortic surgery training at the St. George’s Vascular Institute before carrying out a specialist fellowship at the Royal Prince Alfred Hospital, Sydney.

    Mr Saha regularly lectures and runs workshops across the globe on the latest surgical techniques to treat vascular disease. He has also been awarded a number of research grants from the Royal College of Surgeons, the Circulation Foundation, the Wellcome Trust, the Academy of Medical Sciences, and the British Heart Foundation, which has led to over 80 publications and the development of innovative technologies to help treat patients. For this work, Prakash has received a number of prizes, including the Venous Forum prize from the Vascular Society of Great Britain and Ireland, an International Young Investigator Award, and an Early Career Investigator Award from the American Heart Association.

    A day in the life of Mr Saha involves seeing patients in clinic, operating in surgical theatre or lecturing at his university. He also regularly teaches and presents at vascular and sports medicine conferences.

    Mr Saha is an avid cyclist and tennis player (although yet to get a set of Dr Seth!). Outside of work, he spends time with his family who consists of 3 children and enjoys travelling.

    Dr Gajan Rajeswaran
    Consultant Partner, LBSM
    Consultant in Sports and Musculoskeletal Radiology

    Dr Gajan Rajeswaran is a Consultant Musculoskeletal Radiologist at LBSM, with an extensive background of working in elite sport. He is one of the most recognised radiologists in the sports medicine field. He provides top level imaging and medical diagnostic services for patients and athletes.

    Dr Gajan Rajeswaran completed his undergraduate medical training at Imperial College London and his radiology training at Chelsea & Westminster Hospital. He has obtained two post-CCT fellowships in musculoskeletal imaging. He was appointed as a consultant at Chelsea & Westminster Hospital in 2011.

    He has a passion for all sports having worked as a radiologist at the Glasgow Commonwealth Games and London World Athletic Championships and continues to support The Championships, Wimbledon. He also continues to work with a number of Premier League and Championship Football Clubs, Premier League Rugby Clubs, England Sevens Rugby, British Athletics and the Lawn Tennis Association.

    A day in the life of Dr Rajeswaran involves giving his expert opinion on investigations such as MRI and CT scans, x-rays and ultrasound. He also performs injection lists under ultrasound, CT and X-ray including spinal injections. He also regularly teaches and presents at sports medicine conferences.

    Dr Gajan Rajeswaran is an avid football fan and life-long fan of Tottenham Hotspur (for which he offers no apologies!). Outside of work, he spends time with his family and has a keen passion for photography.

    Dr Ajai Seth
    Medical Director, LBSM
    Consultant in Sport and Exercise Medicine

    Dr Ajai Seth is a Sport and Exercise Medicine Physician. He has dedicated his career to helping people with sport and exercise related injury and illness. He consults and treats everyone from the elite athlete to the weekend warrior.

    Dr Ajai Seth is part of the British Tennis Sports Physician team at the LTA and has also provided cover to elite athletes at Wimbledon Tennis, European Tour Golf, Premier League Football, British Athletics, and the Men’s England Football academies as part of the FA.

    He also prides himself for working in disability sport and is currently the Chief Medical Officer for Team GB Wheelchair Tennis which has taken him to the Olympics and Paralympics.

    Dr Ajai Seth is dedicated to education, training and research and is a Senior Lecturer in Sports Medicine at King’s College London where he lectures in all aspects of Sports Medicine and Science.

    He also has a passion for travel and Expedition Medicine, which has seen him accompany medical, scientific and charity expeditions all around the world. He also has vast experience in treating musculoskeletal injuries from children and adolescents to veteran exercisers, both male and female.

    Dr Seth also has positions in leading Sport Medicine organisations, including the non-executive board for the UK’s largest Sports Medicine charity, BASEM and Past President for the Royal Society of Medicine. 

    A day in the working life of Dr Seth involves consulting his patients in clinic, performing diagnostics and ultrasound guided injections. He also regularly lectures and tutors students and presents at sports medicine conferences internationally. He also spends part of the working week at the National Tennis Centre, LTA, supporting British Tennis players.

    Outside of work, Dr Seth enjoys playing club tennis, triathlon, golf, running and skiing (but will give any sport a go!). He enjoys keeping fit and active and good quality family time with his wife and three children.