This question is primarily directed toward Scott, but anyone else who has an informed opinion is certainly welcome to weigh in: I have been advised to take a steroidal anti-inflammatory drug for a serious nonhealing leg injury. I am highly opposed to the use of such drugs in most cases and have refused to use them thus far, but nothing else (including fish oil) has worked and I am considering throwing in the towel. My question is: does it make any sense to continue taking fish oil in conjunction with a steroidal anti-inflammatory drug? Or would that just be a waste of fish oil? Thanks in advance

Hey Brian- The data on the effects fish oil has on corticosteroid requirements has been somewhat inconsistent, but there is evidence of a sparing effect (1-3). On drugs that act further down the eicosanoid pathway (aspirin, COX-2 inhibitors) there is a [i:8fb11ebab7]synergistic[/i:8fb11ebab7] anti-inflammatory effect (4-6). That being said, it is plausible that a dietary approach that has a favorable effect on inflammation (i.e., anti-inflammatory) would likely decrease the requirement for corticosteroids (or other anti-inflammatory drugs) if needed. In other words, if you are currently following a Zone-favorable (or similar) diet and taking omega-3s, it's not a waste of product to continue to do so if it assists in minimizing or sparing the amount of a drug needed to promote the healing process. Because a low-glycemic load diet and omega-3s can have a siginificant impact on the amount that may be required, be sure to work with your physician on determining the right dose of medication that's needed. Hope that helps and get well, Scott. (1) Seidner DL, et al [i:8fb11ebab7]"An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: a randomized, controlled trial" [/i:8fb11ebab7]Clin Gastroenterol Hepatol 2005 Apr;3(4):358-69 [color=blue:8fb11ebab7]Both intent-to-treat and completed patients given oral supplement had a significantly greater rate of decrease in the dose of prednisone required to control clinical symptoms over 6 months compared with placebo.[/color:8fb11ebab7] (2) Hawthorne AB, et al "Treatment of ulcerative colitis with fish oil supplementation: a prospective 12 month randomised controlled trial." Gut. 1992 Jul;33(7):922-8. [color=blue:8fb11ebab7]Fish oil supplementation produces a modest corticosteroid sparing effect in active disease, but there is no benefit in maintenance therapy.[/color:8fb11ebab7] (3) Maclean CH, et a "Systematic review of the effects of n-3 fatty acids in inflammatory bowel disease" Am J Clin Nutr 2005 Sep;82(3):611-9 [color=blue:8fb11ebab7]Consistent across three studies was the finding that n-3 fatty acids reduce cotricosteroid requirements, although statistical significance was shown in only 1 of these studies[/color:8fb11ebab7] (4) Serhan CN, et al "Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived mediators, and their endogenous aspirin-triggered epimers." Lipids. 2004 Nov;39(11):1125-32. (5) Vardar S, et al "Individual and combined effects of selective cyclooxygenase-2 inhibitor and omega-3 fatty acids on endotoxin-induced periodontitis in rats" J Periodontol 2005 Jan;76(1):99-106 (6) Babcock TA, et al "Synergestic anti-inflammatory activity of omega-3 lipid and rofecoxib pretreatment on macrophage proinflammatory cytokine production occurs via divergent NF-kappaB activiation" J Parenter Enteral Nutr 2004

Hey Brian- in case you missed it, Sears had an answer to your question last month.

I saw that. Thank you both.

Brian, I just read the entire thread posted here. Coincidentally, I was reading something similar in "Anti-Inflammation Zone" last night. Sears recommends using both NSAIDS and fish oil for the treatment of chronic pain or inflammatory injuries. If you have the book, it is worth reading!

To Brian G.: Dr. Sears has an excellent explanation of the way corticosteroids knock out both "good" and "bad" eicosanoids, thus suppressing the immune system, causing cognitive impairment (which, by the way can happen rather rapidly), as well as leading to diabetes if taken for long-term, in various sections of the Omega Rx Zone, as well as other places in his other writings. The side effects of these meds are many. Corticosteriods are known to cause an increase of insulin, thus arguing that fish oil would be VERY beneficial. Of course, he suggests using fish oil instead of them, and adding NSAIDS for "screaming pain", such as that with fibro, arthritis, injuries, etc. (While fish oil helps somewhat with my chronic, constant "screaming pain", it alas has not been efffective enough to eliminate other stronger meds.) This, of course does not help your current situation, as fish oil has not proven totally effective. What Scott has written above seems very reasonable to me: take as low dose as possible while continuing your fish oil, and working with your physician to titrate your lowest necessary dosage. In scanning a couple of papers cited by Scott above, it appears that good quality fish oil may indeed decrease the necessary dose needed for your injury. I certainly hope so! I have had to take corticosteroids many times in my life, but only for short periods. I did notice cognitive impairment often. Best wishes on your recovery as soon as possible, Cheryl To Jenny: NSAIDS and fish oil work further down the pain pathway at the level of prostagladins and thromboxanes only (a more limited number of "bad" eicosanoids. They also knock out these "bad" eicosanoids at a slightly faster rate than the "good" eicosanoids, thus having a lesser effect on insulin.

[quote:357ee97a29="built4hurricanes"] Dr. Sears has an excellent explanation of the way corticosteroids knock out both "good" and "bad" eicosanoids, thus suppressing the immune system, causing cognitive impairment (which, by the way can happen rather rapidly)........Cheryl[/quote:357ee97a29] Can you define "cognitive impairment" i.e. symptoms, specific situations...? Pat

I never took the steroids. Don't believe in them (for injuries anyway).......

Brian- how's the leg?

Cognitive functions All the functions related to cognition. Cognition means the ability to obtain knowledge (ability to read, speak, understand and memorise), the ability to perceive (see and hear) and the ability to move. 8) Pat