Why do women benefit more from Omega-3s at every stage of their lives?

From scientific research comes a loud and clear message: women need Omega 3s even more than men do, which is why they know how to use them better. Some benefits, such as those for fetal development, are particularly well known, but they are not the only ones, quite the contrary. Benefiting from an adequate intake of EPA and DHA, the marine-derived Omega 3s, are women in all age groups.

When it comes to recommending the best dietary sources of Omega 3, the thought inevitably runs to fish: fatty varieties, such as sardines and anchovies, are rich in EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), i.e., the Omega 3s that the human body uses directly to comply with needs such as the production of molecules that modulate inflammatory processes. 

Although they are not essential nutrients in the strict sense (human beings possess the enzymes needed to synthesize them) in fact EPA and DHA are considered as such. In fact, studies in adult men have estimated a poor ability to produce them from their precursor (alpha-linolenic acid, or ALA, obtainable from walnuts and flaxseed). In the case of EPA, the ALA conversion rate in fact stops at 8 percent, and the situation is even worse in the case of DHA, for which an ALA conversion rate ranging from 0 to 4 percent has been estimated. But when the focus turned to women, things seemed slightly different.

Women produce more EPA and DHA than men

It was 2002, and shifting the focus to the female universe was a study published in the British Journal of Nutrition by Graham Burdge and Stephen Wootton, of the University of Southampton (UK). The premise of the two researchers was extremely pragmatic: the fetus, which needs preformed EPA and DHA to develop properly, is totally dependent on the Omega 3s it receives through maternal blood, and this situation represents a not inconsiderable burden on the mother, who already has to meet her own needs. "This is why," Burdge and Wootton explained, "there is a need to understand whether young women, in a non-pregnant state, are different from men in terms of their management of long-chain polyunsaturated fats [of the] Omega 3 series, particularly in their ability to synthesize EPA and DHA from food-derived ALA."

By administering labeled ALA to 6 women between the ages of 24 and 32 and monitoring the participants' blood-labeled fats over the 21 days following ingestion, the two researchers estimated a conversion rate to EPA of 21 percent, thus significantly higher than that reported in studies of men. The ability to derive DHA from ALA was also higher in women, with estimates showing a 9% conversion rate. "Comparison with previous studies," the authors conclude, "suggests that women possess a greater ability to convert ALA than men."

The conclusion reached by Burdge and Wootton finds confirmation in other studies. Trying to pull the sums together was a group of researchers led by Caroline Childs of the University of Southampton School of Medicine, who looked at data obtained in randomized, placebo-controlled trials; their analysis, published in the Nutrition Journal in 2014, found that, in women, increased ALA intake actually leads to a greater increase in EPA levels in membrane phospholipids than is observed in men.

The benefits of Omega 3 in pregnancy and lactation

In the introduction to their study, Burdge and Wootton focused on the needs of the fetus. According to their reasoning, a woman's increased ability to produce EPA and DHA would depend on the possibility of pregnancy during which she would have to take on these needs. 

Information gathered in the scientific literature supports this reasoning. Precisely on the basis of the scientific evidence of the usefulness of Omega 3 for the development of the fetus, first, and the infant, later, the European Food Safety Authority (Efsa) authorizes the use of health claims that DHA taken by the mother "contributes to the normal brain and vision development of the fetus and breastfed infant."

However, we now have data suggesting the usefulness of these polyunsaturated fats during pregnancy and lactation not only to meet the needs of the fetus and infant. As noted back in 2007 in the pages of Biomedicine & Pharmacotherapy by Jean-Marie Bourre, an expert at France's Institut National de la Santé et de la Recherche Médicale (Inserm), "the presence of large amounts of EPA and DHA in the diet slightly lengthens gestation and improves its quality." The mechanisms behind these benefits most likely include the typically anti-inflammatory action of these fats and their ability to improve blood flow in the placenta.

Not only that, some research suggests a role for Omega 3s in the prevention of preeclampsia, as well as their importance in gestational diabetes, associated with reduced passage of these fats into the placenta and reduced levels of DHA in umbilical cord blood. Finally, in the aforementioned publication, Bourge points out that "probably Omega 3 fatty acids (...) reduce the risk of postpartum depression," a condition associated with inadequate intake of these fats, rapid reduction of their stores during pregnancy and lactation, limited fish consumption, reduced levels of DHA in breast milk and red blood cells, and inflammation.

The benefits of Omega 3 in fertile life and in peri- and post-menopause

Going beyond everything related to motherhood, adequate Omega 3 intake can also promote optimal health at other stages of a woman's life. 

Regarding the so-called "fertile life," several studies suggest the usefulness of Omega 3s in the management of conditions such as dysmenorrhea, premenstrual syndrome, ovarian polycystosis, and infertility. Depending on the case, the benefits of taking these fats would depend on their anti-inflammatory properties, their ability to modulate insulin resistance and improve lipid and hormone profiles, and improved uterine perfusion and oocyte quality.

During and after the menopausal transition, however, adequate Omega 3 intake could help manage both the increased cardiovascular risk typically associated with related hormonal changes and other associated health problems. In particular, there have been clues over the years of the possible usefulness of Omega 3 against vasomotor symptoms, depression, and osteoporosis. Not only that, the scientific literature also supports a more general role for these fats against problems typical of old age, such as decline in cognitive ability,osteoarthritis, and the development of cancers (especially breast and colon).

In the particular case of breast cancer, in a review published in 2023 in Food Science & Nutrition, Shirin Osouli-Tabrizi et al pointed out the "significant reduction in perceived stress, sleep disturbances, depression, pain, joint stiffness and fatigue" in patients (not necessarily menopausal) taking Omega 3. According to the researchers, "Omega 3 fatty acids can induce improvements [in] physical, mental, and in some inflammatory and metabolic parameters during the treatment or post-treatment course of breast cancer patients."

Mechanisms

The increased conversion of ALA to DHA in women taking oral contraceptives suggests that coming into play in women's increased ability to utilize the biologically active Omega 3 precursor is the ability of estrogen to increase the activity of the desaturases and elongases involved in this conversion. This hypothesis is also supported by data from studies conducted now quite some time ago in both women and animal models (rats) and more recent research, published in the British Journal of Nutrition by a group of Korean researchers led by Donghee Kim.

In a series of experiments in rats, Kim and colleagues showed that estrogen injection is associated with increased transcription of genes encoding elongases and desaturases. Acting synergistically with a diet low in linoleic acid (the precursor to Omega 6, which competes with Omega 3 for elongase and desaturase enzymes), estrogen increased hepatic levels of DHA in this animal model.

The ability of estrogen to regulate ALA conversion could also contribute to the physiological increase in maternal blood DHA levels during pregnancy. 

How many Omega 3s for women?

According to the current recommendations of the Italian Society of Human Nutrition (Sinu), all women should have a daily intake of 250 mg total between EPA and DHA; 100-200 mg per day of DHA should be added to this requirement during pregnancy and lactation. These indications are complemented by those of Efsa, which, on the other hand, stresses the need to increase daily DHA intake by at least 200 mg to promote normal brain and vision development in the fetus and breastfed baby. But in the case of the other possible applications of Omega 3 in promoting women's health, the guidance on dosages is not always as clear.

In various circumstances, doses in the gram range may be necessary. For the time being, the only other specifications available relate to the benefits of EPA and DHA in the cardiovascular area and in promoting good brain and vision function. Specifically, according to Efsa, they are needed:

- 250 mg daily of EPA + DHA to promote normal heart, brain and visual function;
- 2 g daily of EPA + DHA for triglyceride control;
- 3 g per day of EPA + DHA for blood pressure control.

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