Challenges with musculoskeletal health are of tremendous concern for many people today. The fact that so many people seek qualified acupuncturists is supported by research that shows clinically relevant changes in musculoskeletal health among patients undergoing acupuncture treatment.Along with acupuncture, however, there is often a forgotten nutritional component that underlies optimal health, and that can support a patient’s response to treatment.
Understanding the biochemistry of musculoskeletal signaling pathways can help pinpoint the right options to support its healthy musculoskeletal function. Both eicosanoid modulation and the endocannabinoid system (ECS) have important biochemical implications for healthy signaling to keep one’s body feeling well. Eicosanoid modulation is the process by which the body uses the available fatty acids in the cell membranes to produce signaling molecules to direct the body what to do in many different situations, one of which is to regulate tissue health. One problem occurs when the cell membrane becomes imbalanced with too much omega-6 fatty acids, resulting in an imbalance of eicosanoids, and ultimately affecting the ability of the body to create the appropriate molecules to support healthy resolution physiology. These molecules are called specialized pro-resolving mediators, are derived primarily from omega-3 fatty acids, and support healthy tissue homeostasis.
The ECS also carries much importance with signaling as the CB1 receptor is the most abundant G-coupled receptor in the brain. The ECS can literally affect how humans perceive external stimuli in their brain. When it is operating inappropriately, the lightest touch may result in the sensation of being hit with a hammer. Several endocannabinoids, namely AEA and 2-AG are derived from arachidonic acid. Higher concentrations of AEA activates TRPV1 channels, which are known to be involved in nociception. Increasing the concentration of EPA and DHA in the cell membranes results in competition for the enzymes involved in the production of AEA, thus having a competitive inhibition effect, and may prevent over-activity of the TRPV1 channels.
While acupuncture treatment has a great track record of improving the musculoskeletal health of patients, there is something additional which can be implemented to support healthy cell function and the biochemistry discussed above, and is, quite frankly, very easy to add to any treatment plan. This option is omega-3 fish oil, specifically the essential fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is important to understand that is it very hard to achieve appropriate levels of EPA and DHA when using vegetarian sources of omega-3. The problem is that the human body is very inefficient at converting the vegetarian omega-3 sources to EPA and DHA. It is estimated that about 5% becomes EPA and just 1% DHA. This equates to needing 20 grams of plant-based omega-3 to get 1 gram of EPA and 200 milligrams of DHA.
Identification of need is important when working with patients. Omega-3 deficiency is a serious problem, so serious in fact that in 2011, the Global Summit on Nutrition, Health and Human Behavior stated unanimously, “Brain and heart disorders resulting from LC-Omega-3 (EPA+DHA) deficiency are the biggest challenges to the future of humanity.” In addition to the importance of recognizing the global need for EPA and DHA, individual patients will present with a variety of potential clinical signs of deficiency. To confirm these cases, lab analysis exists by way of testing the omega-3 essential fatty acid content within red blood cell membranes.
The clinical dosing of omega-3 fish oils can range from general recommendations, to specifics that are found in the tens of thousands of published studies on fish oil. Generally, between 2000 and 3000 mg of EPA+DHA is a safe and effective dose to support healthy signaling mechanisms, but it is also important to ensure that the form of fish oil is the most bioavailable. Studies have shown that the triglyceride form is superior to other fish oil forms, including: ethyl ester (most concentrated options are in this form), salmon oil, and krill oil.
The musculoskeletal care that patients receive from a quality acupuncturist is essential, but as clinicians, we should always be looking for options that can provide even more support to our patients. Omega-3 fish oils are an excellent nutritional complement that offers a healthy foundation for your patients to get the most out of the care they are already receiving.
Christopher Oswald, DC, CNS, is a chiropractor, certified nutrition specialist and a graduate of Northwestern Health Sciences University. He practices in Wisconsin focusing on whole body care for those suffering from head and neck pain. In practice, he utilizes the combination of functional movement assessment and functional medicine principles to identify the underlying causes, which guides his direction for the appropriate clinical care. He is an advisory board member of Nordic Naturals and the National Association of Nutrition Professionals. He can be reached at