Omega-3 polyunsaturated fatty acids and inflammatory processes: nutrition or pharmacology?

Summary

Philip Calder is the leading authority on omega-3 fatty acids and inflammation, and this 2013 BJCP review is his most cited synthesis. The paper traces the multiple mechanisms by which EPA and DHA modulate inflammatory responses: incorporation into cell-membrane phospholipids alters which substrates are available for eicosanoid synthesis (prostaglandins, leukotrienes); direct inhibition of leukocyte chemotaxis, adhesion-molecule expression, and T-cell reactivity; reduced inflammatory cytokine production (TNF, IL-1β, IL-6); disruption of lipid rafts that anchor TLR4 signaling; and generation of pro-resolution lipid mediators (resolvins, protectins) that actively terminate inflammation rather than just dampen it. The paper distinguishes "nutrition-dose" effects (typical 1–2 g/day EPA+DHA from regular fish intake, modest anti-inflammatory shifts) from "pharmacology-dose" effects (3–4 g/day or higher, with measurable effects on rheumatoid arthritis and other clinical inflammatory conditions). The clinical evidence base is strongest for rheumatoid arthritis; weaker and inconsistent for inflammatory bowel disease and asthma.