Nutritional support for post-surgery

I frequently support clients who have either had or are going to have operations.

It is common knowledge that your nutritional status and health prior to an operation has a big impact on the outcome of surgery and your recovery post operation. It is estimated that between 24% and 65% of patients are malnourished and unfortunately this tends to increase during hospital stays. Nutritional supplementation has been shown to reduce hospitalisation costs being associated with fewer complications and shorter stays.

I have recently been researching this area for a client with impending surgery This blog is focused on protein and carbohydrate requirements post operation. I will consider micronutrient status in a future blog.

Some degree of muscle loss post-surgery is inevitable. Skeletal muscle serves as the primary source of essential amino acids. If protein intake is below the requirement to sustain daily functions the body will breakdown muscle for protein. To compound this the hormonal stress response following surgery can prevent normal protein generation. All of this is often complicated further by the forced rest and immobility due to the surgery itself.

It is important to try to minimise the muscle loss and if exercise is not feasible nutritional strategies can help to mitigate this.  In healthy individuals, loss of muscle tissue begins to occur in as little as 48 h of inactivity, with significant loss within five days. This is followed by loss of strength and functionality.

Post-surgical amino acid supplementation has been shown to effectively reduce the turnover of whole-body protein and muscle breakdown, and to stimulate an increase in protein generation.

General guidelines for nutrition post surgery

The goal of post-operative nutrition, on the other hand, is to promote nitrogen balance, reduce the loss of lean muscle mass, and facilitate rapid healing and recovery. The guidelines given here are aimed at minimising some of the metabolic consequences of surgery, using nutritional supplementation to overcome some of the issues that whole foods would otherwise present.

The post operative nutrition model is basically the reverse of the preoperative model.

In the early post-surgery period, patient appetite is often suppressed making consumption of solid foods difficult. During this time, free form EAA’s may help to support the immune system. Patients can transition to protein shakes and sports drinks until they are able to consume whole food sources or meals.

During the rehabilitation period, protein intakes of at least 1.6 g/kg/day and up to 2.0–3.0 g/kg/day is generally recommended. If appetite is reduced and this goal is difficult to meet then consumption of EAA’s and/or protein shakes between meals can help to optimise protein and nutrient intake.

Conclusion

In conclusion protein intake supplies the amino acids needed for wound healing, immune function and preservation of muscle mass.  Following surgery, free form amino acids plus supplementary dietary protein can help to support protein generation and an increase in whole-body protein. Depending on proximity to surgery different sources of protein can be used to maximise nutritional intake. Supplemental sources can be useful to support intake during periods when whole foods are not tolerated.

This blog is written to help inform about nutritional needs post-surgery and is based on scientific rationale. However much of this research is relatively new and further research and trials are needed to elaborate. Therefore this information does not override any medical guidelines given directly to prepare for or recover from planned surgery. These will supersede this information unless your medical team are happy to sanction otherwise.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC8156786/figure/nutrients-13-01675-f003

Pre-operative nutrition

I frequently support clients who have either had or are going to have operations.

It is common knowledge that your nutritional status and health prior to an operation has a big impact on the outcome of surgery and your recovery post operation. It is estimated that between 24% and 65% of patients are malnourished and unfortunately this tends to increase during hospital stays. Nutritional supplementation has been shown to reduce hospitalisation costs being associated with fewer complications and shorter stays.

I have recently been researching this area for a client with impending surgery This blog is focused on protein and carbohydrate requirements pre-operation. I will consider micronutrient status in a future blog.

Surgery is stressful and our energy demands increase.  To cope with this our sugar stores (glycogen) are rapidly burnt from the liver and muscle. This can lead to significant skeletal muscles loss and some degree of this post-surgery is inevitable.

There some easy strategies you can implement though to help with muscle preservation and to support and accelerate healing.  Carbohydrate consumption pre-operation helps to:

General guidelines for nutrition before surgery

The goal is to prepare the body for the stress of surgery, support increased metabolic demand, whilst offsetting the consequences of the breakdown of body protein. The goal of pre-operative nutrition is to ensure adequate energy stores to meet the demands of the stress state. The guidelines given here are aimed at minimising some of the metabolic consequences of surgery, using nutritional supplementation to overcome some of the issues that whole foods would otherwise present.

7-10 days prior to surgery - emphasise high-quality carbohydrate and protein intake to ensure optimal nourishment. To maximise glycogen stores, the sports nutrition model suggests consuming ~60% of total energy (8 g per kg body mass) per day of carbohydrate for a minimum of 3–4 days. Protein intakes of 1.2–2.0 g/kg/day, from high-quality protein sources distributed throughout the day (20–40 g of protein per meal) is recommended to help ensure protein needs are met. 

6-12 hours before surgery – consume a well-rounded meal emphasising complex carbohydrates and high-quality protein.

6 hours before - begin abstaining from whole foods, but continue to consume protein and carbohydrate containing beverages, such as a protein shake, a sports drink, or chocolate milk. Since modified carbohydrate supplements rapidly empty from the stomach, consumption may sustain glucose levels for the duration of surgery.

2-4 hours before – It is suggested to ingest free form essential amino acids (EAA’s) to promote a positive protein balance. EAA’s contain all nine essential amino acids and do not require digestion.

Conclusion

In conclusion carbohydrate intake supports the increased post-surgical metabolic (energy) demand and wound healing. Protein intake supplies the amino acids needed for wound healing, immune function and preservation of muscle mass.  Combined amino acid and glucose intake can help to mitigate muscle loss and strength, especially prior to surgery. Depending on proximity to surgery different sources of carbohydrate and protein can be used to maximise nutritional intake. Supplemental sources can be useful to support intake during periods when whole foods are not tolerated.

This blog is written to help inform about nutritional needs pre-surgery and is based on scientific rationale. However much of this research is relatively new and further research and trials are needed to elaborate. Therefore this information does not override any medical guidelines given directly to prepare for planned surgery. These will supersede this information unless your medical team are happy to sanction otherwise.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC8156786/figure/nutrients-13-01675-f003

Having surgery? Here are your nutrition guidelines.

I frequently support clients who have either had or are going to have surgery of various kinds.

It is common knowledge that your nutritional status and health prior to an operation has a big impact on the outcome of surgery and your recovery post operation. It is estimated that between 24% and 65% of patients are malnourished and unfortunately this tends to increase during hospital stays. Nutritional supplementation has been shown to reduce hospitalisation costs being associated with fewer complications and shorter stays.

The biggest issues are muscle loss due to tissue breakdown and metabolic demand exceeding supply due to the increase in stress and energetic demand. Micronutrient status is also important but will be covered in a separate blog. This article is focused on protein and carbohydrate requirements both pre and post operation.

There some easy strategies you can implement to help with muscle preservation and to support and accelerate healing.  Carbohydrate consumption pre-operation helps to:

Post-surgical amino acid supplementation has been shown to effectively reduce the turnover of whole-body protein and muscle breakdown, and to stimulate an increase in protein generation.

General guidelines for nutrition before and after

Pre-Operative Nutrition

The goal is to prepare the body for the stress of surgery, support increased metabolic demand, whilst offsetting the consequences of the breakdown of body protein. The goal of pre-operative nutrition is to ensure adequate energy stores to meet the demands of the stress state. The goal of post-operative nutrition, on the other hand, is to promote nitrogen balance, reduce the loss of lean muscle mass, and facilitate rapid healing and recovery. The guidelines given here are aimed at minimising some of the metabolic consequences of surgery, using nutritional supplementation to overcome some of the issues that whole foods would otherwise present.

7-10 days prior to surgery - emphasise high-quality carbohydrate and protein intake to ensure optimal nourishment. To maximise glycogen stores, the sports nutrition model suggests consuming ~60% of total energy (8 g per kg body mass) per day of carbohydrate for a minimum of 3–4 days. Protein intakes of 1.2–2.0 g/kg/day, from high-quality protein sources distributed throughout the day (20–40 g of protein per meal) is recommended to help ensure protein needs are met. 

6-12 hours before surgery – consume a well-rounded meal emphasising complex carbohydrates and high-quality protein.

6 hours before - begin abstaining from whole foods, but continue to consume protein and carbohydrate containing beverages, such as a protein shake, a sports drink, or chocolate milk. Since modified carbohydrate supplements rapidly empty from the stomach, consumption may sustain glucose levels for the duration of surgery.

2-4 hours before – It is suggested to ingest free form essential amino acids (EAA’s) to promote a positive protein balance. EAA’s contain all nine essential amino acids and do not require digestion.

Post-Operative Nutrition

The post operative nutrition model is basically the reverse of the preoperative model.

In the early post-surgery period, patient appetite is often suppressed making consumption of solid foods difficult. During this time, free form EAA’s may help to support the immune system. Patients can transition to protein shakes and sports drinks until they are able to consume whole food sources or meals.

During the rehabilitation period, protein intakes of at least 1.6 g/kg/day and up to 2.0–3.0 g/kg/day is generally recommended. If appetite is reduced and this goal is difficult to meet then consumption of EAA’s and/or protein shakes between meals can help to optimise protein and nutrient intake.

Conclusion

In conclusion carbohydrate intake supports the increased post-surgical energy demand and wound healing. Protein intake supplies the amino acids needed for wound healing, immune function and preservation of muscle mass.  Combined amino acid and glucose intake can help to mitigate muscle loss and strength, especially prior to surgery. Following surgery, free form amino acids plus supplementary dietary protein can help to support protein generation and an increase in whole-body protein. Depending on the proximity to surgery different sources of carbohydrate and protein can be used to maximise nutritional intake. Supplemental sources can be useful to support intake during periods when whole foods are not tolerated.

This blog is written to help inform about nutritional needs both pre and post-surgery and is based on scientific rationale. However much of this research is relatively new and further research and trials are needed to elaborate. Therefore this information does not override any medical guidelines given directly to prepare for planned surgery. These will supersede this information unless your medical team are happy to sanction otherwise.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC8156786/figure/nutrients-13-01675-f003

Preparing for surgery with nutritional support

I frequently support clients who have either had or are going to have operations.

It is common knowledge that your nutritional status and health prior to an operation has a big impact on the outcome of surgery and your recovery post operation. It is estimated that between 24% and 65% of patients are malnourished and unfortunately this tends to increase during hospital stays. Nutritional supplementation has been shown to reduce hospitalisation costs being associated with fewer complications and shorter stays.

I have recently been researching this area for a client with impending surgery This blog is focused on protein and carbohydrate requirements both pre and post operation. I will consider micronutrient status in a future blog.

Surgery is stressful and our energy demands increase.  To cope with this our sugar stores (glycogen) are rapidly burnt from the liver and muscle. This can lead to significant skeletal muscles loss and some degree of this post-surgery is inevitable. Skeletal muscle serves as the primary source of essential amino acids. If protein intake is below the requirement to sustain daily functions the body will breakdown muscle for protein. Despite this however, the hormonal stress response prevents normal protein generation. All of this is often compounded by the forced rest and immobility due to the surgery itself.

It is important to try to minimise the muscle loss and if exercise is not feasible nutritional strategies can help to mitigate this.  In healthy individuals, loss of muscle tissue begins to occur in as little as 48 h of inactivity, with significant loss within five days. This is followed by loss of strength and functionality.

There some easy strategies you can implement though to help with muscle preservation and to support and accelerate healing.  Carbohydrate consumption pre-operation helps to:

Post-surgical amino acid supplementation has been shown to effectively reduce the turnover of whole-body protein and muscle breakdown, and to stimulate an increase in protein generation.

General guidelines for nutrition before and after surgery

Pre-Operative Nutrition

The goal is to prepare the body for the stress of surgery, support increased metabolic demand, whilst offsetting the consequences of the breakdown of body protein. The goal of pre-operative nutrition is to ensure adequate energy stores to meet the demands of the stress state. The goal of post-operative nutrition, on the other hand, is to promote nitrogen balance, reduce the loss of lean muscle mass, and facilitate rapid healing and recovery. The guidelines given here are aimed at minimising some of the metabolic consequences of surgery, using nutritional supplementation to overcome some of the issues that whole foods would otherwise present.

7-10 days prior to surgery - emphasise high-quality carbohydrate and protein intake to ensure optimal nourishment. To maximise glycogen stores, the sports nutrition model suggests consuming ~60% of total energy (8 g per kg body mass) per day of carbohydrate for a minimum of 3–4 days. Protein intakes of 1.2–2.0 g/kg/day, from high-quality protein sources distributed throughout the day (20–40 g of protein per meal) is recommended to help ensure protein needs are met. 

6-12 hours before surgery – consume a well-rounded meal emphasising complex carbohydrates and high-quality protein.

6 hours before - begin abstaining from whole foods, but continue to consume protein and carbohydrate containing beverages, such as a protein shake, a sports drink, or chocolate milk. Since modified carbohydrate supplements rapidly empty from the stomach, consumption may sustain glucose levels for the duration of surgery.

2-4 hours before – It is suggested to ingest free form essential amino acids (EAA’s) to promote a positive protein balance. EAA’s contain all nine essential amino acids and do not require digestion.

Post-Operative Nutrition

The post operative nutrition model is basically the reverse of the preoperative model.

In the early post-surgery period, patient appetite is often suppressed making consumption of solid foods difficult. During this time, free form EAA’s may help to support the immune system. Patients can transition to protein shakes and sports drinks until they are able to consume whole food sources or meals.

During the rehabilitation period, protein intakes of at least 1.6 g/kg/day and up to 2.0–3.0 g/kg/day is generally recommended. If appetite is reduced and this goal is difficult to meet then consumption of EAA’s and/or protein shakes between meals can help to optimise protein and nutrient intake.

Conclusion

In conclusion carbohydrate intake supports the increased post-surgical metabolic (energy) demand and wound healing. Protein intake supplies the amino acids needed for wound healing, immune function and preservation of muscle mass.  Combined amino acid and glucose intake can help to mitigate muscle loss and strength, especially prior to surgery. Following surgery, free form amino acids plus supplementary dietary protein can help to support protein generation and an increase in whole-body protein. Depending on proximity to surgery different sources of CHO and protein can be used to maximise nutritional intake. Supplemental sources can be useful to support intake during periods when whole foods are not tolerated.

This blog is written to help inform about nutritional needs both pre and post-surgery and is based on scientific rationale. However much of this research is relatively new and further research and trials are needed to elaborate. Therefore this information does not override any medical guidelines given directly to prepare for planned surgery. These will supersede this information unless your medical team are happy to sanction otherwise.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC8156786/figure/nutrients-13-01675-f003

Heart burn, acid reflux, GERD – what is the difference?

All of these conditions occur when acid from the stomach escapes into your oesophagus, via the sphincter at the top of the stomach, creating a burning sensation. 

All of these painful digestive conditions are related and tend to cause similar symptoms, however, they usually develop in stages.

In the case of acid reflux, stomach acid leaks out of the stomach and into the oesophagus. When this progresses, it can be diagnosed as gastroesophageal reflux disease (GERD) which is considered to be more severe. Heartburn is also commonly called GERD.

The most common symptom of GERD is frequent pains in the chest and burning sensations hence the name “heartburn”. Other signs of GERD are difficulty swallowing or keeping down food and liquids, coughing, wheezing and chest pain. Often these symptoms occur or are much worse at night.

An alarming finding from one study conducted in Norway found that the incidence of acid reflux rose from around 11 percent of the population to over 17 percent over a period of 11 years. A similar rise is happening in other industrialised countries too.

It might not be the biggest deal to have acid reflux symptoms on occasion but research shows that people with long-standing, chronic heartburn are at greater risk for serious complications. These include stricture (narrowing) of the oesophagus and inflammation of the oesophagus or oesophagitis. Other developments can include chronic infections and there are concerns re fracture risk and pneumonia (linked to PPI medication).

If we have low stomach acid our food isn’t broken down as quickly or completely so proteins stay in the stomach longer than is normal. This means the acid also stays longer and this can cause digestive issues, especially when we start moving around following a meal. Slowing our digestion down is also a problem as it gives food time to ferment and putrification can occur.  This means bacterial balance can become problematic as certain undesirable species thrive (pathogenic) and yeast and fungus can also start to proliferate. This in turn can lead to more serious problems from an unhealthy microbiome balance and conditions such as IBS and multiple digestive issues.

So we need our stomach acid but we need it in the right place.

What do Nutritional Therapists help with and how to find one?

You might be someone who gets bloated after every meal. Or someone who feels exhausted by mid-morning despite a full night’s sleep. Maybe your skin flares up regularly, or you’re dealing with unpredictable mood or energy changes.

These are just a few of the reasons people turn to nutritional therapists.

Common concerns supported by nutritional therapists include:

You don’t need to be diagnosed with a condition to work with a nutritional therapist. Many clients seek support for prevention, performance, or simply to understand their bodies better.

Why People Seek Nutritional Therapy

Many people turn to nutritional therapists after trying multiple solutions—diets, supplements, or private testing—without clarity or consistent results. Others feel dismissed by standard medical care or overwhelmed by conflicting online advice.

Nutritional therapy offers a structured, evidence-informed approach to identifying patterns and making progress that lasts.

It’s ideal for anyone who:

How to Find a Qualified Nutritional Therapist

To ensure you’re working with a properly trained practitioner:

Discover the Value of Working with a BANT-Registered Nutritional Therapist

Nutritional therapists play a vital role in bridging the gap between general wellness advice and personalised healthcare. They take time to understand how your diet, genetics, environment, and lifestyle interact and use that insight to guide tailored, evidence-based recommendations that help you feel better, for longer.

Generic nutrition tips and one-size-fits-all plans can fall short. Working with a Registered Nutritional Therapist puts your individual needs at the centre. For many clients, it’s the first time their symptoms, history, and goals have been fully explored and connected into a clear plan.

This approach supports symptom improvement while also helping you reconnect with your body, increase daily energy, and take charge of your long-term wellbeing.

If you’re ready to stop guessing and start understanding what your body really needs, a Registered Nutritional Therapist could make all the difference. Please feel free to get in touch or book a call via my website.

What qualification dose a Nutritional Therapist have? Are they different from a "nutrionist"?

In the UK anyone can call themselves a “nutritionist”. The title is not legally protected so regardless of training anyone can call themselves a “nutritionist”.

However, Registered Nutritional Therapists including me are:

This level of regulation ensures clients are receiving safe, evidence-based advice from a qualified professional.It’s important to remember that only those registered with CNHC are recognised to deliver one-to-one clinical care.

In my case I trained with the Institute of Optimum Nutrition (ION) in London and gained a diploma (DipION, Distinction). I also did some preliminary training at the University of Westminster.

Know your numbers

This blog was inspired by an article written by a lady who had a heart attack at the super young age of 42. She did have high cholesterol and some significant family history but it really highlighted to me that ‘knowing your numbers’ is a good thing.  I am generally a cautious tester for various reasons. It can make clients anxious and there is often a lot of work you can do just based on a client’s diet and lifestyle questionnaire.   However knowing certain key health numbers can also save a life, help with motivation and direct a client’s protocol for maximum support.  

HDL cholesterol

Here are the top line numbers we should be aware of and why. 

Known as the good cholesterol, low levels of HDL are linked to an increased risk of heart disease. Cholesterol has a metabolic cycle in the body and if this is functioning well your LDL (known as ‘bad’ cholesterol) will be converted to HDL (known as ‘good’ cholesterol) and returned to the liver with any excess being excreted. It’s the overall pattern and clinical picture that matters so if you are unsure what your numbers mean it’s best to talk to your GP or health professional.

OPTIMAL LEVELS ARE:

Triglycerides

High triglyceride levels can indicate elevated levels of fat (lipids) in the blood.  This figure is measured with a blood test. Remember that fat in the body is not just from fat in the diet. Any sugar that we eat in the diet that the body can’t immediately utilise for energy will be converted to fat. Sugar in the diet is not just from fruit or added sugars such as honey, syrup, sugar etc. We also convert starch from grains and vegetables to sugar during the digestive process and subsequently to fat if your cells and sugar stores (glycogen) are already full. The more processed and refined the food, the quicker this conversion happens.  

OPTIMAL LEVELS ARE: below 1.7mmol/L

Blood pressure

High blood pressure stresses your heart and blood vessels, which increases the risk of cardiovascular disease. Healthy blood pressure is a marker of overall metabolic health. We need to manage stress, exercise regularly and maintain a healthy body fat percentage to regulate our blood pressure.

OPTIMAL PRESSURE IS: 120 /80 mm/Hg systolic/diastolic.

Waist to hip (WHR) ratio

Divide your waist circumference by your hip circumference to obtain your WHR.

WHR measures the ratio of your waist to your hip circumference. It determines how much fat is stored around the waist, hips, and buttocks. It is an easy, inexpensive, and generally accurate way to assess the body’s proportion of fat.  This is important as not all excess weight carries the same health risks. It can help predict your risk of heart disease and diabetes when reviewed alongside other health markers.

OPTIMAL ratio is:

Waist circumference

This is another marker for assessing abdominal obesity which is associated with increased health risks and metabolic conditions such as diabetes and heart problems.

OPTIMAL ratio is:

I hope you have found this guide to your top-level health markers useful. Remember no test is perfect and no test can fully convey the complexity of your health.  To understand your full health picture there are many factors to take into account including information about your diet and lifestyle.

 My next blog will summarise how to improve the body’s blood fat picture.

You can read the full article that prompted this blog here: https://www.womenshealthmag.com/uk/health/conditions/a64363807/young-heart-attack/

What fats can I cook with?

This blog is a reminder of which fats to use for cooking and which ones are best used cold in salad dressings. It also covers which ones to avoid.

Fatty acids are classified according to the presence and number of double bonds in their carbon chain. Saturated fatty acids (SAFA) contain no double bonds, monounsaturated fatty acids (MUFA) contain one, and polyunsaturated fatty acids (PUFA) contain more than one double bond.

This table above shows the fatty acid composition of various culinary oils.

You can see from the table above that oils tend to be classified according to their largest constituent. We need to cook with oils which are stable when heated and therefore have a high smoke point. The more double bonds a fatty acid has, the more unsaturated and unstable it will be, especially when heated.

The most stable fats are solid at room temperature, so lard etc. Olive oil (virgin/extra virgin) is pressed straight from the seed or fruit without further refining. There is research to show that the phenols in unrefined olive oil protect it from degradation during cooking (Ramirez-Anaya, 2015).

Oils such as rapeseed, sunflower and vegetable are obtained by washing and crushing the seeds, and then using processes such as heating, hexane, solvents, extraction, processing, bleaching, deodorization and peroxide to maximise production volume. As these oils are highly unsaturated (many double bonds) the risk of oxidation from processing is high, either during processing or if used to cook with. Most of these oils are also much higher in omega-6 than omega-3. As our diets tend to be more deficient in omega-3, I focus on hemp and flax (small amount) which have a 4:1 and a 0.3:1 ratio respectively (o-6:o-3) to try to redress this. I also advocate cold pressed and organic versions to preserve quality and nutrient content. 

The following table is a guide Whether you wish to cook with animal fats will depend on various criteria including your health and dietary preferences as well as your ability to digest and absorb fat.

Which fat to cook with and which to use for dressings and drizzles

REFS: Del Pilar Ramírez-Anaya, J. et al (2015) Phenols and the antioxidant capacity of Mediterranean vegetables prepared with extra virgin olive oil using different domestic cooking techniques. Food Chemistry Vol 188; pp. 430-438.

Essential fatty acids explained

Image source: https://www.eufic.org/en/whats-in-food/article/the-importance-of-omega-3-and-omega-6-fatty-acids

What they are and how to make sure you eat enough.

There are two fats that humans have to eat as the body cannot make them and they are required for specific functions. They are called omega-3 (ω-3) and omega-6 (ω-6) and known as essential fatty acids (EFA’s) for this reason. They are both polyunsaturated fatty acids (PUFA’s) which means that they have more than one double bond between their carbon back bone. They get their name from the carbon number where their first double bond appears (see pic).

In the diet omega-3 is found in flax, hemp, pumpkin and chia seeds as well as walnuts. The end products of omega-3 (ALA) that the body requires are called EPA and DHA.  Fish already contains both which is why it is such a good source, as the body doesn’t need to convert it. The conversion from other sources is very small and many people struggle with it, hence the oily fish recommendation.  

Omega-6 is found in vegetable oils from seeds of corn, sunflower, safflower, cotton and soybeans.  It is also found in evening primrose oil, borage, starflower and blackcurrant oils. It is converted to a downstream product known as arachidonic acid (AA). This end product (AA) is freely available in meat, egg and dairy products.

Our intake of omega-6 tends to exceed omega-3 considerably due to the nature of most people’s diets and the relatively recent availability of  vegetable and sunflower cooking oils. My parents are over 80 but my mum can still remember how she queued up in the grocers to buy a slab of butter, wrapped in greaseproof paper. Most processed foods and ready-made dressings, sauces and jars also contain omega-6.

Research scientist Simopoulos (2002) believes we historically consumed equal amounts of omega-3 and omega-6, a 1:1 ratio. We now consume 15-16.7 times as much omega-6.

Omega-3 and omega-6 fatty acids are however both important components of cell membranes. During the conversion process they produce downstream products (eicosanoids) which regulate our inflammatory responses. Omega-3 eicosanoids are known to have anti-inflammatory effects. The eicosanoids from omega-3 tend to be more anti-inflammatory and anti-coagulatory than omega-6, which produces both inflammatory and anti-inflammatory versions.

Omega-3 and omega-6 both utilise the same conversion enzyme (delta-6-desaturase) so theories have arisen that one process will deprive the other. A high omega-6 intake is thought to reduce the availability of this enzyme and so diminish our omega-3 conversion.  This theory and the concept of an “ideal” ratio in the diet is contested but it is generally thought that a ratio of 4:1 (ω-6: ω-3) is optimum.

The European Food Safety Authority concluded that 250 mg a day of EPA and DHA was adequate. They also found that European intake was too low at between 20-40 mg per day for EPA and less than 100-130 mg per day for DHA.

It’s kind of difficult to think about ratio’s when you are out shopping or planning your menus, so this is the way I tend to advise clients. Providing your digestion is good then generally you can obtain enough EPA and DHA by consuming oily fish 2-3 times per week. Otherwise supplementation is likely the best option.

References

https://pubmed.ncbi.nlm.nih.gov/12442909

https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2010.1461

https://www.eufic.org/en/whats-in-food/article/the-importance-of-omega-3-and-omega-6-fatty-acids

https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/recommended-dietary-reference-intakes-nutritional-goals-and-dietary-guidelines-for-fat-and-fatty-acids-a-systematic-review/5C2EDA7CD9C4EAB094F8499B2E122E75