Omega-3 Fatty Acids

We’re busy updating our review of omega-3 fatty acids and will provide a rating when that’s complete. While we’re working, we share a summary from our predecessor website, Beyond Conventional Cancer Therapies. The information we share here was last updated in August 2021.

Please consider supporting our update and revision to this information.

Support our work

Omega-3 fatty acids are a type of polyunsaturated fatty acid (PUFA) found naturally in these foods and supplements:

Fish and fish oil: anchovies, bluefish, herring, mackerel, salmon (wild has more omega-3s than farmed), sardines, sturgeon, lake trout and tuna¹WebMD. The Facts on Omega-3 Fatty Acids. Viewed December 1, 2017.
Krill oil
Cod liver oil
Flaxseed oil
Linseed oil
Walnuts
Chia seeds

The three main omega-3 fatty acids are docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA). DHA and EPA generally show greater benefits in cancer, but are found only in animal sources. ALA from plant sources is converted to DHA and EPA in our bodies, but with a low conversion efficiency. ALA is not recommended as your sole source of omega-3s.²Linus Pauling Institute. Essential Fatty Acids. Oregon State University. Viewed May 14, 2019.

Key Points

Before using this therapy, consult your oncology team about interactions with other treatments and therapies. Also make sure this therapy is safe for use with any other medical conditions you may have.
Omega-3 fatty acids are found naturally in many fish and a few seeds and walnuts.
Omega-3s are widely available as supplements.
BCCT is interested in omega-3s because evidence shows benefits in several types of cancer treatment, and preliminary evidence shows omega-3s may reduce risks of breast and colon cancer.
While omega-3s are generally considered safe, a few cautions and interactions are noted.

Clinical Practice Guidelines

Society for Integrative Oncology

Clinical practice guidelines from the Society for Integrative Oncology (SIO) suggest oral supplementation with omega-3 fatty acids to improve the nutritional status in people with lung cancer who have lost muscle mass (sarcopenia).³Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.

American College of Chest Physicians

2013 evidence-based clinical practice guidelines from the American College of Chest Physicians recommended oral nutritional supplementation with omega-3 fatty acids to improve the nutritional status for lung cancer patients with sarcopenia (loss of muscle tissue).⁴Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.

Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

General Cancer

No improved survival with supplementation⁵van der Meij BS, van Bokhorst-de van der Schueren MA, Langius JA, Brouwer IA, van Leeuwen PA. n-3 PUFAs in cancer, surgery, and critical care: a systematic review on clinical effects, incorporation, and washout of oral or enteral compared with parenteral supplementation. American Journal of Clinical Nutrition. 2011 Nov;94(5):1248-65.

Breast Cancer

Improved survival and other outcomes with omega-3s used with chemotherapy in a trials of people with metastatic breast cancer⁶Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62
Reduced all-cause mortality (but not with early stage breast cancer) with marine omega-3s from food but not supplements⁷Patterson RE, Flatt SW et al. Marine fatty acid intake is associated with breast cancer prognosis. Journal of Nutrition. 2011 Feb;141(2):201-6.
No adverse side effects and possible improved anthracycline-based chemotherapy outcome in a small uncontrolled trial of group patients with rapidly progressing visceral metastases⁸Bougnoux P, Hajjaji N et al. Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial. British Journal of Cancer. 2009 Dec 15;101(12):1978-85.

Colorectal Cancer

Improved survival with a diet rich in omega-3 fatty acids⁹Volpato M, Hull MA. Omega-3 polyunsaturated fatty acids as adjuvant therapy of colorectal cancer. Cancer Metastasis Reviews. 2018 Sep;37(2-3):545-555. or omega-3s from both diet and supplements¹⁰Song M, Ou FS et al. Marine omega-3 fatty acid intake and survival of stage III colon cancer according to tumor molecular markers in NCCTG Phase III trial N0147 (Alliance). International Journal of Cancer. 2019 Jul 15;145(2):380-389.
No reduction in mortality when taken before gastrointestinal cancer surgery in a nutritional supplement also including arginine and nucleotides¹¹Adiamah A, Skořepa P, Weimann A, Lobo DN. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Annals of Surgery. 2019 Feb 26.
No decrease in tumor size or improvement in patient survival times with supplementation¹²de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
Increased cell death (apoptosis) in the normal sigmoid colon with a dietary decrease in omega-6s and increase in omega-3s for two years¹³Cheng J, Ogawa K et al. Increased intake of n-3 polyunsaturated fatty acids elevates the level of apoptosis in the normal sigmoid colon of patients polypectomized for adenomas/tumors. Cancer Letters. 2003 Apr 10;193(1):17-24.
Eicosapentaenoic acid (EPA) effects:
- Improved overall survival in patients undergoing liver resection surgery for colorectal cancer liver metastases¹⁴Cockbain AJ, Volpato M et al. Anticolorectal cancer activity of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid. Gut. 2014 Nov;63(11):1760-8.
- Reduced extent of blood vessel networks consistent with reduced creation of new blood vessels to supply tumors (angiogenesis) with EPA use¹⁵Cockbain AJ, Volpato M et al. Anticolorectal cancer activity of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid. Gut. 2014 Nov;63(11):1760-8.
- Reduced crypt cell proliferation and increased cell death (apoptosis) in people with colorectal adenomas with three months of supplementation¹⁶Courtney ED, Matthews S et al. Eicosapentaenoic acid (EPA) reduces crypt cell proliferation and increases apoptosis in normal colonic mucosa in subjects with a history of colorectal adenomas. International Journal of Colorectal Disease. 2007 Jul;22(7):765-76.

Prostate Cancer

Smaller prostates (both benign and malignant components), lower proliferation index, and plasma that inhibited growth of prostate cancer cells in vitro more than the plasma in a group of men with prostate cancer combining omega 3 supplements with a low-fat (15 percent of calories from fat) diet for four to six weeks before prostatectomy¹⁷Abrams DI. An integrative approach to prostate cancer. Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
Decreased prostate cancer proliferation and decreased omega-6:omega-3 ratios in prostate tissue, but no change in serum insulin-like growth factor I (IGF-1) in a small study of men undergoing radical prostatectomy¹⁸Aronson WJ , Kobayashi N et al. Phase II prospective randomized trial of a low-fat diet with fish oil supplementation in men undergoing radical prostatectomy. Cancer Prevention Research (Phila). 2011 Dec;4(12):2062-71.
No impact on prostate-specific antigen levels among people with prostate cancer taking fish oil supplements¹⁹Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62.

Lab and Animal Evidence

Click or tap to open.

Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

Anxiety

Mixed results among people with conditions other than cancer:

Lower scores for anxiety among people with with heart attacks (acute myocardial infarction) with omega-3 fatty acids in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects²⁶Haberka M, Mizia-Stec K et al. Effects of n-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction. Pharmacological Reports. 2013;65(1):59-68.
Lower anxiety scores among healthy medical students with both EPA and DHA in a small RCT²⁷Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain, Behavior and Immunity. 2011 Nov;25(8):1725-34.
Lower scores for anxiety and anger among people who are substance abusers and whose dietary intakes of omega-3s were below recommended levels; EPA levels showed more impact with anxiety in a small RCT²⁸Buydens-Branchey L, Branchey M, Hibbeln JR. Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers. Progress in Neuropsychopharmacology & Biolological Psychiatry. 2008 Feb 15;32(2):568-75.
No impact on anxiety scores among people with obsessive-compulsive disorder with EPA in a small RCT²⁹Fux M, Benjamin J, Nemets B. A placebo-controlled cross-over trial of adjunctive EPA in OCD. Journal of Psychiatric Research. 2004 May-Jun;38(3):323-5.
Lower scores during menopause, but only in the absence of depression³⁰McCabe D, Lisy K, Lockwood C, Colbeck M. The impact of essential fatty acid, B vitamins, vitamin C, magnesium and zinc supplementation on stress levels in women: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2017 Feb;15(2):402-453.
Lower scores and duration of anxiety among women experiencing symptoms of premenstrual syndrome in a mid-sized RCT³¹Sohrabi N, Kashanian M, Ghafoori SS, Malakouti SK. Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: “a pilot trial”. Complementary Therapies in Medicine. 2013 Jun;21(3):141-6.
Lower scores on several measures of anxiety, including cortisol levels, among students with test anxiety after three weeks of supplementation with both omega-3 and omega-6 fatty acids (1:4 ratio), with apparently (but not analyzed) more improvement than students receiving placebo in a small trial³²Yehuda S, Rabinovitz S, Mostofsky DI. Mixture of essential fatty acids lowers test anxiety. Nutritional Neuroscience. 2005 Aug;8(4):265-7.

Body Weight and Composition

Omega-3 fatty acid (EPA and DHA) capsules or supplements with EPA have been associated with weight stabilization, gain in lean body mass, and improvement in quality of life markers in patients losing weight as a result of advanced pancreatic and head and neck cancers.³³Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
Promoted weight maintenance or gain during cancer treatment, and improved scores of physical function and global health status with omega-3s³⁴de Aguiar Pastore Silva J, de Souza Fabre ME, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66. or EPA alone, with a trend toward fewer interruptions of chemotherapy treatment³⁵Trabal J, Leyes P, Forga M, Maurel J. Potential usefulness of an EPA-enriched nutritional supplement on chemotherapy tolerability in cancer patients without overt malnutrition. Nutricion Hospitalaria. 2010 Sep-Oct;25(5):736-40.
Maintained³⁶Silva Jde A, Trindade EB et al. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutrition and Cancer. 2012;64(2):267-73. or benefited³⁷van der Meij BS, van Bokhorst-de van der Schueren MA, Langius JA, Brouwer IA, van Leeuwen PA. n-3 PUFAs in cancer, surgery, and critical care: a systematic review on clinical effects, incorporation, and washout of oral or enteral compared with parenteral supplementation. American Journal of Clinical Nutrition. 2011 Nov;94(5):1248-65. body weight during chemotherapy
Increased weight of patients with gastrointestinal cancer (anal, colorectal, esophageal, stomach) with EPA supplementation.³⁸Lavriv DS, Neves PM, Ravasco P. Should omega-3 fatty acids be used for adjuvant treatment of cancer cachexia? Clinical Nutrition ESPEN. 2018 Jun;25:18-25.
EPA and DHA reduced muscle loss and myosteatosis (the presence of intermuscular and intramuscular adipose tissue) in clinical studies.³⁹Ewaschuk JB, Almasud A, Mazurak VC. Role of n-3 fatty acids in muscle loss and myosteatosis. Applied Physiology, Nutrition, and Metabolism. 2014 Jun;39(6):654-62.
EPA increased mean weight and energy levels in an uncontrolled trial of colorectal cancer patients undergoing chemotherapy with folinic acid, 5-fluorouracil, irinotecan (FOLFIRI)⁴⁰Read JA, Beale PJ et al. Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial. Supportive Care in Cancer. 2007 Mar;15(3):301-7.
Reduced weight loss in cancer patients receiving chemotherapy after surgical tumor (mainly gastrointestinal) removal with fish oil supplementation⁴¹Bonatto SJ, Oliveira HH et al. Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids. 2012 Apr;47(4):383-9.
Omega-3 supplements improved outcomes, especially body composition, in patients undergoing chemotherapy and/or radiotherapy.⁴²de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
EPA reduced deterioration of nutritional status resulting from antineoplastic therapies (therapies to block the formation of neoplasms) by improving calorie and protein intake⁴³Pappalardo G, Almeida A, Ravasco P. Eicosapentaenoic acid in cancer improves body composition and modulates metabolism. Nutrition. 2015 Apr;31(4):549-55.
Increased lean-body mass, decreased resting energy expenditure, improved performance status in patients with cachexia (weakness and wasting) and improved appetite with a combintation therapy of medroxyprogesterone or megestrol acetate, eicosapentaenoic acid (EPA), L-carnitine and thalidomide⁴⁴Mantovani G, Macciò A et al. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist. 2010;15(2):200-11.
Improved chemotherapy-related appetite loss with a combination omega-3 fatty acid and microbial cell preparation⁴⁵Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191.

Depression

Pure eicosapentaenoic acid (EPA) or an EPA/docosahexaenoic acid (DHA) combination of a ratio higher than 2 (EPA/DHA >2) are considered effective, according to the International Society for Nutritional Psychiatry’s consensus-based practice guideline for clinical use of omega-3s in major depressive disorder (although not specific to people with cancer).⁴⁶Guu TW, Mischoulon D et al. International Society for Nutritional Psychiatry research practice guidelines for omega-3 fatty acids in the treatment of major depressive disorder. Psychotherapy and Psychosomatics. 2019;88(5):263-273.
Lower scores and duration of depression among women experiencing symptoms of premenstrual syndrome in a mid-sized RCT⁴⁷Sohrabi N, Kashanian M, Ghafoori SS, Malakouti SK. Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: “a pilot trial”. Complementary Therapies in Medicine. 2013 Jun;21(3):141-6.
Lower scores for depression among people with with heart attacks (acute myocardial infarction) with omega-3 fatty acids in a small RCT⁴⁸Haberka M, Mizia-Stec K et al. Effects of n-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction. Pharmacological Reports. 2013;65(1):59-68.

Fatigue

Reduced cancer-related fatigue in people with breast cancer increasing dietary omega-3 fatty acids combined with guarana extract and a diet rich in whole foods, fruits and vegetables⁴⁹Pereira PTVT, Reis AD et al. Dietary supplements and fatigue in patients with breast cancer: a systematic review. Breast Cancer Research and Treatment. 2018 Oct;171(3):515-526.
Improved fatigue with a combintation therapy of medroxyprogesterone or megestrol acetate, eicosapentaenoic acid (EPA), L-carnitine and thalidomide⁵⁰Mantovani G, Macciò A et al. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist. 2010;15(2):200-11.
Relieved chemotherapy-related fatigue with a combination omega-3 fatty acid and microbial cell preparation⁵¹Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191.

Gastrointestinal Effects, including Nausea and Vomiting

Relieved chemotherapy-related nausea and vomiting and diarrhea with a combination omega-3 fatty acid and microbial cell preparation⁵²Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191.

Pain

Improved chemotherapy-related pain with a combination omega-3 fatty acid and microbial cell preparation⁵³Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191.

Peripheral Neuropathy

Reduced paclitaxel-induced peripheral neuropathy people with breast cancer⁵⁴Ghoreishi Z, Esfahani A et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled trial. BMC Cancer. 2012 Aug 15;12:355.
Reduced incidence of peripheral neuropathy in one review,⁵⁵de Aguiar Pastore Silva J, de Souza Fabre ME, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66. but another review found insufficient evidence yet exists to recommend use for treating or preventing chemotherapy-induced peripheral neuropathy (CIPN)⁵⁶Schloss JM, Colosimo M, Airey C, Masci PP, Linnane AW, Vitetta L. Nutraceuticals and chemotherapy induced peripheral neuropathy (CIPN): a systematic review [published correction appears in Clinical Nutrition. 2015 Feb;34(1):167]. Clinical Nutrition. 2013;32(6):888–893.

Stress

Stable scores of rated anger and confusion during a stressful task with omega-3 supplementation among young adults, whereas controls receiving a placebo had rising anger and confusion, but no further effects on mood, cognitive function, cortisol, or IL-1β in a mid-sized RCT⁵⁷Giles GE, Mahoney CR et al. Omega-3 fatty acids and stress-induced changes to mood and cognition in healthy individuals. Pharmacology Biochemistry and Behavior. 2015 May;132:10-19.
Decrease in stress/anxiety ratings, accompanied by reduced cortisol basal levels throughout the day, among male alcoholics undergoing residential rehabilitation with EPA and DHA compared to controls in an RCT⁵⁸Barbadoro P, Annino I et al. Fish oil supplementation reduces cortisol basal levels and perceived stress: a randomized, placebo-controlled trial in abstinent alcoholics. Molecular Nutrition & Food Research. 2013 Jun;57(6):1110-4.

Other Side Effects and Symptoms

Improved function of blood neutrophils in cancer patients receiving chemotherapy after surgical tumor (mainly gastrointestinal) removal with fish oil supplementation⁵⁹Bonatto SJ, Oliveira HH et al. Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids. 2012 Apr;47(4):383-9.
Less dry mouth (xerostomia) among women with advanced breast cancer undergoing neoadjuvant chemotherapy with adriamycin/cyclophosphamide⁶⁰de la Rosa Oliva F, Meneses García A et al. Effects of omega-3 fatty acids supplementation on neoadjuvant chemotherapy-induced toxicity in patients with locally advanced breast cancer: a randomized, controlled, double-blinded clinical trial. Nutricion Hospitalaria. 2019 Aug 26;36(4):769-776.
High-dose EPA inhibited bone resorption in breast cancer survivors taking aromatase inhibitors.⁶¹Hutchins-Wiese HL, Picho K et al. High-dose eicosapentaenoic acid and docosahexaenoic acid supplementation reduces bone resorption in postmenopausal breast cancer survivors on aromatase inhibitors: a pilot study. Nutrition and Cancer. 2014;66(1):68-76
Reduced postoperative infectious complications and hospital stay after colorectal cancer surgery in one study⁶²Xie H, Chang YN. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis. OncoTargets and Therapy. 2016 Dec 9;9:7435-7443. but no improvement in infectious or non-infectious postoperative complications in another⁶³Sorensen LS, Thorlacius-Ussing O et al. Randomized clinical trial of perioperative oXie H, Chang YN. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis. OncoTargets and Therapy. 2016 Dec 9;9:7435-7443.mega-3 fatty acid supplements in elective colorectal cancer surgery. British Journal of Surgery. 2014 Jan;101(2):33-42.
Improved quality of life with a combination omega-3 fatty acid and microbial cell preparation⁶⁴Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191.
Possibly shorter hospital stay with supplementation after oncology surgery⁶⁵van der Meij BS, van Bokhorst-de van der Schueren MA, Langius JA, Brouwer IA, van Leeuwen PA. n-3 PUFAs in cancer, surgery, and critical care: a systematic review on clinical effects, incorporation, and washout of oral or enteral compared with parenteral supplementation. American Journal of Clinical Nutrition. 2011 Nov;94(5):1248-65.
Reduced infectious complications, length of hospital stay and co-morbidities in cancer patients undergoing surgery with supplementation with omega-3 fatty acids, arginine and nucleotides⁶⁶Soldati L, Di Renzo L et al. The influence of diet on anti-cancer immune responsiveness. Journal of Translational Medicine. 2018 Mar 20;16(1):75; Adiamah A, Skořepa P, Weimann A, Lobo DN. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Annals of Surgery. 2019 Feb 26.

Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Breast Cancer

Higher omega-6 to omega-3 ratios are associated with higher risk of breast cancer,⁶⁷Serna-Thomé G, Castro-Eguiluz D et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Revista de Investigacion Clinica. 2018;70(3):136-146. while omega-6/omega-3 ratio of 2-4:1 are associated with a reduced risk.⁶⁸Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine. 2017 Dec;6(1):25.
Reduced risk with higher omega-3 levels from combined diet and supplements are associated with lower risk of breast cancer.⁶⁹Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62.
Higher consumption of dietary marine omega-3 polyunsaturated fatty acids is associated with a lower risk of breast cancer.⁷⁰Zheng JS, Hu XJ, Zhao YM, Yang J, Li D. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies. BMJ. 2013 Jun 27;346:f3706.
No impact of supplements on breast cancer recurrence with early stage breast cancer, but marine omega-3s from food were associated with reduced risk of additional breast cancer events.⁷¹Patterson RE, Flatt SW et al. Marine fatty acid intake is associated with breast cancer prognosis. Journal of Nutrition. 2011 Feb;141(2):201-6.
Higher levels from combined diet and supplements are associated with reduced risks of breast cancer.⁷²Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62. No impact of supplements was found on breast cancer recurrence in patients with early stage breast cancer, but marine omega-3s (DHA and EPA) from food were associated with reduced risk of additional breast cancer events.⁷³Patterson RE, Flatt SW et al. Marine fatty acid intake is associated with breast cancer prognosis. Journal of Nutrition. 2011 Feb;141(2):201-6.
Reduced risk of breast cancer with consumption of omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and an omega-6/omega-3 ratio of 2-4:1⁷⁴Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine. 2017 Dec;6(1):25.

Colorectal Cancer

Decreased risk of colorectal cancer with increased consumption of omega-3 fatty acids in fish⁷⁵Song M, Chan AT. Environmental factors, gut microbiota, and colorectal cancer prevention. Clinical Gastroenterology and Hepatology. 2019 Jan;17(2):275-289; Hall MN, Chavarro JE, Lee IM, Willett WC, Ma J. A 22-year prospective study of fish, n-3 fatty acid intake, and colorectal cancer risk in men. Cancer Epidemiology, Biomarkers & Prevention. 2008 May;17(5):1136-43.
Decreased risk of colon cancer with fish oil supplements,⁷⁶Kim S, Sandler DP, Galanko J, Martin C, Sandler RS. Intake of polyunsaturated fatty acids and distal large bowel cancer risk in whites and African Americans. American Journal of Epidemiology. 2010 May 1;171(9):969-79; Satia JA, Littman A, Slatore CG, Galanko JA, White E.Associations of herbal and specialty supplements with lung and colorectal cancer risk in the VITamins and Lifestyle study. Cancer Epidemiology, Biomarkers & Prevention. 2009 May;18(5):1419-28. especially in men, but an increased risk was found with individuals with high genetic risk⁷⁷Kantor ED, Lampe JW, Peters U, Vaughan TL, White E. Long-chain omega-3 polyunsaturated fatty acid intake and risk of colorectal cancer. Nutrition and Cancer. 2014;66(4):716-27.
Decreased risk of distal large bowel cancer with lower ratios of omega-6 to long-chain omega-3s, but only in Americans of European descent, and not among Americans of African descent⁷⁸Kim S, Sandler DP, Galanko J, Martin C, Sandler RS. Intake of polyunsaturated fatty acids and distal large bowel cancer risk in whites and African Americans. American Journal of Epidemiology. 2010 May 1;171(9):969-79.
Reduced number and size of rectal adenomas⁷⁹Katona BW, Weiss JM. Chemoprevention of colorectal cancer. Gastroenterology. 2020;158(2):368–388.
Reduced risk of colon cancer with consumption of omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and an omega-6/omega-3 ratio of 2-4:1⁸⁰Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine. 2017 Dec;6(1):25.
EPA alone:
- Reduced number and size of polyps in patients with familial adenomatous polyposis with eicosapentaenoic acid (EPA) alone⁸¹Song M, Chan AT. Environmental factors, gut microbiota, and colorectal cancer prevention. Clinical Gastroenterology and Hepatology. 2019 Jan;17(2):275-289.
- No reduction in the proportion of patients with at least one colorectal adenoma in patients with sporadic colorectal neoplasia, used either with or without aspirin, compared with a placebo⁸²Hull MA, Sprange K et al. Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial. Lancet. 2018 Dec 15;392(10164):2583-2594.

Kidney Cancer

Reduced risk of kidney (renal) cancers with consumption of omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and an omega-6/omega-3 ratio of 2-4:1⁸³Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine. 2017 Dec;6(1):25.

Lung Cancer

Decreased risk of lung cancer with omega-3 supplementation⁸⁴Satia JA, Littman A, Slatore CG, Galanko JA, White E.Associations of herbal and specialty supplements with lung and colorectal cancer risk in the VITamins and Lifestyle study. Cancer Epidemiology, Biomarkers & Prevention. 2009 May;18(5):1419-28.

Prostate Cancer

Data on omega-3 fatty acid supplementation for prostate cancer prevention are inconclusive.

A 2017 review of the literature showed no clear relationship between fish-derived omega-3 fatty acids and risk of prostate cancer⁸⁵Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62.
A separate review found a reduced risk prostate cancer with consumption of omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and an omega-6/omega-3 ratio of 2-4:1⁸⁶Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine. 2017 Dec;6(1):25.

Lab and Animal Evidence

Click or tap to open.

Optimizing Your Terrain

Creating an environment within your body that does not support cancer development, growth or spread

Reduced inflammation,⁸⁸Pappalardo G, Almeida A, Ravasco P. Eicosapentaenoic acid in cancer improves body composition and modulates metabolism. Nutrition. 2015 Apr;31(4):549-55; de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66. or improved anti-inflammatory markers⁸⁹Sorensen LS, Thorlacius-Ussing O et al. Effects of perioperative supplementation with omega-3 fatty acids on leukotriene B₄ and leukotriene B₅ production by stimulated neutrophils in patients with colorectal cancer: a randomized, placebo-controlled intervention trial. Nutrients. 2014 Sep 29;6(10):4043-57; Silva Jde A, Trindade EB et al. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutrition and Cancer. 2012;64(2):267-73; Xie H, Chang YN. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis. OncoTargets and Therapy. 2016 Dec 9;9:7435-7443; Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191; Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62. including when accompanying anticancer treatment⁹⁰Mocellin MC, Camargo CQ, Nunes EA, et al. A systematic review and meta-analysis of the n-3 polyunsaturated fatty acids effects on inflammatory markers in colorectal cancer. Clinical Nutrition. 2016;35:359–369. and in patients undergoing radical colorectal cancer resection⁹¹Liang B, Wang S, Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients. World Journal of Gastroenterology. 2008 Apr 21;14(15):2434-9.
Lower markers of inflammation among healthy medical students with both EPA and DHA in a small RCT⁹²Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain, Behavior and Immunity. 2011 Nov;25(8):1725-34.
Improved immune functions in cancer patients undergoing surgery⁹³Soldati L, Di Renzo L et al. The influence of diet on anti-cancer immune responsiveness. Journal of Translational Medicine. 2018 Mar 20;16(1):75; Adiamah A, Skořepa P, Weimann A, Lobo DN. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Annals of Surgery. 2019 Feb 26.

Modes of Action

Four mechanisms are identified:⁹⁴Polokowski AR, Shakil H, Carmichael CL, Reigada LC. Omega-3 fatty acids and anxiety: a systematic review of the possible mechanisms at play. Nutritional Neuroscience. 2020 Jul;23(7):494-504.

Inflammatory response
Brain-derived neurotrophic factor (BDNF)
Cortisol
Cardiovascular activity

Cautions

A few cautions are noted. Please see the Memorial Sloan Kettering Cancer Center’s About Herbs website for more information.

High blood concentrations of omega-3s are associated with increased risk of prostate cancer (see the see the Foundation for Alternative and Integrative Medicine for an analysis of the study that found this for an analysis of the study that found this).
Increased resistance to chemotherapy is a concern;⁹⁵Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8. a type of omega-3 fatty acid, 16:4(n-3), can reduce the activity of the chemotherapy drug cisplatin. Use is not recommended on the days surrounding chemotherapy.⁹⁶Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8.
2018 review conclusions:⁹⁷Abrams D. An integrative approach to prostate cancer. The Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
- Four grams of supplementation may impair clotting; patients may want to eliminate omega-3 supplements before and immediately after surgery.
- A few adverse reactions and interactions with prescription and other drugs have been observed.

Dosing

CancerChoices does not recommend therapies or doses, but only provides information for patients and providers to consider as part of a complete treatment plan. Patients should discuss therapies with their physicians, as contraindications, interactions and side effects must be evaluated. Levels of active ingredients of natural products can vary widely between and even within products. See Sourcing Quality Herbs and Supplements.

Dosage recommendations are available from these sources:

Natural Medicines Database (requires purchase)
Also see the protocols listed below.

Integrative Programs, Protocols and Medical Systems

For more information about programs and protocols, see our Integrative Programs and Protocols page.

Programs and protocols
- Alschuler & Gazella complementary approaches⁹⁸Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
  - Breast cancer
  - Colon cancer
  - Lung cancer
  - Pancreatic cancer
  - Prostate cancer
- Block program⁹⁹Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
  - Breast cancer case study
  - Lung cancer case study
  - Prostate cancer case study
  - Core diet plan
  - Remission support diet
  - Chemotherapy coupler
  - Radiation therapy coupler
  - Normalizing coagulation
  - Blocking inflammation
  - Blocking tumor-fueling enzymes
  - Boosting immune surveillance
  - Self-care program for stress chemistry and circadian rhythm
- Chang strategies¹⁰⁰Chang R. Beyond the Magic Bullet: The Anti-Cancer Cocktail. New York: Square One Publishers. 2012.
- Lemole, Mehta & McKee protocols¹⁰¹Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
  - Breast cancer
  - Colorectal cancer
  - Endometrial cancer
  - Lung cancer
  - Prostate cancer
- MacDonald breast cancer program¹⁰²MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. (self-published, Amazon, 2016).
- McKinney protocols¹⁰³McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.
  - General cancer
  - Breast cancer
  - Leukemia amd myelodysplastic syndrome
  - Melanoma
  - Prostate cancer
  - Sarcoma
  - Thyroid cancer
  - Depression
  - Fatigue
  - Weight loss
- Parmar & Kazcor treatment plans¹⁰⁴Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Canada: Medicatrix Holdings Ltd. 2020.
- Traditional systems
  - Ayurveda
  - Traditional Chinese medicine

Note: CancerChoices has not conducted an independent review of research of Omega-3 fatty acids. This summary draws from the Memorial Sloan Kettering Cancer Center’s About Herbs and other sources as noted.

Helpful links

Memorial Sloan Kettering Cancer Center’s About Herbs website: Omega-3
Deng G, Gubili J. Omega-3 Fatty Acids. ASCO Post. March 10, 2019.
American Institute for Cancer Research website: more than 100 articles and scientific reports on omega-3 fatty acids and cancer
TRC Natural Medicines website (subscription is required): in-depth information, ratings of effectiveness and safety and evaluation of specific omega-3 fatty acid products
Consumer Labs: Product Review (subscription required): Fish Oil and Omega-3 and -7 Fatty Acids Supplement Review
Moss Reports (purchase required): Select from the list of cancers down the left side of the page for a report describing uses of conventional, complementary, alternative and integrative therapies related to that cancer. Ralph Moss is among the most knowledgeable and balanced researchers of integrative cancer therapies. The cost of his Moss Reports is not negligible, but many patients find them of considerable value. Moss is also available for consultations.
Harvard Health Publishing: Should you be taking an omega-3 supplement?
Linus Pauling Institute, Oregon State University: Essential Fatty Acids
Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition
Dawn Lemanne and Victoria Maizes: Advising Women Undergoing Treatment for Breast Cancer
Block KI, Block PB, Gyllenhaal C: Integrative Treatment for Colorectal Cancer
Keith Block and others: A Broad-Spectrum Integrative Design for Cancer Prevention and Therapy
Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
Neil McKinney, BSc, ND: Naturopathic Oncology, 3rd Edition
Ted Schettler, MD, MPH: The Ecology of Breast Cancer: The Promise of Prevention and the Hope for Healing
Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
National Cancer Institute: Office of Cancer Complementary and Alternative Medicine
Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer

References[+]

1	WebMD. The Facts on Omega-3 Fatty Acids. Viewed December 1, 2017.
2	Linus Pauling Institute. Essential Fatty Acids. Oregon State University. Viewed May 14, 2019.
3, 4	Deng GE, Rausch SM et al. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e420S-e436S.
5, 37, 65	van der Meij BS, van Bokhorst-de van der Schueren MA, Langius JA, Brouwer IA, van Leeuwen PA. n-3 PUFAs in cancer, surgery, and critical care: a systematic review on clinical effects, incorporation, and washout of oral or enteral compared with parenteral supplementation. American Journal of Clinical Nutrition. 2011 Nov;94(5):1248-65.
6	Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62
7, 71, 73	Patterson RE, Flatt SW et al. Marine fatty acid intake is associated with breast cancer prognosis. Journal of Nutrition. 2011 Feb;141(2):201-6.
8	Bougnoux P, Hajjaji N et al. Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial. British Journal of Cancer. 2009 Dec 15;101(12):1978-85.
9	Volpato M, Hull MA. Omega-3 polyunsaturated fatty acids as adjuvant therapy of colorectal cancer. Cancer Metastasis Reviews. 2018 Sep;37(2-3):545-555.
10	Song M, Ou FS et al. Marine omega-3 fatty acid intake and survival of stage III colon cancer according to tumor molecular markers in NCCTG Phase III trial N0147 (Alliance). International Journal of Cancer. 2019 Jul 15;145(2):380-389.
11	Adiamah A, Skořepa P, Weimann A, Lobo DN. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Annals of Surgery. 2019 Feb 26.
12	de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
13	Cheng J, Ogawa K et al. Increased intake of n-3 polyunsaturated fatty acids elevates the level of apoptosis in the normal sigmoid colon of patients polypectomized for adenomas/tumors. Cancer Letters. 2003 Apr 10;193(1):17-24.
14, 15	Cockbain AJ, Volpato M et al. Anticolorectal cancer activity of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid. Gut. 2014 Nov;63(11):1760-8.
16	Courtney ED, Matthews S et al. Eicosapentaenoic acid (EPA) reduces crypt cell proliferation and increases apoptosis in normal colonic mucosa in subjects with a history of colorectal adenomas. International Journal of Colorectal Disease. 2007 Jul;22(7):765-76.
17	Abrams DI. An integrative approach to prostate cancer. Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
18	Aronson WJ , Kobayashi N et al. Phase II prospective randomized trial of a low-fat diet with fish oil supplementation in men undergoing radical prostatectomy. Cancer Prevention Research (Phila). 2011 Dec;4(12):2062-71.
19, 85	Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62.
20	Serna-Thomé G, Castro-Eguiluz D et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Revista de Investigación Clínica. 2018;70(3):136-146.
21	VanderSluis L, Mazurak VC, Damaraju S, Field CJ. Determination of the relative efficacy of eicosapentaenoic acid and docosahexaenoic acid for anti-cancer effects in human breast cancer models. International Journal of Moleculat Sciences. 2017 Dec 4;18(12). pii: E2607.
22	Tanaka A, Yamamoto A et al. Polyunsaturated fatty acids induce ovarian cancer cell death through ROS-dependent MAP kinase activation. Biochemical and Biophysical Research Communications. 2017 Nov 4;493(1):468-473.
23	Hopkins MM, Meier KE. Free fatty acid receptor (FFAR) agonists inhibit proliferation of human ovarian cancer cells. Prostaglandins, Leukotrienes and Essential Fatty Acids. 2017 Jul;122:24-29.
24	Wan XH, Fu X, Ababaikeli G. Docosahexaenoic acid induces growth suppression on epithelial ovarian cancer cells more effectively than eicosapentaenoic acid. Nutrition and Cancer. 2016;68(2):320-7.
25	Khadge S, Sharp JG et al. Immune regulation and anti-cancer activity by lipid inflammatory mediators. International Immunopharmacology. 2018 Dec;65:580-592.
26	Haberka M, Mizia-Stec K et al. Effects of n-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction. Pharmacological Reports. 2013;65(1):59-68.
27, 92	Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain, Behavior and Immunity. 2011 Nov;25(8):1725-34.
28	Buydens-Branchey L, Branchey M, Hibbeln JR. Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers. Progress in Neuropsychopharmacology & Biolological Psychiatry. 2008 Feb 15;32(2):568-75.
29	Fux M, Benjamin J, Nemets B. A placebo-controlled cross-over trial of adjunctive EPA in OCD. Journal of Psychiatric Research. 2004 May-Jun;38(3):323-5.
30	McCabe D, Lisy K, Lockwood C, Colbeck M. The impact of essential fatty acid, B vitamins, vitamin C, magnesium and zinc supplementation on stress levels in women: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2017 Feb;15(2):402-453.
31, 47	Sohrabi N, Kashanian M, Ghafoori SS, Malakouti SK. Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: “a pilot trial”. Complementary Therapies in Medicine. 2013 Jun;21(3):141-6.
32	Yehuda S, Rabinovitz S, Mostofsky DI. Mixture of essential fatty acids lowers test anxiety. Nutritional Neuroscience. 2005 Aug;8(4):265-7.
33	Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
34, 55	de Aguiar Pastore Silva J, de Souza Fabre ME, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
35	Trabal J, Leyes P, Forga M, Maurel J. Potential usefulness of an EPA-enriched nutritional supplement on chemotherapy tolerability in cancer patients without overt malnutrition. Nutricion Hospitalaria. 2010 Sep-Oct;25(5):736-40.
36	Silva Jde A, Trindade EB et al. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutrition and Cancer. 2012;64(2):267-73.
38	Lavriv DS, Neves PM, Ravasco P. Should omega-3 fatty acids be used for adjuvant treatment of cancer cachexia? Clinical Nutrition ESPEN. 2018 Jun;25:18-25.
39	Ewaschuk JB, Almasud A, Mazurak VC. Role of n-3 fatty acids in muscle loss and myosteatosis. Applied Physiology, Nutrition, and Metabolism. 2014 Jun;39(6):654-62.
40	Read JA, Beale PJ et al. Nutrition intervention using an eicosapentaenoic acid (EPA)-containing supplement in patients with advanced colorectal cancer. Effects on nutritional and inflammatory status: a phase II trial. Supportive Care in Cancer. 2007 Mar;15(3):301-7.
41, 59	Bonatto SJ, Oliveira HH et al. Fish oil supplementation improves neutrophil function during cancer chemotherapy. Lipids. 2012 Apr;47(4):383-9.
42	de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
43	Pappalardo G, Almeida A, Ravasco P. Eicosapentaenoic acid in cancer improves body composition and modulates metabolism. Nutrition. 2015 Apr;31(4):549-55.
44, 50	Mantovani G, Macciò A et al. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist. 2010;15(2):200-11.
45, 51, 52, 53, 64	Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191.
46	Guu TW, Mischoulon D et al. International Society for Nutritional Psychiatry research practice guidelines for omega-3 fatty acids in the treatment of major depressive disorder. Psychotherapy and Psychosomatics. 2019;88(5):263-273.
48	Haberka M, Mizia-Stec K et al. Effects of n-3 polyunsaturated fatty acids on depressive symptoms, anxiety and emotional state in patients with acute myocardial infarction. Pharmacological Reports. 2013;65(1):59-68.
49	Pereira PTVT, Reis AD et al. Dietary supplements and fatigue in patients with breast cancer: a systematic review. Breast Cancer Research and Treatment. 2018 Oct;171(3):515-526.
54	Ghoreishi Z, Esfahani A et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled trial. BMC Cancer. 2012 Aug 15;12:355.
56	Schloss JM, Colosimo M, Airey C, Masci PP, Linnane AW, Vitetta L. Nutraceuticals and chemotherapy induced peripheral neuropathy (CIPN): a systematic review [published correction appears in Clinical Nutrition. 2015 Feb;34(1):167]. Clinical Nutrition. 2013;32(6):888–893.
57	Giles GE, Mahoney CR et al. Omega-3 fatty acids and stress-induced changes to mood and cognition in healthy individuals. Pharmacology Biochemistry and Behavior. 2015 May;132:10-19.
58	Barbadoro P, Annino I et al. Fish oil supplementation reduces cortisol basal levels and perceived stress: a randomized, placebo-controlled trial in abstinent alcoholics. Molecular Nutrition & Food Research. 2013 Jun;57(6):1110-4.
60	de la Rosa Oliva F, Meneses García A et al. Effects of omega-3 fatty acids supplementation on neoadjuvant chemotherapy-induced toxicity in patients with locally advanced breast cancer: a randomized, controlled, double-blinded clinical trial. Nutricion Hospitalaria. 2019 Aug 26;36(4):769-776.
61	Hutchins-Wiese HL, Picho K et al. High-dose eicosapentaenoic acid and docosahexaenoic acid supplementation reduces bone resorption in postmenopausal breast cancer survivors on aromatase inhibitors: a pilot study. Nutrition and Cancer. 2014;66(1):68-76
62	Xie H, Chang YN. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis. OncoTargets and Therapy. 2016 Dec 9;9:7435-7443.
63	Sorensen LS, Thorlacius-Ussing O et al. Randomized clinical trial of perioperative oXie H, Chang YN. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis. OncoTargets and Therapy. 2016 Dec 9;9:7435-7443.mega-3 fatty acid supplements in elective colorectal cancer surgery. British Journal of Surgery. 2014 Jan;101(2):33-42.
66, 93	Soldati L, Di Renzo L et al. The influence of diet on anti-cancer immune responsiveness. Journal of Translational Medicine. 2018 Mar 20;16(1):75; Adiamah A, Skořepa P, Weimann A, Lobo DN. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and meta-analysis. Annals of Surgery. 2019 Feb 26.
67, 87	Serna-Thomé G, Castro-Eguiluz D et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Revista de Investigacion Clinica. 2018;70(3):136-146.
68, 74, 80, 83, 86	Zárate R, El Jaber-Vazdekis N, Tejera N, Pérez JA, Rodríguez C. Significance of long chain polyunsaturated fatty acids in human health. Clinical and Translational Medicine. 2017 Dec;6(1):25.
69, 72	Fabian CJ, Kimler BF, Hursting SD. Omega-3 fatty acids for breast cancer prevention and survivorship. Breast Cancer Research. 2015 May 4;17:62.
70	Zheng JS, Hu XJ, Zhao YM, Yang J, Li D. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies. BMJ. 2013 Jun 27;346:f3706.
75	Song M, Chan AT. Environmental factors, gut microbiota, and colorectal cancer prevention. Clinical Gastroenterology and Hepatology. 2019 Jan;17(2):275-289; Hall MN, Chavarro JE, Lee IM, Willett WC, Ma J. A 22-year prospective study of fish, n-3 fatty acid intake, and colorectal cancer risk in men. Cancer Epidemiology, Biomarkers & Prevention. 2008 May;17(5):1136-43.
76	Kim S, Sandler DP, Galanko J, Martin C, Sandler RS. Intake of polyunsaturated fatty acids and distal large bowel cancer risk in whites and African Americans. American Journal of Epidemiology. 2010 May 1;171(9):969-79; Satia JA, Littman A, Slatore CG, Galanko JA, White E.Associations of herbal and specialty supplements with lung and colorectal cancer risk in the VITamins and Lifestyle study. Cancer Epidemiology, Biomarkers & Prevention. 2009 May;18(5):1419-28.
77	Kantor ED, Lampe JW, Peters U, Vaughan TL, White E. Long-chain omega-3 polyunsaturated fatty acid intake and risk of colorectal cancer. Nutrition and Cancer. 2014;66(4):716-27.
78	Kim S, Sandler DP, Galanko J, Martin C, Sandler RS. Intake of polyunsaturated fatty acids and distal large bowel cancer risk in whites and African Americans. American Journal of Epidemiology. 2010 May 1;171(9):969-79.
79	Katona BW, Weiss JM. Chemoprevention of colorectal cancer. Gastroenterology. 2020;158(2):368–388.
81	Song M, Chan AT. Environmental factors, gut microbiota, and colorectal cancer prevention. Clinical Gastroenterology and Hepatology. 2019 Jan;17(2):275-289.
82	Hull MA, Sprange K et al. Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial. Lancet. 2018 Dec 15;392(10164):2583-2594.
84	Satia JA, Littman A, Slatore CG, Galanko JA, White E.Associations of herbal and specialty supplements with lung and colorectal cancer risk in the VITamins and Lifestyle study. Cancer Epidemiology, Biomarkers & Prevention. 2009 May;18(5):1419-28.
88	Pappalardo G, Almeida A, Ravasco P. Eicosapentaenoic acid in cancer improves body composition and modulates metabolism. Nutrition. 2015 Apr;31(4):549-55; de Aguiar Pastore Silva J, Emilia de Souza Fabre M, Waitzberg DL. Omega-3 supplements for patients in chemotherapy and/or radiotherapy: a systematic review. Clinical Nutrition. 2015 Jun;34(3):359-66.
89	Sorensen LS, Thorlacius-Ussing O et al. Effects of perioperative supplementation with omega-3 fatty acids on leukotriene B₄ and leukotriene B₅ production by stimulated neutrophils in patients with colorectal cancer: a randomized, placebo-controlled intervention trial. Nutrients. 2014 Sep 29;6(10):4043-57; Silva Jde A, Trindade EB et al. Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients. Nutrition and Cancer. 2012;64(2):267-73; Xie H, Chang YN. Omega-3 polyunsaturated fatty acids in the prevention of postoperative complications in colorectal cancer: a meta-analysis. OncoTargets and Therapy. 2016 Dec 9;9:7435-7443; Golkhalkhali B, Rajandram R et al. Strain-specific probiotic (microbial cell preparation) and omega-3 fatty acid in modulating quality of life and inflammatory markers in colorectal cancer patients: a randomized controlled trial. Asia-Pacific Journal of Clinical Oncology. 2018 Jun;14(3):179-191; Aucoin M, Cooley K et al. Fish-derived omega-3 fatty acids and prostate cancer: a systematic review. Integrative Cancer Therapies. 2017 Mar;16(1):32-62.
90	Mocellin MC, Camargo CQ, Nunes EA, et al. A systematic review and meta-analysis of the n-3 polyunsaturated fatty acids effects on inflammatory markers in colorectal cancer. Clinical Nutrition. 2016;35:359–369.
91	Liang B, Wang S, Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients. World Journal of Gastroenterology. 2008 Apr 21;14(15):2434-9.
94	Polokowski AR, Shakil H, Carmichael CL, Reigada LC. Omega-3 fatty acids and anxiety: a systematic review of the possible mechanisms at play. Nutritional Neuroscience. 2020 Jul;23(7):494-504.
95, 96	Daenen LG, Cirkel GA et al. Increased plasma levels of chemoresistance-inducing fatty acid 16:4(n-3) after consumption of fish and fish oil. JAMA Oncology. 2015 Jun;1(3):350-8.
97	Abrams D. An integrative approach to prostate cancer. The Journal of Alternative and Complementary Medicine. 2018 Sep/Oct;24(9-10):872-880.
98	Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
99	Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
100	Chang R. Beyond the Magic Bullet: The Anti-Cancer Cocktail. New York: Square One Publishers. 2012.
101	Lemole G, Mehta P, McKee D. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.
102	MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. (self-published, Amazon, 2016).
103	McKinney N. Naturopathic Oncology, 3rd Edition. Victoria, BC, Canada: Liaison Press. 2016.
104	Parmar G, Kaczor T. Textbook of Naturopathic Oncology: A Desktop Guide of Integrative Cancer Care. 1st edition. Canada: Medicatrix Holdings Ltd. 2020.