The Low Omega 6 Diet for AERD 

(Samter's Triad)

Diet & Lifestyle

Diet Overview

AERD & Alcohol

Low Omega 6 Diet

Dietary Salicylates

The Brigham & Women's AERD Center has developed a diet specifically for the treatment of AERD symptoms and published their research on this diet in 2018. According to the AERD Center's 2017 newsletter, patients following a diet low in omega 6 fatty acids and high in omega 3 fatty acids saw some dramatic improvement in their symptoms. Other experts on the disease such as Dr. Andrew White of Scripps clinic have said that all patients should be offered this diet as a treatment option. 

How to Follow the Diet

This is a diet low in omega 6 fatty acids and high in omega 3 fatty acids. The goal of this diet is to reduce omega 6 intake to no more than 4 grams per day and no more than 2 grams per meal. At the same time, you want to increase your omega 3 intake to about 3 grams per day. Researchers believe that reducing intake of omega 6 is more important than boosting omega 3, but it's recommended that you do both. 

Does it Work?

This diet was studied at the Brigham & Women's AERD Center. Omega-6 fatty acids in the diet produce some of the substances that cause symptoms of AERD (leukotrienes and prostaglandins), so researchers theorized that decreasing their intake might benefit patients. The results of the study were recently published. The diet was studied in 10 AERD patients for 2 weeks. Leukotriene and prostaglandin levels were decreased in patients following the diet and sinus symptoms were significantly reduced. 

 

There is other research to suggest that dietary fatty acid modification may help. A 1989 study found that a low fat diet high in omega 3 fatty acids could reduce the production of certain leukotrienes that play a role in AERD (Samter's Triad). There have also been case reports that supplementation with omega 3 fatty acids has alleviated symptoms in patients with aspirin and NSAID intolerance. These studies focused on the benefits of adding omega 3, but the experts at The Brigham & Women's AERD Center believe that reducing omega 6 is even more important. 

About Omega Fatty Acids

The modern diet contains an excess of omega 6 fatty acids and a lack of omega 3 fatty acids. Importantly, our bodies cannot produce these essential fatty acids - they can only be obtained in the diet. Essential fatty acids play vital roles in a variety of bodily processes, including blood clotting and regulating inflammation. Omega 6 fatty acids are pro-inflammatory, while omega 3 fatty acids have anti-inflammatory effects. 

There are two critical omega 3 fatty acids -  eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA are found in cold water fish such as salmon, sardines, herring, mackerel, black cod, and bluefish. They can also be obtained from krill or marine algae. Plants such as flax, chia, and walnuts do not contain EPA and DHA. They contain a precursor called alpha-linolenic acid (ALA). ALA has not been shown to have the same anti-inflammatory effects as DHA and EPA. Some ALA is converted to EPA and DHA in the body, but research has shown that this conversion rate is low. Therefore, it is recommended to include sources of DHA & EPA when following this diet. 

A typical modern diet contains an omega6/omega 3 ratio of about 20:1. The goal of this diet is to balance that ratio by decreasing omega 6 intake and increasing omega 3 intake. It is important that you reduce omega 6 in the diet, as opposed to just supplementing with omega 3. These fatty acids have opposing effects and compete with one another in the body. 

Things to Consider

Omega 3 fatty acids have been shown to have beneficial health effects. This diet is considered safe for most people to follow, but you should always discuss diets and supplements with your doctors. Omega 3 supplements may increase bleeding risk.  The FDA recommends not exceeding 3 g/day EPA and DHA combined, with up to 2 g/day from dietary supplements. Patients taking high dose aspirin or other blood thinning medications should use omega 3 supplements with caution. If you take omega 3 supplements, they should always be stopped before surgery.

If you're a vegetarian, it may be difficult to meet the omega 3 goal. The most abundant sources of omega 3 fatty acids are fish products, but there are vegetarian sources of omega 3 such as flaxseed and chia. As discussed above, however, these plant sources contain ALA rather than DHA & EPA. Vegetarians can also take an algae based omega 3 supplement, which does contain DHA & EPA.

At least until you get the hang of the diet, it may be tricky to figure out your omega intake. The "Track Nutrition" button below links to a site where you can track nutrition data for free. The SELF Nutrition Data Website is recommended by Brigham and Women's, but the Cronometer web site may also be helpful. Explore the other links below to read Brigham & Women's guidelines for the diet, as well as a sample menu. 

 

Tips

This diet seems complicated at first glance, but it is not difficult to meet the guidelines once you know the basics. Eliminating the vegetable oils and processed foods from your diet will go a long way toward meeting the goals. View the guidelines below to get started.

Reduce Omega 6

  • Change your cooking oil. Most vegetable oils contain large amounts of omega 6 and little omega 3. Olive oil is preferable to other vegetable oils, but still must be used in moderation. Grass-fed butter is preferable to vegetable oils.

  • Limit processed foods. This is one of the easiest ways to cut omega 6. Most processed food manufacturers use vegetable oils to mass produce products. 

  • Read food labels. Look at total fat content, as well as the source of the fat in products. Avoid high fat products and those that have added vegetable oils.

  • Avoid dressings, margarine, mayonnaise and spreads. Look for fat-free versions or make your own.

  • Opt for fat-free or low-fat foods. If given a choice, choose the lower fat version. 

  • Avoid deep fried foods. Deep fried foods are a primary source of omega 6 in the modern diet. 

Increase Omega 3

  • It's not just fish. Eating fatty fish, like salmon, is a great way to add omega 3 to your diet, but be sure to incorporate other sources, such as flaxseed and chia.

  • Seek out EPA and DHA fortified foods.  There are products available that have been enriched with EPA and DHA fatty acids. Make sure that the products you choose are also low in omega 6. 

  • Buy grass-fed (pastured) animal products. As opposed to products from animals that are fed corn and soy, products from pastured animals have higher amounts of EPA and DHA. 

  • EPA & DHA supplements. You should try to meet your omega 3 requirements through your diet, but a supplement can help fill the gaps. The most popular are omega-3 fatty acids derived from fish oil, but there are also plant-based DHA and EPA supplements extracted from algae.

What Can I Eat?

The goal of this diet is to balance your omega fatty acid ratio by increasing omega 3 and decreasing omega 6. The below charts contain some guidelines that may be helpful, but there's no single way to follow this diet. You need to become aware of your omega 6 intake and reduce it drastically, while simultaneously increasing omega 3. You can eat fatty fish and fresh or frozen veggies in unlimited quantities, but you should also incorporate rice, beans, lentils, and fat free dairy products. Meat, eggs, and dairy products from grass-fed (pastured) animals can be eaten in moderate quantities, but you should avoid products from animals that ate corn or soy. 

Things to Eat

Fatty fish (salmon, tuna, sardines, mackerel, anchovies, etc.)

All fresh and frozen fruits and vegetables (except avocado)

White rice, coucous, barley

Beans and lentils (except chick peas, soybeans)

Grass-fed animal products 

All fat free foods are neutral (skim milk, etc)

Things to Avoid

Vegetable oils and margarine (and dips, dressings, and sauces made with these)

Corn products, quinoa

Soy products, chick peas

Animal products from animals that ate corn and soy

Avocado

Nuts and seeds (except flax, chia)

Deep fried foods

Processed foods with added vegetable oils

Pastries, donuts, high fat deserts

 

What About Grass-Fed Animal Products?

The above chart was one of the study materials from the Brigham & Women's study on this diet. You can see that meat, full fat dairy, and eggs (containing the yolk) are in the "avoid" category. 
Dr. Laidlaw has since clarified (in her webinar) that grass-fed animal products can be incorporated into this diet in moderation. You want to avoid meat, dairy, and eggs from animals that were fed corn or soy. Grass-fed animal products have a better omega 6 to omega 3 ratio and can be eaten in moderation.

Dr. Laidlaw Discusses the Low Omega 6 Diet at 40:38

Diagram provided by Brigham & Women's AERD Center

This diagram demonstrates how omega 6 fatty acids contribute to the inflammatory pathways involved in AERD.

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