TEAM TRAINING: OMEGA 3

A community pharmacy environment that fosters teamwork ensures high levels of consumer satisfaction. This series of articles is designed for you to use as a guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.

The below information, considerations and checklist provide support to enable you to run a team training session and identify opportunities for learning within the topic of Omega 3. Omega-3 is one of the most widely studied areas of nutrition, with claims of benefits to multiple aspects of health, from AMD to CVD.

Fish oil’s popularity has soared in recent years, propelled by research that suggests consuming omega-3 fatty acids can ward off heart disease. Community pharmacists play an important role in helping patients make informed decisions about fish oil and omega-3 supplementation. But with hundreds of OTC options available (and labels claiming that the supplements treat everything from bipolar disorder to menstrual cramps) how can pharmacists distinguish between them to help patients make the best choice? Fish oils are a type of polyunsaturated fatty acids (PUFAs). They are the omega-3 and omega-6 fatty acids. Regarding heart health, the active ingredients in fish oils are DHA and EPA. The hypothesis is that omega-3s offer protection from cardiovascular disease by reducing the heart’s susceptibility to arrhythmias, decreasing platelet aggregation and lowering blood pressure and triglyceride levels. Sold by pharmacists since the early years of the 20th century, cod liver oil is one of the oldest and most well-known food supplements. The oil first gained its reputation as an effective preventative against rickets because of its high vitamin D content and it was taken by generations of children, decreasing in popularity only when, in the 1960s, the British government decided to phase it out as a welfare food.

Fish oils are most commonly used in supplements for conditions related to the heart and blood system. They may also be used for many kidney-related problems. There are eleven types of Omega-3 but the three most referred to are:

• ALA (alpha linolenic acid) which contributes to overall health but is deemed to be of lower importance that other types. • EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are both deemed to be of most importance to over health,

Consider:

 Is the pharmacy team fully trained on the indications and benefits of all products for the treatment of acute pain?  How are pain relief products (oral and topical) displayed in the pharmacy?  Do we make the most of the potential for linked sales (e.g. oral and topical analgesics, food supplements, complementary therapies, support bandages)  Am I up to date with the latest guidance?  Am I aware which preparations are recommended first-line? essential for healthy circulation.

ALA can contribute to the production of EPA and DHA in the body but not in amounts enough to be of benefit. There is little doubt that n-3 fatty acids have an important role in nutrition. They are significant structural components of the phospholipid membranes of tissues throughout the body, particularly in the brain and retina. Because of their role in cell membranes, n-3 fatty acids are essential for the formation of new tissue and are therefore important for development and growth (eg, during foetal and infant development). For optimal foetal health, women can be advised to take a DHA dominant Omega-3 oil from the start of their pregnancy. Long chain n-3 fatty acids (and other fatty acids) are present in breast milk and European Union regulations now allow their addition to infant formulas.

Pharmacy team should be aware of, and understand, the following key points: • Those who could benefit from an increased intake of n-3 fatty acids. The typical Irish diet contains relatively low amounts of these.

• Fish oil appears to reduce the risk of CHD. It may help to reduce the risk of thrombosis (by increasing bleeding

Key Points:

 The causes of acute pain, including the various types of injury  What types of pain can be considered for management in the pharmacy  Which customers should be referred to the pharmacist  The use of the PRICE method

 The importance of not taking certain oral analgesics for longer than three days without referral  Questions to ask the customer

 The role of dietary supplements

tendency), reduce blood levels of triacylglycerols, prevent atherosclerosis and arrhythmias and reduce blood pressure • Fish oil may have a role in various mental disorders, such as depression, schizophrenia and Alzheimer’s disease, but research in this area is in its infancy

How much Omega-3 is required?

The ideal intake of Omega-3 likely varies by age, gender and overall health. International guidelines vary and take the form of portion recommendations rather than actual amounts of Omega-3. The Irish Heart Foundation advises eating fish twice a week for a healthy heart. One adult portion of salmon contains approximately 1.24 grams of DHA and 0.59 grams of EPA. Generally, daily intake of Omega-3 should not exceed 3 grams. The Association of UK Dieticians gives the following weekly oily fish portion recommendations for overall health:

• 18 months to 3 years – 1-3 tablespoons • 4 to 4 years – 2-4 tablespoons • 7-11 years – 4-6 tablespoons • 12 years to adult – 140g.

Actions:

Ensure support staff understand the following key points:  The common types of acute pain  The characteristics of a good analgesic for OTC use in the treatment of acute pain  The benefits and limitations of OTC medicines

 The importance of what outcome a patient presenting with pain wants  Lifestyle issues that may impact on pain recovery, and tips on improving lifestyle  What approaches are recommended by the World

Health Organisation (WHO) analgesic ladder  When to refer customers to the pharmacist.