I recently got turned down for a second generation B cell depleting drug. It hasn't been officially approved for WG and the subjects in the one small study developed an allergic reaction to RTX. After recent blood work, I know my B cells are depleted everywhere, except for the glob of fat between my ears. RTX struggles to cross the blood brain barrier, since it is a large molecule. So, I'm developing my own treatment. This ain't my first rodeo.

I completed my first task this morning. Determining whether fish oil should be on my menu. I ate one can of sardines and promptly felt an immune response in my eyes 30min later. Fish oil and I have a complicated relationship. RTX has been known to cause Ulcerative Colitis in some weggies, including me. Fish oil is the only anti-inflammatory that has proven to alleviate my symptoms. Unfortunately, fish oil can activate B cells in my brain, which escape depletion by RTX.

"The current study suggests that dietary DFO increases B cell activation, likely benefiting situations where the host is challenged and a humoral response is required......Enhanced humoral immunity could have beneficial and deleterious implications, depending on the population that is consuming the fish oil. Elucidating the functional and mechanistic effects of fish oil on B cells is critical, given that immunocompromised populations may benefit, whereas others may not." Not true, if being immunocompromised is what we require!My unqualified opinion:

Since I very rarely get sick, as in infections, I don't need or want stray humoral responses, while being on RTX. I can see a place for fish oil, if one has a serious bacterial or viral infection. But if you are merrilly going about your business, then large doses of fish oil shouldn't be necessary. I've always told my doctors I take fish oil, without so much as them saying anything about it, which leads me to believe those supplement lists, we give our providers, are for liability reasons, rather than for clinical effectiveness. Always talk to your doctor, even if they never say a word about your supplement list. As for me, I'm reducing my fish oil intake by 50%, hoping both my colitis and WG stay quiet. Instead of taking high doses of omega-3's, it's always better to lower your omega-6's first. It's the ratio between the two that's most important. I'm predisposed towards a high omega-6mega-3 ratio and I'm sure many weggies are also. This post is especially important for weggies with brain involvement and on RTX. Either way, it's an interesting study.


DHA-enriched fish oil targets B cell lipid microdomains and enhances ex vivo and in vivo B cell function

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597837/#:~:text=DHA%2Denriched%20fish%20oil%20enhances,to ward%20a%20systemic%20Th2%20response.