The Resolvin Threshold

Have you ever heard that Omega-3 fatty acids can help your patients to more effectively modulate inflammation? Have you ever wondered why? The precise answer is multi-faceted and fairly complex, but we can distill the critical role of Omegas and their relationship with the body’s inflammatory response processes down to 3 primary faculties:

  • Omega-6: Omega-3 Ratio
  • Omega-3 Index
  • Production of Resolvin

The Omega-6: Omega-3 Ratio

There’s a reason why humans have a tendency to crave food with high levels of Omega-6; Omega-6 is required to perform many functions in the human body and is relatively difficult to come by in nature. Unfortunately, our technology has evolved while our biology has remained largely the same. We now process, fry, and prepare our foods with hydrogenated oils and other “bad” fats, yielding far more Omega-6 than we could ever need, use, or that we were biologically designed to get.

Theoretically, our Omega-6: Omega-3 ratio should be 1:1; we can sort of “limp along” with a 3: 1 Omega-6: Omega 3 ratio (it’s not optimal, but it’s a more realistic goal to shoot for with most patients). Many practitioners are shocked when they discover that many of their patients have, on average, ratios ranging from 15:1 to 25:1 when their Omega-6: Omega-3 ratio is tested. Considering that Omega-6 is pro-inflammatory, and that Omega-6 competes with Omega-3 for the same delivery enzymes in order for the body to absorb them, the summation of excessive Omega-6 and inadequate Omega-3 can be very problematic. In other words, the more Omega-6 your patients consume relative to their Omega-3 intake, the more likely they are to be suffering from inadequate and unhealthy inflammation modulation.

Omega-3 Index

In a nutshell, the Omega-3 Index is a critical measure indicating the amount of Omega-3 fatty acids in the blood. A healthy Omega-3 index is between 8%–12% and has a very strong correlation with a healthy systemic (acute and chronic) inflammatory response. You can find more information about this in some of our previous posts, but in summary, an Omega-3 Index of less than 8% is bad . . . and an Omega-3 Index of less than 4% can cause critical acute and chronic issues.


That brings us to the star of this post—Resolvin. Discovered by Professor Charles Serhan of Harvard Medical School, Resolvin is a miraculous molecule, and its discovery is a marvel of modern biological science. Resolvin is a molecule that is made by the body on demand at the time of injury. As you can see from the following chart, Resolvin is absolutely essential for the body to “resolve” inflammation and to progress to the body’s healing phase:

In the chart above, you can see an example of two systematic reactions to the same injury. In the first example of Patient 1 on the top, the patient is able to produce adequate amounts of Resolvin. Notice anything? That patient’s injury goes all the way from the initial damage/injury through the acute inflammation stage (which, of course, is healthy, natural, and necessary), all the way through to the replacement of damaged cells with healthy ones, full restoration of function and, in short, new, healthy tissue to replace the old, damaged, injured tissue. This injury is resolved.

Now, consider the second example. Patient 2 was not able to produce adequate Resolvin (we’ll get into the reason why in a second). What was the result? In short, although both injuries were “healed,” the injury suffered by patient 2 wasn’t actually resolved; after the acute inflammation phase completed its due cycle, the injured tissues cycled into the chronic inflammation state (which is almost NEVER healthy, natural, or necessary). From here, instead of producing new, healthy tissues, the body detects the abnormality, senses as a threat to the rest of the system, and encases the dysfunction/injury in a fibrotic (scar tissue) state. As this tissue doesn’t naturally turn over (healthy cells die and are replaced), these injuries can become more or less permanent unless they are disrupted (such as through deep tissue therapy, massage therapy, or other methods to break these scar tissues down).

As I said before, Resolvin is produced only at the moment that it is needed—at the same moment that the body detects an injury and is spooling itself up with signaling enzymes to trigger the acute inflammatory cascade. If you would, please consider the difference between Patient 1 and Patient 2: Patient 1 was able to make the full and complete process from injury to resolution thanks to the production of Resolvin. As a result, Patient 1’s musculoskeletal injuries are restored to pre-injury status.  But why was Patient 1 able to produce adequate Resolvin while Patient 2 was not? Great question!  Professor Serhan’s research concluded that the body’s Omega-3 Index has a direct relationship with the body’s ability to produce adequate amounts of Resolvin—let’s call it the “Resolvin Threshold.” If your patient’s blood yields an Omega-3 Index of less than 8% (minimum—even 7.9% or less is apparently too low), Resolvin is not produced because the Resolvin Threshold has not been met.

Let’s think about this “Resolvin Threshold” in practical terms relative to your patients, their supplement regimen, and their recovery from injury. Every single patient is going to have different nutritional needs—they are all going to require different amounts of Omega-3 in order to meet their threshold. But remember . . . getting close to the Threshold then missing the mark doesn’t get you anything with Resolvin. Even if your patient is at 7.9% on their Index, the research is clear: They cannot produce adequate Resolvin to restore the injured tissue to the pre-injury status. That means if your patient requires 4 softgels daily in order to reach their Threshold, but you’ve only been recommending 3, then in terms of Resolvin, they might as well be taking nothing. That’s right—the old mindset of “well, at least it’s doing some good; even though I’m not taking as much as I should, it’s better than nothing” holds absolutely no water here. Resolvin is a zero-sum game. If you prescribe low, you might as well not prescribe at all.

If even missing the mark by a small amount means no Resolvin, then how do you know how much Omega-3 each of your patients needs to consume daily? That is where there is some really good news: Tests are now available for at-home use, wherein patients can very easily and economically check for themselves exactly where their levels fall in terms of both the Omega-6: Omega-3 ratio and the Omega-3 Index. And more good news: Once you and your patients are armed with the information about their status, and you have worked up an adequate protocol to address any Omega-3 deficiencies, the focus can shift to maximizing the patient’s “Resolvin Potential,” which is, in effect, the body’s “bank account” of accumulated Omega-3. If this Threshold is met and maintained, the body will have it when it needs it, and can then produce adequate Resolvin at the time of injury to facilitate a full recovery to the pre-injury state.

In summary:

  • Resolvin is a remarkable, arguably miraculous molecule that can help your patients to recover completely from musculoskeletal injury, returning to the pre-injury status.
  • A subject is only able to produce Resolvin when the body’s Omega-3 Index is at adequate levels (min. 8%).
  • In order to be sure that a subject’s Omega-3 Index has met this threshold, a blood test must be performed.
  • Once the subject’s unique needs are determined, a unique protocol must be tailored for the subject to address the Omega-3 deficiency.

I can’t underscore enough that this threshold is a journey, not a destination—the patient’s threshold amount must be taken every day in order to maintain the “bank account” of Resolvin potential. Once the threshold has been reached, it must be maintained. The most effective way to combat chronic inflammation is to get in front of it—make sure each of your patients is taking adequate levels of high-quality Omega-3 (please see our previous posts for some good options) so that they have what they need to recover from injuries when the time comes.

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