Omega-3 Awareness Day

It’s a great time to learn about the benefits of these essential fatty acids, which improve everything from brain health and immune function to depression and arthritis.

By Naila Francis

It had been years since Mario Di Egidio had been to a doctor.

When the Bensalem resident finally scheduled a routine checkup, he was in for a shock.

“I found out I had type 2 diabetes and my cholesterol was through the roof,” he says.

With his cholesterol levels at almost 300, Di Egidio was a likely candidate for a cholesterol-lowering drug.

But, based on a recommendation made to his wife Carolyn, he began taking a fish oil supplement instead.

After three months, at his first diabetes checkup, his cholesterol level was down to 139.

“I was shocked that it could go from being extremely high, dangerously high, to perfectly normal in three months,” says Di Egidio.

That was two and a half years ago.

Today, his cholesterol level is at 128, and while Di Egidio acknowledges that he has modified his lifestyle to include a healthier diet and more exercise and is still being treated for his diabetes, he credits the fish oil supplements for his low cholesterol levels and therefore improved heart health.

“I certainly would never stop using it,” he says. “To me, it’s something you can do to definitely improve your overall health. Sure, you can exercise and you can restrict your diet, but taking this definitely is going to help even people who don’t do that. It’s a no-brainer.”

Dr. Carol Locke agrees, which is why the Harvard-trained psychiatrist and omega-3 expert has targeted today as the first International Omega-3 Awareness Day.

The inaugural nonprofit campaign is being spearheaded in conjunction with medical professionals and scientists across the country, including William S. Harris, co-founder of the Omega-3 Index, a test created to measure the amount of omega-3 fatty acids in a person’s bloodstream, and pediatric neurosurgeon Dr. William E. Butler, who also is an assistant professor of neurosurgery at Harvard Medical School.

“It’s getting people, both the public and the medical profession, aware that this isn’t just any old vitamin. This is something we all need to get into our diet in any way we can because of the profound health benefits,” says Locke, who also is the founder of the Center for Creating Health in Southern California and the creator of OmegaBrite, the first high-purity, high-concentrate omega-3 supplement, which she developed while on the faculty of Harvard Medical School in 1998.

With all the published reports and studies touting the benefits of omega-3 in the last few years, not to mention the proliferation of supplements from recognized and emerging brands, it would seem that the public and the medical community have been sufficiently educated on its healing and preventive properties. Statistics in fact indicate that more people in the United States took omega-3 last year than they did traditional vitamins, elevating it to the No. 1 supplement in the country.

But according to a joint study by the Centers for Disease Control and Prevention and the Association of Schools of Public Health, between 72,000 and 96,000 preventable deaths occur each year due to omega-3 deficiency. The study, released last June and based on 2005 data, listed low consumption of omega-3 as the sixth-leading cause of preventable death linked to diet, lifestyle and metabolic factors (high LDL cholesterol, high blood glucose, obesity and physical inactivity, high blood pressure and smoking were the top five).

“This is a disease and we have to treat it,” says Dr. Michael Gross, vice president and chief medical officer for Physician Recommended Nutriceuticals, a Plymouth Meeting-based company specializing in clinical nutrition, particularly the creation and marketing of omega-3 products supported by medical and scientific research. “Since we’re so disease-focused, we had to come up with a name for it, and that’s omeganemia: the lack of omega-3 from marine sources.”

The Doylestown resident is a former practicing ob/gyn who for several years served as director of both wellness and new business development for the Health and Wellness Center by Doylestown Hospital. When he began getting more interested in the nutritional aspects of wellness, his research led him to the many documented benefits of omega-3s, which he saw as a valuable clinical tool that doctors could begin using in treating their patients. He has since trademarked the term omeganemia, has been lecturing extensively on it and will be writing a book on the condition.

“Everybody talks about omega-3 fish oil for its cardiovascular benefits, for lowering cholesterol. What many doctors don’t realize is that there’s also a large body of evidence supporting its use for arthritis, autoimmune diseases, menstrual conditions, rheumatoid diseases …. Doctors need to recommend this and use it as a food-based medicine alongside other things,” says Gross.

For International Omega-3 Awareness Day, Locke will be part of an event at the University of California, Irvine, featuring speakers, music performances and tables set up by the American Heart Association and other groups.

“What we wanted to do was just put this on the map and hopefully it will grow in a grass-roots way,” says Locke. “Because (omega-3) is a nutrient and not a big pharma product, you don’t have the education or that push behind it, but our goal is to make sure that people and physicians start to build it into their lives.”

With the campaign geared toward promoting the facts and science behind the benefits of omega-3, here is a primer on this healthy fatty acid.

WHAT IS OMEGA-3?

Omega-3 is considered an essential fatty acid (EFA) because it’s needed for the body’s overall health, but can only be obtained through diet since the body doesn’t produce it.

There are two basic types of omega-3. ALA (alpha-linolenic acid) is found in flax, soybean and pumpkin seeds, along with their oils, as well as in walnuts and walnut oil, canola oil and some fruits and vegetables. EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) can only be found in fish, algae and certain seaweeds and crustaceans.

EPA is a natural anti-inflammatory and therefore helpful in preventing or alleviating inflammatory conditions such as cardiovascular disease, rheumatoid arthritis, asthma, Chrohn’s disease and irritable bowel syndrome (IBS). It also promotes mood elevation and combats the inflammatory properties of omega-6, another essential fatty acid that while necessary for good health, exists in excessive amounts in the American diet since it is found in many grains, hormone-injected meats, processed foods and most vegetable oils.

While some inflammation in the body is necessary to help it repair itself, too much can lead to chronic degenerative disease.

“The normal diet should approach a 1-to-1 balance of omega-6 to omega-3,” says Gross. “When we get to a 4-to-1 ratio, that’s good, but the average American has an imbalance of 25-to-1 omega-6 to omega-3, which is why we have so much chronic inflammatory disease and why Americans are so sick.”

While EPA helps to counter the inflammatory properties of omega-6, DHA is essential for neurological and visual development in the fetus and in newborns, but also helps to sustain brain and eye health over time.

But even these benefits are just a small sampling of the many conditions omega-3 has been proven to help.

“It has been shown to delay or prevent death from most of the known conditions that we treat every day,” says Dr. William Kracht, a family physician with the Woodlands Healing Research Center in Quakertown. “People who are on fish oil basically live longer than those who aren’t.”

According to Locke, such improved longevity speaks to omega-3s’ benefits throughout the entire life cycle of an individual. Infants who do not receive sufficient omega-3 from their mothers during pregnancy are at risk for developing vision and nerve problems, while omega-3s help protect against Alzheimer’s and other conditions involving memory and cognitive performance as we age.

“In children, DHA and EPA are associated with mood, with focus, with increased reading and math scores. We’re looking to have these young people develop brains and bodies that are healthy and that are going to continue to be healthy,” she says. “That’s what’s so exciting and important about this. You’re talking about something people can add right now to start getting that protection right away.”

TO SUPPLEMENT OR NOT TO SUPPLEMENT

But while advocacy of supplements as a primary source of omega-3s has been steadily growing, they’re not necessarily the first option recommended to boost dietary intake.

Kracht, a former family physician with the Air Force who has been with the Quakertown integrative medicine practice since 1995, has long been encouraging his patients, even in the Air Force, to add low-mercury cold-water fish to their diets. He suggests this as a first resort, advising that they eat at least two or more servings of anchovies, wild or Alaskan salmon, sardines, tuna, scallops, shrimp or cod a week.

“Those fish that are smaller on the food chain and have far less contamination tend to be the ones that have the most omega-3s,” he says, while the bigger fish that live closer to the shore tend to be more contaminated.

There’s some disagreement over whether farm-raised fish have as much omega-3 as their wild counterparts. Farmed salmon are usually fed fish meal, which is made from ground-up smaller fish, and as a result they can have as much omega-3 as wild salmon. But farmed fish that are fed vegetable oil or grain — as tilapia and catfish often are — may have much more omega-6 than omega-3.

And farmed fish, like some wild fish, may also be contaminated with PCBs and other toxins. Even doctors who prefer a diet-based approach to boosting omega-3 levels acknowledge that it’s difficult to find any oily fish that doesn’t have some level of contamination. And the safest fish to eat — sardines, herring and anchovies — are the ones least favored by Americans.

“I’ve had people try to (get more omega-3) with diet alone who have literally ended up with mercury toxicity,” says Dr. Wendy Warner, a board-certified ob/gyn with Medicine in Balance in Langhorne. “If you’re eating just regular lower-quality, grocery-store fish that was farmed and not caught at sea, you’re going to end up getting contamination.”

You could try to get your omega-3 from plant sources instead, as many vegetarians do. But ALA, while beneficial in many ways, doesn’t seem to have as many powerful health benefits as EPA and DHA. The body is able to convert some ALA to EPA and DHA, but “we don’t do a good job of converting it,” says Warner, who also is board-certified in holistic medicine.

And so rather than recommend fish oil supplements to help only with certain conditions, many physicians have incorporated them as part of routine preventive care.

“Pretty much every single person I see ends up needing fish oil,” says Warner. “It’s kind of like vitamin D. It pretty much helps everything and you can’t really get enough of it in your diet.”

CAN IT REPLACE OTHER MEDS?

Fish oil is not intended as a substitute for traditional medicine, though many individuals with high cholesterol have been able to avoid or get off cholesterol-lowering drugs by taking a fish oil supplement (fish oil lowers the level of triglycerides in the body, a fat that at elevated levels increases one’s risk of heart disease). But even this is in tandem with a lifestyle that includes diet modifications and exercise.

Still, there are studies that have proven its effectiveness in cutting back the number of drugs a patient may be taking.

“I see that in certain inflammatory conditions where we’re able to decrease the amount of pain medication someone is taking, particularly for arthritis and spinal pain,” says Kracht.

Dr. Joseph Maroon, professor of neurosurgery at the University of Pittsburgh School of Medicine and author of the book “Fish Oil: The Natural Anti-Inflammatory,” has conducted significant research on the subject. A longtime athlete who has completed more than 60 triathlons, including three Hawaiian Ironman races, he began looking for a natural anti-inflammatory when he developed an ulcer from taking Advil to manage his overuse injuries.

“I found that (fish oil) really helped my joints and also my hands,” says Maroon, who also serves as medical adviser to Nordic Naturals, a leading supplier of fish oils. “I do a lot of bone and spine work and I found that my joints were aching as well from that. I was impressed with (fish oil’s) ability to alleviate the pain of arthritis.”

In 2004, he conducted a study with 250 patients, all of whom were on standard non-steroidal anti-inflammatories such as Advil, Celebrex, Vioxx and Naproxen, for treatment of neck and low back pain as a result of degenerative disc conditions and arthritis. He put them on 21/2 to 3 grams a day of omega-3 fish oil.

“Sixty percent were able to get off their drugs and take the fish oil as a natural anti-inflammatory,” he says. “I’d much rather have them take extra fish oil than ibuprofen, which kills about 15,000 people a year from gastric ulcers.”

In a subsequent study of professional athletes, in which the cause of sudden death after age 30 is usually due to a heart attack from acute blockage of the coronary arteries, fish oil supplements also proved powerfully effective. Maroon, who also is the team neurosurgeon for the Pittsburgh Steelers, took 36 football players between the ages of 23 and 41 and put half on a fish oil supplement and the other half on a placebo.

“It statistically significantly improved their cardiovascular risk factors, lowered their triglycerides and improved a dangerous part of their cholesterol fraction (raising their high-density lipoproteins, a form of good cholesterol, and lowering their low-density lipoproteins, a form of bad cholesterol),” says Maroon.

ARE YOU DEFICIENT?

With thousands of scientific articles and studies documenting such beneficial effects on health, it would almost seem like folly not to take an omega-3 supplement or at least begin incorporating more of these essential fatty acids into one’s diet.

Gross offers the following consideration: In Japanese and Mediterranean cultures, where fish consumption is high, conditions such as cardiovascular disease, Alzheimer’s, dementia and macular degeneration are almost non-existent.

“The average American lives to be 78 years old, but the average American has at least one or more chronic diseases by age 68, so you have 10 years of horror because of these chronic, debilitating diseases that precede our death,” says Gross. “In Japan, the life span is 88 years old, 92 or 97 in some places, and when they die, they don’t die of chronic illness. Their life span is almost equal to their health span.”

While an omega-3 deficiency has been linked to depression, anxiety and other mood disorders, as well as Alzheimer’s disease, ADHD and ADD, recognizing a deficiency isn’t easy, given that other risk factors also are at play in such instances. The Omega-3 Index test can provide an accurate measure of a deficiency, but the simple finger-prick test is expensive (averaging about $149.95) and isn’t covered by insurance.

So why not take a simple, proactive approach?

“They say genetics pulls the gun but lifestyle pulls the trigger. Your gun may be loaded with certain things, but the trigger will not get pulled unless certain environmental influences come into play. And what’s a bigger environmental influence than diet?” says Gross.

“If you do one thing,” says Locke, “it would be to get omega-3 into your diet. You’re protecting your brain, your eyes, your heart …. That’s pretty profound that we have something this powerful, with no side effects, that we can add in right now that our body needs and wants.”

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Breakout: Food sources of omega-3

If you want to get omega-3 through diet alone, your best bet is to eat fish regularly. Seafood is the primary food source of EPA and DHA, the fatty acids with the most widely documented health benefits.

The American Heart Association recommends eating two 3.5-ounce servings of fish a week, particularly fatty fish, which have the highest levels of EPA and DHA.

Here are the estimated omega-3 amounts for some common varieties of fish and shellfish:

MARINE SOURCES OF OMEGA-3 (EPA + DHA)

(in mg per 3-ounce serving)

2,270 mackerel

2,251 shad

2,130 Atlantic salmon, farmed

1,991 chinook (king) salmon, wild

1,414 canned red salmon

1,017 canned pink salmon

1,108 sockeye salmon, wild

834 canned sardines in oil

808 canned white tuna in water

708 bluefish

425 flounder

385 canned white tuna in oil

239 canned light tuna in water

215 swordfish

207 yellowfin tuna

183 scallops

172 canned light tuna in oil

166 cod

Some plant foods contain a different kind of omega-3, called ALA, which has been shown to have health benefits of its own — though not as much as EPA and DHA, according to most studies. The body can also convert a small portion of ALA to EPA and DHA.

Adequate intake levels developed by the Food and Nutrition Board of the National Academy of Sciences recommend 1.6 grams of ALA daily for men and 1.1 grams for women.

Here are some good sources of ALA:

PLANT SOURCES OF OMEGA-3 (ALA)

(in mg per serving)

2,542 walnuts, 1 ounce (about 14 halves)

2,338 flaxseed, whole, 1 tablespoon

1,279 canola oil, 1 tablespoon

489 firm tofu, 3 ounces

352 spinach (frozen), cooked, 1/2 cup

135 brussels sprouts, 1/2 cup

87 blueberries, 1/2 cup

81 kale, cooked, 1/2 cup

42 dried oregano, 1 teaspoon

Source: Nutritiondata.com

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Breakout: Guidelines for selecting a high-quality product

It goes without saying that a good omega-3 supplement should be purchased from a reputable supplier.

Here are a few guidelines to help you choose a high-quality product.

WHAT SHOULD I LOOK FOR ON A SUPPLEMENT LABEL?

• A specific breakdown of the content of EPA and DHA rather than a generic notation such as “1000 mgs of omega-3s” (for the average individual, without any pre-existing conditions or a family history of high cholesterol, that would be 500 to 600 mg of EPA and 300 to 400 mg of DHA a day, says Dr. Wendy Warner of Medicine in Balance, though the American Journal of Cardiology has published articles indicating that 1 to 3 grams daily of EPA and DHA combined is a safe cardioprotective dose for all Americans)
• The fish from which the oil has been extracted (preferably sustainable, small mid-ocean fish like sardines, herring or anchovies)
• Indication that the fish oil is in a natural triglyceride form rather than in ethyl ester form

WHERE DOES MY OMEGA-3 SUPPLEMENT STAND?

• Visit www.consumerlab.com, an independent company that tests the quality of hundreds of health and nutritional products. There is a nominal fee to join, but according to Dr. William Kracht, of Woodlands Healing Research Center, the vast amount of information provided is well worth the fee.

TAKE THE BITE TEST

Still wondering if you’ve gotten the best product possible? Experts agree there’s a full-proof method to make sure your supplement conforms to the purest standards. Bite into it!

“If you can’t taste the fish oil and you get a chemical taste that’s so bad or burns really badly, then you know you’re getting a crappy oil,” says Dr. Michael Gross, vice president and chief medical officer of Physician Recommended Nutriceuticals.

Other sure signs of an inferior fish oil include burping up a fishy aftertaste, experiencing gas, bloating or other kinds of stomach upset.

Beware of bottles, however, that promise “no fish burps,” as some fish oils are coated in thick, enteric capsules designed to combat stomach irritation but which actually keep the body from absorbing the necessary nutrients, says Gross. Fish oils with high amounts of vitamin E should also be suspect, he notes, as that is usually added to prevent further degradation of the inferior oil inside.

WHAT IF I’M A VEGETARIAN?

There are fish oil supplements made from genetically modified algae that contain DHA but no EPA, but no longterm data on the safety of such supplements is available. It also is unusual for DHA to be offered without EPA since the two naturally occur together in nature, so a better source would be certain seaweeds that contain both.

However, because vegetarians are consuming less omega-6 in their diets, they are likely to have a healthier omega-6-omega-3 ratio to begin with.

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Breakout: Not all fish oil is created equal 

Sure, it would be easy to pick up a bottle of fish oil capsules from just about any store, but just because a supplement is packaged as a fish oil does not necessarily mean that consumers are getting the benefits of omega-3.

For one thing, the oils that exist in fish, particularly the essential fatty acids EPA and DHA, are in triglyceride form. Those oils, typically pressed from the body of fish including cod, tuna, mackerel and salmon, are molecularly distilled to remove impurities and contaminants such as mercury, lead and industrial compounds like PCBs.

But according to Michael Gross, vice president and chief medical officer for Physician Recommended Nutriceuticals, the alcohol used to clean the fish oil — which is basically what molecular distillation is — converts it from triglyceride form to a chemical form known as an ethyl ester.

The body cannot absorb that form and tries to convert the oils back to triglyceride form upon ingestion, usually causing stomach upset.

“There are no ethyl ester fish in the ocean; there is no way for human physiology to absorb a nutrient in chemical form. Ethyl ester fish oil is not natural and it’s not something that the body handles well,” he says.

“Almost all the concentrated fish oils in America are sold in the ethyl ester form and since there’s no regulation on this (by the Food and Drug Administration) and it came from a fish, they call it fish oil.

“What really needs to be done is that the molecular structure needs to be changed back to a triglyceride so that the body can absorb it more readily. The oil needs to be converted back to its natural form.”

The lack of FDA regulation means that manufacturers don’t have to note whether customers are getting their fish oil in triglyceride form or ethyl ester form. Some may even be getting more filler in their supplements than their required daily dose of EPA and DHA, but this, too, is not readily apparent to the average individual who doesn’t know any better.

According to Dr. Joseph Maroon, professor of neurosurgery at the University of Pittsburgh School of Medicine, the type of fish used, the method of extracting the oil and how the oil is processed all play a role in ensuring a high-quality supplement.

The burping and gastrointestinal upset that some experience, he says, is often caused by rancid fish oil, a result of the oil being exposed to oxygen during the manufacturing process. But oil stored under a nitrogen blanket — the buffer gas used to protect products in a storage container — will retain its freshness and stability.

“One of the most difficult things about fish oil is it rapidly becomes rancid when it hits the air,” says Maroon. “Oxygen causes it to deteriorate quickly, and if you get the cheapest quality on the market, you’re getting the kinds of fish oil that haven’t been prepared in the most efficient and best way.”

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Breakout: Omega-3s offer a helping hand

Here is a partial list of functions in the body that omega-3 has been shown to support:

• Improved heart and circulatory health
• Improved immune function
• Enhanced learning and memory
• Enhanced joint flexibility and movement
• Protection for the brain, eyes and nervous system
• Balanced blood sugar levels
• Optimal metabolism
• Positive mood and well-being
• Positive support for the body’s natural anti-inflammatory response
• Healthier hair and skin

– The Intelligencer and Bucks County Courier Times 

3/3/10