Omega-3 SupremacyDr. Zoltan P. Rona, MD, M.Sc. June 1, 2011
Essential Fatty Acids Benefit the Brain, Heart, and More
Virtually every new patient I have seen in my private practice in the past 10 years has been taking at least one or more nutritional supplement. In my experience, the most popular ones by far are omega-3 fatty acids coming from fish oil, seafood, and other animal life. If it isn’t the tried and true cod liver oil, it’s halibut liver oil, salmon oil, krill oil or seal oil. Aside from the fact that the natural health industry has been promoting omega-3 for decades, numerous conventional doctors (GPs, psychiatrists, cardiologists, and rheumatologists) now also recommend it to many of their patients.
Omega-3 fatty acids are also often referred to as essential fatty acids (EFAs) or polyunsaturated fatty acids (PUFAs). EFAs make up at least 60% of the mass of our brains. These are called essential because our bodies cannot produce them from other nutrients, and must therefore be obtained from either diet or supplements. They are needed as basic elements of our cell membranes, controlling the inflammatory response and hence, pain and the spread of disease. They also mediate the immune response, control hormone production, and regulate nerve transmission.
The ideal ratio of omega-6 to omega-3 fatty acids is 1:1. The standard North American diet, due to the over-consumption of breads, cereals, eggs, poultry, nuts, and vegetable oils such as safflower, corn, soy, and sunflower from processed foods, has a ratio of between 20:1 and 30:1. This relative omega-3 deficiency is believed to be the cause of numerous health problems.
Why are so many people recommending and using omega-3 oils? Conventional doctors will usually only recommend something if there is enough evidence to warrant a prescription. Numerous epidemiological studies and randomized clinical trials have documented the benefits of certain amounts of the omega-3 oils known as EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid) in several major areas:
BRAIN AND COGNITIVE HEALTH
Omega-3 fatty acids are critical to the structure and function of neuronal membranes. The communication between various nerves could not occur in a normal way without omega-3 fatty acids. As a result, just about every brain condition would benefit from optimal levels of DHA and EPA.
Depression is one of many common conditions that could be improved with omega-3 fatty acids, as they influence something called the cytokine system in the brain. These cytokines are known as interleukin-1, -2, and -6, interferon-gamma, and tumour necrosis factor alpha. They can directly and indirectly influence the severity and outcome of depression.
Cognitive health promotion is another area proven to benefit from omega-3 fatty acids. The incidence of ADHD (Attention Deficit Hyperactivity Disorder) is rapidly escalating, with a greater and greater dependency on drugs such as Ritalin (an amphetamine). In fact, at one time in the 1990s, so much Ritalin was being prescribed that the drug companies manufacturing it ran out of stock and could not keep pace with the demand.
The good news is that there are now numerous studies supporting the use of EPA and DHA in the treatment of ADHD. EPA and DHA are crucial to proper retinal and brain development. They improve school performance, learning, focussing on tasks, and behaviour in children.
One study from Australia, published by Sinn and Bryan in 2007, concluded that a 30-week treatment of children with ADHD with fatty acid capsules (providing 560 mg/day of EPA, 175 mg/day of DHA, 60 mg/day of gamma-linolenic acid, and 10 mg/day of vitamin E) plus a multivitamin tablet containing low (RDA) amounts of vitamin and minerals yielded slightly better results than seen in children who used Ritalin. These fish oils work to reduce ADHD symptoms regardless of whether a child is on Ritalin or not.
For those wanting a regulatory seal of approval, Health Canada’s Natural Health Product Directorate (NHPD) requires a minimum of 1.5 – 3.0 g of EPA and DHA per day, including at least 1.0 g of EPA per day (at a ratio of 2:1) to support mood balance. And as we all know, if Health Canada says so, it must be true.
Back in the 1970s, it was reported that despite a relatively high-fat diet, the Inuit people of Greenland had little incidence of heart disease. They had long winters with little sun exposure – a factor thought to increase the risk of psoriasis – yet psoriasis was rare in the Inuit. Their secret was a large consumption of omega-3 fatty acids.
It is now a fairly well-established fact that heart disease, especially coronary artery disease, is the end result of inflammation. Omega-3 fatty acids are anti-inflammatory, so it would stand to reason that EPA and DHA would be of help in both the prevention and treatment of cardiovascular disease. A review paper of 25 clinical trials by Harris showed this to be exactly true. Major cardiovascular events were inversely correlated with tissue levels of EPA and DHA.
EPA and DHA also prevent blood from becoming too sticky and forming arterial blockages. People who have received recommendations to take a baby aspirin a day would do just as well to take adequate amounts of DHA and EPA. I usually recommend about 1000 mg in a 2:1 ratio of EPA:DHA for prevention of heart disease, and significantly more (4000 – 8000 mg) for various inflammatory conditions (e.g. arthritis, multiple sclerosis, colitis, Crohn’s disease, psoriasis, etc.).
Three major trials have documented the efficacy of omega-3 fatty acids in the secondary prevention of coronary artery disease. The DART (Diet and Reinfarction Trial) was a randomized trial on 2,033 men with recent heart attacks. EPA and DHA were administered in the form of either oily fish or fish oil capsules. The results showed that a two-year all-cause mortality was reduced in the study group by 29%, mostly from heart disease. Of particular interest was the fact that the subgroup that consumed only fish oil capsules, as opposed to increasing fish consumption, showed a more remarkable reduction in cardiovascular events.
FISH OIL SUPPLEMENTS A CLEANER SOURCE OF OMEGA-3
In my practice, I test every fish and seafood eater for blood and hair levels of mercury. Invariably, those who eat fish or seafood on a regular basis have elevated mercury levels either in the blood or hair or both. The bigger the fish, the higher the mercury levels. The most polluted fish are tuna, sea bass, swordfish, and Japanese sushi. Smaller fish like salmon, anchovies, mackerel, and tilapia are relatively lower in mercury, but still unacceptably contaminated with PCBs and dioxins.
Those who rarely eat fish or seafood, but use fish oil supplements, never show elevated mercury levels unless they have numerous mercury amalgam dental fillings. This is because most manufacturers remove mercury and other toxic heavy metals from their fish oil supplements.
The second trial was called the GISI study. It randomized 11,323 post-heart attack patients to one capsule per day of omega-3 fatty acids, providing 850 mg EPA/DHA. At the end of year one, patients had a 21% reduction in all-cause mortality and a 30% reduction in cardiovascular mortality. After four months of fish oil supplementation, there was a 45% reduction in sudden cardiac death.
The third trial, known as the JELIS trial, studied 18,645 patients with high blood levels of cholesterol, 70% of whom were women. The patients were randomized to a statin drug (e.g. Lipitor, Crestor) alone or a statin in addition to EPA/DHA of 1,800/day. Five years later, those randomized to EPA/DHA had a 19% reduction in major cardiovascular events.
Researchers now believe that the mechanism by which EPA/DHA works is the enrichment of cell membrane phospholipids. Omega-3 fatty acids also reduce blood pressure, increase vasodilation (enlarge the calibre of arteries), improve arterial and endothelial function, and reduce platelet aggregation. They also raise blood levels of HDL (the “good” cholesterol carrying lipoprotein).
According to Health Canada’s Natural Health Products Directorate (NHPD), fish oil supplementation between 2,800 and 3,000 EPA plus DHA per day at a ratio of 2:1 in conjunction with conventional therapy is considered efficacious for rheumatoid arthritis.
In a study by Kremer et al., the fish oil group (compared to a group that took corn oil capsules) experienced significant decreases in tender joints, duration of morning stiffness, and overall evaluation of global arthritis activity.
In another double-blind study, Cleland et al. compared a fish oil supplement (18 g/day) with an olive oil supplement for 12 weeks and found that the production of leukotrienes (inflammatory molecules) was reduced by 30% in the fish oil group, and unchanged in the olive oil treated group.
The message here is obvious. If you have inflammation, there’s a very good chance that omega-3 fatty acids will help reverse your disease, especially if it’s rheumatoid arthritis.
OTHER MAJOR BENEFITS OF OMEGA-3 OILS
Allergies, asthma, eczema, constipation, and learning disabilities have all been linked to a deficiency of omega-3 fatty acids.
Omega-3 fatty acids preserve the blood levels of vitamin D, now universally acknowledged as one of the most important nutrients for the prevention of cancer, heart disease, inflammation of any kind, diabetes, and all auto-immune diseases. Most scientists now believe that the reason why omega-3 is so important is that it supports the many functions of vitamin D. If you want to read more about vitamin D, but do not want to spend weeks doing so, read my new book, Vitamin D, The Sunshine Vitamin.
HOW TO CHOOSE OMEGA-3 SUPPLEMENTS
Look for purity, potency, and freshness. The brand name you choose should be able to provide you with a detailed biochemical and toxicological analysis of the contents of the bottle, whether in capsule or liquid form.
The potency should be measured in milligrams, with a ratio of 2:1 EPA:DHA. Ignore products with “extra high potency” claims that charge up to four times the price for regular potency brands. This is a gimmick. The total milligrams per bottle should be the deciding factor in your choice. Also, make sure that you check the expiry date and avoid buying any supplements that do not give you enough time to consume the product.
If you are buying capsules, make sure that you purchase ones that are enteric coated. This ensures that the oils reach the small intestine before they are dissolved higher up in the stomach. Capsules that are not enteric coated produce a fishy regurgitation smell. Unless you have no sense of smell, you will find non-enteric coated supplements very unpleasant.
Do not buy any supplements containing omega-3, 6, and 9, no matter how well they are hyped. Buy only omega-3. Nobody, except someone who has suffered from protein calorie malnutrition for months, needs to take omega-6. All of us get enough omega-6 fatty acids from our diet, so supplementation is unwarranted. Too much omega-6 blocks the absorption of omega-3 and creates a relative deficiency. If you have any questions concerning supplementation, consult a natural health care practitioner.
- Rona, Zoltan P. Rheumatoid Arthritis. Vancouver: Alive Books. 2000.
- Rona, Zoltan P. Vitamin D, The Sunshine Vitamin. Tennessee, USA: Alive Books, 2010
- Colter, AL, et al. Fatty acid status and behavioural symptoms of Attention Deficit Hyperactivity Disorder in adolescents: A case-control study. Nutrition Journal, Vol. 7, No. 1, February 14, 2008, p. 8 www.nutritionj.com/content/7/1/8
- Harris WS, Poston WC, Haddock CK. Tissue n-3 and n-6 fatty acids and risk for coronary artery disease events. Atherosclerosis 2007;193:1-10.
- Germano, M, et al. Plasma, red blood cells phospholipids and clinical evaluation after long chain omega-3 supplementation in children with attention deficit hyperactivity disorder (ADHD). Nutritional Neuroscience, Vol. 10, February/April 2007, pp. 1-9.
- Burr ML, Fehily AM, Gilbert JF, et al. Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet And Reinfarction Trial (DART). Lancet 1989;2:757-61.
- Sorgi, PJ, et al. Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder. Nutrition Journal, Vol. 6, 2007, pp. 16-23.
- Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI- Prevenzione trial Fruppo Italiano per lo Studio dell Sopravvivenza nell’Infarto miocardico (errata in Lancet 2001;357:642 and Lancet 2007;369:106). Lancet 1999;354:447-55.
- Sinn, N. and Bryan, J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Development-al & Behavioral Pediatrics, Vol. 28, April 2007, pp. 82-91.
- Schachter, HM, et al. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? Canadian Medical Association Journal, Vol. 165, November 27, 2001, pp. 1475-88.
- Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomized open-label, blinded end-point analysis. Lancet 2007; 369:1090-8.
- Richardson, A.J. and Montgomery, P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics, Vol. 115, May 2005, pp. 1360-66.
- Harris WS. Omega-3 fatty acids and cardiovascular disease a case for omega-3 index as a new risk factor. Pharmcol Res 2007;55:217-23.
- Arnold, L. Eugene. Alternative treatments for adults with ADHD. Annals of the New York Academy of Sciences, Vol. 931, June 2001, pp. 310-41.
- Lavie DJ, Milani RV, Mehra MR, et al. Omega-3 Polyunsaturated Fatty Acids and Cardiovascular Diseases. JACC 2009;54:585-94.
- Burgess, John R., et al. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 327S- 30S.
- Fish Oil Monograph. Retrieved November 1, 2009 from https://www.hc-sc.gc.ca/dhp-mps/prodnatur/applications/licen-prod/monograph/mono_fish_oil_ huile_poisson-eng.php Natural Health Products Directorate, Health Canada.
- Stordy, B. Jacqueline. Dark adaptation, motor skills, docosahexaenoic acid, and dyslexia. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 323S-26S.
- Kremer JM, Lawrence DA, Petrillo GF et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal anti-inflammatory drugs. Clinical and immune correlates. Arthritis Rheum 1995; 38(8):1107-14.
- Cleland LG, French JK, Betts WH et al. Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis. J Rheumatol. 1988;15:1471-5.
- Logan AC. Omega-3 fatty acids and major depression: A primer for the mental health professional. Lipids in Health and Disease 2004
- Bourre JM, Dumont O, Piciotti M et al. Essentiality of omega-3 fatty acids for brain structure and function. World Rev Nutr Diet 1991, 66:103-117.
- Maes M, Smith RS. Fatty acids, cytokines, and major depression. Biol Psychiatry 1988, 43:313-314.
- Suarez EC, Krishnan RR, Lewis JG. The relation of severity of depressive symptoms to monocyte-associated proinflammatory cytokines and chemokines in apparently healthy men. Psychosom Med 2003, 65:362-368.
Dr. Zoltan P. Rona is a graduate of McGill University Medical School (1977) and has a Masters Degree in Biochemistry and Clinical Nutrition from the University of Bridgeport in Connecticut (1984). He is the author of 11 books on natural medicine – three of which are Canadian bestsellers, <a href="https://www.amazon.com/Joy-Health-Zoltan-Rona/dp/0888821301">The Joy of Health (1991)</a>, <a href="https://www.amazon.com/Return-Joy-Health-Alternative-Complaints/dp/0920470629/ref=sr_1_1?keywords=Return+to+the+Joy+of+Health+%281995%29&qid=1581538703&s=books&sr=1-1">Return to the Joy of Health (1995)</a>, and <a href="https://www.amazon.com/Childhood-Illness-Allergy-Connection-Nutritional/dp/076150611X/ref=sr_1_fkmr0_1?keywords=Childhood+Illness+and+The+Allergy+Connection+%281997%29&qid=1581538770&s=books&sr=1-1-fkmr0">Childhood Illness and The Allergy Connection (1997)</a>. He is co-author with Jeanne Marie Martin of <a href="https://www.amazon.com/Complete-Candida-Guidebook-Jeanne-1996-06-15/dp/B01K90OQ8M/ref=sr_1_1?keywords=The+Complete+Candida+Yeast+Guidebook+%281996%29&qid=1581538837&s=books&sr=1-1">The Complete Candida Yeast Guidebook (1996)</a> and is medical editor of the Benjamin Franklin Award-winning <a href="https://www.amazon.ca/Encyclopedia-natural-healing-authoritative-alternative/dp/0920470750">Encyclopedia of Natural Healing (1998)</a>. He has had a private medical practice in Toronto for the past 42 years, has appeared on radio and TV as well as lectured extensively in Canada and the U.S. Visit his <a href="https://highlevelwellness.ca/">website</a> for appointments, call (905) 764-8700; Office: 390 Steeles Ave. W. Unit 19, Thornhill, ON