Gretchen Vannice

Kudos to Kromhout and his group in the Netherlands for completing a 3-plus year dietary trial with nearly 5,000 subjects (NEJM, 2010). While the press and bloggers are having a field day with the results, pushing toward the negative, I’m not certain that we should be so surprised by the findings.

It’s been shown, in an analysis of 97 randomized, controlled trials, that EPA and DHA omega-3 are as-good-or-better than statin drugs at reducing risk of death by heart attack (Studer et al, Arch Int Med, 2005).

It’s also been shown, in analysis of thousands of people, that consuming at least 250 mg of EPA and DHA per day can reduce the risk of fatal cardiac death by 37% (Mozaffarian, Am J Clin Nut, 2008).

In the United States, the American Heart Association (AHA), the American Dietetic Association and the American Psychiatric Association recommend that people eat fish twice a week. AHA recommends at least 1000 mg of EPA and DHA per day for those with cardiovascular disease (that is all the subjects in this study). Many countries recommend a minimum intake of 500 mg EPA and DHA for their citizens.

So, when a group of older adults (nearly 80% men) - who have had a heart attack and are on a myriad of prescription drugs (more than 85% of them on statin meds) - are given a modest amount of EPA and DHA omega-3 (376 mg/day), what do we expect? What should we expect?

Nearly 1 in 6 of the subjects smoked, 1 in 5 had diabetes, and 1 in 4 was obese; a good cross sample of the population. And even though 9 of 10 of them were on blood pressure medications, their systolic blood pressure was still elevated (141 mm Hg avg.).

We are talking about nutrients – vitamins – chemicals that are required for the human body to function. When did that catapult them into being miracle workers? Are we expecting nutrients to reverse the effect of prior damage? Do we expect that of drugs? What’s the thinking here?

Sure, consuming a modest amount of EPA and DHA omega-3 didn’t prevent more heart attacks than those who didn’t eat the special study margarine. Nearly all the subjects ate fish at least once a week anyway.

This appears to be a case of unrealistic expectations. And maybe too little, too late.

Note: In future studies, it would be useful to look at a higher dose of EPA and DHA omega-3, consider a true placebo group, and/or investigate individuals who are less heavily medicated. Studies which have compared statin meds with EPA and DHA omega-3 are impressive; that was not investigated here.

PS. Something NOT to overlook; there were less cardiac deaths (statistically significant) in subjects with diabetes who consumed the margarine with EPA and DHA omega-3 compared to those consuming ALA, the plant-source omega-3 or placebo.

Last week, a paper by Dangour et al., published in the American Journal of Clinical Nutrition (AJCN), reported the results of an investigation into fish oil supplementation and cognition. The researchers gave a bit more than what many countries consider a minimum recommended intake of omega-3 EPA and DHA to healthy adults age 70 to 79 years, and after two years, there was no statistically significant difference in cognition between the omega-3 group and the placebo group. The press has had fun with this one.

Omega-3 EPA and DHA intake from diet were similar in both groups from the Dangour study. About one-third of each group ate white fish once a week and about one-third ate white fish more than once a week.  About 12% of each group ate oily fish once a week and about 16% ate oily fish more than once a week. (Oily fish contains more omega-3, but white fish has some.) Most people in both groups ate fish with some regularity; only 8% ate it once a month or less.

The researchers here are a highly esteemed group. The study was well designed; in fact, it used a classic design in which healthy seniors were randomly selected to participate, and neither the subjects nor the researchers knew who was getting omega-3 EPA and DHA and who was getting the olive oil placebo. Unexpectedly, the results indicated no change in cognitive scores in either group over the two years. But does it mean that omega-3s have no impact on preventing cognitive decline?

Some things to consider

First, we know omega-3 EPA and DHA are important in mental health and brain function. Human studies using these omega-3s (usually more EPA) have shown good benefit for those with depression, including those at risk for suicide. They have also shown benefit in children with learning problems. DHA is particularly important, as it is selectively and critically used in brain cells and eyes. In fact, DHA’s highest concentration is in the brain and eyes, although it is found throughout the body. This study doesn’t change these facts.

Second, it is possible that omega-3 intake was already adequate in the healthy adults in the Dangour study, and taking more omega-3 didn’t make a measurable difference in just two years. In fact, omega-3 levels were not measured at study onset, although the researchers found that both groups had sufficient levels at the end of the study.  

Third, the science is still young when it comes to nutrition in seniors and cognition, but some studies have reported that omega-3 EPA and DHA is associated with less risk of cognitive decline (AJCN, 2003) and less actual cognitive decline (AJCN, 2004). DHA levels from diet have also been associated with better cognitive function in middle adulthood (J Nutrition, 2010) and less risk for Alzheimer’s disease (Arch Neuro, 2003).  

Some other issues

Is using a dose that is just above what several developed countries consider the daily minimum enough to make a difference, to create an intervention? The researchers intentionally used a dose (700 mg EPA and DHA) that could be consumed through regular dietary intake from about 2 servings of fish a week. Because metabolic effects are related to dose and time, perhaps the dose wasn’t enough to see a significant change over 2 years.

It’s hard to measure change when neither group declines. In this study, neither group showed cognitive decline (that could be worth celebrating!).  Regarding research, however, if neither group changes, it is difficult to measure difference in change.

What if the two-year timeframe wasn’t adequate? Levels of nutrients in the brain change slowly.  The brain is designed this way; for example, nutrient levels in the brain do not vary from meal to meal; this is a good thing.

It’s challenging to see immediate change with nutrition. It is possible that benefit from omega-3 EPA and DHA will not be seen for a few years.  What we eat today makes a difference later. We know that with calcium and bones.  Bone mass laid down in adolescence and young adulthood makes a greater difference in osteoporosis risk than calcium consumption in adulthood.

It is also possible that taking omega-3 EPA and DHA at the age of 70+ is too late. Can we replete a deficiency in the brain late in life? Adults in England clearly see value in omega-3 EPA and DHA because 43% of the nearly 14,000 persons contacted about potential participation in the study were already taking fish oil supplements and thus were excluded from participation.

It’s likely those taking fish oil were taking it for their heart or arthritis. Daily intake of 700 mg of omega-3 EPA and DHA is less than recommended for those at risk for heart disease and for those with rheumatoid arthritis looking for pain relief (with or without their RA meds); maybe 700 mg (in addition to diet consumption) isn’t enough to make a difference for the brain, measured in a 2 year period.  Two years in the life of a 75 year old is very different from 2 years in the life of a child; while the brain uses nutrition at all ages, the metabolic machinery is different. Things don’t happen as fast.  

I admit my bias. I have been following the omega-3 science for years. The chemical structures of these fatty acids are unique: they are slow to change in cell membranes yet serve an essential purpose in every cell in the body. And they’re tough to get into the diet of the average American, who isn’t particularly fond of fish.

We don’t know why the researchers didn’t see a change in these cognitively healthy people with 700 mg omega-3 (200 mg EPA + 500 mg DHA) in just two years. For future studies, do we need higher doses or a different ratio of EPA and DHA? Do the participants need to begin younger? Do they need to be followed longer?

Dangour et al. did not have big results, and for some that may be disappointing. It doesn’t make omega-3 fatty acids any less important for the body. It’s easy to get excited about spectacular interventions with nutrition, and just as easy to overlook the less exciting but equally important everyday nutritional requirements. 

The number of people with cognitive impairment is increasing around the globe. Knowing the science as I do, I’ll hedge my bets, and continue to make sure my cognitively healthy 80-year-old mother, who has been taking fish oil for years, continues to take it.  She likes to tell her friends that it keeps her brain oiled; she might be on to something. 

Here’s an idea………what if we all committed to benefiting the earth by living healthier lives!  We would also have more money at our disposal; living healthier costs less.   

Just think of the reduction in resources that would demand (e.g. in medical supplies, drug manufacturing); the reduction in labor costs (e.g. less time lost from work, fewer sick days), allowing for more employee benefits and greater company morale. 

If we used our bodies for transport, we would have less demand for cars, gas and new roads.

When we eat more plant-based foods as they occur in nature, we reap the benefits of real nutrition.  Eating less meat (some, not too much) helps the earth. Buying less items in plastic containers helps both our health and the earth.

The best way we can help the earth is by being committed to healthy living and raising our children with these principles in mind.  Keep it simple; stay healthy!

I burned a fair patch of skin on my forearm the other day by touching the side of the hot tea kettle.  Oops. The burn didn’t break the skin, but it sure got red and it hurt! 

I was reminded of something I learned years ago.  Vitamin E oil put directly on skin that has been burned is a great healer.  It’s important that the skin not be ‘broken’, and the wound not open, as you don’t want skin to heal over an open wound.

I was surprised by how quickly the vitamin E oil was absorbed into the skin.  My goal was to keep the skin from getting dry so I kept a thin layer on the burn spot for 24 hours. 

Sure enough, the burn is subsiding and the skin is intact. 

Vitamin E is a fat-soluble vitamin and component of skin cell membranes; the healing properties are consistent with how vitamin E works when we take it internally. 

A nice little home remedy.  If you don’t have pure vitamin E oil in a bottle, you can open vitamin E capsules. 

In the world of academia, there are standards of education.  Diplomas are earned through demonstrating what you have learned, according to proven standards.  For example, when I meet a fellow Registered Dietitian, I know that he/she and I have been exposed to the same information, held to the same standard, and when we become licensed, we passed the same test – a test that had been independently documented to show a level of knowledge.  Test scores will vary by individual, but a pass/fail indicates baseline knowledge (or not). Institutions that maintain standards of excellence are accredited. 

In the world of internet and mail-order, certificates and diplomas are distributed.  In order to get the certificate or diploma, something was done.  It could involve paying a fee, answering a few questions, maybe some course work.  They are most-often not accredited and the information delivered would not meet a higher standard. 

For example, let’s use just the academic portion of becoming a Registered Dietitian (RD):  RD’s have a minimum 4 years of college beyond high school. They must take at least 3 years of chemistry as well as food safety and sanitation, anatomy and physiology, the science of food, biology, etc.  They are trained to keep someone alive in the Intensive Care Unit of a hospital.  In short, they have extensive training in human health, medical nutrition therapy, food science, nutrition, etc.

Above, I wrote ‘just the academic portion’ because RD’s also spend at least one year in the hospital getting advanced training (internship), and take a nationally accredited licensing exam (which not everyone passes) to become licensed.     

In general, mail-order and internet certificate and diploma programs offer interesting information which may or may not be valid.  Usually no technical background is required (e.g. basic chemistry for a nutrition certificate) and typically the person doesn’t need to prove any skills or learning.

I’d love to hear comments about why people trust individuals with mail-order and internet diplomas for their health care information. 

A op-ed article (‘A Fish Oil Story’ by Paul Greenberg) in the New York Times today is enlightening and well intended but off the mark. 

I appreciate the attention to omega-3 fatty acids, as these are essential dietary nutrients with proven benefit and documentation that Americans under consume them. I also appreciate the attention on environmental impact and corporate responsibility. 

The unfortunate piece of this article is the mis-information regarding the source of oil used in fish oil supplements in the United States.  Yes, Omega Protein is involved with the menhaden business, but they are not the primary source of oil sold in fish oil supplements in the US.  Not by a long shot.  Anchovies and sardines are the predominant source of oil in fish oil supplements.  I could go on, but it’s important that I make another point.

Paul writes ‘some of those omega-3 supplements you have been forcing on your children’.  Tell me, why does the act of well-intended and educated parents, providing a much needed nutrient (that we’ve all but removed from our food supply) to their children need to be discussed in the context of force?  Does providing adequate nutrition for children have to be a forceful event?  The makers of food disguised as toys and games want us to believe that.  Come on, poor nutrition is key (and ignored) in the demise of our health and healthcare system.  Being nourished is something to welcome, not force. 

And a note on fish oil supplements for children, if the product doesn’t taste good, just like Paul in writing his article – look at the source.  Like anything on the market, there is always a cheap, low-grade product selection; with nutritional products, that can be reflected in taste (and quality).

It’s cold across most of the continental US right now.

Growing up in central region of British Columbia, Canada, deeply cold winters were ordinary.  I have fond memories of dodging snow balls, dipping ice sickles into jello powder and less fond memories of getting up for 6 am ice skating lessons; the one arena in our small town was used for hockey practice after-school and for public skating on weekends.   

Moose and wild game hunting is a common sport, and profession for some. Those who frequented the wilderness country knew the locations of hunting cabins, usually set miles apart and stocked with food and wood.  And it was always said, ‘gotta keep a bottle of whiskey with you, it will keep you from freezing’.  This perplexed me as a child, never certain if it was truth or myth.   

We know alcohol doesn’t freeze, but will it prevent death from extreme cold exposure? I still don’t know.  If you do, please tell me.

Fish exist in the cold arctic waters.  In fact, the richest sources of EPA and DHA omega-3 are found in cold, deep water fish. Fish don’t freeze (well, my gold fish froze in its bowl one year when the heater stopped working while we were gone for Christmas; all the plumbing froze, too).  Ok, most fish don’t freeze. 

Omega-3 fish oil doesn’t freeze. EPA and DHA, the two predominant omega-3 fatty acids in fish oil are unique fats due to their very long chains and multiple double-bonds (hence, called long chain, polyunsaturated fatty acids).  This unique chemical structure allows them to perform distinct metabolic properties that other fats just can’t. It also keeps them from freezing.

I’m reminded, once again, during these cold days of the special and unparalleled properties of omega-3 fish oil. Will they keep you from freezing?  I don’t know that either.  Unlike whiskey, however, omega-3s are essential nutrients in human nutrition.  They can reduce the aches and pains in your joints while you are shoveling snow or building a snowman. And we know that sufficient intake can significantly reduce your risk of heart attack; we can’t say that about whiskey. 

I recently saw fish oil capsules for sale in clear, plastic bottles.  Remember learning that light destroys sensitive nutrients?  We stopped selling milk in clear glass containers years ago because light destroys some of the B-vitamins that occur in milk.  It is dark in your refrigerator, but not in store shelves.     

Omega-3 EPA and DHA are special dietary fats.  They are special for many reasons, but mostly because they are vital in human nutrition, and we (humans) can not make omega-3 or omega-6 fats in our bodies.  They are also special because they need keen attention during manufacturing to protect the EPA and DHA during manufacture. This is why better fish oil costs more. 

Putting fish oil in clear bottles is encouraging disintegration of the oil.  That means less benefit for your body and less value for your wallet. 

There is a reason for the standard statement ‘store in a cool, dark place’.

The important question ‘Can Omega-3 Fatty Acids Enhance Stress Resilience, Wellness, and Military Performance?’ will be addressed next week (Oct 13 & 14) at a 2-day conference at the National Institute of Health in Rockville, MD. 

A prestigious group of world-renowned experts in omega-3 research are speaking, including Dr. J. Hibbeln, Dr. S. Innis, Dr. M Muldoon, Dr. M Crawford, Dr. J Kiecolt-Glaser, Dr HY Kim, Dr. T. Mickleborough, Dr. P Howe and others. 

The opening keynote speaker is Richard Carmona, MD, MPH, FACS, the 17^th Surgeon General of the United States. 

They will look at the biochemistry of omega-3 fatty acids, utilization in the human brain, neurotrophic effects and the scope of the problem with the cycles of stress among warfighters. Research findings with omega-3 fats and aggression, suicide and stress, cognitive function, wound healing, in surgery, with cardiometabolic health and physical performance will be presented.  The meeting will conclude with a broad discussion of how the findings presented may be applied within the military environment. 

I’m thrilled to see this mind tank of scientists and military representatives coming together to address this vital topic. 

The conference is being presented as a live webcast.  Archived pod casts of the conference will be available a few weeks after the event.  Feel free to email me for the link.    

I support natural products.  I managed natural food stores for 10 years; I teach people to eat food in its most natural state; I write and speak about natural products from an evidence-based approach in my work today.   I like ‘natural’.

And sometimes, natural just doesn’t make sense.  That is the case here.

I recently reviewed a new product on the market that is sold as a natural omega-3 fish oil supplement.   Problem is, the product contains more of the fats we ought to be reducing in our diet, and provides little omega-3.  

This new product contains 24% saturated fat. One-fourth of each capsule is solid, saturated fat.  People take EPA and DHA Omega-3 because it’s a dietary essential fat.  This new product contains a lot of other fats we don’t need (e.g. not essential) and offers a mere 20% omega-3 EPA and DHA.  Each 1000 mg capsule has 90 mg EPA and 110 mg DHA. 

Typical omega-3 fish oil capsules provide 30% omega-3 EPA and DHA, and products providing 60 – 75% EPA and DHA are becoming more common.  

A product providing 20% of EPA and DHA with a generous portion of saturated fat and other non-essential fat is not a good value or a healthful choice. 

One more thing, this said company claims to have clinical research on their branded product.  There’s a nice graphic on their website.  I’ve contacted the company twice inquiring about the ‘clinical research trial’, and have received no response. 

A pretty graphic without any reference to who, or where, or when or how the study was completed, is just a cartoon picture.