by Integrative Clinical Pharmacist Scott Berliner, RPh
It seems like everyone, including very traditional-minded people, is talking about the group of nutrients called essential fatty acids. These polyunsaturated fats, known as PUFAs, are made up of Omega-3 and Omega-6 fatty acids.
The two main fatty acids are called ALA or alpha-linolenic acid, an omega-3 fatty acid, and LA or linolenic acid, an Omega-6 fatty acid. The longer chain fatty acids EPA and DHA can be synthesized from ALA and the long chain fatty acid AA or arachidonic acid can be synthesized from LA. The problem is that EPA/DHA synthesis may not be sufficient under many circumstances, leading to deficiencies with severe health consequences.
Western diets appear to be much richer in Omega-6 fatty acids than some diets from other parts of the world. Some think that the ratio of Omega-6 to Omega-3 in American diets is as much as 20:1. It is generally believed that an equal ratio of the Omega-3s to the Omega-6s is ideal. Therefore, it is important to restore the balance of these healthy fats. A large body of research indicates that higher dietary Omega-3 fatty acid intakes are associated with reductions in cardiovascular disease risk, prompting the American Heart Association to recommend that all adults eat fish, particularly the oily fish, at least twice a week. Randomized controlled trials show that higher Omega-3 consumption can decrease the risk of myocardial infarction or heart attack and even reduce the risk of sudden cardiac death.
Increasing the consumption of EPA-DHA can help diabetics, especially those with elevated triglyceride levels. It appears that increasing the intake of DHA may also help with neurological development. Even baby-formula companies are adding DHA to aid in brain, eye, and neurological development in infants.
These same EPA-DHA fatty acids appear to reduce inflammation in the joints and reduce the need for anti-inflammatory medication in rheumatoid arthritis patients.
Preliminary studies indicate that increased supplementation with Omega-3 fatty acids may be beneficial in the treatment of depression, bipolar disorder and schizophrenia. Other studies have shown benefit to people suffering with inflammatory bowel disease, Crohn’s and ulcerative colitis.
EPA and DHA are found in high concentration in the cell membranes. Although the body makes its own EPA and DHA from precursors, evidence suggests that the body may not be able to make sufficient quantities under certain conditions. Therefore, EPA and DHA may also be considered essential meaning that we need to consume them.
DHA is more concentrated in the retina of the eye and animal studies indicate that it is necessary for the development of the retina. It is also important for the development of the phospholipids of brain gray matter.
While it is true that the oily fish, like salmon, halibut, tuna, and cod are rich in these fatty acids, eating them more than twice a week for the average individual may present other problems, like excess consumption of heavy metals like mercury, arsenic, cadmium and lead. The waters are polluted and, therefore, the fish are polluted. Some people believe that pregnant women should not consume these fish at all, yet we know that they are essential for the development of the brain, eyes and nervous system of the developing fetus. I believe that the lack of these nutrients is a contributing factor to the high number of cases of ADD, ADHD, and even autism. It is with these facts in mind that I tend to recommend eating fish, if you like it, but supplementing with good quality fish oil for the omega-3 content.
Animal studies have shown that depletion of DHA can result in learning deficits.
During an inflammatory response, EPA can be used to synthesize molecules that are anti-inflammatory and prevent the release of excess histamine. This is why fish oil consumption is believed to help arthritic conditions as well as asthma.
When purchasing good quality fish oil it is important to remember why we are buying the supplement instead of eating the fish. Read labels carefully to make sure the oil is pure and has been tested for contaminants like mercury, arsenic, cadmium, lead, PCBs, and dioxins. PCBs and dioxins are a particular problem with farm-raised fish as the farms are often in polluted waters. Products found at the Center for Integrative Medicine all have statements on their labels as to the purity and testing, often by a third party.
When purchasing good quality fish oil, it is important to remember why we are buying the supplement instead of eating the fish and read labels carefully to make sure they indicate that the oil is pure and has been tested for contaminants like mercury, arsenic, cadmium, lead, PCBs, and dioxins. The PCBs and dioxins are a particular problem with farm-raised fish, as the farms are often in polluted waters. We carry Metagenics’ EPA-DHA 720, which meets all of those requirements and more. It is a high quality, well-priced, option.
For people who have previously tried fish oil with bad experience, try it again and take a good quality oil that has been purified, and take it at the beginning of a meal. If “fish burps” are the problem, enteric coated oil like Metagenics’ “EPA-DHA Extra Strength” will usually solve the problem as it is designed to bypass the stomach and open in the intestine. If this is not satisfactory, try storing your oil in the freezer and take it frozen.
It appears from numerous studies that consumption of 2 to 3 grams of EPA and DHA is ideal for many situations, though less certainly has benefits. When trying to calculate this dose remember that many of the supplements come in 1000mg capsules but this number only represents the weight of the oil within the capsule and not the amount of EPA and DHA. For example, Metagenics’ EPA-DHA 720 capsules each weigh 1.3 grams or 1300mg but contain 430mg of EPA and 290mg of DHA. These are quite potent, but for optimal benefit this may require 4 to 6 capsules a day. With these concentrated sources, EPA/DHA can offer multiple benefits in risk reduction from cardiovascular disease, diabetes, arthritis and even asthma.
Most of these benefits take at least 12 weeks to become apparent, but the benefits should be motivating enough to stay with the supplementation.
There are few supplements that have as much clinical documentation for effectiveness and safety as Omega-3 rich fish oils. I encourage every individual to take a good, rich EPA-DHA supplement before trying less proven approaches to any of the conditions I have mentioned. With today’s advances in distillation of these oils, it is now possible to supplement without the fishy taste or nausea experienced in the past.
There are many other essential oils available in the marketplace, such as flaxseed oil, evening primrose oil (EPO), and borage oil. All of these vegetarian oils have wonderful properties, but none are sources of omega-3s exclusively. Because of the dietary habits of most Americans, the balance of omegas is often far greater in the omega-6s than in the “3s,” and therefore it is considerably better to consume Omega-3s to help rebalance the ratio of the omega-3s to the 6’s.
Flaxseed oil is generally considered to be the vegetarian’s alternative to fish oil, but barring philosophical considerations, it still contains the 6s and 9s in addition to the 3s. The omega-3s do exceed these by 3:1 so it is a good alternative.
Evening primrose oil and borage oil do not contain any of the omega 3s; just the omega-6s and the omega-9s. They have been used traditionally, for eczema and other inflammatory issues with the skin. More recently they are being used for other inflammatory conditions like arthritis and also for issues involving the menstrual cycle, like breast tenderness.
In addition, the GLA (gamma-linolenic acid) in borage seed oil and EPO can prevent the formation of blood clots, help to keep the cell membranes flexible, and support the body’s immune function.
I would like to stress that these GLA-containing oils are not necessary in healthy adults, as we make the GLA from linoleic acid, so there is often no benefit in supplementing oils other than the ones containing omega-3 fatty acids.
At this point in time, fish oil containing a rich source of omega-3s is considered a “core nutrient” and therefore people of all ages can benefit from supplementation, especially because there really aren’t any reasonable dietary sources that one can turn to on an ongoing basis.