Tag Archive for: omega-3

Questions About Fish Oil

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While I’m spending the day making sure today’s primary election in Michigan goes smoothly in my precinct, here are some of my thoughts and questions about fish oil and omega-3 fatty acids.

  • None of the research to date has focused on complete nutrient intake, and that may have an impact on fish oil utilization. I’ve suggested that before, but vitamins, minerals, and especially phytonutrients from food may have a role to play in how the body uses fish oil and all the fatty acids within it.
  • Speaking of the fatty acids, the omega-3s that are always mentioned are EPA and DHA. In reality, they make up a small part of the fatty acid distribution in fish oil. Could that make a difference? In other words, would the emphasis on those fatty acids impact how omega-3s are used in the body, positively or negatively, compared with straight fish oil?
  • The form of the omega-3 may be important when it comes to bioavailability. There are phospholipids, re-esterified triglyceride (rTG), TG, free fatty acids (FFAs), and ethyl-ester forms of omega-3s. Does the form matter?
  • This is just my opinion, but there’s something in fish that works to improve absorption of omega-3s. Maybe it’s the other fatty acids or maybe it’s the protein in the fish when we eat it. There’s no evidence that oily fish intake increases AFib, so why would the oils alone contribute to any issue unless something is impacting the form mentioned above?

That’s the way I see it. It’s also why I think eating a good diet will prove to be beneficial when taking fish oil. We’ll just have to wait and see.

What are you prepared to do today? If you’re in Michigan, I hope you’re prepared to go vote.

        Dr. Chet

Obesity and Prenatal Omega-3s

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Scientists continue to research the causes of obesity. For many, as we’ll see, it’s not as simple as eating less and moving more; in the study I’m going to review this week, the researchers are going prenatal.

The Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC) is an ongoing longitudinal study to examine the effects of omega-3 supplementation in the third trimester of pregnancy on a number of factors. The primary objective was to see if allergies and asthma were reduced in the offspring of women who took the omega-3s versus those who took a placebo. Asthma or persistent wheeze showed a 31% reduction in risk in the group receiving fish oil compared to 23% the placebo group.

The researchers also collected a variety of anthropometric data, plus blood samples for metabolic and blood lipid analysis, and assessed body composition. In a prior paper when the children were age six, the omega group were about one pound heavier but with a proportional increase in lean and fat mass.

In the current analysis at age ten, the omega group were determined to have an increased BMI, increased risk of being overweight, a tendency for increased fat percentage, and higher metabolic syndrome score when compared to the placebo group. That doesn’t sound good. Does this mean women should avoid omega-3 fish oil during pregnancy, especially the third trimester? I’ll let you know on Saturday.

Tomorrow is the monthly Insider Conference Call. I’m going to cover starvation but not the Minnesota Starvation Study—you’ll come away stunned. I’ll also answer your questions. If you’re not an Insider, become one by 8 p.m. tomorrow and you can join in.

What are you prepared to do today?

        Dr. Chet

References:
1. BMJ 2018. doi: https://doi.org/10.1136/bmj.k3312
2. AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

Research Update: Omega-3s and Lung Function

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Lung function declines as we age; depending on how we treat our lungs, our habits can determine the rate of decline. Working in toxic situations (or even worse, smoking cigarettes) can accelerate the decline. That’s why a recent study that examined blood levels of omega-3 fatty acids and measures of lung function found that our diet has an impact on lung function. Let’s look at this study.

Increases in Omega-3 Levels Prevent Decline

Of the two studies reported in the paper, I’ll stick to the longitudinal study, although both demonstrated the positive impact of omega-3s on lung function. A couple definitions first.

  • Forced expiratory volume 1 (FEV1) is the amount of air that one can forcefully breathe out in one second. The normal range is 2,500 to 3,250 milliliters.
  • Forced vital capacity (FVC) is the amount breathed out after a normal exhalation. The normal range is 3,700 ml to 4,800 ml.

One more thing: in this study, the mean rate of lung function decline was 36.8 mL per year for FEV1 and 35.8 mL per year for FVC.

Researchers examined a pooled group of studies that were part of the National Heart, Lung, and Blood Institute Pooled Cohorts Study. Studies were chosen because of the repeated measurements of both lung function and plasma phospholipid omega-3 fatty acids. The study found that higher omega-3 fatty acid levels were associated with less decline in lung function for 15,063 participants. The omega-3 that provided the most benefit was the omega-3 fatty acid DHA. In plain English, the more the DHA levels increased over time, the more the decline in lung function was prevented. I know that sounds funny to say it “prevented decline” but to say that it improved lung function would be incorrect.

The Questions

In both studies, nutritional information wasn’t collected, or if it was collected, it wasn’t used in the statistical analyses performed. The assumption seems to be that seafood and plants were the primary sources of omega-3 fatty acids, and that may be true. But it raises a question about the potential for using omega-3s in dietary supplements. Would the same response occur in reducing the risk of chronic kidney disease as it did for the loss of lung function?

It also raises another question. Many studies on the benefits of omega-3 supplements on heart health and other organs are often less than overwhelming. Could it be that there is a nutrient or nutrients in fish that, together with omega-3s, could contribute to benefits? Or could it be there’s a factor that helps with digestion, absorption, and utilization in the actual form of omega-3s used as supplements? We don’t know at this time.

The Bottom Line

While the benefits of omega-3s, specifically DHA, were small, the fact that they prevented decline over years contributes to aging with a vengeance. I think having a diet that includes the regular intake of fatty fish is the key to a healthy lifestyle, and I still think regular use of fish oil supplements may prove to be beneficial as the research continues. I’ll keep you posted.

What are you prepared to do today?

        Dr. Chet

References:
1. Am J Respir Crit Care Med. 2023 Jul 20. doi: 10.1164/rccm.202301-0074OC
2. BMJ 2023;380:e072909. doi: 10.1136/bmj-2022-0729092

The Supplementation Sweet Spot, Part Two

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We’ve got the beginning of our sweet spot for supplementation started with a multivitamin-multimineral and probiotics; today I’ll finish it up with two more—depending.

Omega-3 Fatty Acids

Recommendations on the type of omega-3s seem to be in flux with disagreements over docosahexaenoic acid (DHA). The cause for concern seems to be the potential relationship between DHA and atrial fibrillation. I’m still not satisfied as to the relevancy of the risk in the general population with one exception: those people who’ve had myocardial infarctions (heart attacks) that resulted in the loss of heart muscle. For now, those people may want to be cautious. My research continues and when I have an answer, so will you.

Unless you regularly eat servings of cold-water fish two or three times a week, part of your foundation supplementation should be 1–3 grams of EPA, DHA, or the plant-sourced alpha linoleic acid (ALA), or a combination of all three. You can pick any body system, and omega-3s are most likely beneficial. This is especially true of the cardiovascular and nervous systems.

Vitamin D

The final foundation supplement that makes up our sweet spot is vitamin D but with a catch. Instead of taking massive amounts of vitamin D, the best way to determine whether you need to supplement with vitamin D is to get your blood levels checked via a 25 hydroxyvitamin D (25(OH)D) blood test. If you’re low in vitamin D, below 30 ng/mL, add more vitamin D to your supplements in 50 mcg (2,000 IU) increments until your blood level reaches 40–60 ng/mL. Obviously, you need to see your doctor for the test, but you should be seeing your doctor regularly anyway.

Depending on where you live, sunlight will help you maintain healthy vitamin D levels with about 15 minutes exposure per day. However, in Northern areas such as here in Grand Rapids, that only happens about half the year, so we make sure to take our vitamin D supplement and bump it up a little in winter.

More

Vitamin D has become controversial with the current COVID-19 outbreak. Vitamin D will not prevent you from catching COVID-19; it will help reduce the severity of symptoms. But megadosing on vitamin D can have consequences that can result in bone loss. That’s why basing your intake on a blood test is the right way to go.

The Bottom Line

There you have the sweet spot for foundation supplements that all of us need, regardless of the quality of our diet. What about all those other supplements out there? Fine tuning supplementation to meet your personal needs is where supplements get complicated and need to be personalized. With the billions of dollars spent on supplements every year, if everyone began with the sweet spot of foundation nutrients, everyone would be better off, just like the sweet spots for diet and exercise.

If you want to know more about the science behind these supplements as well as how to assess a quality manufacturer, get a digital copy of Supplementing Your Diet; if you want to pass along the information to others, get a 5-pack of CDs at reduced prices. They’re all on sale at 25% off, and that’s in addition to Member and Insider discounts. You can also find info on supplementation for other conditions such as high blood pressure, pregnancy, migraines, weight loss, and more at the Store at drchet.com.

What are you prepared to do today?

        Dr. Chet

The Bottom Line on Omega-3s

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When you consider the research studies I reviewed last week and this week on omega-3 fatty acids, they may seem confusing. The reason is that in both of those studies, they were looking at very specific outcomes. In last Thursday’s memo, it was changes in the quantity of specific cytokines, chemicals that are inflammatory in nature. In the study from Tuesday, it was for reduction of cardiac events. There are other ways that omega-3s can contribute to health, and I thought a little review would be in order.

Cellular Membranes

Cells seem to work better when they contain omega-3 fatty acids. Remember, a cell has an exterior wall of a lipid bilayer. If the diet contains a high amount of saturated fat, a high amount of saturated fat becomes part of that lipid bilayer. If the diet contains more omega-3 fatty acids, whether by eating fish or by taking a dietary supplement, the cell membranes contain a higher proportion of omega-3 fatty acids. While the mechanisms are not known, the cells seem to function better when they contain more omega-3s.

Let me give you a couple of examples. Nerve tissue seems to function better when there’s a high amount of DHA in the bloodstream; DHA supplementation seems to be beneficial for nerve problems such as migraine headaches, depression, and Parkinson’s disease. It’s not a cure, but somehow the omega-3s become integrated into those nerve cells and they work better. The same holds true for the eyes; vision is dependent on the nervous system to operate properly, and high DHA appears to benefit eye health as well.

Hormone Control

The study I reviewed last Thursday focused on one type of inflammatory chemicals called the cytokines, but there are other pro-inflammatory hormones that may be better controlled with both high EPA and DHA supplementation. Cortisol is a known stress hormone. In times like we’re experiencing now and for those who are overweight or obese, cortisol levels are higher; that may be due to the increased presence of saturated fat. If omega-3s become part of triglycerides, the potential for inflammatory hormones such as cortisol can be decreased.

There’s also the possibility that persistent use of both EPA and DHA reduces atherosclerotic plaque, the hard layer of fat that builds up in arteries, or it may prevent cholesterol from being manufactured in the first place. While it’s too long of a process to explain in a Memo, our bodies make cholesterol two carbon molecules at a time. When there’s a higher amount of saturated fat, the process can speed along unabated; but when there’s a high percentage of omega-3 fatty acids present, the process gets interrupted. We don’t know the mechanisms; we just know omega-3s help.

The Bottom Line

Those are some of the possible ways omega-3 fatty acids are used for our health. Undoubtedly there are many more that haven’t been discovered or haven’t been examined in enough clinical trials at this point. The most important thing for you and me is to make sure that either we eat several servings of fatty fish per week or we take up to four grams of high EPA-DHA omega-3 supplements every day—let the science work it out later. Our job is to provide our body with nutrients that are beneficial.

What are you prepared to do today?

        Dr. Chet

Omega-3s and Cardiac Events

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There was another study this week on omega-3 fatty acids. While the study I talked about last Thursday was small with only 21 subjects, this trial contained over 13,000 subjects from 675 hospitals and clinical centers all around the world. In this five-year study, one of the omega-3 fish oil medications was being tested to see if it would reduce cardiac events such as heart attacks, stroke, and death when compared with subjects taking a corn-oil placebo. The study was stopped early when it was clear there were going to be no significant differences in any of the outcomes that were being studied. In other words, the prescription fish oil did not reduce cardiovascular disease events.

While that may seem disappointing, there are some factors that most likely impacted the outcome and a couple that may have but could not be tested.

The Subject Pool

The subjects in this clinical trial had significant risk for CVD; they were required to have established coronary artery disease or significant risk factors to be included in the clinical trial. Those risk factors included being a type 1 or type 2 diabetic, with at least one additional risk factor including chronic smoking, hypertension, hs-CRP higher than two mg/L, moderately increased protein loss, or being older with similar factors as the diabetics.

The Data Not Collected

In reading the study, there were three criteria that came to mind that could have impacted the outcome if the corresponding data had been collected and considered in the statistical analysis. I emailed the relevant author and got the answers.

1. Were data collected on exercise habits of the subjects? No.

2. Were nutritional data collected on the subjects? No.

3. Was the form of omega-3 used, a highly purified carboxylic acid form, assessed as to how the metabolism impacts the omega-3s’ mechanism of action? No.

It seems to me that if the data could be analyzed on exercisers versus sedentary as well as using nutritional factors, even just daily caloric intake, there may have been significant results. As for the form of omega-3s, the CA form is highly absorbed and doesn’t require a fat in the diet to assist with that process. There might have been something else that happens during metabolism that normally assists in the risk reduction. We just don’t know.

The Bottom Line

The authors acknowledge that this subject pool was at high risk for cardiac events. One explanation is that the progression of disease may have already been too advanced and could have impacted the efficacy of the medication. For people with less established CVD, the omega-3s might have been more effective.

Many in the medical field wrote about the failure of omega-3s in medication or supplement form to prove that they have any impact on CVD events or mortality. I think they’re wrong. The one outcome they never test is the quality of life. Granted, it’s difficult to assess but if people can live their lives even 10% better, regardless of CVD events, that seems worth it. Paula and I are still taking our omega-3 supplements; in fact Riley takes one, too, even though he’s only five and we’re not concerned about his heart. Whether you’re worried about your heart or not, omega-3s have many benefits. This study shows no reason why you or I should stop taking them.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. 2020;324(22):2268-2280. doi:10.1001/jama.2020.22258

Can Omega-3s Reduce Inflammation?

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Omega-3 fatty acids have been in the science news this week. In this Memo, I’ll take a look at a small study that examined the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on specific markers of inflammation in 21 subjects between 50 and 75 who had elevated levels of inflammation. Researchers had subjects follow a particular regimen: take three grams of either DHA or EPA for 10 weeks, cease all omega-3s for 10 weeks, and then take three grams of the other omega-3.

The study showed both omega-3s were effective; they just worked differently, and I can’t explain that without getting technical. It seemed that DHA reduced specific cytokines such as TNF-alpha, IL-6, and IL-10 to a greater degree than did EPA. One of the ways that may have happened was a reduction or replacement of the proinflammatory omega-6 arachidonic acid. The important point is this: however they worked and although they worked in different ways, both DHA and EPA were effective in reducing the inflammatory response in this small study.

Could adding high-DHA fish oil supplements to the diet reduce cytokine production in every case? Specifically, could it potentially have some benefit for the cytokine storm that’s associated with severe cases of COVID-19? We don’t know that yet because that specific research hasn’t been done. But since there are so many other well-documented benefits of omega-3s, make sure you regularly eat fatty fish or take fish oil supplements with DHA and EPA. It’s always a good bet.

What are you prepared to do today?

        Dr. Chet

Reference: DOI:https://doi.org/10.1016/j.atherosclerosis.2020.11.018

2018’s Worst Most-Read Paper

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In March of last year, the Journal of the American Medical Association published a viewpoint written by two experts in public health titled “Vitamin and Mineral Supplements. What Clinicians Need to Know”; it was one of the nutrition papers most read and most shared last year. The only problem is that clinicians really won’t find out much by reading it.

I’m going to pick one recommendation because everything after it won’t matter. The authors recommend that all clinicians recommend that patients get their nutrients from food. I absolutely agree with that. They go on to advise clinicians to tell their patients there’s no need to take any dietary supplements if they eat a healthy diet. That’s plain wrong.

We already know that over 90% of all adults do not get enough servings of vegetables, fruit, and whole grains every day—and it’s proven that food contains less nutrition than in the past—yet the authors did not recommend doing a nutrition analysis for the patient. With little to no information about the patient’s diet, clinicians are to tell their patients to eat a healthy diet, don’t take any supplements, and go on their way.

These are exceptional researchers; they know how poor the American diet is because they’ve done much of that research. To publish this opinion was incomplete in my opinion and thus it ranks as one of the worst papers of 2018. With almost a quarter million reads and shares passed along through social media and news feeds, millions read what they wrote, and it will influence millions. My opinion is that millions will be less healthy because they accepted these recommendations and dropped their nutrition insurance: their multivitamin and omega 3s and so on.

That doesn’t mean you take every dietary supplement that comes along. The rule is simple: know what supplements you take and more important, exactly why you’re taking them. And work on eating a healthier diet in 2019 as well.

What are you prepared to do today?

        Dr. Chet

How to Reduce Nerve Pain

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Do you ever have pain that shoots down your leg? How about your hands getting numb or painful? Ever get a headache because you’ve clenched your neck muscles so tight due to stress? More than likely, you’re experiencing some form of pain caused by a firing nerve, and these three examples are the ones I’m asked about most often.

It’s always important to get an examination and diagnosis of the potential cause of the pain. If it’s mechanical, that’s one thing. If it’s neural, your approach will be slightly different. The cause of the pain may be a completely different location than where you feel the pain. In the first example, the probable cause is an impingement of the sciatic nerve somewhere; it could be in the spine where the nerve exits the spinal cord or it could be in the pelvic girdle. The second is the classic symptom of carpal tunnel syndrome; the nerves in the neck and shoulder are the primary cause even though the resulting pain is in the wrist and hands.

The critical part of dealing with nerve pain is to try to relieve the pressure on the nerve. Physical therapy and possibly massage that stretches and strengthens the appropriate joints are critical, but they must be done consistently. For some, pain relievers other than non-steroidal anti-inflammatories may be beneficial. Supplements that may help would be high-DHA omega-3s, gingko biloba, and magnesium. If you pushed me to say what’s the best approach, I would say take whatever you can to relieve the pain so you can do the physical therapy. Use the supplements for a longer term solution.

One more type of pain to look at Saturday.

What are you prepared to do today?

Dr. Chet

 

How to Reduce Mechanical Pain

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Every morning, the process of getting my body moving is challenging. My back is stiff and my knee is tender, on the border of painful. The longer I’m up, the better I move. After about 30 minutes, I can get my workout. It takes my knee 10 minutes to warm-up once I start running.

I’m going to talk about pain this week—specifically, three types of pain and what may help. Today it’s mechanical pain. Remember the time you slipped and twisted your knee? Wrenched your shoulder when you picked up something you thought was a lot lighter? Broke your ankle skiing? Those are the types of injuries that can lead to mechanical changes that can result in pain; the injury heals but the tendons, ligaments, and cartilage are not quite the same. It can lead to pain, even many years later. That’s what happened to my right knee.

What can you do about it? Strengthen the supporting tissues to the extent you can. I went to a physical therapist, got an evaluation, was assigned some exercises and I do them regularly. It has strengthened the muscles that directly and indirectly impact the knee. While it’s still tender when I wake up, the swelling is gone and I can run if I choose. To me, that’s the most important thing. But I also take a timed release non-steroidal anti-inflammatory in the morning and use omega-3s, turmeric, and glucosamine twice a day. That works for me. You may need more pain relievers or you may need none.

That’s how you can deal with mechanically-induced pain. On to nerve-induced pain on Thursday and disease-related pain on Saturday.

What are you prepared to do today?

Dr. Chet