Omega-3 For Life Application through Life’s Stages Mark Lange, PhD Director, Quality Control Market America

Disclaimer The statements contained in the following presentation have not been evaluated by the Food and Drug Administration. The ingredients discussed are not intended to diagnose, treat, cure or prevent any disease.

Essential Fatty Acids ALA deemed “Essential” because of its apparent benefits in animal studies. Later found that DHA provides the health benefits to eye and brain. ALA is converted to DHA (<1% efficient). Therefore, DHA is “Conditionally Essential” because the body can make it – but not enough. Essential nutrients are required in the body for optimal human health and must be consumed because the body does not produce this nutrient. Alpha-linolenic acid was early on classified as essential because in it was found that supplementation with ALA had a positive effect on brain and eye development in animal studies. Later, it was discovered that ALA was being converted into the physiologically-essential DHA. So the term, conditionally essential was used to describe DHA because it can be formed to some limited extent in the body my metabolism. Because of the very limited conversion efficiency of ALA to DHA, one should not rely upon ALA for ensuring adequate levels of DHA in the body and optimal health.

Plant and Marine Sources of Omega-3 Vegetable oils contain significant ALA, but no EPA/DHA. Fish oils have concentrated EPA/DHA and trace ALA. Typical America diet provides 2-3 g/day ALA and 50-80 mg/day EPA/DHA. Certain vegetable oils such as flaxseed, canola oil and walnuts contain significant amounts of alpha-linolenic acid. In contrast, fish and fish oils contain the omega-3 fatty acids known commonly as EPA and DHA along with minor amounts of ALA. Flaxsee and other plant-derived oils are totally lacking in DHA and EPA combined. The typical American diet provides 2-3 grams per day of ALA, whereas EPA and DHA are consumed at levels less than 100 mg per day. Therefore, the average American’s dietary and metabolic intake of EPA and DHA is about 150 mg per day.

Omega-3 Health Benefits DHA is required at high levels in the brain and retina for optimal learning ability and mental development and visual acuity. DHA/EPA support cardiovascular health. There has been a dramatic surge in interest recently, amongst the public and health professionals alike, of the health effects of omega-3 fatty acids derived from fish/fish oils. DHA is required in high levels in the brain and eye for optimal learning ability, mental development and visual acuity. DHA plus EPA are both considered to have beneficial effects in the prevention and management of cardiovascular disease. omega-3 fatty acids found in fish oil have various effects that tend to reduce risk of heart disease and strokes.

Pregnancy Stage Taken to support the health of the baby during neonatal period. Particularly important during last trimester. Consuming fish is risky because of mercury contamination. Take at least 300 mg DHA per day. If someone chooses to take supplements, they need to first consult with their physician.

Pregnancy Stage Clinical trials show that women with higher DHA intake have infants with higher cognitive development scores and children with higher IQ scores. Daniels, J.L. Fish intake during pregnancy and early cognitive development of offspring. Epidemiology. 15:394-402, 2004 Cohen, J.T. A quantitative analysis of prenatal intake of n-3 polyunsaturated fatty acids and cognitive development. Am. J. Prev. Med 29(4):366-374, 2005

Pregnancy Stage Evidence that mothers with higher intake of DHA give birth to infants with improved sleep patterns. Cheruku, S.R. Higher maternal plasma DHA during pregnancy is associated with more mature neonatal sleep-state patterning. Am. J. Clin. Nutri. 76:608-613, 2002

Low Omega-3 Intake Linked to Depression in Pregnancy Women consuming 1500 mg omega-3 from seafood per week were less likely to have depressive symptoms than those consuming none. Avon Longitudinal Study of Parents and Children. Epidemiology 2009, Jul; 20(4); 598-603 Depression during pregnancy has adverse consequences for both mother and child. Although common in western countries, depression appears to be virtually absent in countries with high seafood intake. This study had mothers at 32 week’s gestation complete a questionnaire that included symptoms of depression along with a questionnaire from which the amount of omega-3 fatty acids from fish was calculated. Analyses showed lower intake of omega-3 from seafood was associated with high levels of depressive symptoms. Women consuming more than 1.5 grams of omega-3 from seafood per week were the least likely to display depressive symptoms.

Postpartum Depression and Fish Consumption Hibbeln, J.R. (2002) Journal of Affective Disorders 69(1-3) 15-29 25.0 South Africa Brazil 22.5 New Zealand r = - 0.76 p < 0.0001 W. Germany 20.0 Australia 17.5 Saudi Arabia United States Italy 15.0 Netherlands UK Canada Edinburgh Postnatal Depression Scale Postpartum depreessed % 12.5 France Ireland Israel Chile 10.0 Switzerland Sweden Higher concentrations of DHA in mothers' milk and greater seafood consumption both predicted lower prevalence rates of postpartum depression. Countries with the highest per capita consumption of fish, such as Japan, have the lowers frequency of postpartum depression. The levels of alpha-linolenic The AA and EPA content of mothers' milk were unrelated to postpartum depression prevalence. 7.5 Hong Kong 5.0 Malaysia Japan 2.5 Singapore 20 40 60 80 100 120 140 160 Fish Consumption (lbs/ person/year)

Pregnancy Stage Higher intakes of DHA/EPA during pregnancy (150+ mg/day) have increased birth weights and reduced risk of preterm delivery. Lucas, M. Gestational age and birth weight in relation to n-3 fatty acids among Inuit. Lipids. 39:617-626, 2004. Olsen, S.F., Low consumption of seafood in early pregnancy as a risk factor for preterm delivery. BMJ. 324:1-5, 2002

Lactation/Infancy Stage The level of DHA in breast milk is very low because fish is only consumed about every 10 days. (80 mg/day average.) Women consuming 11,000 mg ALA/day still have very low DHA in milk. Taking 300 mg DHA/day elevates breast milk levels from 0.14% of total milk fats to 0.39%. Although DHA is beneficial to a newborn’s development, DHA levels in breast milk is very low because fish is only consumed about every 10 days. Even when consuming 11 grams of ALA/day, DHA levels are low in breast milk. However, by consuming 300 mg DHA/day, DHA elevates to beneficial levels.

Lactation/Infancy Stage Supplementing with 200 mg/day DHA for four months after delivery resulted in higher scores on the Bayley Psychomotor Development Index at 30 months of age. Jensen, C.L. Effects of maternal DHA intake on visual function and neurodevelopment in breastfed term infants. Am. J. Clin. Nutr. 82:125-132. 2005 The Bayley Scale is a standardized assessment of cognitive and motor development for children ages 1 month through 42 months. It covers such things as memory, problem solving, large muscle coordination, vocalization and emotions.

Lactation/Infancy Stage There is a positive correlation between mother supplementing with fish oil EPA/DHA during lactation and their child’s visual acuity at 4 months age. Lauritzen, L. Maternal fish oil supplementation in lactation: effect on visual acuity and n-3 fatty acid content of infant erythrocytes. Lipids. 38(3): 195-206, 2004

Pregnant and Lactating Women World Association of Perinatal Medicine, the Early Nutrition Academy, and the Child Health Foundation support: Pregnant and lactating women should get at 200 mg DHA per day. Infant formula contain 0.2 – 0.5% DHA of total fat. Baby should continue taking omega-3 after first 6 months of life. J. Perinat. Med. 2008; 36(1);5-14 These three medical organizations support developing and newborn babies receiving long chain omega-3s in amounts sufficient to support optimal visual and cognitive development. Moreover, these organizations conclude that consumption of long chain omega-3s during preganancy reduces the risk for early premature birth. Pregnant and lactating women should aim to achieve an average daily intake of at least 200 mg DHA. When breastfeeding is not possible, infant formula providing DHA at levels between 0.2 and 0.5 weight percent of total fat. Long chain omega-3 intake should continue after the first six months of life, but currently there is not sufficient information for quantitative recommendations.

Infancy Stage Infant formulas containing 0.36% DHA provided 8% improved performance on the Mental Development Index, a measure of memory, problem solving, vocalization, and math. Birch, E.E. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Dev. Med. And Child Neur. 42:174-181,2000

Childhood Stage ADHD children have low blood levels of DHA. A study using functional food sources of omega-3 providing 514 mg DHA + 100 mg EPA showed significant reduction in aggression. Hamazaki, T. The effect of DHA-containing food administration on symptoms of ADHD – a placebo-controlled doubled blind study. Eur. J. Clin. Nutr. 58:838,2004 Voight, R.G. A randomized, double-blind, placebo-controlled trial of DHA supplementation with AD/hyperactivity disorder. J. Ped. 138(2): 189-196,2001 Based on evidence that essential fatty acids are necessary for the proper development of brain function in growing children, EFAs have been tried for the treatment of ADHD and related conditions. This study looked at omega 3 supplementation in 26 children with Attention Deficit Hyperactivity Disorder. This was a double blind, radomized, placebo controlled study; however the number of subjects was not large. These studies found some evidence that consuming DHA might improve ADHD symptoms, especially a reduction in aggression towards others.

Omega-3s Help Prevent All-Cause Adult Mortality and CVD Events Placebo controlled study of 563 men aged 64 – 76 years for three years. Diet counseling plus 2.4 g EPA+DHA per day. Omega-3 reduced all-cause mortality by 47% and heart attack risk by 11%. Einvik, G. et al. Euro. J. Cardiovas. Prev. & Rehab. 10 April 2010 (online) This study showed that supplementation with Omega-3 EPA and DHA was associated with a reduced risk of death from all causes and a reduced risk of cardiovascular events. The researchers studied 563 Norwegian men aged 64 to 76 years for three years. After considering age at the time of the study, smoking status, hypertension, body mass index and serum glucose, long chain omega-3 supplementation reduced all-cause mortality by 47% and reduced risk of cardiovascular events by 11%.

Management of Adult Hypertriglyceridemia Fish oil effective at lowering triglycerides. 2-4 g total EPA/DHA per day lower TGs 30-50%. Can be used in combination with statins with doctor’s supervision. Bucher  HC, Griffith  LE, Guyatt  GH.  Systematic review on the risk and benefit of different cholesterol-lowering interventions.  Arterioscler Thromb Vasc Biol.  1999;19:187–95. Fish oil is hypothesized to exert several separate effects that act together to help protect the heart. The most important action of fish oil may be its apparent ability to reduce high triglyceride levels. Like cholesterol, triglycerides are a type of fat in the blood that tends to damage the arteries, leading to heart disease. According to most, though not all, studies, fish oil supplements can reduce triglycerides by as much as 30-50%%. In a detailed review of 47 randomized trials, researchers concluded that fish oil is capable of significantly reducing triglyceride levels with no change in total cholesterol levels and only slight increases in HDL (“good”) cholesterol and LDL (“bad”) cholesterol. Randomized controlled trials have shown that, along with statins, fish oil is the only other lipid-lowering agent that can decrease all-cause mortality in patients with known heart disease.

Fish Consumption and the Annual Prevalence of Major Depression 6 New Zealand (5.8%) r= -0.84 p< 0.005 Canada (5.2%) 5 France (4.5%) W. Germany (5.0%) 4 Annual prevalence, (rate /100 persons) Major Depression, 3 United States (3.0%) Puerto Rico (3.0%) Korea (2.3%) 2 A number of studies support a connection between dietary fish consumption and a lower prevalence of depression. A possible mechanism is through cytokine modulation. Researchers have found elevated cytokine levels are associated with depression. Many antidepressant drugs inhibit the release of these inflammatory cytokines. Cytokines are proinflammatory chemicals that have direct and indirect effects on the CNS, including how our body reacts to stress and regulates mood and emotions. Omega-3s, and EPA in particular, are well documented inhibitors of proinflammatory cytokines. 1 Taiwan (0.8%) Japan (0.12%) 20 40 60 80 100 120 140 160 Apparent Fish Consumption (lbs./ person/year) Hibbeln, The Lancet, 1998

Age Related Eye Disease Study An average intake of 64 mg/day DHA and 42 mg/day EPA associated with 27% reduction in age-related macular degeneration. A study, published in the Journal of Opthamology and the British Journal of Opthamology, studied the combined effect of multiple dietary nutrients on the risk of Age-related Macular Degeneration (AMD). The highest average intakes of DHA of over 64 mg per day were associated with a 27 per cent reduction in advanced AMD, compared with intakes less than 25 mg per day. Moreover, EPA intakes over 42.3 mg per day were associated with a 26 per cent reduction, compared to intakes of less than 12.7 mg per day. The latest AREDS study published in December 2009 in the American Journal of Clinical Nutrition found participants
 who 
reported 
the 
highest 
long chain omega-3 intake (median: 
0.11%
of 
total 
energy 
intake)
 were 
30%
 less 
likely 
to develop 
AMD compared to participants with the lowest intake of long chain omega-3s.

Omega-3s and Inflammation The application of omega-3 FA’s for long-term pain relief and management of inflammation is warranted. Dose for analgesia effect is 3 grams or more daily of EPA plus DHA. Nutrition & Dietetics. 2009:66;4-6 The use of fish oil has become established as a means for the management of chronic pain arising from joints and the spine. However, there is no evidence that fish oil will slow the progression of a painful condition such as rheumatoid arthritis. The dose needed for anti-inflammatory effect or long-term analgesia is 3 g – 7g daily of EPA plus DHA. These are very high amounts of omega 3 fish oils to take in a day compared to what is typically taken. So take the blood thinning property of fish oil must be taken into consideration.

Conclusion DHA is essential for the growth and functional development of the brain in infants. The visual acuity of healthy, full-term, formula-fed infants is increased when their formula includes DHA. Decreases in DHA in the brain are associated with cognitive decline during aging. Strong correlation between fish consumption and reduction in sudden death from myocardial infarction. DHA is essential for the healthy development of the brain and eyes in infants. Likewise, DHA is needed for maintenance of normal brain function in adutls. The inclusion of plentiful DHA in the diet improves learning ability, whereas deficiencies of DHA are associated with deficits in learning. As we age, DHA helps to reduce triglycerides in the blood and helps to maintain a healthy cardiovascular system. Epidemiological studies have shown a strong correlation between fish consumption and reduction in sudden death from heart attack. Because of omega-3s vast health benefits, foods fortified with DHA are becoming commonplace, including eggs, infant formulas, yoghurt, and milk. Every person, no matter their age, will benefit from consuming more omega-3s through their diet or through supplementation.