1. Omega 3’s and Health Kevin Thomas, RD POMH Food and Nutrition Services

2. Outline  Why are Omega-3 fatty acids unique?  Sources of Omega-3  Omega-3 to Omega-6 ratio  Benefits of Omega-3’s  Prevention & Treatment  Recommended Intake of Omega-3  Fitting Omega-3’s into one’s healthy lifestyle

3. Fats, Fats, and more Fats In US, 26g of sat. fat per day In US, less than 2.5g per day

4. What are Omega-3 fatty acids?  Omega-3 fatty acids are polyunsaturated fatty acids (PUFAs) with a double bond (C=C) at the third carbon atom from the end of the carbon chain.

5. Sources of Omega-3

6. Omega-3 to Omega-6 Ratio  Omega-3 fatty acids (primarily EPA and DHA) are less potent induces of inflammation, blood vessel constriction (tightening), and coagulation (blood clots) than Omega-6 fatty acids  This is not to say that Omega-6’s are all bad but just remember that Omega-3 and Omega-6 complete for absorption.

7. Current State of Fat Consumption  Why is the ratio so unbalanced?  Consider…  The Western diet’s most common source of omega-6 is linoleic acid, found in corn oil, soybean oil, safflower oil, cottonseed oil, sunflower oil, poultry, and some nuts and seeds.  Dr. Joseph Hibbeln at the National Institutes of Health estimates that soybeans, usually in the form of oil, account for an astonishing 10% of our total calories in the United States.

8. Current State of Fat Consumption  No standard recommendation on the ratio omega-6 and omega-3 fatty acid; however, a ratio of 2:1 to 4:1 may be best. and some health educators advocate even lower ratios.  The typical American diet tends to contain 14:1 to 25:1 ratio!

9. Omega-3 versus other “fats”  The human body and it’s tissues are made up mostly of saturated and mono-unsaturated fats whereas the amount of Omega-3’s needed are normally quite small.  As such, humans normally do not have an omega-3 fatty acid deficiency  Tube fed patients  Research on omega-3 deficient rats revealed significant impairments in learning and memory

10. What are Omega-3 fatty acids?  The three types of omega-3 fatty acids  Alpha-linolenic acid(ALA) (found in plant oils, nuts, and seeds)  ALA consumption ranges from approximately 1.3- 2.0 g/day or approximately 0.6% of total energy intake  Eicosapentaenoic acid (EPA-found in marine oils)  Average U.S. consumption is 0.04g/day  Docosahexaenoic acid (DHA-found in marine oils)  Average U.S. consumption is 0.07g/day  It’s commonly estimated that 5% to 10% of ALA is converted to EPA, but less than 2% to 5% of it is converted to DHA.  So, if one does not consume any fish its quite likely they have very little intake of Omega-3’s.

11. Where are Omega-3’s Stored  Red blood cells  White blood cells  Atherosclerotic plagues  Heart tissues  Retina of the eye. Inadequate amounts of DHA leads to permanent abnormalities in eye function  Brain. Concentrations of Omega 3’s found primarily in the brain’s gray matter. Depletion of DHA can impact neurotransmitters of the brain.

12. Disease, Past and Present

13. Clinical Trial of Omega-3’s Number of Trials Cardiovascular disease and stroke2340 Omega 3 fatty acids (potential health benefits) 534 Omega 3 fatty acids and risk factors links to CVD: CVD or stroke 110 Metabolic syndrome 16 Diabetes or obesity 12 Inflammation 97 Dyslipidemia 55 Hypertension 10 Total 290

14. Benefits of Omega-3

15. Heart Health and Fish Consumption  Evidence is accumulating that increasing intake of Omega-3, through fish consumption can:  Decrease the risk of cardiovascular disease  Decrease the risk of blood clots that can lead to sudden cardiac death  Decrease triglycerides  Slows the growth of atherosclerotic plaque  Improve vascular endothelial function (blood vessels keep blood flowing)  Lower blood pressure slightly  Decrease inflammation

16. Disease Prevention and Omega-3  Visual and neurological development  200mg of DHA per day for pregnant mothers (found in fish)  In the US, baby formula contains 8-17mg of DHA per 100 calories (5 ounces)  3 rd trimester of pregnancy and first 6 months of postnatal life are critical periods for DHA build up in the brain and retina.  Studies (12 trials with 1,902 infants) found no effect of Omega-3 supplements on infant cognition at one year of age, but…  Studies (19 trials, 1,949 infants) found a beneficial effect of Omega-3 supplementation with regards to visual acuity

17. Disease Prevention & Fish Intake  2012 meta-analysis of 17 studies with 315,812 participants and an average follow up of 15.9 years showed:  Low (1 serving/week) or moderate fish consumption (2-4 servings/week) had a significant beneficial effect on the prevention of CHD mortality.  16% -21% lower risk of fatal CHD

18. Heart Disease Treatment  Omega-3 found in fish (7-14oz/week)  Decreased total mortality 29%  Supplemental Omega-3 (fish oil pills)  The largest randomized controlled trial of supplemental omega-3 showed 45% lower risk of sudden death that those who didn’t take supplements.  20% lower risk of death from all causes  Took only 4 months to see a significant decrease in sudden death and decease in total mortality.

19. Diabetes Treatment & Fish Intake  Heart disease is the leading cause of death for people with diabetes  A meta-analysis of 23 randomized controlled trials found that omega-3 fatty acid supplements  Lower triglycerides  Lowered VLDL  No changes in total cholesterol, HDL, fasting glucose, fasting insulin

20. Inflammatory Treatment & Fish Intake  Rheumatoid arthritis – 2012 meta- analysis involving 10 controlled trials: High dose supplementation (2.7g/day omega-3) spares the need for anti- inflammatory medications and may reduce joint pain and swelling in some RA patients.  Crohn’s and Ulcerative Colitis - Omega- 3’s not supported by the current evidence  Asthma – No significant effects on clinical outcomes measures

21. Depression Treatment & Omega-3  Data from ecologic studies across different countries suggest an inverse association between seafood consumption and national rates of major depression and bipolar disorders  According to WebMD, “some researchers have found that cultures that eat foods with high levels of omega-3s have lower levels of depression. Fish oil also seems to boost the effects of antidepressants and may help the depressive symptoms of bipolar disorder.

22. Lipid Profile Changes and Omega-3’s  Higher doses of omega-3 fatty acids can lower elevated serum triglyceride levels  3 to 5 g/d of fish oil can reduce triglyceride levels by 30% to 50%, minimizing the risk of both coronary heart disease and acute pancreatitis.  LOVAZA is a combination of ethyl esters of omega 3 fatty acids, principally EPA and DHA. Each one-gram capsule of Lovaza contains 465 mg of EPA and 375 mg of DHA.

23. Summary of Omega-3’s and Heart Disease  Increasing fish consumption to at least 2 servings of oily fish per week has been associated with sufficient reductions in fatal heart attacks and sudden cardiac death as well as showing potential benefits with reducing inflammation.  This amount would provide about 400- 500mg/day of EPA+DHA.

24. Recommendations  American heart association and American Diabetes Association  Eat fish (particularly fatty fish) at least two times (two servings) a week. Each serving is 3.5 ounce cooked, or about ¾ cup of flaked fish. Fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna are high in omega-3 fatty acids.  Institute of Medicine did not establish a tolerable upper intake level (UL) for omega-3 fatty acids, caution was advised with the use of supplemental EPA and DHA, especially in those who are at increased risk of excessive bleeding.

25. Omega 3 Supplements  GNC Triple Strength Krill Oil 1000  GNC Triple Strength Fish Oil 1240  Vitamin World Omega-3 Red Krill Oil 1500mg  Triple Strength Omega-3 Fish Oil ***Prices can vary from as little as.25 to $1.00/day*** Enteric coated is best

26. More Fish or more Fish Oil Pills?  Fish is not the same as fish oil.  Research tends to be more positive on fish versus fish oil (pills)  In one study comparing the effects of fish and fish oil, researchers found that levels of DHA after 6 weeks of salmon consumption were nine times higher than after fish (pills) oil administration.  Fish oil pill’s composition (amount of DHA/EPA) can be much higher than fish, however, those levels mean very little unless we consider how well they’re absorbed. Actual fish is absorbed much better.  Also, omega-3’s are better absorbed with a meal that contains fat.

27. FACT: The benefits of Omega-3’s depends upon many factors

28. Any questions?

29. Cited Sources (found in slide notes)  1. https://en.wikipedia.org/wiki/Omega-3_fatty_acidhttps://en.wikipedia.org/wiki/Omega-3_fatty_acid  2.http://www.todaysdietitian.com/newarchives/040114p20.shtml  3. http://www.ncbi.nlm.nih.gov/pubmed/10852422http://www.ncbi.nlm.nih.gov/pubmed/10852422  4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494243/  5. http://www.cnn.com/2007/HEALTH/diet.fitness/09/22/kd.gupta.colu mn/ http://www.cnn.com/2007/HEALTH/diet.fitness/09/22/kd.gupta.colu mn/  6. http://www.webmd.com/diet/guide/your-omega-3-family- shopping-listhttp://www.webmd.com/diet/guide/your-omega-3-family- shopping-list  7. http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Hea lthyDietGoals/Fish-and-Omega-3-Fatty- Acids_UCM_303248_Article.jsp#.VruTpPkrLcs http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Hea lthyDietGoals/Fish-and-Omega-3-Fatty- Acids_UCM_303248_Article.jsp#.VruTpPkrLcs  8. http://www.ncbi.nlm.nih.gov/pubmed/24342605http://www.ncbi.nlm.nih.gov/pubmed/24342605  9. http://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty- acidshttp://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty- acids