What Does Science Say? Bioavailability of Triglyceride vs. Ethyl Ester Forms of Fish Oil

Uncategorized

by Chris Speed, MND APD, April 2015

Introduction

Some sellers of fish oil products make superiority claims about the TG form of fish oil, compared to the EE form. This paper reviews current science on the bioavailability of omega-3s in human health WhatDoesScienceSay

Background

Triglycerides are a form of dietary fat. Most fats in foods—vegetable oils, meats, dairy foods, and fish— exist in triglyceride form. Most of the fat in our blood are triglycerides and this form is the predominant form stored in adipose tissue. A triglyceride (TG) molecule is composed of three (3) fatty acids attached to a glycerol backbone by an ester bond. The fatty acids can be saturated, monounsaturated, or polyunsaturated. In fish, about 20-30% of the triglycerides are omega-3 fatty acids: EPA, DPA, or DHA.

Non-concentrated fish oils and cod liver oils are pressed from fish and from cod livers, so they are also 20-30% omega-3. These oils are in the natural triglyceride formb and are sometimes called nTG oils.

To produce fish oil supplements with meaningful doses of EPA and DHA Omega-3 per serving, omega-3s are concentrated up from the starting 20-30% omega-3 in unprocessed fish oil. Concentrated products contain fish oil in either ethyl ester (EE) form or re-esterified triglyceride (rTG) form.

background

Consumers and health professionals like concentrated fish oil products. Higher doses of EPA and DHA are often required to achieve desired nutrition and health benefits. Concentrated fish oil products can provide double or more of the amount of EPA and DHA than regular fish oil but not at double the price. Concentrated fish oil products offer more omega-3 in fewer capsules and are often a better value.

Manufacturing concentrated fish oil: EE and rTG forms

To begin, the three types of fatty acids (saturated, monounsaturated, or polyunsaturated) in the triglyceride are liberated from glycerol and attached to an ethyl alcohol and become ethyl ester (EE) fatty acids. The production of the EE form is a necessary first step. Conversion into the EE form allows omega-3 fatty acids to be separated from the saturated and monounsaturated fatty acids without damaging the omega-3s. At this point, EE omega-3s (EPA, DHA, or DPA) can be molecularly distilled, concentrated to the desired level, delicately purified, and encapsulated, or it can be further processed into a rTG fish oil product.

To produce a rTG fish oil, the EE omega-3 fatty acids are enzymatically re-attached to a vegetable glycerol molecule by a process called re-esterification (rTG), and then distilled, concentrated, purified, and encapsulated. Note that not all of the fatty acids are re-attached as triglycerides: according to The European Pharmacopoeia, a rTG must contain at least 60% triglycerides; the rest is di-glycerides and mono-glycerides. Technology has improved; some manufacturers are now able to employ sophisticated processes to produce rTG oils that contain up to 80-90% triglycerides. This additional processing (re-esterification) adds additional cost to the final product.

Currently, no distinctions or labeling is required for natural triglycerides vs. re-esterified triglycerides, and companies generally refer to both forms as ‘natural’. There are, however, distinct differences in the composition of these two TG forms. In fish and in non-concentrated fish and cod liver oils (nTG), the omega-3 fatty acids are typically, naturally bound to the glycerol molecule in the middle position (SN-2) and hence contain about 20-30% omega-3. In other words, about one out of three fatty acids attached to the glycerol molecule is omega-3 (the 20-30%). In contrast, during production of rTG fish oils, the omega-3 fatty acid is randomly attached to any position on the glycerol molecule (SN-1, 2, or 3) and the statistical probability is that more omega-3 will attach at SN-1 and/or SN-3 than at SN-2. It is unknown if any physiological differences exist due to the location of attachment of the omega-3 fatty acids to the glycerol. Though claims are made, a preliminary human study suggests that the location of attachment does not affect absorption. 1

It is often argued that the rTG form of omega-3 is natural and the EE form is not, but in reality, both EE and rTG forms of fish oil are relatively new as concentration of fish oils began in the 1980s. 2

Absorption

Under normal conditions, humans absorb 85-95% of the fat we consume. 3 Research has also shown that we absorb omega-3 from fish and fish oil capsules equally well. 4 It is the tissue levels of omega-3 that matters most. Regardless of the form (e.g., EE) or source (e.g., fish or supplements), improving tissue levels of omega-3 takes time.

Bioavailability

Bioavailability is the degree and rate at which a nutrient is absorbed or made available at the site of physiological activity. There are essentially two definitions of bioavailability:

  • Short-term bioavailability measures the amount and rate at which a nutrient gets absorbed and enters the blood stream.
  • Long-term bioavailability measures how much and how effectively a nutrient reaches its target tissue where it is physiologically active.

There are substantial differences between these two types of bioavailability. For example, the amount of omega-3 fats that enter the bloodstream is different from (and greater than) the amount that reaches target tissues. Measuring levels of omega-3s in the blood is relatively simple and inexpensive, but the conclusions that can be made from this information is limited because omega-3s are not active in the blood stream; omega-3s function in tissue. Blood levels of omega-3s change within hours of intake but this doesn’t reflect tissue, or cellular, levels. It is the amount of omega-3 that reaches ‘steady state’ levels in tissues that matters. Membrane tissue levels are the best measure of omega-3. It takes 8-12 weeks to see meaningful changes in tissue levels, and it takes months of consistent consumption for tissue levels to stabilize, or reach ‘steady state’. Furthermore, individual factors such as age and body weight influence how much omega-3 reaches tissue levels. For example, it takes longer for omega-3 tissue levels to change in overweight individuals, and one study measured faster changes in omega-3 tissue levels in older individuals, compared to younger adults. 5,6,7,8 There are other factors that influence absorption of omega-3 from fish oil, too.

tissueistheissueFor example, enteric coating of capsules can delay or reduce absorption and consuming fat in a meal or snack along with the omega-3 supplement will increase absorption. 9

Clinical Research Review:

Several short-term bioavailability studies have reported no difference between the EE and TG forms:

  • When two doses (35% and 54%) of EPA and DHA from nTG and EE forms were compared, no difference in absorption was measured. 10
  • A comparative study of meals containing omega-3 as EE or TG showed normal absorption of both EPA and DHA. 11
  • It is known that absorption of omega-3 fatty acids is better when consumed with a fat-containing meal. When researchers compared absorption of EE and TG forms in male volunteers consuming a low-fat (8g) versus high-fat meal (44 grams total fat), there was a marked increase in absorption of EE form, but absorption of both TG and EE forms significantly improved. 12
  • A 2-week study in healthy males reported no difference in the absorption between EE and nTG omega-3 when the equivalent amount of EPA and DHA were consumed. 13

One comparative study reported that rTG increased blood levels faster in the short-term:

  •  A 2-week study in healthy adults evaluated absorption of five forms of omega-3 fish oils: EE fish oil; rTG fish oil; free fatty acids; and fish body oil and cod liver oil containing nTG form. 1 Doses ranged between 3,100 – 3,600 mg EPA and DHA.
  • Omega-3 blood levels increased at a faster rate with the rTG than with the EE form but the study didn’t last long enough for blood levels to reach steady state. The different forms of fish oil were well absorbed and this study suggested there may be differences in the rate of absorption in the short-term but it does not show change in tissue levels over time. In addition, it’s unknown if subjects consumed the supplements with fat-containing food or snacks.

Several longer-term bioavailability studies have reported similar benefits between the EE and TG forms:

  •  A 7-week placebo-controlled study that compared the impact of EE and rTG form (3,400 mg and 3,600 mg EPA and DHA, respectively) in healthy male subjects reported similar and beneficial influence from both forms on platelet function. 14
  • A 12-week randomized, double-blind study compared the impact of 2,000 and 4,000 mg of EE and rTG omega-3 in subjects with elevated triglycerides. With both forms, plasma triglycerides were lowered and no differences in assimilation or triglyceride lowering were measured. 15
  • A 6-month double-blind, placebo controlled trial compared the effect of 1,680 mg of EPA and DHA in rTG and EE forms on omega-3 levels in red blood cells (the Omega-3 Index). 8
  • The omega-3 index increased significantly in both rTG and EE groups. It increased more in the rTG group, but again, the study authors noted that whether or not this difference has meaningful impact on clinical outcomes (e.g., reducing triglycerides, reducing risk of sudden cardiac death) is unknown. Faster increases in blood levels don’t imply better efficacy.
  • A 6-month randomized controlled trial in men with documented heart disease compared the effects of EE (7 grams) and rTG (6 grams) omega-3 versus placebo. In both omega-3 groups, plasma omega-3 levels increased significantly and mean triglyceride levels reduced significantly. 16

EE fish oils have an excellent safety profile:

The long-term safety of the EE form of omega-3 fish oil is excellent. Safety has been documented in thousands of human studies. 8,17,18

Conclusion

Based on clinical evidence, there does not appear to be meaningful differences in bioavailability between EE and rTG forms of fish oil.

globalorganizationofepaanddha

References

1 Dyerberg J, Madsen P, et al. Prosta Leuko Ess Fatty Acids 2010;83(3):137-141.

2 von Schacky C. Vasc Health Risk Manag. 2006;2(3):251-262.

3 Essential fatty acids. Linus Pauling Institute, Corvallis, OR.

4 Harris WS, Pottala JV, et al. Am J Clin Nutr 2007;86:1621–1625.

5 Schuchardt JP, Hahn A. Prostaglandins Leukot Essent Fatty Acids. 2013 Jul;89(1):1-8. 6 Neubronner J,

Schuchardt JP, et al. Eur J Clin Nutr 2011;65(2):247-254.

6 Neubronner J. Schuchardt JP, et al. Eur J Clin Nutr 2011;65(2):247-254.

7 Flock MR, Skulas-Ray AC, et al. J Am Heart Assoc. 2013;2(6):e000513.

8 Vandal M, Freemantle E, et al.. Lipids 2008;43(11):1085-1089.

9 Lawson LD, Hughes BG. Biochem Biophys Res Commun 1988;156(2):960-963.

10 Luley C, Wieland H, et al. Akt Ernaehr-Med 1990;15:122-125.

11 Nordoy A, Barstad L, et al. Am J Clin Nutr 1992;53:1185-1190.

12 Raatz SK, Redmon JB, et al.. J Am Diet Assoc 2009; 109:1076-1081.

13 Krokan HE, Bjerve KS, et al. Biochim Biophys Acta 1993; 1168(1): 59-67.

14 Hansen JB, Olsen JO, et al. Eur J Clin Nurt 1993; 47(7):497-507.

15 LA Simons, A Parfitt, J Simons, and S Balasubramaniam. Aust N Z J Med 1990; 20(5): 689-694.

16 Reis GJ, Silverman DI, et al. Am J Cardiol 1990; 66(17): 1171-1175.

17 Harris WS, Ginsberg HN, et al.. J Cardiovasc Risk 1997;4(5-6):385-391.

18 Bays HE, Tighe AP, et al. Expert Reviews Cardiovasc Ther 2008;6(3) 391-409.

What Are Plant Sterols? Why Are They Important?

Education

plantsterolsblogheader

Sterols are fat molecules in the cell membranes of animals and plants with several functions, including a role in making hormones. Cholesterol is the major sterol in humans. We consume it in our diets and our bodies make it as well. Phytosterols come from plants and we can only get them from our diet, as our bodies don’t make them. Both kinds of sterols circulate in our blood and tissues although we have 100’s of times more cholesterol than phytosterols in circulation.

People who consume foods rich in phytosterols (also called plant sterols) tend to have lower LDL levels but to get measurable reductions in LDL we need to consume at least 800 mg and up to 2,000 mg a day. Most of us consume only 150-400 mg daily. Beta-sitosterol is the most common plant sterol and it’s important to read the label to know what you   are getting.

Plant Sterol Graphic

Plant sterols reduce cholesterol by replacing cholesterol in the intestines and blocking absorption, and there seems to be an additive effect when phytosterols are consumed in conjunction with cholesterol-lowering medications.

Foods rich in plant sterols include avocados, nuts (pistachios, pecans, almonds, cashews), sesame seeds, and dark chocolate. Unrefined corn and vegetable oils also contain plant sterols along with omega-6 fats. Beta-sitosterol is absorbed best when consumed with fat (taking it with fish oil   is a good idea). Plant sterols are effective when consumed once a day or over the course of the day.

In addition to supporting healthy cholesterol levels, beta-sitosterol has been shown to help men who have enlarged prostate, also known as BPH, by improving urinary flow and emptying of the bladder. Beta-sitosterol also supports breast, lung, stomach, and colon health.

 

GretchenGretchen Vannice, MS, RDN

Nutrition Consultant

For more information contact:

support@wileysfinest.com

Marine Stewardship Council: The Best Environmental Choice in Seafood

Education

Fishing is hard work; selecting fish shouldn’t be.  

MSC Sustainable SourceFounded in 1996, the Marine Stewardship Council (MSC) was modeled after the Forest Stewardship Council (FSC).  Both the MSC and FSC evolved from coalitions of businesses and environmental organizations that sought to more effectively harness market demand to reward current sustainable harvest practices while creating an incentive to improve practices among less well-managed forests and fisheries. Certified producers work with scientists, fishery managers, and community leaders to responsibly use marine resources now and into the future. The resulting synergy between delivering seafood, producing profits, and protecting ecosystems has changed the game.  Eco-labeling programs, like those from the FSC and MSC, not only give consumers a voice, but they amplify their voice.[i]  They allow us to “vote with our wallets.”

A sign of the MSC’s growing prominence was that the second largest fishery in the world sought their endorsement: Alaska pollock. This already well-managed fishery underwent assessment, and in 2005 became one of the first dozen fisheries globally to be certified. This is the fish sourced by Wiley’s Finest for its omega-3 fish oil. Remarkably, Alaska pollock comprises 30 percent of all U.S. fish landings by weight, and is the fifth most consumed species in the U.S. It was recertified in 2010 (fisheries are required to go through a reassessment process every five years to remain certified).

The MSC abides by three principles:

  1. Sustainable fish stocks:  The fishing activity must be at a level that can be maintained for a fish population. Any certified fishery must operate so that fishing can continue indefinitely and is not overexploiting the resource.
  2. Minimizing environmental impact: Fishing operations should be managed to maintain the structure, productivity, function and diversity of the ecosystem on which the fishery depends.
  3. Effective management: The fishery must meet all local, national, and international laws, as well as must have a management system in place to respond to changing circumstances and maintain sustainability.[ii]

It is different from other seafood eco-labeling or rating programs in several key regards: 

  • It’s not an environmental organization, a seafood or fishing industry group, a federal agency, or a scientific center.
  • It undertakes rigorous, research-based reviews and represents scientific consensus on best international practices for fisheries management rather than special interests.
  • It uses a third-party assessment and certification process that is impartial, transparent and thorough with no influence or interference from the MSC itself.
  • It employs chain-of-custody traceability to combat fraud. In fact, MSC has a mislabeling rate of less than 1 percent compared to the supply chain of non-MSC labeled products of which 18-56 percenthave been found to be incorrect.[iii]

MSC Certified SustainableLike the Consumer Reports ratings or the century-old Good Housekeeping Seal of Approval, the MSC logo assures consumers they’re buying the best. Ask your grocer and nutrition supplier to carry MSC-certified seafood and fish oil supplements. Products bearing the MSC endorsement are good for the ocean, for you, and for the fishing communities worldwide that are committed to protecting fish stocks now and into the future.

About the Author:

PattiParisi

Patti Parisi is a Journalist focused on sustainability, fitness, and healthy living. She co-founded Passionfish(.org) and is producing Ocean Tapas, a celebration of seafood from the ocean to the plate. Patti is also a National Academy of Sports Medicine (NASM) certified personal fitness trainer (CPT), senior fitness specialist (SFS), and weight loss specialist (WLS).

 

References:


[i] Roheim, C. A., Asche, F. and  Santos, J. ‘The Elusive Price Premium for Ecolabeled Products’, Journal of Agricultural Economics, Vol. 62, (2011) pp. 655-668.

[ii] http://www.msc.org/about-us/standards/standards/msc-environmental-standard-for-sustainable-fishing

[iii] http://www.msc.org/about-us/21-facts

ADHD Awareness Month

Education, News

 ADHDawarenessOctober is ADHD Awareness month and this short article is designed to do exactly that – raise awareness by explaining a little about what ADHD is all about from a scientific perspective. 

Attention Deficit Hyperactivity Disorder (ADHD) is by far one of the most pervasive neurodevelopmental disorders worldwide. It is characterized by age-inappropriate symptoms of inattention, hyperactivity (also as in disorganization) and impulsivity. It is thought to affect approximately 6-13% of all children, across cultures, and has an estimated 4:1 higher prevalence in males than females [1, 2]. The term neurodevelopment describes a series of sensitive processes which are both complex and closely interwoven with a number of simultaneous developments such as neuronal migration, neurogenesis, synaptogenesis and myelination, all of which implicate the role of omega-3 highly unsaturated fatty acids (HUFAs).

The process of neural development is mediated by a multitude of factors including genetic and metabolic diseases, immune disorders, infectious diseases, deprivation, physical trauma, toxicity and environmental influences and undoubtedly nutritional factors. Any interruption as a result of any of these factors may result in adverse neurodevelopmental outcomes.

ADHD is highly heritable within families with an estimated 3-5 times greater risk in first-degree relations. So, what this means is if you are a parent with ADHD you will have a better than 50% chance of having a child with ADHD. Similarly, about 25% of children with ADHD have parents who meet the formal diagnostic criteria for ADHD.

ADHDADHD often co-occurs with other behavioral or learning differences such as dyslexia, oppositional defiant disorder and autistic spectrum disorders. There are 3 recognized sub-types: (1) the predominantly inattentive (ADD), (2) the hyperactive-impulsive and (3) the combined. Symptoms are present before the age of 12, commonly manifest around the age of 5-6 years but can be observable in children as young as 2 years.

In regards to the hyperactive-impulsive subtype, characteristic behaviors include an inability to sit still for any period of time, for example on a mat for story time at nursery, fidgeting, tapping, squirming and general restless behavior in particular in a classroom environment. Children with ADHD have immense difficulty following instructions, are prone to talking excessively and make frequent and repetitive interruptions during the conversations of others. In addition, they seem unable to play quietly, are constantly on the go – as if driven by a motor – and can be highly impulsive.

The inattentive subtype can be described metaphorically as the child with their head in the clouds. These children seemingly have an inability to pay close attention to detail unless it is something of immense personal interest. They often make careless mistakes, fail to complete school and homework, struggle to pay attention for any length of time and appear not to be listening even when spoken to directly. Additionally, children with ADD often fail to complete chores around the home and are prone to wondering off, easily distracted. They frequently lose everyday items necessary for everyday functioning, are often messy and disorganized, and have little or no concept of time. This general absent-minded behavior can be utterly debilitating and often lead to chaos in the young person’s life [3].

Children for whom ADHD is not identified, diagnosed or-managed have an even greater risk of adverse outcomes including educational failure, substance misuse and the development of conduct disorder-related and  anti-social related behaviors [2]. The calculated cost of ADHD to society and healthcare systems is substantial in the region of tens of billions of U.S. dollars per annum [4].

According to the National Institute for Clinical Excellence (2008), the first stage of intervention for school children are group-based education programs and parent-training sessions (NICE, 2008). Drug treatment is meant to be reserved for those young people with more severe symptoms and impairment, or those with moderate severity who have declined other non-drug treatments or have not responded sufficiently to group psychological treatment or parent-training/education programs (NICE, 2008). However, for many reasons, parents often seek natural alternatives and a much debated area of research is the potential role of omega-3 in ADHD [5].

Omega3&NervousSystemOmega-3 HUFAs play a critical role throughout the central nervous system and docosahexaenoic acid (DHA) is particularly abundant in neuronal membranes. These fats are involved in complex and varied functions including but not restricted to cell-signaling (e.g., 75% of the myelin sheath coating neurotransmitters is made up of these specialized fats), gene expression and regulation of serotonin and dopamine. DHA is thought to specifically increase neuronal responses by enhancing the flexibility of cell membranes. Several randomized clinical trials have found that supplementation with omega-3 fats can help improve symptoms of ADHD in children [6-8]. Our research team in the Section of Nutritional Neurosciences at the National Institutes of Health are about to test the potential role of omega-3 in reducing clinical symptoms of ADD/ADHD in adults, for further information please visit clinical trials.gov: http://clinicaltrials.gov/show/NCT02156089

DISCALIMER: In no way or form does the content of this article represent any policy or position of the US Federal Government. All material is referenced to its appropriate source or is solely the opinion of the author.

 

Rachel V. Gow professional photo

 

By Dr. Rachel V. Gow / www.drrachelvgow.com / twitter #drrachelvgow / f facebook.com/pages/Inside-ADHD/ email: dr.rachelvgow@gmail.com

 

 

References

[1] J. Biederman, S.V. Faraone, Attention-deficit hyperactivity disorder, The Lancet, 366 (2005) 237-248.

[2] R.V. Gow, J.R. Hibbeln, Omega-3 Fatty Acid and Nutrient Deficits in Adverse Neurodevelopment and Childhood Behaviors, Child and adolescent psychiatric clinics of North America, 23 (2014) 555-590.

[3] S. Effat, N. Mohamed, H. Hussein, H. Azzam, A. Gouda, H. Hassan, 670 – ADHD symptoms: relation to omega 3 serum levels before and after supplementation, European Psychiatry, 28, Supplement 1 (2013) 1.

[4] W.E. Pelham, E.M. Foster, J.A. Robb, The economic impact of attention-deficit/hyperactivity disorder in children and adolescents, Ambul Pediatr, 7 (2007) 121-131.

[5] N. Parletta, C.M. Milte, B.J. Meyer, Nutritional modulation of cognitive function and mental health, J Nutr Biochem, 24 (2013) 725-743.

[6] M.H. Bloch, A. Qawasmi, Omega-3 Fatty Acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis, J Am Acad Child Adolesc Psychiatry, 50 (2011) 991-1000.

[7] A.J. Richardson, J.R. Burton, R.P. Sewell, T.F. Spreckelsen, P. Montgomery, Docosahexaenoic acid for reading, cognition and behavior in children aged 7-9 years: a randomized, controlled trial (the DOLAB Study), PloS one, 7 (2012) e43909.

[8] A.J. Richardson, P. Montgomery, The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder, Pediatrics, 115 (2005) 1360-1366.

 

 

The Case for Omega-3s has Never Been Stronger!

Education, Uncategorized

Case For Omega3s Has Never Been Stronger!

Recent research findings continue to support the case that EPA and DHA Omega-3s – the omega-3s found in fish and fish oil – are an essential pillar of a properly balanced and healthy diet.

FDA Revises seafood intake during pregnancy – a study by the National Institute of Health (NIH) showed that a deficiency in Omega-3 of the mother’s diet during pregnancy is linked to a lower IQ of the child during later years of childhood.  While many people believe that mercury content of fish is a big concern, in fact Omega-3 deficiency from not eating fish is a much larger and more severe dietary issue. Recent findings indicate that the benefit of getting enough omega-3 for both mother and child is far more important than the potential risk of consuming mercury. An infant needs DHA omega-3 to develop normally and it good for mothers, too. Many well-read dietitians and nutritionists have long known that the challenge is for mothers to get enough seafood, not to worry about them consuming too much!

In June of this year, as a result of a careful review of recent dietary research, the FDA and EPA updated its published guidelines for seafood intake during pregnancy. Instead of previous confusing recommendations that pregnant mothers limit seafood consumption to not more than 12 ounces per week, the FDA and EPA now recommend that mothers eat at least two  (and up to three) servings of fish per week during pregnancy for proper child development. In their official updated advice, FDA notes, “The nutritional value of fish is especially important during  growth and development before birth, in early infancy for breastfed infants, and in childhood.”

EPA and DHA Omega-3s help lower blood pressure – In March, a landmark scientific review of over 70 randomized controlled trials that were designed to study blood pressure was published. The review found significant scientific agreement that consumption of over 2000mg of EPA and DHA Omega-3 per day was just as or more effective at lowering blood pressure as other common lifestyle interventions, such as limiting sodium, getting exercise, or limiting alcohol consumption. This is significant, since about 1 in 3 Americans have high blood pressure, and many don’t even know it.  High blood pressure is a major contributor to heart disease.Blood Pressure Chart

 

Omega-3 consumption leads to Lower Healthcare costs – a recent study commissioned by the Council for Responsible Nutrition found that nearly 98,000 hospitalizations for heart disease events could be avoided for a combined net savings of $348.8 million per year. These cost savings would be realized simply with enough Omega-3 consumption via supplementation. This is supported by prior research conducted by Harvard School of Public Health researcher Dr. Dariush Mozaffarian, which found that as little as 250mg of EPA and DHA Omega-3s per day would reduce the risk of sudden death due to a heart attack by 1/3 or 35%.

Heart disease is a major issue – it is the number one killer of both men and women. It is estimated that nearly 7% of all adults in the U.S. have heart disease about 1 of every 6 deaths in the US is due to heart disease. The risk sharply increases with age, as over 16% of those over age 55 have heart disease.

The US lags the rest of the developed world by not having a recommended daily intake for EPA and DHA Omega-3 –Research has exploded in the last decade and the National Institutes of Health are behind in setting recommendations. Most countries in Europe recommend at least 250mg of EPA & DHA, and many suggest 500 mg EPA and DHA. Japan and Korea have recommended intakes as high as 2000mg/day of EPA and DHA Omega-3s. In the US, Academy of Nutrition and Dietetics recommends at least 500 mg of EPA and DHA per day for general health. The American Heart Association and American Psychiatric Association suggest 1000 mg per day of EPA and DHA for people with a history of heart disease or mood and impulse control problems.

The source of Omega-3s matters – Plant sources such as vegetable oils, nuts, and grains – like flax and chia seeds – deliver short chain omega-3s, which the body has difficulty efficiently transforming into the long-chain Omega-3s EPA and DHA.  These short chain omega-3s just don’t work the same as premade EPA & DHA from fish, seafood, and fish oils.  EPA and DHA Omega-3s from Marine sources are necessary for good mental health, heart health, healthy eyes and maintaining proper joint health.

How do I get enough Omega-3s – food or supplements?  Food is always the best source– eating oily fish delivers the best forms of Omega-3s, Vitamin D, as well as other nutrients such as iron, potassium, magnesium, calcium, and selenium. It is also a fantastic source of protein for building and maintaining healthy muscles.

However, many people do not like to eat fish, cannot afford to eat fish regularly, or do not have regular access to high quality fish which isn’t breaded and deep-fried.  Unless you eat fish or take fish oil supplements every day, you are probably not getting enough Omega-3s in your diet. Thankfully, fish oil supplements can deliver affordable daily doses of EPA & DHA Omega-3s – a high quality supplement can deliver a meaningful amount for less than $1.00 per day. I try to eat fish several times a week, but I also make sure to take a fish oil supplement every day to fill in the gaps.

If you are planning to rely on eating fish to get all your omega-3s, the kind of fish eaten is very important: fatty ocean fish such as salmon and sardines have high levels of Omega-3s and some freshwater fish, like trout, have a good amount as well, but farmed tilapia, catfish or swai are fed lots of corn and soy and as a result have very little EPA and DHA Omega-3s. Pregnant women should avoid eating shark, swordfish, orange roughy, and eat not more than a can of albacore tuna a week.

Mankind grew up near the sea – civilization developed around eating fish and seafood. Omega-3 fats found in fish, seafood and fish oils. (good fats) are essential for your heart health, brain health, for managing your body’s natural inflammation  process  and most of all for prenatal and infant development.  However you get your Omega-3s, make sure you are getting enough in your diet every day to realize their full potential for making a difference in your health and daily life for you and your family.  Children need them, too.

Omega-3′s and Joint Health

Education

jointhealth.png

 

  • EPA and DHA omega-3s are essential nutrients for joint health.
  • Omega-3s help joints stay healthy and flexible in adults of all ages.
  • Individuals with rheumatoid arthritis can benefit from regular consumption of sufficient fish oil.

Everybody needs omega-3s, but people who experience joint pain and stiffness or have rheumatoid arthritis have a special need for EPA and DHA, the long-chain omega-3s. These healthy fats, which are necessary for good nutrition, are specifically helpful for healthy joints, such as hips and knees.  Because our bodies cannot make EPA and DHA, we need to eat them in our diet.

Arthritis is the leading cause of disability

Arthritis is a condition that affects the joints.  There are many types of arthritis but common to them all is joint pain, discomfort, and restricted mobility.  Arthritis affects more women than men and more adults over 45 years of age and older.  Over time, arthritis can seriously impair quality of life. It is the leading cause of disability in the United States[1].

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease distinguished by chronic inflammation in multiple joints in the body.  Individuals with RA experience joint pain, swelling, morning stiffness, limited flexibility, and impaired motion, all indicators of joint and tissue inflammation.

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How do omega-3s work?

EPA and DHA omega-3s are important for people with joint pain and stiffness and for people with RA because they strengthen the immune system and help lower inflammation in joints and tissues. Research has identified that omega-3s work in several ways. For example, EPA omega-3 is directly and indirectly involved in reducing inflammation while EPA and DHA together help manage joint mobility and restore joint and tissue health. Plus there is an added benefit: people with RA have a higher risk for heart disease and EPA and DHA are well known for supporting good heart health[2],[3],[4].

Many studies using fish oil for joint health and RA have been completed over the past 20 years. Studies have reported improvement in several RA symptoms after daily consumption for several months of at least 3 grams of EPA and DHA omega-3: less joint pain, smaller number of painful joints, less morning stiffness (shorter duration), and less use of non-steroidal anti-inflammatory (NSAID) medications. Research also shows continued improvement with consistent supplementation.  Conversely, it is important to note that studies routinely report no benefit for RA until at least 3 months of regular supplementation and no reduction of symptoms from consuming less than 1000 mg EPA and DHA per day[5],[6],[7],[8],[9],[10].

Regular consumption is key.RA research consistently reports that regular consumption of sufficient amounts of EPA and DHA is key to reducing symptoms and improving quality of life.

How much to consume

It is recommended that individuals with joint pain and stiffness consume 1,000 – 2,000 mg EPA and DHA per day. For individuals with RA, daily doses of at least 3 grams (3,000 mg) of EPA and DHA with relatively more EPA than DHA are suggested4,6,7,8.  (Note: Research has shown good results with up to 6 grams per day, but it’s best to talk with your doctor or dietitian before consuming this much omega-3).

Read labels carefully.The amount of fish oil per serving is not the same as the amount of EPA and DHA per serving.  Be sure to read the label for mg of EPA and DHA.

Because frequent and substantial consumption of omega-3 rich fatty fish, such as salmon and sardines, is essential for improving arthritis, consuming enough omega-3s in the diet can be challenging. For people who don’t like fish or who won’t eat fish, and for those who want the convenience and reliability of a supplement, purified and concentrated fish oil supplements are an effective choice. Fish oil supplements (capsules or liquid) should be taken with food, all at one time (with a meal) or over the day.

Summary

Regular consumption of EPA and DHA omega-3s supports joint health and helps reduce joint stiffness as well as symptoms of rheumatoid arthritis when consumed over long periods of time. In addition, omega-3s support the heart and healthy blood pressure levels, improve mood, and provide good nutrition, all attributes that contribute to better health and more youthful aging.

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By Gretchen Vannice, MS, RDN ©All rights reserved 2014

About the author: Gretchen Vannice, the Omega-3 RD, is a registered dietitian, nutritionist, and consultant who specializes in omega-3 fatty acids and natural foods. She is a strategist, trainer, speaker, and author. Gretchen is lead author of the “Position of the Academy of Nutrition and Dietetics: Dietary Fatty Acids for Healthy Adults” published January 2014 and author of the Omega-3 Handbook: A Ready Reference Guide for Health Professionals. She can be reached at www.omega3handbook.com.

Disclaimer:  Written by an independent nutritional expert, this information is provided for educational purposes only.  It is not intended as medical advice.  Always consult your healthcare provider for medical advice.

References


[1] http://www.cdc.gov/features/dsadultdisabilitycauses/

[2] Calder PC.  n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases.  Am J Clin Nutr 2006;83(6 Suppl):1505S-1519S.

[3] Walsh N. Fish oil for rheumatoid arthritis. Family Practice News, 2004;34(20).

[4] Hill C, Gill TK, et al. The use of fish oil in the community: Results of a population-based study. Rheumatology 2009;48:441-442.

[5] Fortin PR, Lew RA, et al. Validation of a meta-analysis: The effects of fish oil in rheumatoid arthritis. J Clin Epidemiol 1995, 48(11):1379-1390.

[6] Kremer JM. Omega-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr 2000;71:349S-351S.

[7] Goldberg RJ, Katz J.A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain.Pain, 2007;129(1-2):210-223.

[8] Lee YH, Choi SJ, et al. AB0613 omega-3 polyunsaturated fatty acids for the treatment of rheumatoid arthritis: A meta-analysis. Ann Rheum Dis 2013;71:673.

[9] Galarraga B, Ho M, et al. Cod liver oil (n-3 fatty acids) as a non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology 2008;47:665-669.

[10] Proudman SM, Cleland LG, James MJ. Dietary omega-3 fats for treatment of inflammatory joint disease: Efficacy and utility. Rheum Dis Clin North Am 2008;34(2):469-479.

Lemon Berry Omega-3 Smoothie Recipe

Fish Dish of the Month, Products

Lemon Berry Omega-3 Smoothie Recipe

After making the Orange Burst smoothie a few months ago, I was happy to try this Lemon Berry Omega-3 Smoothie with Wiley’s Finest Wild Alaskan Fish Oil Peak Omega-3 Liquid. Smoothies are my way of getting several nutrients in a single serving. My go-to smoothie includes berries, chia seeds, spinach and sometimes other fruits or greens. I wanted to try this fish oil in a berry smoothie to see if it would make any difference in flavor.

Lemon Berry Omega-3 Smoothie Recipe Lemon Berry Omega-3 Smoothie Recipe Lemon Berry Omega-3 Smoothie Recipe Lemon Berry Omega-3 Smoothie Recipe   Peak Omega-3 Liquid Supplement Facts

The Peak Omega-3 Liquid is a great source for Omega-3s. It has 2,150 mg of EPA + DHA per serving. That’s a lot for just one teaspoon! They have different sizes of bottles, so you can just get the 12 servings to try it out and make sure you like it first, which is great.

The flavor of this fish oil is so good, you can’t even tell it’s fish oil. It makes this smoothie taste more like a dessert than a healthy beverage. I would recommend trying it with several different smoothie recipes including this one.

Lemon Berry Omega-3 Smoothie Recipe

Here’s what you’ll need:

1/2 cup frozen or fresh blueberries

5 medium sized frozen or fresh strawberries

1/2 cup baby spinach leaves

1 tablespoon black chia seeds

1 teaspoon Wiley’s Finest Fish Oil Peak Omega-3 Liquid – Naturally Lemon Flavored

1 cup almond milk (or any milk you prefer and sometimes I use just water)

2 ice cubes (optional, usually used when not using frozen fruits)

Lemon Berry Omega-3 Smoothie Recipe  Lemon Berry Omega-3 Smoothie Recipe

 

Directions:

Place blueberries, strawberries, spinach, chia seeds, Peak Omega-3 Liquid, and almond milk into blender. Pulse 10 times and blend on high for 1 minute. If more liquid is needed add 1/4 cup of water or until it blends easily.

Lemon Berry Omega-3 Smoothie Recipe

Pour smoothie into a 16 oz cup. Now enjoy this delicious Lemon Berry Smoothie! Be sure to refrigerate any leftover.

I hope you enjoy this smoothie as much as I did. The flavor is great and it even has an award winning taste, so you know it’s really good. Be sure to try it in your next smoothie! Buy it here.

Peak Omega-3 Liquid Taste Award

Healthy Pregnancy: Third Trimester

Pregnancy, Prenatal DHA

The third trimester is marked by little feet kicking your ribs, going to the bathroom all the time, and just feeling incredibly big. I am getting pretty tired of hitting counters, cabinets, doors, etc. with my big belly. This is  a time of preparation gathering up the last items you need to welcome your child into the world and, above all, patience. I find it helpful to remind myself the baby really does need those last few weeks and days to grow and develop before they are ready to make their grand entrance. Part of your preparations should continue to include healthy habits as you get ready for the work of labor and delivery and the first few weeks postpartum.

Healthy Eating:

  • Eat nutrient rich meats. The last trimester the baby needs lots of DHA and your iron requirements really jump. Eat fatty fish several times a week to get more DHA (think salmon, sardines, and herring). Red meat and organ meats (livers and hearts) are amazing sources of heme-iron, although I will admit I really don’t like organ meats so I just take a supplement (see below).

Exercising:

  •  Be mindful of the bump. The baby takes up a lot of room now and it quite heavy, which can throw you off balance. Just be careful when exercising and stay away from twisting, bending over, and lifting heavy items (like your toddler).

Supplements:

  • More DHA! The baby’s brain and eyes go through a final growth spurt in the third trimester and baby needs a lot of DHA. To be sure you’re getting adequate amounts of DHA, a supplement is really best. The Prenatal DHA has 600 mg of DHA per serving, but you should consider taking 900 mg (3 pills) of DHA in the last trimester. I am currently taking 3 Prenatal DHA softgels and 1 teaspoon of Peak Omega-3 Liquid a day so baby gets enough DHA for their brain and eyes and mommy gets enough EPA for the back aches.
  • Iron. Many women become anemic during the third trimester so you should consider an iron supplement. You can have your doctor or midwife do a simple blood test for anemia especially if you are feeling very tired all the time. Iron supplements can cause nausea and constipation. There are also a couple different forms of iron salts that can be used to make iron supplements. The most bio-available and gentlest form is ferrous gluconate. The liquid, herbal iron supplements are generally agreed (by myself and friends) to have the fewest side-effects. I would recommend trying Floradix Iron and Herbs or Gaia PlantForce Liquid Iron.

For more information about the importance of DHA while pregnant and nursing, see our blog post by Gretchen Vannice, MS, RDN.

 

37 weeks

Just a few more weeks until baby Wiley #2 arrives!

Spicy Korean Fish Soup (Maeuntang) Recipe

Fish Dish of the Month

Spicy Korean Fish Soup (Maeuntang)

 

When contemplating what way I should prepare seafood my mind always leaps to memories of Korean food—bubbling jjigae impossible to consume without tearing up, spicy sauted squid eaten over rice for breakfast, fish cakes sold by teasing street vendors, and exquisitely fresh octopus still wriggling and clinging to my throat while I swallow. However, in the Midwest it is nearly impossible to find anything but a pale imitation of the delicious Korean food I fell in love with in Seoul, unless you prepare it yourself that is or are fortunate enough to know an indulgent ahjumma. So in a fit of nostalgia—and the demands of a deprived palate—I decided to tackle making maeuntang (spicy fish stew) over the weekend.

One of my favorite aspects of Korean cooking is plethora of vegetables found in the dishes, as well as the predilection for incorporating meat or seafood cuts often ignored in American cuisine. The use of bones and the fish head in this soup infuse the soup with oodles of nutrients and a delicious flavor. Another appealing trait of many Korean dishes is how simple and swift the dish prep and cooking time often are despite extensive ingredient lists, making them ideal for pulling together swiftly after long work days. All the ingredients for this dish should be easy to locate at a local Asian grocery.

Prep Time: 20 minutes. Cooking Time: 30 minutes.

Ingredients:

  • 1 whole fish (cod or snapper is preferable)
  • 1 1/2 cups Korean radish (daikon can also be used)
  • 1 block firm tofu
  • 1 bunch of edible chrysanthemum leaves (ssukgat or shungiku)
  • 1 bunch green onions
  • 1-2 handfuls of bean sprouts
  • 2 tbsp gochujang
  • 1 tsp red pepper flakes
  • 4 shiitake mushrooms
  • 1 small bunch enoki mushrooms
  • 2 tbsp fish sauce
  • 2 tbsp soju or cooking wine
  • 6 cloves garlic
  • 1 tsp ginger root
  • 6-8 cups water
  • 1 sheet of kelp (optional)

Using really fresh fish is key to this dish, maeuntang is actually often prepared in Korea alongside sashimi orders—creating another dish out of the fish pieces left over from sashimi preparation. If fresh whole fish are not easily attainable where you live then fish fillets can be easily substituted. However, a whole fish is preferable since the head and bones give the soup’s broth its wonderful taste.

Ascertaining the freshness of prospective fish at your local fishmonger or market can seem slightly daunting, but there are a handful of easily recognizable indicators. Firstly, check the gills, they should be a deep red colour, if they have already changed to a dull rusty shade then the fish is spoiled. Another clear sign of freshness is bright clear eyes—older fish tend to have cloudy eyes. Also look for firm resilient flesh and a distinct lack of a fishy reek.

Spicy Korean Fish Soup

 

Prep~

Scale the fish (if necessary), wash it thoroughly in cold water, and remove the fins—kitchen shears are ideal for this task. Then cut it into several large chunks, reserving the head.

Spicy Korean Fish Soup 2

 

Scrub the radish and slice it thinly. Cut the ends off of the enoki mushrooms and then separate them. Gently wipe off any dirt on the shiitake mushrooms with damp paper towel and then thickly slice them.

Spicy Korean Fish Soup 3

 

Wash the chrysanthemum leaves and trim them into 6-7 inch long pieces, discarding the thicker portions of the central stalk. Rinse the bean sprouts and pat them dry. Peel the garlic cloves and ginger and chop them finely. Wash the green onions and slice them into ½ inch segments.

 

Cooking~

First prepare the stock by adding the radish slices, shiitake mushrooms, and kelp to the water and then simmering for 15-20 minutes. Note: if you aren’t keen on the idea of serving a finished dish with a fish head floating in it now is also a good time to add in the fish head. After 15-20 minutes discard the kelp (and fish head if added earlier) and skim off the broth.

Spicy Korean Fish Soup 5

 

Add the gochujjang, pepper flakes, fish sauce, soy sauce, garlic, ginger, and fish to the pot and bring to a boil. Simmer until the fish is completely cooked, 15 minutes or so. Then add the green onions, bean sprouts, tofu, and chrysanthemum leaves and cook for 2-3 minutes longer till the tofu is warmed and the vegetables are lightly cooked. Serve it alongside hot rice.

A delightful bonus to Korean soups is that in addition to providing a vibrant, healthy combination of vegetables and protein, they also keep quite well and reheat easily. So I love making them on the weekend and indulging in the leftovers throughout the week. You can also vary the components of maeuntang extensively to suit your preferences or whatever fresh produce you might have on hand that week. Common additions to the soup tend to be zucchini, fresh chilis, clams, shrimp, and water dropwart.

Spicy Korean Fish Soup 4

Testing Your Omega-3 Blood Levels

Education

Ed Note: A breakthrough has enabled scientists to develop My Omega Blood Test, to measure the balance of Omega-3 and Omega-6 in blood so that consumer’s know that a real problem exists so they can start to fix it. The test has been used by thousands of individuals who are now able to helps them make informed dietary decisions and determine whether their dietary changes are actually having the desired effect on their omega-3 and 6 blood levels. Our regular contributor Sarah reviews this great tool for learning more about your own personal Omega-3 levels.

When I was asked to test my Omega-3 levels, I was fairly confident of the result. My love of reading and cooking has propelled me through a whole host of books about nutrition (both conventional and alternative) and has given me the tools I need to make wise food choices for myself and my family. The ideal ratio of Omega-3 to Omega-6 fatty acids is at least 1:1 (meaning that your Omega-3 levels should be equal to or higher than your Omega-6), and that’s what I expected to find. Boy, was I wrong.

But let’s back up a little bit. The test came through the mail in a tidy packet from My Omega Blood Test and was quite easy to use.

Omega-3 Blood Test

The package comes with two needles, which need to have their little purple tips pulled off before use, like so:

Needles

Then you massage the tip of the finger you want to prick (This is important to increase blood flow. I neglected to follow the instructions the first time around and so didn’t get enough blood for the test to work), wipe it with the provided sanitizing wipe, and then poke it with one of the two needles. I had to squeeze my finger a bit in order to cover the test area completely, but the whole ordeal was much less painful than getting a shot. There are two circular test areas that must be covered for the test to be accurate.

Test Area

Once you’re finished, the test goes into a sealed bag which fits neatly into a pre-addressed envelope. Pop it back in the mail, and you’re good to go.

After I sent in my test (the one with the correct amount of blood – it really is important to fill the test areas completely!), I received an emailed link to a the OmegaSense test site with login information to view the status of my test. Another two weeks later, my results were emailed to me.

The report you receive after taking this test is quite detailed. The first page after the cover shows you your Omega-3 to Omega-6 ratio with a helpful graph:

Omega-3 Blood Test Page 1

Ugh, the amount of red (Omega-6) in that picture was a surprise to me. My Omega-6 levels are nearly three times higher than my Omega-3s! This is of course discouraging, but it is also motivational, as it is forcing me to take a hard look at the reality of my eating habits. Here are a few things I have discovered:

1. I do not eat nearly as much fish as I think I do. People eat very little fish here in the States, so it is easy to imagine that because I eat more than the norm I am eating enough. That simply isn’t true. According to Dr. Frank Sacks, a Professor of Cardiovascular Disease Prevention at Harvard, in order to get my Omega-3s through diet alone, I ought to be consuming at least one serving of fatty fish daily. Eating fish once or twice a week, as I usually do, is not eating a lot of fish, and it is certainly not eating enough fish.

2. My haphazard approach to supplement-taking must go. I have a neat little row of pill-bottles on my shelf, each one of which I have thoroughly researched. But truthfully, I have no idea how often I actually take them. As is often the case with us parents, I am much more diligent about my children’s fish oil consumption than my own. They both take Wiley’s Finest Orange Burst Liquid every morning, and, according to my three-year-old daughter’s reasoning, it’s the “medicine which makes me big enough to ride my big girl bike!”

3. I have fallen further from my nutritional ideals than I had realized. To be fair to myself, we’ve undergone a quite a lot of upheaval in the past few months, from a death in family that completely changed our plans to a sudden move and an adjustment to our new circumstances. But now is a good time to put away processed foods (which are not only generally nutritionally inferior, but are also often horribly high in Omega-6 fatty acids) in favor of a return to vegetables, fruits, nuts, and fish.

Fortunately for me, the test report also comes with a recommendation page. Some of the information was new to me; some of it I knew already but had forgotten to consider when at the grocery store.

Omega-3 Blood Test Page 2

According to this report, I have two basic steps to take from here.

The first is to examine what kind of fat content I’m getting from my food. According to both the Mayo Clinic and the Union of Concerned Scientists (This is a long report, but it’s very interesting and informative, should you be inclined to read it), milk and meat from pasture-fed cattle tend to have higher levels of Omega-3s then do their conventional counterparts. Aside from just generally eating more fish, making sure my meat and dairy contain high-quality fat seems to be the most significant dietary change I can make.

The second, and, likely most important step (at least at this remedial stage), is to dramatically increase my Omega-3 supplementation. Four grams of EPA/DHA Omega-3 (the kind found in fish oil) is the recommended daily amount for someone with my blood levels. That’s a whole lot of fish oil. The easiest way I could find to consume such a high amount daily is to take two teaspoons of Wiley’s Finest very concentrated Peak Omega-3 Liquid daily. This stuff both tastes great and makes ingesting the recommend amount of Omega-3s much easier than taking a handful of giant pills. In order to track how regularly I’m taking it, I wrote the date I started on the bottle in sharpie.

Peak Omega-3 Liquid Fish Oil

I’ll continue with this level of supplementation until I take the recommended retest in November. I’m excited to see what a few simple changes in my diet might mean for my overall health.

I highly recommend testing your Omega-3 levels for yourself. This certainly has been an eye-opening experience for me, and I’m finding it much easier to make wise choices once I’ve faced the truth about the choices I’ve been making.

So what’s for dinner tonight? Well, I’m currently deciding between Katie’s reinvented Tuna Noodle Casserole and our old standby, Salad Niçoise. Either way, it’ll be delicious.

{This article is not intended to provide or serve as a substitute for professional medical advice.}