American Omega-3 Deficiency

Written by Dr. Steve Chaney on . Posted in Food and Health, Health Current Events, Omega-3 Deficiency, Supplements and Health

Is There an American Omega-3 Deficiency?

Author: Dr. Stephen Chaney

omega 3 deficiencyOmega-3s have been controversial in recent years.  However, virtually everyone agrees that omega-3 intake in North American is low. But, would you believe that the United States and Canada are dead last with respect to omega-3 status – that we are among the countries with the lowest omega-3 status in the world? Is there an American omega-3 deficiency?  That is what a recent study suggests!

Omega-3 Deficiency in Americans

Previous studies have suggested that the American and Canadian diets were deficient in long chain omega-3s like EPA and DHA, but those studies were based on 24-hour diet recalls or food frequency surveys which might underrepresent the true amount of omega-3s in the diet. Therefore, a group of investigators from the United States and Canada decided to look at blood levels of EPA and DHA.

This study (Stark et al, Progress In Lipid Research, 63: 132-152, 2016) was a meta-analysis of 298 studies that recorded blood levels of EPA and DHA. These studies were from 36 counties and distinct regions around the world. They converted all of the measurements to a common unit expressed as percent by weight of EPA + DHA relative to the total weight of fatty acids in the blood.

American omega-3 deficiencyThey combined all studies from a given country or region to give an average value of percent EPA + DHA and then divided the countries and regions into four groupings based on the average weight percentage of EPA + DHA in the blood. If all that seems confusing, the figure on the right (taken from Stark et al, Progress In Lipid Research, 63: 132-152, 2016) should clear things up.

  • Red = very low (< 4%) EPA + DHA levels
  • Orange = low (4-6%) EPA + DHA levels
  • Yellow = moderate (6-8%) EPA + DHA levels
  • Green = adequate (>8%) EPA + DHA levels
  • Grey = no valid measurements in those countries

It is clear from this study that most Americans and most Canadians don’t do a very good job of incorporating omega-3 fatty acids into their diet, as several previous dietary surveys have suggested.  This could contribute to omega-3 deficiency.

Is The United States Dead Last In Omega-3 Status?

The global map of EPA + DHA blood levels certainly suggests that the United States is among a handful of countries with the very lowest omega-3 status. There are a few caveats, however.

  • As the large areas of grey indicate, there are a number of countries with no valid omega-3 blood measurements. The United States might have lots of company in the very low omega-3 status category.
  • There are some very large countries like Russia which have relatively few omega-3 blood measurements, and those measurements are only from a few regions of the country. The average omega-3 status for the entire country might be lower than indicated in this map.

On the other hand, there are lots of omega-3 blood measurements from countries like Japan, so it is clear that there are countries with much better omega-3 status than the United States.

What Does This Study Mean To You?

The important questions are, of course:Does it matter? What do these blood levels of EPA + DHA actually mean? Is < 4% EPA + DHA low enough to matter? What are the health consequences of low omega-3 status?  If you have an omega-3 deficiency, what are the risks?

Let’s start with the first question: How do we translate a blood level of EPA + DHA into how much we should be getting in our diet? While there is no established Dietary Reference Intake for EPA + DHA, several expert panels and international organizations have made recommendations for EPA + DHA intake. Those recommendations generally range from 250 mg/day to 500 mg/day for general health and 500 mg/day to 1,000 mg/day for heart health. Unfortunately, most people in the United States and Canada consume less than 200 mg/day of omega-3 fatty acids, and most of those are short chain omega-3s that are inefficiently converted to the long chain EPA and DHA.

More importantly, a recent study (Patterson et al, Nutrition Research, 35: 1040-1051, 2015) has examined how much additional EPA + DHA must be consumed by someone eating a typical North American diet to significantly improve their omega-3 status. It showed that:

  • 200 mg/day of EPA + DHA is required to improve omega-3 status from very low to low.
  • 500 mg/day of EPA + DHA is required to improve omega-3 status from very low to moderate.
  • 1250 mg/day of EPA + DHA is required to improve omega-3 status from very low to adequate.

omega-3 for heart healthIt is no surprise that these numbers correlate so well. My recommendation would be to consume at least 500 mg/day of EPA + DHA for general health and at least 1,000 mg/day for heart health.

Now let’s look at the last question: What are the health consequences of low omega-3 status? There are multiple health benefits associated with optimal omega-3 status, but the best evidence is for the beneficial effects of omega-3s on fetal and infant neurodevelopment and heart health. For example:

  • In case you have been confused by recent studies suggesting that omega-3s have no effect on heart health you should know that most of those studies were looking at the effect of EPA + DHA in patients who were already taking 3 or 4 heart medications. The studies actually concluded omega-3s provided no additional benefits in people already taking multiple heart medications. That is a totally different question.

Where Should You Get Your Omega-3s?

fish oil supplementsNow that you know how important the long chain omega-3s, EPA and DHA, are for your health, and you know that most of us have a very poor omega-3 status and therefore have an omega-3 deficiency , your next questions are likely to be: “What’s the best way to improve my omega-3 status?” and “Where can I find EPA and DHA in my diet?” The answer is complicated.

  • Cold water, oily fish like salmon are a great source of EPA and DHA. Unfortunately, our oceans are increasingly polluted and some of those pollutants are concentrated even more in farm raised fish. A few years ago a group of experts published a report in which they analyzed PCB levels in both wild caught and farm-raised fish from locations all around the world (Hites et al, Science 303: 226-229, 2004) . Based on PCB levels alone they recommended that some wild caught salmon be consumed no more than once a month and some farm raised salmon be consumed no more than once every other month!

Unfortunately, when you buy salmon in the grocery store or your favorite restaurant, you can ask whether the salmon is wild or farm-raised, but you have no idea where the salmon came from. You have no idea how safe it is to eat. I love salmon and still eat it on occasion, but not nearly as frequently as I used to.

As an aside, the buzzword nowadays is sustainability. I support sustainability. However, the easiest way to assure that fish are sustainable is to raise them in fish farms. When a waiter tells me how sustainable the “catch of the day” is, I ask them how polluted it is. If they can’t answer, I don’t buy it. My health is more important to me than sustainability.

  • Nuts, seeds, and canola oil are good sources of ALA, a short chain omega-3 fatty acid. These food sources are less likely to be contaminated, but the efficiency of conversion of ALA to EPA and DHA is only around 5-10%. In other words, you need to eat a lot of ALA-rich foods to enjoy the health benefits associated with EPA and DHA.
  • That leaves fish oil supplements, but you need to remember that the EPA + DHA supplements you purchase in the health food store come from polluted fish. Unfortunately, many manufacturers have inadequate purification and quality control standards. In other words, neither you nor they know whether their omega-3 products are pure. You need to make sure that the omega-3 supplement you purchase is made by a manufacturer with stringent quality control standards.

 

The Bottom Line

 

  • A recent study has shown that most Americans are deficient in long chain omega-3s like EPA and DHA. In fact, the mainland United States and Canada were tied with half a dozen other countries for the lowest omega-3 status in the world.  Omega-3 deficiency in Americans seems to be the worst.
  • That is unfortunate because recent studies have shown that optimal blood levels of EPA and DHA are associated with a number of health benefits, especially fetal and infant neurodevelopment and heart health.
  • Other studies suggest that most Americans should consume an extra 500 mg/day of EPA + DHA for general health and at least 1,000 mg/day for heart health.
  • Unfortunately, it is not easy get those levels of EPA and DHA from our diet:
  • Oily, cold water fish are a great source of EPA and DHA, but our oceans are increasingly polluted and experts recommend that some fish that are the best sources of EPA and DHA be consumed no more than once a month. The situation is even worse for farm-raised fish.
  • Of course, nowadays the buzzword for fish is sustainability, but sustainability does not guarantee purity. Sustainable fish can be just as polluted as the worst of the farm raised fish.
  • seeds and canola oil are great sources for ALA, a short chain omega-3 fatty acid. This source of omega-3s is less likely to be contaminated, but the efficiency of conversion of ALA to EPA and DHA in our bodies is only around 5-10%.
  • Fish oil supplements can be a convenient source of the EPA and DHA you need, but the fish oil often comes from polluted fish and many manufacturers have inadequate purification methods and quality control standards. If you choose fish oil supplements as your source of omega-3s, be sure to choose a manufacturer with stringent quality control standards. Otherwise, neither you nor the manufacturer will know whether their omega-3 supplement is pure.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Should We Use Supplements For Cardiovascular Health?

Posted July 10, 2018 by Dr. Steve Chaney

Are You Just Wasting Your Money On Supplements?

Author: Dr. Stephen Chaney

 

supplements for cardiovascular health wast moneyYou’ve seen the headlines. “Recent Study Finds Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.”  You are being told that supplements are of no benefit to you. They are a waste of money. You should follow a healthy diet instead. Is all of this true?

If I were like most bloggers, I would give you a simple yes or no answer that would be only partially correct. Instead, I am going to put the study behind these headlines into perspective. I am going to give you a deeper understanding of supplementation, so you can make better choices for your health.

 Should we use supplements for cardiovascular health?

In today’s article I will give you a brief overview of the subject. Here are the topics I will cover today:

  • Is this fake news?
  • Did the study ask the right questions?
  • Is this a question of “Garbage In – Garbage Out?
  • Reducing Heart Disease Risk. What you need to know.

All these topics are covered in much more detail (with references) in my book “Slaying The Supplement Myths”, which will be published this fall.

 

How Was This Study Done?

supplements for cardiovascular healthThis study (D.J.A. Jenkins et al, Journal of the American College Of Cardiology, 71: 2540-2584, 2018 ) was a meta-analysis. Simply put, that means the authors combined the results of many previous studies into a single database to increase the statistical power of their conclusions. This study included 127 randomized control trials published between 2012 and December 2017. These were all studies that included supplementation and looked at cardiovascular end points, cancer end points or overall mortality.

Before looking at the results, it is instructive to look at the strengths and weaknesses of the study. Rather than giving you my interpretation, let me summarize what the authors said about strengths and weaknesses of their own study.

The strengths are obvious. Randomized control trials are considered the gold standard of evidence-based medicine, but they have their weaknesses. Here is what the authors said about the limitations of their study:

  • “Randomized control trials are of shorter duration, whereas longer duration studies might be required to fully capture chronic disease risk.”
  • “Dose-response data were not usually available [from the randomized control studies included in their analysis]. However, larger studies would allow the effect of dose to be assessed.”

There are some other limitations of this study, which I will point out below.

Is This Fake News?

supplements for cardiovascular health fake newsWhen I talk about “fake news” I am referring to the headlines, not to the study behind the headlines. The headlines were definitive: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” However, when you read the study the reality is quite different:

  • In contrast to the negative headlines, the study reported:
    • Folic acid supplementation decreased stroke risk by 20% and overall heart disease risk by 17%.
    • B complex supplements containing folic acid, B6, and B12 decreased stroke risk by 10%.
    • That’s a big deal, but somehow the headlines forgot to mention it.
  • The supplements that had no significant effect on heart disease risk (multivitamins, vitamin D, calcium, and vitamin C) were ones that would not be expected to lower heart disease risk. There was little evidence from previous studies of decreased risk. Furthermore, there is no plausible mechanism for supposing they might decrease heart disease risk.
  • The study did not include vitamin E or omega-3 supplements, which are the ones most likely to prove effective in decreasing heart disease risk when the studies are done properly (see below).

Did The Study Ask The Right Question?

Most of the studies included in this meta-analysis were asking whether a supplement decreased heart disease risk or mortality for everyone. Simply put, the studies started with a group of generally healthy Americans and asked whether supplementation had a significant effect on disease risk for everyone in that population.

That is the wrong question. We should not expect supplementation to benefit everyone equally. Instead, we should be asking who is most likely to benefit from supplementation and design our clinical studies to test whether those people benefit from supplementation.

supplements for cardiovascular health diagramI have created the graphic on the right as a guide to help answer the question of “Who is most likely to benefit from supplementation?”. Let me summarize each of the points using folic acid as the example.

 

Poor Diet: It only makes sense that those people who are deficient in folate from foods are the most likely to benefit from folic acid supplementation. Think about it for a minute. Would you really expect people who are already getting plenty of folate from their diet to obtain additional benefits from folic acid supplementation?

The NIH estimates that around 20% of US women of childbearing age are deficient in folic acid. For other segments of our population, dietary folate insufficiency ranges from 5-10%. Yet, most studies of folic acid supplementation lump everyone together – even though 80-95% of the US population is already getting enough folate through foods, food fortification, and supplementation. It is no wonder most studies fail to find a beneficial effect of folic acid supplementation.

The authors of the meta-analysis I discussed above said that the beneficial effects of folic acid they saw might have been influenced by a very large Chinese study, because a much higher percentage of Chinese are deficient in folic acid. They went on to say that the Chinese study needed to be repeated in this country.

In fact, the US study has already been done. A large study called “The Heart Outcomes Prevention Evaluation (HOPE)” study reported that folic acid supplementation did not reduce heart disease risk in the whole population. However, when the study focused on the subgroup of subjects who were folate-deficient at the beginning of the study, folic acid supplementation significantly decreased their risk of heart attack and cardiovascular death.  This would seem to suggest using supplements for cardiovascular health is a good idea.

Increased Need: There are many factors that increase the need for certain nutrients. However, for the sake of simplicity, let’s only focus on medications. Medications that interfere with folic acid metabolism include anticonvulsants, metformin (used to treat diabetes), methotrexate and sulfasalazine (used to treat severe inflammation), birth control pills, and some diuretics. Use of these medications is not a concern when the diet is adequate. However, when you combine medication use with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial.

Genetic Predisposition: The best known genetic defect affecting folic acid metabolism is MTHFR. MTHFR deficiency does not mean you have a specific need for methylfolate. However, it does increase your need for folic acid. Again, this is not a concern when the diet is adequate. However, when you combine MTHFR deficiency with a folate-deficient diet, health risks are increased and supplementation with folic acid is more likely to be beneficial. I cover this topic in great detail in my upcoming book, “Slaying The Supplement Myths”. In the meantime, you might wish to view my video, “The Truth About Methyl Folate.”

Diseases: An underlying disease or predisposition to disease often increases the need for one or more nutrients that help reduce disease risk. The best examples of this are two major studies on the effect of vitamin E on heart disease risk in women. Both studies found no effect of vitamin E on heart disease risk in the whole population. However, one study reported that vitamin E reduced heart disease risk in the subgroup of women who were post-menopausal (when the risk of heart disease skyrockets). The other study found that vitamin E reduced heart attack risk in the subgroup of women who had pre-existing heart disease at the beginning of the study.

Finally, if you look at the diagram closely, you will notice a red circle in the middle. When two or three of these factors overlap, that is the “sweet spot” where supplementation is almost certain to make a difference and it may be a good idea to use supplements for cardiovascular health.

Is This A Question Of “Garbage In, Garbage Out”?

supplements for cardiovascular health garbage in outUnfortunately, most clinical studies focus on the “Does everyone benefit from supplementation question?” rather than the “Who benefits from supplementation?” question.

In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.

Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.

 

Should We Use Supplements For Cardiovascular Health?

 

If you want to know whether supplements decrease heart disease risk for everyone, this meta-analysis is clear. Folic acid may decrease the risk of stroke and heart disease. A B complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but the analysis did not include vitamin E and/or omega-3s.

However, if you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.

I would be remiss, however, if I failed to point out that we know healthy diets can decrease heart disease risk. In the words of the authors: “The recent science-based report of the U.S. Dietary Guidelines Advisory Committee, also concerned with [heart disease] risk reduction, recommended 3 dietary patterns: 1) a healthy American diet low in saturated fat, trans fat, and meat, but high in fruits and vegetables; 2) a Mediterranean diet; and 3) a vegetarian diet. These diets, with their accompanying recommendations, continue the move towards more plant-based diets…” I cover the effect of diet on heart disease risk in detail in my book, “Slaying The Food Myths”.

 

The Bottom Line

 

You have probably seen the recent headlines proclaiming: “Vitamin and Mineral Supplements Don’t Lower Heart Disease Risk.” The study behind the headlines was a meta-analysis of 127 randomized control trials looking at the effect of supplementation on heart disease risk and mortality.

  • The headlines qualify as “fake news” because:
    • The study found that folic acid decreased stroke and heart disease risk, and B vitamins decreased stroke risk. Somehow the headlines forgot to mention that.
    • The study found that multivitamins, vitamin D, calcium, and vitamin C had no effect on heart disease risk. These are nutrients that were unlikely to decrease heart disease risk to begin with.
    • The study did not include vitamin E and omega-3s. These are nutrients that are likely to decrease heart disease risk when the studies are done properly.
  • The authors of the study stated that a major weakness of their study was that that randomized control studies included in their analysis were short term, whereas longer duration studies might be required to fully capture chronic disease risk.
  • The study behind the headlines is of little use for you as an individual because it asked the wrong question.
  • Most clinical studies focus on the “Does everyone benefit from supplementation question?” That is the wrong question. Instead we need more clinical studies focused on the “Who benefits from supplementation?” question. I discuss that question in more detail in the article above.
  • In addition, most clinical studies of supplementation are based on the drug model. They are studying supplementation with a single vitamin or mineral, as if it were a drug. That’s unfortunate, because vitamins and minerals work together synergistically. What we need are more studies of holistic supplementation approaches.
  • Until these two things change, most supplement studies are doomed to failure. They are doomed to give negative results. In addition, meta-analyses based on these faulty supplement studies will fall victim to what computer programmers refer to as “Garbage In, Garbage Out”. If the data going into the analysis is faulty, the data coming out of the study will be equally faulty. It won’t be worth the paper it is written on. If you are looking for personal guidance on supplementation, this study falls into that category.
  • If you want to know whether supplements decrease heart disease risk for everyone, this study is clear. Folic acid may decrease the risk of stroke and heart disease. A B-complex supplement may decrease the risk of stroke. All the other supplements they included in their analysis did not decrease heart disease risk, but they did not include vitamin E and/or omega-3s in their analysis.
  • If you want to know whether supplements decrease heart disease risk for you, this study provides no guidance. It did not ask the right questions.
  • However, we do know that healthy, plant-based diets can decrease heart disease risk. I cover heart healthy diets in detail in my book, “Slaying The Food Myths.”

 

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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