DHA Supplements During Pregnancy

Written by Dr. Steve Chaney on . Posted in DHA and Pregnancy

Author: Dr. Stephen Chaney

 

dha supplementation saves moneyA recent study has estimated that taking DHA supplements during pregnancy, specifically in the last two trimesters, could save the US healthcare system close to $6 billion/year (Shireman et al, Prostaglandins, Leukotrienes and Essential Fatty Acids, 111: 8-10, 2016) .

Another study has come to similar conclusion in Australia (Ahmed et al, Prostaglandins, Leukotrienes and Essential Fatty Acids, 102-103: 5-11, 2015) .

When you have two well done studies by different investigators in different countries that come to the same conclusion, it is time to take the studies seriously and start to ask some important questions. For example:

  • Are these studies true?
  • Should we change our public health recommendations during pregnancy?
  • Is this just a public health issue, or does it affect you personally?

The Value of DHA Supplements During Pregnancy

dha supplements during pregnancyThe US study was called “Kansas University DHA Outcomes Study” (KUDOS). It studied health outcomes for 197 pregnant moms who gave birth to a single baby at the Kansas University Hospital between 2006 and 2010. The moms came from the Kansas City metropolitan area and consisted of 42% moms who self-identified as Black and 58% as other races.

The women were randomly assigned to consume 3 capsules per day containing either 600 mg DHA or a placebo containing corn and soybean oil during their second and third trimesters (starting around 14.5 weeks after gestation). Multiple pregnancy outcomes were assessed, but the main focus was on early preterm birth (infants born before 34 week’s gestation). That’s because a recent meta-analysis has reported that omega-3 fatty acid supplementation during pregnancy reduces early preterm births by 58% (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) .

The results of the KUDOS study were:

  • Taking DHA supplements during pregnancy, specifically in the last two trimesters, reduced early preterm birth from 4.8% to 0.6%.
  • DHA supplementation reduced average hospital costs per infant born in the Kansas Medical Center by $1678. This was primarily because of a significant reduction in the average length of time spent in the neonatal intensive care unit because of the reduction in early preterm births.
  • When the cost of supplementation was taken into account, there was a 10-fold return in hospital cost savings for every dollar spent on supplementation.
  • When the authors extrapolated this analysis to the 4 million live births in the US each year, they estimated a potential savings of $6.6 billion.
  • This corresponds to a net savings of $5.94 billion to the US health care system if you take into account the cost of providing all pregnant women in the US with 600 mg of DHA/day during the last two trimesters of pregnancy.

The authors of the KUDOS study concluded “…a public health policy to increase DHA intake during pregnancy could result in significant cost savings to the health care system in our country”.

Are These Studies True?

truthTruth in science is always elusive. It requires many years of research and multiple clinical studies. However, two well done studies in two different countries have concluded that taking DHA supplements during pregnancy significantly reduces health care costs. In addition, a recent meta-analysis of 6 published clinical studies (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) has concluded that omega-3 fatty acid supplementation during pregnancy reduces early preterm births by 58%.

These are all small studies, but their results are remarkably consistent. If you were to generalize the conclusions of all these studies into a statement saying “Omega-3 fatty acid supplementation during pregnancy significantly reduces health care costs”, there is a good probability that statement would be true. However:

  • The exact cost savings is uncertain.
  • The source of omega-3s (DHA, EPA, or a mixture of the two) is uncertain.
  • The amount of omega-3 fatty acids needed to reduce early preterm births is uncertain.

Let’s look at each of these in turn:

Cost Savings of Using DHA Supplements During Pregnancy

  • On the minus side, 42% of the women in the KUDOS study were Black, while the national average is 16%. That is significant because the rate of early preterm births is twice as high for black women as it is for White and Asian women. If the results of the KUDOD study were extrapolated to the percentage of Black women in the US population, the cost savings to the US health care system would only be around $4 billion – still a pretty substantial number!
  • On the plus side, the initial hospital costs associated with early preterm birth are just the tip of the iceberg. There are also considerable long-term expenses for special education services associated with disabling conditions common with premature infants.  A recent study (Mangham et al, Pediatrics 123: e312-e327, 2009) calculated the costs of preterm birth in the UK from birth to 18 years of age and came up with an estimate of $4.567 billion in US dollars. If we assume that omega-3 supplementation results in a 58% decrease in early preterm birth (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016) and extrapolate that cost savings to the US population, the total cost savings would be $13.2 billion. Now we’re talking real money!

Source of Omega-3s:

  • DHA has been the focus of the two most recent studies on cost savings because of the role of DHA in nerve, brain and visual development, but EPA is also likely to be important in neonatal development. In addition, the efficiency of conversion of EPA to DHA is very high.
  • In fact, when we look at the individual studies included in the meta-analysis described above (Kar et al, European Journal of Obstetrics & Gynecology and Reproductive Biology 198: 40-46, 2016), DHA, EPA, and EPA+DHA supplementation all gave comparable reductions in early preterm births.

Amount of Omega-3s:

  • While the 600 mg/day used in the KUDOS study is probably a good starting point, the individual studies in the meta-analysis used a wide range of dose. All of them seemed to have at least some efficacy in reducing early preterm births. Obviously, more studies are needed to determine the optimal dose.

What Does This Mean For You?

All this talk about reducing health care costs may seem esoteric. You may be wondering “What does this have to do with me?”

  • Don’t be lulled to complacency by the estimated cost savings of $1678/birth mentioned above. That is the average costs of all births. Early preterm births represent only 4.78% of all the births in the study. If you give birth to a baby earlier than 34 weeks of gestation, there is a high probability your infant will end up in the neonatal intensive care unit and your health care costs will be orders of magnitude more than $1678. How that affects your wallet will depend on your insurance plan.
  • Early preterm birth is associated with increased risk of global and selective cognitive defects. These can range from relatively mild impairment of IQ, memory, executive function, non-verbal skills, and motor skills to much more serious conditions like cerebral palsy, mental retardation, and disorders of psychological development. The possibility of avoiding those kinds of defects in your child is priceless.

 

The Bottom Line

  • Recent studies in the US and Australia have shown that taking 600 mg of DHA supplements during pregnancy during the last two trimesters  significantly reduces early preterm births (infants born before 34 weeks gestation) resulting in an estimated savings to the US health care system of around $6 billion/year.
  • Other studies suggest that supplementation with EPA and EPA+DHA mixtures give similar results.
  • Discussions of cost savings to the US healthcare system sound somewhat esoteric. However, if you are pregnant or considering becoming pregnant, there are real benefits to you associated with reducing the risk of early preterm birth. That is because:
  • The costs associated with early preterm births are substantial. How much they affect your wallet will depend on your health insurance policy.
  • Early preterm births are associated with a variety of global and selective cognitive defects (for details, read the article above). The possibility of avoiding those kinds of defects in your child is priceless.

 

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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Can Plant-based Diets Be Unhealthy?

Posted September 10, 2019 by Dr. Steve Chaney

Do Plant-Based Diets Reduce Heart Disease Deaths?

Author: Dr. Stephen Chaney

 

plant-based diets vegetablesPlant-based diets have become the “Golden Boys” of the diet world. They are the diets most often recommended by knowledgeable health and nutrition professionals. I’m not talking about all the “Dr. Strangeloves” who pitch weird diets in books and the internet. I am talking legitimate experts who have spent their life studying the impact of nutrition on our health.

Certainly, there is an overwhelming body of evidence supporting the claim that plant-based diets are healthy. Going on a plant-based diet can help you lower blood pressure, inflammation, cholesterol and triglycerides. People who consume a plant-based diet for a lifetime weigh less and have decreased risk of heart disease, diabetes, and cancer.

But, can a plant-based diet be unhealthy? Some people consider a plant-based diet to simply be the absence of meat and other animal foods. Is just replacing animal foods with plant-based foods enough to make a diet healthy?

Maybe not. After all, sugar and white flour are plant-based food ingredients. Fake meats of all kinds abound in our grocery stores. Some are very wholesome, but others are little more than vegetarian junk food. If you replace animal foods with plant-based sweets, desserts, and junk food, is your diet really healthier?

While the answer to that question seems obvious, very few studies have asked that question. Most studies on the benefits of plant-based diets have compared population groups that eat a strictly plant-based diet (Seventh-Day Adventists, vegans, or vegetarians) with the general public. They have not looked at variations in plant food consumption within the general public. Nor have they compared people who consume healthy and unhealthy plant foods.

This study (H Kim et al, Journal of the American Heart Association, 8:e012865, 2019) was designed to fill that void.

 

How Was The Study Done?

plant-based diets studyThis study used data collected from 12,168 middle aged adults in the ARIC (Atherosclerosis Risk in Communities) study between 1987 and 2016.

The participant’s usual intake of foods and beverages was assessed by trained interviewers using a food frequency questionnaire at the time of entry into the study and again 6 years later.

Participants were asked to indicate the frequency with which they consumed 66 foods and beverages of a defined serving size in the previous year. Visual guides were provided to help participants estimate portion sizes.

The participant’s adherence to a plant-based diet was assessed using four different well-established plant-based diet scores. For the sake of simplicity, I will include 3 of them in this review.

  • The PDI (Plant-Based Diet Index) categorizes foods as either plant foods or animal foods. A high PDI score means that the participant’s diet contains more plant foods than animal foods. A low PDI score means the participant’s diet contains more animal foods than plant foods.
  • The hPDI (healthy plant-based diet index) is based on the PDI but emphasizes “healthy” plant foods. A high hPDI score means that the participant’s diet is high in healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) and low in animal foods.
  • The uPDI (unhealthy plant-based diet index) is based on the PDI but emphasizes “unhealthy” plant foods. A high uPDI score means that the participant’s diet is high in unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) and low in animal foods.

For statistical analysis the scores from the various plant-based diet indices were divided into 5 equal groups. In each case, the group with the highest score consumed the most plant foods and least animal foods. The group with the lowest score consumed the least plant foods and the most animal foods.

The health outcomes measured in this study were heart disease events, heart disease deaths, and all-cause deaths. Again, for the sake of simplicity, I will only include 2 of these outcomes (heart disease deaths and all-cause deaths) in this review. The data on deaths were obtained from state death records and the National Death Index. (Yes, your personal information is available on the web even after you die.)

 

Do Plant-Based Diets Reduce Heart Disease Deaths?

plant-based diets reduce heart deathsThe participants in this study were followed for an average of 25 years.

The investigators looked at heart disease deaths over the 25 years and compared people with the highest intake of plant foods to people with the highest intake of red meat and other animal foods. The results were:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

What Else Did The Study Show?

The investigators made a couple of other interesting observations:

  • The association of the overall diet with heart disease and all-cause deaths was stronger than the association of individual food components. This underscores the importance of looking at the effect of the whole diet on health outcomes rather than the “magic” foods you hear about on Dr. Strangelove’s Health Blog.
  • Diets with the highest amount of healthy plant foods were associated with higher intake of carbohydrates, plant protein, fiber, and micronutrients, including potassium, magnesium, iron, vitamin A, vitamin C, folate, and lower intake of saturated fat and cholesterol.
  • Diets with the highest amount of unhealthy plant foods were associated with higher intake of calories and carbohydrates and lower intake of fiber and micronutrients.

The last two observations may help explain some of the health benefits of plant-based diets.

 

Can Plant-Based Diets Be Unhealthy?

plant-based diets unhealthy cookiesNow, let’s return to the question I asked at the beginning of this article: “Can plant-based diets be unhealthy?” Although some previous studies have suggested that unhealthy plant-based diets might increase the risk of heart disease, this study did not show that.

What this study did show was that an unhealthy plant-based diet was no better for you than a diet containing lots of red meat and other animal foods.

If this were the only conclusion from this study, it might be considered a neutral result. However, this result clearly contrasts with the data from this study and many others showing that both plant-based diets in general and healthy plant-based diets reduce the risk of heart disease deaths and all-cause deaths compared to animal-based diets.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

There is one other subtle message from this study. This study did not compare vegans with the general public. Everyone in the study was the general public. Nobody in the study was consuming a 100% plant-based diet.

For example:

  • The group with the highest intake of plant foods consumed 9 servings per day of plant foods and 3.6 servings per day of animal foods.
  • The group with the lowest intake of plant foods consumed 5.4 servings per day of plant foods and 5.6 servings per day of animal foods.

In other words, you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet.

 

The Bottom Line

A recent study analyzed the effect of consuming plant foods on heart disease deaths and all-cause deaths over a 25-year period.

When the investigators looked at heart disease deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

A more subtle message from the study is that you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet. The people in this study were not following some special diet. The only difference was that some of the people in this study ate more plant foods and others more animal foods.

For more details on the study, 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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