Is Omega-3 Uptake Gender Specific?

Written by Dr. Steve Chaney on . Posted in current health articles, Nutritiion, Supplements and Health

Do We Need To Reexamine Everything We Thought We Knew About Omega-3s?

Author: Dr. Stephen Chaney

is omega-3 uptake gender specific

Some of you may remember the book from a few years ago titled “Men are from Mars, Women are from Venus”. The book proposed that men and women communicate differently (Who would have guessed?), and understanding that fact would help husbands and wives communicate with each other more effectively. I know that some people complained that it was an overly simplistic viewpoint, but I know it sure helped me communicate more effectively with my wife.

I came across a very interesting article recently that suggested the omega-3 fatty acid EPA might be metabolized and utilized differently by men and women. You might say that the statement “Men are from Mars, Women are from Venus” applies to omega-3 utilization as well.

The Science Behind the Study

Now that I’ve captured your interest, perhaps I should fill in a few details. We have known for years that the long chain omega-3 fatty acids EPA and DHA appear to be beneficial at reducing the risk of heart disease. There are several mechanisms for that protective effect:

  1. Omega-3s reduce the stickiness of platelets so that platelet aggregation, a fancy name for blood clotting, occurs less readily. Of course, we want our blood to clot when we cut ourselves, but we don’t want it to clot inside our arteries, because that is the very process that can lead to heart attacks and stroke.
  1. Omega-3s lower triglycerides and reduce inflammation, two important risk factors for heart disease.
  1. Omega-3s help keep the walls of our blood vessels elastic, which enhances blood flow and reduces the risk of hypertension.

However, for any of those things to occur, the omega-3 fatty acids must first be incorporated into our cell membranes. Thus, it is not just how much omega-3s we get in our diet that is important. We need to know how many of those omega-3s are actually incorporated into our membranes.

What if the efficiency of omega-3 uptake into cellular membranes were different for men and women? That would change everything. It would affect the design of omega-3 clinical studies. It would affect omega-3 dietary recommendations for men and women. The implications of gender-specific uptake of omega-3s would be far reaching.

Is Omega-3 Uptake Gender Specific?omega-3

The authors of this week’s study (Pipingas et al., Nutrients, 6, 1956-1970, 2014) hypothesized that efficiency of omega-3 uptake might differ in men and women. They enrolled 160 participants in the study (47% male and 53& female) with an average age of 59 years. The study excluded anybody with pre-existing diabetes or heart disease and anybody who was significantly overweight. The study also excluded anyone taking drugs that might mask the effects of the omega-3 fatty acids and anybody who had previously consumed fish oil supplements or more than two servings of seafood per week.

This was a complex study. In this review I will focus only on the portion of the study relevant to the gender specificity of omega-3 uptake. For that portion of the study, both male and female participants were divided into three groups. The first group received 3 gm of fish oil (240 mg EPA and 240 mg DHA); the second group received 6 gm of fish oil (480 mg EPA and 480 mg of DHA); and the third group received sunflower seed oil as a placebo. The study lasted 16 weeks, and the incorporation of omega-3 fatty acids into red blood cell membranes was measured at the beginning of the study and at the end of 16 weeks.

When they looked at men and women combined, they found:

  • A dose specific increase in EPA incorporation into red cell membranes compared to placebo. That simply means the amount of EPA that ended up in the red blood cell membrane was greater when the participants consumed 6 gm of fish oil than when they consumed 3 gm of fish oil.
  • Very little incorporation of DHA into red blood cell membranes was seen at either dose. This was not unexpected. Previous studies have shown that EPA is preferentially incorporated into red cell membranes. Other tissues, such a neural tissue, preferentially incorporate DHA into their membranes.

When they looked at men and women separately, they found:

  • The efficiency of EPA incorporation into red cell membranes compared to placebo was greater for women than for men. In women increased EPA uptake into red cell membranes was seen with both 3 gm and 6 gm of fish oil. Whereas, with men increased EPA incorporation into red cell membranes was only seen at with 6 gm of fish oil.

What Is The Significance Of These Observations?

The authors concluded “This is an important area for future research because dietary recommendations around long chain omega-3 polyunsaturated fatty acid intake may need to be gender specific.”

However, there are a number of weaknesses of this study:

  1. It was a very small study. Obviously, this study needs to be repeated with a much larger cohort of men and women.
  1. This study was just looking at incorporation of omega-3s into red cell membranes. We don’t yet know whether the specificity of omega-3 uptake will be the same for other tissues. Nor do we know whether there will be gender specificity in the biological effects of omega-3s.
  1. Most importantly, not all previous studies have reported the same gender specificity in omega-3 uptake seen in this study.

So what does this mean for you? Should men be getting more omega-3 fatty acids in their diet than women, as the authors suggested? That is an intriguing idea, but based on the weaknesses I described above, I think it’s premature to make this kind of recommendation until these results have been confirmed by larger studies.

The Bottom Line

  1. A recent study has suggested that women may be more efficient at incorporating the omega-3 fatty acids EPA into their cellular membranes than men. The authors of the study concluded that “…dietary recommendations around long chain omega-3 polyunsaturated fatty acid intake may need to be gender specific.”
  1. However, the study has a number of weaknesses:
  • It was a very small study. Obviously, it needs to be repeated with a much larger cohort of men and women.
  • This study was just looking at incorporation of omega-3s into red cell membranes. We don’t yet know whether the specificity of omega-3 uptake will be the same for other tissues. Nor do we know whether there will be gender specificity in the biological effects of omega-3s.
  • Most importantly, not all previous studies have reported the same gender specificity in omega-3 uptake seen in this study.
  1. The idea that men and women may differ in their needs for omega-3 fatty acids is intriguing, but based on the weaknesses described above, it is premature to make this kind of recommendation until the results of the current study have been confirmed by larger studies.

 

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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Comments (3)

  • kathleen sibbel

    |

    this was very interesting, I find that the more Omegaguard I take the better I feel, less aches and pains (arthritis) still, my Dr. wants to put me on statin drugs, tried them once for about 3wks. and stopped, Told him I would rather die of a stroke than be in the pain those things caused in me.
    Being Diabetic I have to go in regularly for blood work, and it always seems to be a battle. And I am always told I take too much Vita E. I just reply: better to have too much than an amputation (not in my vocabulary and better not be in his) Am anxious to show him the Dr. letter for the new Blood Pressure supplement Shaklee has introduced.
    Thanks for all your articles. so good and informative.

    Reply

  • Sheri Duncan

    |

    That is interesting but only looks at one source of omega 3’s. I’d be interested in one that looks at Flax Seed oil with omega 3,6 & 9 which is what I take. not fair, I’m a subscriber & would like those freebies too. Do you already make them available to us? I don’t check my e-mails often. Thanks Sheri

    Reply

    • Dr. Steve Chaney

      |

      Dear Sherri,
      I usually emphasize sources of long chain omega-3 fatty acids because those are the ones most likely to be missing from the American diet. Most naturally occurring oils contain a mixture of omega-3, omega-6 and omega-9 fatty acids. Vegetable oils other than flaxseed and canola are the best source of omega-6 fatty acids, but also have omega-3 and omega-9. Olive and peanut oil are the best sources of omega-9, but also have omega-3 and omega-6. Flaxseed and canola oil are the best source of omega-3, but also have omega-6 and omega-9.
      Flaxseed oil is not magical, but it is a very healthy oil. What you should know is that vegetable oils such as flaxseed and canola contain short chain omega-3 fatty acids and the efficiency of conversion of those to the beneficial long chain fatty acids is around 10%. That means that you need about 25 grams of flaxseed oil to get the same health benefits that you would experience with 2 or 3 grams of fish oil. That’s OK if you are using a tablespoon or two of flaxseed oil as a salad dressing, but don’t count on much benefit from a flaxseed oil supplement.
      As for the free offers you missed, they were indeed contained in the emails you didn’t read, but I can give you links for each offer. For “Three Things Every Diet Must Do” eBook, click on:
      https://www.healthtipsfromtheprofessor.com/go/thank-you-three-things/
      For the “Myths of the Naysayers” eBook, click on:
      https://www.healthtipsfromtheprofessor.com/go/thank-you-new/
      Dr. Chaney

      Reply

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Latest Article

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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