Sunday, October 5, 2008

Fish Oil v Fish

From, posted May 9, 2006

"A new tuna warning for pregnant women” article in the Health section of the June 12, 2006 issue of the Los Angeles Times stirred quite a controversy in the health and wellness community.

As a result, the NEW™ Institute in Malibu, California has received a number of inquiries. The original article (May 9, 2006) was published in response to legitimate concerns of the general public caused by mass media desire to cause a sensation, rather than provide useful information.

Fish oil supplementation has waxed and waned in popularity over the past decade.In the late 1990s when large clinical trials such as the GISSI study were published supporting the cardiovascular benefits of omega-3 fatty acids, fish oil became one of the most sought after supplements.

Hence, most health and wellness experts recommend consumption of fish and shellfish to meet some of the human bodies’ requirement for fish oil.However, due to fish oil's less than desirable taste characteristics, it was not well tolerated by even its most ardent supporters.

Improved molecular distillation processing has helped to enhance fish oil's purity and flavor and there are now even more studies to support the benefits of fish oil supplementation that reach beyond heart health.Some of the these studies were presented at the Omega-3 Fatty Acids: Recommendations for Therapeutics and Prevention Symposium, Institute of Human Nutrition, Columbia University College of Physicians and Surgeons, New York in October of 2005.

Recent studies by Craig L Jensen, M.D. (that included outcome measurements of gestational length and birth weight, preeclampsia, recurrent miscarriages, and maternal depression) have found positive associations between fish intake and gestational length and birth weight.

In a randomized multi-center trial, supplementation of 2.7g EPA and DHA from 20 weeks gestation or 6.1 g EPA and DHA from 33 weeks gestation reduced risk of preterm delivery.Preeclampsia is a common problem during pregnancy, especially as maternal age increases.

Observational data of potential effects of n-3 fatty acids on preeclampsia and related conditions show benefit.Additionally, the potential effects of n-3 fatty acids and recurrent miscarriages are promising.

Pilot study supplemented fish oil in patients with persistent anti-phospholipid syndrome associated recurrent miscarriages and found over a 3-year period, 86% of the patients had well babies.

Clinical depression has been associated with low levels of n-3 fatty acids, particularly DHA. A large, multi-country observational study of postpartum depression found a negative correlation between seafood consumption and/or breast milk DHA concentrations and postpartum depression.

Maternal DHA levels decline during pregnancy (as well as postpartum) as DHA is transferred to the fetus or newborn to aid in neural development.

Studies by Susan E. Carlson, M.D. clearly demonstrated that there is definitive evidence that DHA is essential in cognitive and visual development of a fetus/child because DHA is concentrated in the brain and retina.

Dr. Carlson discussed the positive long-term effects of early DHA supplementation related to higher Bayley Psychomotor Developmental Index (PDI) (gold standard for neurological development, measures body control, coordination and fine motor skills) in scores at 30 months, higher IQ at 4 years, higher MFFT (Matching Familiar Figures Test) score and speed at 6 years, and lower diastolic and mean blood pressure at 6 years of age.

However, the specific benefits of adequate DHA intake during periods of rapid brain development may not be measurable until older ages. Infant development studies often compare formula to human milk.

Human milk levels vary and the United States is considered an "at risk population" for low DHA levels, because US women consume lower levels of DHA compared to intake in other countries.
Human milk DHA content varies primarily as a result of mother's dietary intake differences.

The highest levels of DHA in human milk are found in the Japanese and marine China female populations.The United States has some of the lowest levels of DHA in human milk. In the United States, DHA was added to infant formula in 2002.

To reach worldwide median human milk DHA consumption levels, formula should contain 0.3% to 0.4 % DHA and women who are considering getting pregnant, who are pregnant and are breastfeeding should consider supplementation -- current recommendations are 300 mg/day.

Epidemiologic studies in the United States report 500 mg/day of n-3 fatty acids can decrease CHD (coronary heart disease) risk and mitigate many risks of pregnancy as well as to contribute to the fetal and neonatal cognitive development.The average American diet only provides 100 mg EPA and DHA per day.

This is 5 times less than the amount observed for cardiovascular benefit and also 5 times less than the WHO's current dietary recommendation for EPA and DHA. Not only are consistent recommendations needed, strategies to increase intakes are also necessary.
Some recommendations are to increase fish intake, while others recommend specific amounts of EPA and DHA either as supplemental or marine sources.

Since March 2004, the Food and Drug Administration and the Environmental Protection Agency have recommended women who are pregnant, nursing or planning to become pregnant should eat no more than 6 ounces of albacore tune a week; and recommends up to 12 ounces (the amount of fish in two meals) per week of fish and shellfish low in mercury, such as shrimp, salmon, light tuna and catfish for general population.

Current prudent recommendations for consumption of fish (other than tuna) high in n-3 fatty acid contents are anchovies, mackerel, salmon, sardines, sea bass, swordfish, and trout.Some of these fish also need to be consumed in limited amounts because of mercury and other toxins. Swordfish, king mackerel, shark, and tilefish should be limited to 7 oz/week; red snapper should be limited to 14 oz/week; while salmon, catfish, and mahi-mahi have no restrictions.

Water sources have differing toxic levels of mercury, PCBs, digoxins, and others that may alter these general suggestions.However, Consumer Reports magazine published by Consumers Union recently said that 6% of canned tuna tested by the FDA “contained at least as much of the metal—in some cases more than twice as much—as the average albacore”.

It further recommends that women who are pregnant, nursing or planning to become pregnant eat neither “fresh”, nor canned tuna.

Again, this a “knee-jerk” overreacting by an ill qualified layman organization that creates panic, without informing the general population of the fact, that nutritional benefits of fish oil in seafood (especially in general population) easily outweigh the risk of trace amounts of contaminants.

Clearly, the general public often receives conflicting, and frequently contradicting, recommendations from mass media, Governmental and private sources--not only are consistent recommendations needed (please see above), but strategies to increase intakes are also necessary.

An effort by Kris-Etherton to substitute fish oil with walnut, flaxseed, soybean, and canola oil can contribute to meet LNA (pre-cursor of EPA and DHA) failed, despite the results from the landmark Lyon Diet Heart Study.

A Mediterranean style diet could provide approximately 0.6% to 1% energy or 2 g LNA, no more than 7 g per day LA, be rich in oleic acid, poor in saturated fat, and low in n-6 fatty acid sources.

The American diet, unfortunately, does not mimic these fatty acid intakes and is very high in n-6 fatty acid intake, which hinders the ability for LNA to be converted to EPA and DHA.

Having understood the critical importance of EPA and DHA for healthy childbearing and proper cognitive development of fetuses, infants, children and adults, and following the recent recommendation of the Consumer Reports, where should a pregnant and/or breastfeeding women to turn to?

Nutritional supplements of the health food grade fish oil, even in rather lower doses recommended by most of the over-the-counter manufacturers (700-1500 mg/day) generally provide a proper level of protection for pregnancy and child development.

Levels of in-organic (Dioxins, Mercury, etc), as well as microbial contamination of those supplements could be as high as in the fish it’s made from. However, in the recommended doses the possible side effects of contaminants are, probably, negligible.

The commercial grade fish oil is affordable and easily available.

Pharmaceutical grade (PG) oil is produced through 8-stage purification process followed by concentration with resulting no trans fats, and higher levels of EPA and DHA and low contaminants levels.

Some PG fish oil products contains 100 times less PCB's than health food grade fish oil, has twice the EPA and DHA as found in health-food grade fish oil.

Further, most people will not experience mild gastric problems often found with high doses of health-food grade fish oil.

The supply of this type of pharmaceutical grade fish oil is very limited since it takes 100 kg. of health-food grade fish oil to make just 1 kg. of pharmaceutical grade fish oil!

One teaspoon of the liquid OmegaRxTM contains 1.8 grams of EPA and 0.9 grams of DHA.

Such quality of fish oil is usually not available in health food stores because the supply of this type of pharmaceutical grade fish oil is very limited since it takes 100 kg. of health-food grade fish oil to make just 1 kg. of pharmaceutical grade fish oil!

And that is why one teaspoon of the liquid OmegaRxTM may contain 1.8 grams of EPA and 0.9 grams of DHA.

Although pharmaceutical-grade fish oil costs 10-20 times more than health-food grade, responsible manufacturers keep their price per gram of EPA and DHA as low as possible as shown below:

Product Grade: Price PerGram ofEPA & DHA

Lowest grade health food grade $0.30
Molecular distilled health food grade $0.54
OmegaRxTM Pharmaceutical grade capsules $0.56
OmegaRxTM Pharmaceutical grade liquid oil $0.49

All & all, pharmaceutical grade fish oil offers significant advantages and wellness benefits than the health food grade one, a
nd, yes, higher concentration requires a lesser number of capsules to swallow!

Happy fishing and/or fish oiling.

Be Well!

***This article is to be used for education and general discussion purposes only. It does not constitute medical opinion and should not be used for or relied upon as medical advice. Publication of this newsletter does not create physician-patient relationship between the reader and the author. The article does not contain comprehensive description of the subject issues discussed. It is based on present medical knowledge which is subject to change and is unclear in numerous respects. Statements regarding the bio-efficacy of the nutritional supplements have not been evaluated by the FDA. They are not intended to diagnose, treat, cure or prevent any disease. The issues discussed can not be resolved without specific analysis of the specific circumstances of each person. The readers should consult with their individual health care/wellness professional to resolve their individual situation.

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