Omega-3 Fish Oils DHA and EPA: Are They a Panacea?

The Omega-3 fatty acids found in fish and fish oils have long captured the attention of scientists whose investigation is steadily uncovering the many medicinal benefits of nature’s maritime gold.   It all began about 25 years ago, after epidemiological studies revealed that Greenland Inuits had substantially reduced rates of heart attacks compared with Western control subjects, despite a diet that was as high in fat.  As you know, it was the high intake of omega-3 fatty acids from fish that held the key. Fats are divided into three categories:  the good (monounsaturated and polyunsaturated), the bad (saturated), and the just plain awful (trans fats).  In the good group are the omega-3s: DHA (docosahexaenoic acid), EPA (eicosapentaenoic acid), and ALA (alpha-linolenic acid).  All three are good for you, but evidence for a health protective role is strongest for the DHA and EPA found in fish and fish oils.  ALA, which is derived from plants, is less and only indirectly beneficial if you are trying to boost your omega-3s; the body uses most of it for energy and metabolizes only a small amount (< 10%) of ALA into DHA and EPA.

Much of the early research in the area of omega-3s focused on heart disease.  Dozens of observational studies have shown that eating fish lowers your risk of having a heart attack or stroke.  Subsequent randomized controlled trials have now clearly demonstrated the cardioprotective effects of omega-3s, DHA and EPA, found in fish and fish oil. The ways that omega-3 fatty acids reduce cardiovascular disease risk are still being studied, however, research has shown that they:

  • Decrease risk of arrhythmias (abnormal heart rhythms), which can lead to sudden cardiac death.
  • Decrease triglyceride levels.
  • Decrease progression of atherosclerotic plaque and stabilize existing plaque so it is less likely to rupture and cause sudden heart attacks.
  • Lower incidence of blood clotting, which can lead to heart attack or stroke.
  • Reduce inflammatory responses.
  • Lower blood pressure.

DHA and EPA have since been studied in myriad trials and if there is any panacea out there, it appears that they may just be it.  Scientific evidence indicates that the omega-3 fatty acids, DHA + EPA, may have potential benefits in the prevention and/or treatment of the following health conditions:

  • Alzheimer’s disease and other cognitive diseases
  • Asthma
  • Attention deficit hyperactivity disorder (ADHD)
  • Bipolar disorder and Depression
  • Cancer
  • Cardiovascular disease
  • Crohn’s disease and Ulcerative colitis
  • Diabetes
  • Eczema and Psoriasis
  • High blood pressure
  • Huntington’s disease
  • Lupus
  • Joint disease including Rheumatoid arthritis and Osteoarthritis
  • Macular Degeneration
  • Migraine headaches
  • Multiple sclerosis (MS)
  • Obesity

Awareness of why and how to boost your omega-3s is more important than ever.  It turns out that the modern western diet has taken us far from the diet of our remote ancestors.  Instead of eating diets rich in omega-3s we are loaded with omega-6s.  Physiological consequences of this shift in dietary representation of these fats include an increase in inflammation and inflammation-related conditions like heart disease and those listed above.  The absence of adequate quantities of DHA and EPA in our diets is so devastating that even the relatively conservative American Heart Association (AHA) has recommended supplemental intake of these nutrients for people with heart disease or multiple cardiovascular risk factors.  The AHA’s recommended intake of combined DHA + EPA for such individuals is approximately 1,000 mg daily.  Physicians often utilize higher daily doses in the range of 2,000-4,000 mg daily as part of a treatment plan to manage patients with elevated triglycerides or other inflammation-based medical conditions.

It is vital to be an educated consumer:  make sure to read the label and look for purified fish oil supplements that provide your target dose of combined DHA + EPA (not ALA or omega-6s, or omega-9s).  The hoax is that many products boast they have “1,000mg Fish Oils” knowing that’s the all important number, BUT if you examine the finer print under the supplement facts you will find they fail to provide what you’re looking for:  1,000 mg of combined DHA+EPA.

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Is Sugar the New Fat?

With the attack on obesity in our society and the spotlight on saturated fats, the food industry has introduced an army of low fat foods.  The problem is that these low fat substitutes are often high in sugary carbohydrates. When we eat carbohydrates – whether from a piece of whole-grain bread or a chocolate chip cookie – they are converted in the body to glucose.  The increase in our blood sugar triggers the pancreas to secrete insulin, which helps digest foods and moderate blood sugar levels.  All carbohydrates cause an increase in blood glucose levels and a concomitant increase in circulating insulin, but not all carbohydrates are created equal.  Just like with the fats, there are “good” carbs and “bad” carbs.  The key for carbs is how much and how fast they increase blood sugar.

A few years ago I came across a book entitled Naturally Slim and Powerful – The Natural Way to Boost Serotonin Without Drugs. As a psychiatrist, prescribing medications that influence serotonin levels for my patients who were depressed or anxious, this piqued my curiosity.  I read further and discovered the term “glycemic index” – a quantification of how much blood sugar a particular carbohydrate creates.  This is important because of the cascade of events that follow an elevation in blood sugar: insulin increases, which beyond controlling rising blood sugars, also affects serotonin levels, and deposits fat!  A carbohydrate with a high glycemic index is “bad” because it produces more blood sugar, which in turn requires more insulin for digestion.  Not only does excess insulin deposit fat, but this spike in insulin can drive blood sugar too low, causing you to crave more carbohydrates and start you on an endless cycle of spiking and crashing blood sugars.  In contrast, foods that break down slowly in the body, causing glucose levels to ascend more slowly and to a lesser extent, have a low glycemic value (good carbs).  Slower digestion tends to delay hunger and reduce the secretion of insulin.  Consuming more good carbs than bad carbs throughout the day will keep the rise and fall of insulin levels smoother and less pronounced.  I put it to the test and the results were fairly dramatic:  decreased cravings for carbohydrates, weight loss that had previously been difficult, and enhanced well-being.

Beyond weight control, keeping insulin levels in balance will serve your health in other ways.  It will help prevent type 2 (adult-onset) diabetes, a devastating disease that can cause damage throughout the body, particularly the eyes, kidneys, the heart, and general circulation. The incidence of diabetes in our current society is alarming, occurring more frequently and at a younger age than ever before.  Finally, chronically high insulin levels are associated with adverse effects on the immune system – weakening the body’s natural defense mechanisms against diseases including cancer – and can also increase the likelihood of heart disease, Alzheimer’s, osteoporosis and arthritis.

Using the glycemic index to regulate weight and blood sugar can be very effective, but trying to memorize the glycemic number associated with every food may make your head spin.  Let me help you simply get an intuitive feel for what increases blood sugar and insulin levels.  In general, foods that are ground into fine particles or are high in sugar are generally worse carbohydrate choices, having a greater effect of increasing blood sugar.  Most bread, cakes, cookies and pastries that melt in your mouth like sugar, also resemble sugar in their effect on the body.  Refined carbohydrates, such as flour, white sugar, and white rice, turn into blood sugar faster than unrefined whole grains do because the refining process removes the hard-to-digest fibrous outer shells from the whole grains, leading to accelerated digestion. Coarsely ground or intact grains like brown rice, oats, whole-wheat pasta, sprouted-wheat breads, and beans, have a slow, limited, and steady effect on the blood sugar and insulin levels.  Pasta tends to have a bad reputation, but if consumed “al dente” and in moderation it can be a healthful part of a balanced diet.  Make sure not to over cook it; overly cooking pasta causes the starch to be broken down into sugar more readily. White potatoes are high in sugar; a better choice would be sweet potatoes with half the calories, half the glycemic index, and an abundance of nutrients like beta-carotene.

Avoid instant foods.  Most rice is a good carbohydrate, but instant rice is a bad carbohydrate because the process of making rice (or similar products) into an instant food destroys the fibrous structure found in good carbohydrates.  Look for rice that requires at least twenty minutes to cook. Brown rice, or wild rice, is a better choice than white rice, with respect to glycemic index and overall nutritional value. Choose steel cut oats instead of instant oatmeal.  In general, avoid overly processed foods. Rice cakes are extremely processed, bearing little resemblance to rice, they release about twice the blood sugar as properly cooked rice.

Overly ripe fruit should be avoided because it creates excess blood sugar.  For example, avoid overly ripe bananas that can produce nearly twice the blood sugar, as do firm bananas.  Most vegetables are good carbohydrates, which is not surprising because they closely resemble the diet of our ancestors. A good rule of thumb:  Eat what comes from the earth, not that which is wrapped in cellophane!

Legumes – chickpeas, beans, edamame, and lentils – produce very little blood sugar. In fact, combining legumes with other foods drastically reduces the amount of blood sugar produced by the resulting meal.  They are also low in fat, high in folate, potassium, iron and magnesium, and a good source of protein that can be a healthful substitute for meat.

Combining carbohydrates with proteins and fats is another good practice because it slows down the rate at which sugar enters the bloodstream.  For example, prunes are a nutritious snack, but when eaten by themselves have a slightly higher glycemic value; instead have 4 prunes with about ten almonds and sugar is absorbed into the bloodstream more slowly, you are satisfied longer, and your nutrient intake has tripled.  Instead of having a plain apple, add a tablespoon of peanut butter and get the same result.  It may seem like a bit more to think about at first, but a little effort will yield big benefits.  My advice:  Don’t go on a diet; change the way you eat and forever reap countless rewards.

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