Fish Oil: It Conveys Much More Than Cardiovascular Health

woman jogging at sunrise
Numerous studies have evaluated the effects of the omega-3 fatty acids, DHA and EPA, on cardiovascular health. Overwhelmingly, scientists and clinicians involved in such research believe that omega-3 fatty acids play various beneficial roles in preserving optimal vascular and cardiac health: Anti-Inflammatory, Anti-Thrombotic, Anti-Arrhythmic, and TG-Lowering effects are considered to be the most relevant. Recently, Smith et al. published a fascinating and novel clinical trial looking at a non-cardiovascular yet widespread adverse aspect of aging: muscle mass decline. They published their findings in the American Journal of Clinical Nutrition: Fish oil–derived n–3 PUFA therapy increases muscle mass and function in healthy older adults. All parameters evaluated improved with the administration of 3,200 mg of daily DHA+EPA. Thigh muscle volume, handgrip strength, one-repetition maximum (1-RM) lower- and upper-body strength, and average power during isokinetic leg exercises all demonstrated statistically significant improvement. Improving muscle strength as we age can have far-reaching beneficial consequences that could reduce both morbidity and mortality. Thus, these findings need to be further studied in larger and even more consequential trials. But what additional meaning can we garner from their trial?

I believe that beyond their fascinating and clinically pertinent findings there actually lies a far more evocative message. It is simply that we should be extraordinarily cautious about abandoning the evaluation of therapies (even dietary) when they make biological and physiological sense. Fish oil consumption is woefully low in the US when compared to the far more healthy Japanese population. Our life expectancies are far shorter and various cancers occur more frequently in the US. It is scientifically quite plausible that our deficiency in omega-3 fatty acids plays a significant role in our relatively diminished health. But, after the publication of a few clinical trials failed to demonstrate the cardiovascular benefit of fish and fish oil in select patient populations, some physicians truly abandoned their prior admonitions for patients to augment fish consumption. They were derailed by the controversial results of just a few trials (that many exceptional researchers consider to be flawed in the first place). This type of knee jerk reaction has no place in medicine. It is dangerous and counterproductive. To protect our patients and maintain our scientific integrity, we must always practice with open and attentive minds. Once again I implore my scientific colleagues as well as the oftentimes superficially inquisitive media to follow the science, not the hype.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information about the supplements and vitamins critical to your everyday health visit www.vitalremedymd.com.

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Homocysteine and Folic Acid Supplementation: Another Medical “About Face”

On March 15, 2015 JAMA published on line the results of a superbly designed and potentially practice changing trial. The China Stroke Primary Prevention Trial (CSPPT), tested whether or not the addition of folic acid to anti-hypertension medication could reduce the occurrence of a first stroke. As three quarters of all strokes are “first strokes” and as strokes are a leading cause of death and disability worldwide, the question posed by this trial had far reaching implications. The trial met its endpoint so quickly and incontrovertibly that for ethical reasons it was prematurely terminated. Folic acid can reduce the risk of stroke. Those of us who have open-mindedly interpreted prior studies expected this finding; many others found the results to be shocking.

Important homocysteine related trials like HOPE 2 and others had already demonstrated either statistically significant reductions in stroke with folic acid supplementation or at least signals toward such an outcome. Yet many of the most “vocal” researchers, physicians, and reporters proclaimed that since heart attacks were not reduced with folic acid, “the homocysteine hypothesis was dead.” This perspective always bothered me. We had observational and even interventional trial data supporting the use of folic acid in certain settings. And stroke, the disorder we could impact with a simple vitamin, is horrific. Strokes are terrifying, disabling, and deadly. They are also extraordinarily common. So why would these doctors, scientists, and media members snub data supporting a simple and safe vitamin treatment to potentially reduce such events? It would be helpful to know the reason, as the same phenomenon is currently occurring in relation to omega-3 fish oils.

Plenty of data support fish oil supplementation yet a few trials do not. And as with homocysteine, it seems that the media and many scientists/doctors have chosen to focus their attention on the limited neutral – and oftentimes overtly flawed – data rather than supportive experimental, biologic, physiologic, clinical trial, and common sense evidence. Interestingly, one of the vital lessons gleaned from CSPPT is that those individuals with either specific genetic mutations or very low levels of folic acid received the greatest benefit (reduction of stroke) from taking folic acid. In parallel fashion, one of the key trial limitations of fish oil studies has been the persistent failure to measure blood levels of the omega-3 fatty acids DHA and EPA. It certainly stands to reason that those with lower levels of these critical fats will also gain the greatest advantage from their supplementation. So why not simply measure them? Well, in clinical practice, some of us do. And some of us even advise correcting abnormally low levels with simple and safe fish and fish oil pill consumption.

I am at once elated and disturbed by the CSPPT findings. They prove the efficacy of a simple therapy; yet, they broadcast the hubris of many in my field. Time and again we have had to make an about face in our opinions and recommendations. I see nothing inherently wrong in changing our position as more data emerge. What I struggle with is the egg on our face, the about face that occurs far too late, long after adequate data have told us what to do. Perhaps we will learn though. Maybe as more trials like CSPPT emerge, as more scientists and doctors with the conviction and devotion to finding a greater truth push tirelessly along their paths we will finally learn to be more open minded and accepting of ideas and findings even when they go against our grain.

For more information about the supplements and vitamins critical to your everyday health visit www.vitalremedymd.com.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

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An Update From the 2014 American Society for Preventive Cardiology (ASPC) Annual Meetings

Two weeks ago was the ASPC’s Annual meeting in Boca Raton, FL. The event was superb. Internationally recognized experts in a variety of disciplines convened in Boca Raton for the three–day-event. Nearly 200 healthcare practitioners from around the country came to listen to Professors from Northwestern, Harvard, NYU, The Mayo, Columbia University, The Miami Miller School of Medicine, Emory, Ohio State, UCLA…  Topics such as the somewhat controversial 2013 ACC/AHA Cholesterol and Obesity Guidelines, the enormously under-recognized disorder Familial Hypercholesterolemia, and the vast sex differences in CVD presentation and treatment were discussed.

My lecture was entitled, “The Omega-3 Fatty Acids DHA and EPA: Caution when interpreting the Trials. It’s time to get back to the basics.”  The talk highlighted enormous limitations inherent in recent omega-3 studies. It is not only clinicians and laypeople who must understand such issues, but the press as well. Too many reporters – and even physicians in the news – misinterpret clinical studies, oftentimes sending not just misleading messages to the pubic, but potentially damaging ones as well.

DHA and EPA are the essential fatty acids found in fish, NOT flax, Chia, or olive/canola oil. These fatty acids have been studied in a variety of disorders ranging from heart attacks to dementias, ADHD, eye disease, inflammatory bowel disorders, and Rheumatologic ailments. The list is actually even more extensive than this. Their benefits are legion – anti-inflammatory, anti-oxidant, anti-arrhythmic, and anti-thrombotic to name a few. Scientists across the globe are spending their entire careers evaluating the myriad biological effects of these fatty acids. Although we still do not know precisely how DHA and EPA will fit into our medicinal armamentarium, we do know that they have an important role to play. More studies and clinical trials are needed. One thing is clear however. DHA and EPA are here to stay. They represent a component in our diets that should be emphasized, not neglected. Nearly daily fatty fish or fish oils should be a part of most people’s dietary habits.

Beyond the value of DHA and EPA is an even more important message though. The media, in their unbridled attempt to produce quick and enticing stories, often critically misses the mark. Consequently we all must be very careful about how we interpret what we read or hear. We must always be vigilant when drawing conclusions about our health as well as other consequential matters.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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ConsumerLab Approval: A Brief Boast about VitalOils1000

couple bike riding

I make it my practice not to blog about VitalRemedyMD or any of its products, but this week demands a self-promoting shout-out. VitalRemedyMD is a company I started over ten years ago. It is now owned and operated by my wife (Laura Baum – also an MD). VitalOils1000 was created about six years back as the first and only enteric-coated fish oil pill to contain a full 1,000 mg of combined DHA and EPA. Thus, VitalOils1000 was the first omega-3 fish oil to meet the American Heart Association recommendation for individuals with cardiovascular disease in just one pill. This fact holds true even when considering prescription fish oil.

Yesterday we made the grade again. On April 6th ConsumerLab.com, the preeminent watchdog of the nutritional supplement world, released their every-other-year study of omega-3 fish oil products. Once again VitalOils1000 was “approved.” This year, in addition to “proving” our purification, concentration, and quality of enteric coating, we were also tested for PCBs and Dioxins. We were one of only two products tested in this comprehensive fashion, and we “passed” this important criterion as well. Our purification process of supercritical fluid technology enables us to achieve these exceptionally high standards for safety and purity.  There is so much confusion about omega-3 products that I felt compelled to write about our continued success with VitalOils1000. Needless to say, I am very proud. Thank you for permitting me a moment to boast.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Omega-3 Fish Oils – Misleading and Erroneous Interpretations of Scientific Studies Can Cause Harm

Recent statistics demonstrate a small but pervasive decline in national sales of fish oil supplements. Before I continue, let me make it clear that I have a bias here. In 2007 I formulated VitalOils1000, the first omega-3 fish oil carefully and uncompromisingly concentrated and purified so as to enable the American Heart Association’s recommended 1,000 mg of combined EPA and DHA to be placed in a single enteric coated soft gel.

Now, seven years later, VitalOils1000 still stands alone among a sea of fish oil choices (sorry; I couldn’t resist). Needless to say, I am very proud of that accomplishment. So my conflict is clear; I want people to take VitalOils1000. I believe it’s good for them. In fact – that’s why I designed it. So I am disturbed by the decline in people’s consumption of fish oils. Though the “business” ramification of this decline bothers me, I am far more disturbed by its root cause. Falsely frightened people have crumbled under the illusory conclusions of a few poorly constructed trials and the even-more-poorly constructed conclusions derived by “critics” of these trials.

Consider first the fact that four decades of research spanning bedside to bench and back again have demonstrated the sweeping benefits of the omega-3 fatty acids DHA and EPA – fish oil’s “active ingredients”. That’s forty years of thousands of brilliant minds examining the omega-3 issue from a multitude of vantage points. Forty years of overwhelmingly positive conclusions! Then come a few – and I mean a few – poorly designed studies with at times truly ridiculous conclusions. As with most other aspects of news reporting, the negative draws more readers and listeners than the positive. And so the media ran with the story. Some doctors even jumped on the bandwagon. “Fish oil is not what we thought it was,” they concluded. In response, omega-3 experts from around the world voiced their discontent. But their voices were muted as they failed to resonate with fear. The scientists and doctors spoke with authority and knowledge, devoid of histrionics. And so their side of the story didn’t sell newspapers or airtime. The outcome we now witness is that some people prematurely “drank the media cool aide”. They stopped their fish oils.

The problem is that I and many others in this field are left with the great concern that these individuals have left themselves less well protected against a host of disorders than they had been while taking fish oils. Unless they’ve dramatically increased their fatty fish consumption, they have certainly placed themselves in a relative omega-3 deficient state. Think of this: the average American consumes about 100 mg of combined EPA and DHA daily while the average Japanese consumes eight times this amount. And the Japanese have far lower rates of heart disease and prostate cancer than do Americans. Yet, the scant research behind the omega-3 fear mongering cited concerns about the ineffectiveness of omega-3s in cardiovascular disease as well as the possibility of omega-3s predisposing to prostate cancer.

There are many other plausible explanations for these inconclusive trials (see my blog www.fpim.org). Throwing the fish out with the fish water is however not called for. And so my conclusion here is once again to read the primary research. Do you own homework – though it may be hard – and decide for yourself what you think is best. If you need help evaluating the literature, look for the opinions of those who are true leaders in this field – William Harris, PhD, Bruce Holub, PhD, Tom Brenna, PhD, Susan Carlson, PhD (not the owner of the supplement company), and Kevin Maki, PhD for starters. There are plenty of others but be sure to listen to the experts.

Sadly we can no longer rely upon the media’s “Medical Experts” to be our source of scientific veracity. They are too busy, and often forced to weigh in on disciplines far removed from their particular areas of expertise. They cannot possibly be expected to know everything about every medical field. I am sorry to leave you with the task of “doing your own homework”, but nowadays it is something we must all become accustomed to do.

For more information about the supplements and vitamins critical to your everyday health visit www.vitalremedymd.com.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

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Beware the Pervasive Reach of Bias – Fish Oil Study Questioned

“Striking a Nerve: Bad Odor to This Fish Oil Study” was the catchy and misleading title for a MedPage headline last week. The “fishy study” to which the cynic refers was published in The American Academy of Neurology. Not exactly a shabby journal. The authors – William Harris, PhD and James Pottala, PhD – erudite and prolific contributors to omega-3 fatty acid research examined the brains of aging women from the Women’s Health Initiative Memory Study and noted a statistically significant association between hippocampal size and omega-3 RBC (Red Blood Cell) levels. In other words, women with low levels of the omega-3s DHA and EPA had more hippocampal atrophy than those with high levels. The importance here is that dementia is frighteningly prevalent (affecting 20% of women) and the hippocampus is likely playing a causal role in its development. Therefore, if we can identify factors – whatever they may be – that prevent hippocampal atrophy, we must pay close attention and examine them further. This is precisely what the authors stated; their findings were encouraging and hypothesis generating. In fact, their final statement, “This study thus adds to the growing literature suggesting that higher omega-3 FA tissue levels, which can be achieved by dietary changes, may hold promise for delaying cognitive aging and/or dementia” does not declare certainty, simply solid hope.

Why then would this study be unfairly condemned? This is a somewhat rhetorical question as I don’t have a clear answer. What I can say with certainty though is that no one should read or listen to an opinion and accept it as fact without first going to the primary source. Everyone would agree this to be true in politics. We must now sadly acknowledge its validity in the world of science as well.

Find more info on the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

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Learn to Read the Label: What to Look for When Choosing an Omega-3 Fish Oil Supplement

Omega-3 fish oil supplement labels can be very deceiving. This video explains how to choose the appropriate fish oil supplement.

Get more info on the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

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When Passions Collide – Omega-3s Are Essential So Why Would We Remove Them From Our Diets?

Last week the Cleveland HeartLab held its fourth annual Clinical Symposium. Excellent speakers addressed the group of some four hundred physicians and nurse practitioners from across the country. One in particular spoke with passion and unswerving conviction about his brand of a “no heart disease” diet. Dr. Caldwell Esselstyn vociferously and vehemently admonished the audience not to include any oils in their diets. “No oils” he repeatedly shouted pounding his fists in the air. No one can deny he walks his talk; he is extraordinarily svelte, clearly carrying no superfluous fat on his own body. My talk was about the essential role omega-3 and omega-6 fatty acids play in health and disease. And I too have my convictions and passions. And so we collided.

I steadfastly adhere to a worldview incorporating moderation, scientifically rigorous reflection on every aspect of human beings (from our evolutionary roots to the most reductionist biologic understanding), and acknowledgement that we do not and likely will never know everything. My position does not make room for Dr. Esselstyn’s view. His is simply too extreme. It also fails to consider the fact that human beings cannot adequately produce some vital fats such as EPA and DHA; those afforded us by our friends, the fish. EPA and DHA are indisputably essential contributors to the entire gamut of health considerations. From skin to eyes to brains and hearts, our organs need these fats to thrive. In fact, every cell in the human body requires DHA for optimal function. And even more compelling is the fact that we cannot adequately manufacture this fat. We need to eat it. So why eschew it? That is the problem with his thesis. Even if his handful of subjects adhering to this diet fails to develop cardiovascular events, it does not prove that the lack of fat plays any role. There are just too many other variables left unconsidered. Additionally, what diseases might be borne of such an unnaturally restricted diet? Too many questions remain for us to make a global experiment of Dr. Esselystyn’s hypothesis. We’ve done this before with dietary advice and hormone replacement recommendations and sadly we’ve been wrong every time.

In sum, I genuinely applaud Dr. Esselstyn for his dedication to extinguishing heart disease. His passion is real and his motivation pure. Still, that does not mean I must agree with him.

Get more information on the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

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Omega-3 Fatty Acids and Risk for Prostate Cancer

This article by William S. Harris, PHD was originally published by the Foundation for Health Improvement and Technology’s on the lecturepad.org website.

William S. Harris, PhD
Senior Research Scientist, Health Diagnostic Laboratory, Inc. (Richmond, VA)
Professor, Department of Internal Medicine, Sanford School of Medicine, University of South Dakota
President, OmegaQuant Analytics, LLC (Sioux Falls, SD)

On July 11, 2013 a paper was published online by Brasky et al. in the Journal of the National Cancer Institute entitled, “Plasma Phospholipid Fatty Acids and Prostate Cancer Risk in the SELECT Trial.” The authors found that higher plasma omega-3 fatty acid levels were associated with increased risk for developing prostate cancer. In this study, plasma phospholipid omega-3 levels were measured in 834 men who eventually developed prostate cancer (the time between plasma sampling and diagnosis is not available from the abstract), and 1393 men who did not. Using standard statistical methods, they found that men in the highest quartile of omega-3 had a 43% to 71% increased risk for prostate cancer (depending on severity). This is the same conclusion that the same group reached in 2011 in a study in another cohort entitled, “Serum Phospholipid Fatty Acids and Prostate Cancer Risk: Results from the Prostate Cancer Prevention Trial.”(1) So with two studies reaching the same conclusion, it is important to seriously consider its findings.

I will be the first to admit that had this study turned out the “right” way, I would have embraced its findings and had no criticism of its design or methods. It is disingenuous, therefore, for me to find fault with the way the study was conducted just because I don’t agree with the findings. Nevertheless, we should examine the methods to be clear on the context of the conclusions.

First, the reported EPA+DHA level in the plasma phospholipids in this study was 3.62% in the no-cancer control group, 3.66% in the total cancer group, 3.67% in the low grade cancer group, and 3.74% in the high-grade group. These differences between cases and controls are very small and would have no meaning clinically as they are within the normal variation. Based on experiments in our lab, the lowest quartile would correspond to an HS-Omega-3 Index of <3.16% and the highest to an Index of >4.77%). These values are obviously low, and virtually none of the subjects were in “danger” of having an HS-Omega-3 Index of >8%. In Framingham, the mean Omega-3 Index of participants who were not taking fish oil supplements was 5.2% and for those taking supplements, it was 7.5%.(2) Both of these numbers are considerably higher than the values reported by Braskey et al., even in their highest quartile. Thus, it is extremely unlikely that these patients were taking fish oil supplements. Indeed, the SELECT study (in which all these patients were participants) was a randomized trial of vitamin E and selenium supplements for the prevention of prostate cancer. In the study protocol, it is stipulated that if the subjects wanted to take a multi-vitamin, the study would provide it; nothing is said about fish oil supplements, but it is hard to imagine their use was widespread in this trial.

So to conclude that regular consumption of 2 oily fish meals a week or taking fish oil supplements (both of which would result in an Index above the observed range) would increase risk for prostate cancer is extrapolating far beyond the data. This study did not test the question of whether giving fish oil supplements (or eating more oily fish) increased prostate cancer risk; it looked only a blood levels of omega-3 which are determined by intake, other dietary factors, metabolism, and genetics. The endless repetition of “supplements are dangerous” in the news media is not based on any data from this study.

But even granting that the associations they reported are real, the findings of this study do not mean that EPA and DHA play any role in the development of prostate cancer. Associations do not imply causation. For example, it is possible that some component of whatever fish these patients were consuming was carcinogenic, in which case the serum omega-3 levels were just a marker of fish (i.e., carcinogen) intake.

It is important to put these findings into perspective (which the authors failed to do). First consider the risk of dying from prostate cancer vs. ischemic heart disease (IHD). Based on the National Vital Statistics Report for deaths in the US in males in 2010, (http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf), there were about 28,500 deaths from prostate cancer and 207,500 deaths from IHD: a 7.3x higher rate of death for heart disease. If one assumes (conservatively) that higher fish intake reduces risk for death from heart disease by only 10%, and (liberally) increases risk for death from prostate cancer by 50%, then the chances of dying from coronary heart disease (CHD) are still 4.4x higher than from prostate cancer. This very crude analysis suggests that even in the worst case scenario, the benefit of higher omega-3 intakes/levels still outweighs the risk.

The authors also failed to present the fuller story taught by the literature. The same team reported in 2010 that the use of fish oil supplements was not associated with any increased risk for prostate cancer.(3)A 2010 meta-analysis of fish consumption and prostate cancer reported a reduction in late stage or fatal cancer among cohort studies, but no overall relationship between prostate cancer and fish intake.(4) Terry et al. in 2001 reported higher fish intake was associated with lower risk for prostate cancer incidence and death,(5) and Leitzmann et al. in 2004 reported similar findings.(6) Higher intakes of canned, preserved fish were reported to be associated with reduced risk for prostate cancer.(7) Epstein et al. found that a higher omega-3 fatty acid intake predicted better survival for men who already had prostate cancer,(8) and increased fish intake was associated with a 63% reduction in risk for aggressive prostate cancer in a case-control study by Fradet et al..(9) So there is considerable evidence actually FAVORING an increase in fish intake for prostate cancer risk reduction.

Another piece of the picture is to compare prostate cancer rates in Japan vs. the US. Here is a quote from the World Foundation of Urology*:

“[Prostate cancer] incidence is really high in North America and Northern Europe (e.g.,  63 X 100,000 white men and 102 X 100,000 Afro-Americans in the United States), but very low in Asia (e.g., 10 X 100,000 men in Japan).” (http://www.prostatecancerprevention.net/index.php?p=prostate-cancer)

Since the Japanese typically eat about 8x more omega-3 fatty acids than Americans do and their blood levels are twice as high, you’d think their prostate cancer risk would be much higher… but the opposite is the case.

There is also a wealth of evidence from randomized clinical trials with fish oils in which the incidence of cancer (rarely subsetted) is always tracked as a possible adverse event. The table below shows the findings for the 8 major studies reported to date which included over 78,000 patients. In none of these studies was cancer incidence significantly increased by omega-3 fatty acid supplementation.

Table:
Reported incident cancer diagnosis (cancer deaths) Trial    

                                                                n         Dur. (yrs)  Placebo  N-3
Alpha-Omega(10) (prostate cancer)    4,837      3.4              0.8%         1.4%
Heart Failure(11) (cancer death)          6,975      3.9              3.2%         3.1%
GISSI-Prevenzione(12)                        11,320    3.5              2.25%       2.65%
JELIS(13)                                             18,645    4.6              2.4%         2.6%
SUFOLOM3(14) (cancer death)           2,501      4.2              6.5%          7%
Origin(15)                                            12,536     6.2   no difference in cancer rate
Risk and Prevention(16)                      12,513     5                 7.2%         7.9%
Omega(17)                                           3,851      1                 1.4%          1.7

In summary, the work of Brasky et al. does add to the evidence-base for omega-3 fatty acids and prostate cancer, which taken as a whole (not even getting into animal studies which are typically positive) support a neutral, if not beneficial, effect of fish oil in prostate cancer. The RCT data do not support an effect of omega-3 on cancer risk in general, and a 2012 review of omega-3 and prostate cancer concluded, “Thus, epidemiological studies provide inconsistent results, suggesting an inverse association of LC n-3 PUFA.”(18)

There will always be mixed findings in studies of “diet” and “disease” since both predictor and outcome entail so many variables, known and unknown. Higher omega-3 levels are associated with lower rates of death from any cause,19,20 from sudden cardiac arrest,21 and with slower rates of cellular aging.22 The risk benefit for fish oils remains very favorable. Read More…

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What You Need to Know About Omega-3 Fatty Acids – a slideshow

omega-3 nuts

Health Central has created a great slideshow illustrating the many benefits of consuming omega-3 fatty acids as part of a normal diet and as supplements. Here’s the link: HealthCentral.com

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