Omega-3s during Pregnancy and Lactation

Maintaining optimal levels of omega-3’s is important for all of us, but one population that deserves special attention is women who are pregnant and nursing. The omega-3 fatty acids are critical for optimal brain health and function at all ages of life, but these essential fatty acids play a vital role during fetal development and infancy. Pregnant women have a higher requirement of omega-3s, in particular DHA, because of the rapid cell growth and development of new tissues and organ systems. Optimal development of the brain and central nervous system, the eyes, and the immune system – have all been associated with adequate intake of DHA. In fact, DHA is a major structural fat in the human brain and eyes, representing about 97% of all omega-3 fats in the brain and 93% of all omega-3 fats in the retina. During the last trimester, the fetus accumulates 50-70 mg DHA each day, nearly the same amount that most American’s consume from diet alone. Both the mother’s DHA intake and circulating DHA concentrations are important in determining fetal blood concentrations of DHA. Without supplementation, maternal levels of omega-3s will decrease during pregnancy and will be further decreased when breast-feeding, as the essential fatty acids are also components of breast milk. These nutrients continue to be vitally important for development of the brain during infancy and this is the reason DHA is now added to infant formulas. Babies continue to accrue DHA into the central nervous system until about 18 months of age.

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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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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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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

Learn more about the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

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Key Preventive Health Measures – Be Your Own Healthcare Advocate

woman weight trains on beach
Today most health insurance policies provide yearly health examines and very limited preventive medicine coverage. It’s imperative though that people be proactive in their approach to healthcare to avoid illness and get treatment for on-going conditions before they become serious. People must become their own healthcare advocates.

Here are some basic recommendations:

  • Get a check-up. How often you have a check-up can be determined by your age, sex and overall health.  Have your blood pressure checked and get screened for hypertension.
  • Stay physically active and exercise regularly. Something as simple as a daily 30-minute walk will do wonders for your overall health.
  • Weight can be a killer. Address any overweight and obesity issues you may have.
  • Eat a healthful diet that features daily servings of a variety of fruits and vegetables and at least one serving of fatty fish (salmon, tuna, trout) per week. Consider a high quality fish oil pill that has been concentrated and purified to give you 1,000 mg of combined DHA and EPA in a single soft gel.
  • Limit foods and drinks high in sugar, salt, and saturated fat. Avoid unhealthful snacks. Stay away from processed foods to the best of your ability. Avoid simple carbohydrates. Sugar is your enemy.
  • Talk to your doctor about whether or not taking a daily aspirin to prevent heart attacks and stroke is right for you.
  •  Get immunized: Annual flu shots are recommended for adults 50 and older, as well as immunization of adults 65 and older against bacteria that causes pneumonia and related diseases. Children should get immunized for measles, mumps, diphtheria, tetanus, whooping cough, rubella, polio, hepatitis B, etc.
  • Cholesterol screening is imperative. Request an assessment of not only your LDL but your LDL particle number as well. Liposcience does this in their NMR LipoProfile.
  • Never smoke; quit smoking if you’ve already started; and avoid second hand smoke.
  • Adults 50 and older should have a routine colorectal-cancer screening.
  • Cervical cancer screening for sexually active women and women over 21 years of age.
  • Routine breast-cancer screening for women 50 and older and discussion with women ages 40 to 49 to set an age to begin screening. Other special recommendations may apply to high risk women. Speak to your doctor.
  • Calcium-supplement counseling for adolescent girls and women.
  • Get an eye exam, particularly adults 65 and older.

Please remember that central to overall health is daily exercise, a healthful diet, and maintenance of an optimal weight. We call this TLC, or Therapeutic Lifestyle Changes. TLC is paramount for health!

 

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Clinical Trials and Scientific Articles: Read and Believe with Caution

A disclaimer should accompany every scientific article, “Read and Believe with Caution”. To say that weekly there is a study contradicting a prior clinical trial is probably an underestimation of the state of medical/scientific affairs. Hundreds of peer-reviewed journals now cross our desks and computer screens. How do we, the doctors and scientists, assimilate all these data? This is particularly difficult when one considers the complexity of statistical analyses that must be thrashed through in order to do justice to any single study. And then one must remember that we do not have every hour of every waking day to analyze trials. The result is far too often a leap to erroneous but easy conclusions. We saw this recently with a JAMA meta-analysis regarding fish oils (see the blog of my letter to JAMA) wherein standard statistical analysis was plainly deviated from. The result, an unfounded conclusion that no one on TV every mentioned. Perhaps they did not have the preparatory time necessary to dissect the statistics. Whatever the case, medical and lay opinions were unfairly and wrongly influenced by this trial.

And now we have another interesting study, this time in favor of supplements. On October 17th JAMA published on-line the results of a multivitamin analysis of Harvard’s famed Physicians’ Health Study. This trial revealed that simple (low dose) multivitamins could decrease cancer rates in men. Prior studies using high dose supplements have failed to demonstrate this. At the risk of being self-serving, over ten years ago I performed a small clinical trial (published in JANA – the Journal of the American Nutraceutical Association) demonstrating the possible downside of high-dose supplements. I responded to my own trial by forming a very conservative supplement company, VitalRemedyMD.  And my first products were two simple daily multiples with no more than 100% of the RDV of the essential vitamins and minerals (the Daily2Tab and DailyMultiple – innovative names, I know). No more than that. I based these formulations more upon my review of basic science literature, than our too-highly-revered RCT (Randomized Clinical Trials). A decade later, the clinical trial is “catching up” with something that science had already taught us. My point here is that we in the medical world have shunned our roots, basic science. And, we have cut ourselves off from our mentors, the basic scientists. In fact, just last week an article I wrote on this subject that was published online – A Survey of Internists and Cardiologists: Are Discoveries in Fatty Acids Truly being translated into Clinical Practice? Prostaglandins, Leukotrienes and Essential Fatty Acids (available online 25 October 2012). It tells this story. There is a disconnect between science and medicine. It is real, prevalent, and very disturbing. It undermines our ability to grow and limits our capacity to cure. The only way I see we can conquer this impediment is by opening a continual and non-confrontational dialogue among the diverse elements of science and medicine. Only then can we have true translational medicine, the application of what is learned in the lab to the patient in our offices or hospital wards. Short of dialogue we will continue to exist in a modern tower of babble, and we all know how well that worked out.

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