Are You Getting Enough Omega-3s? Take a blood test and see…

Omega-3 fatty acids are essential fatty acids in the human diet that are primarily found in oily fish like salmon, sardines, albacore tuna, herring, mackerel, etc. They are also available in fish oil soft gels. The principle omega-3 fatty acids are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).  Over the last 25 years, compelling evidence has accumulated from epidemiological studies and large clinical trials demonstrating their beneficial impact on joint, brain, eye, and heart function.  With regard to the cardioprotective effects of omega-3 oils, the strongest evidence to date relates to reducing risk for sudden cardiac death, the primary cause of coronary heart disease (CHD) death in the US today.

The American Heart Association reports that CHD is the number one killer of American men and women, accounting for more than one of every five deaths in the United States, usually as sudden death from cardiac arrest.  Recognizing the cardioprotective effects of omega-3s, the American Heart Association (AHA) recommends that patients with documented CHD should consume about 1,000 mg of omega-3s (specifically, combined DHA+EPA) per day; those without documented CHD should eat a variety of fish, preferably oily, at least twice a week, to provide about 500 mg of EPA+DHA per day.  It is very difficult, however, to reliably estimate omega-3 consumption based upon fatty fish intake because DHA and EPA vary greatly with species, season, maturity, fish’s diet, post-catch processing, and cooking methods.  A high-quality, highly purified fish oil supplement can deliver a more precise amount of omega-3s.  Even then, individual differences in absorption, metabolism, and distribution can lead to variable responses to a given intake.

So how do you know if you are getting enough omega-3s?

Now there is a blood test —the HS-Omega-3 Index™— that can measure your levels of the cardioprotective omega-3 fatty acids, DHA and EPA. Researchers have discovered that one of the best risk indicators for sudden cardiac death is the level of omega-3 fatty acids (EPA and DHA) found in red blood cell membranes. The HS-Omega-3 Index test measures levels of DHA + EPA in the phospholipids of red blood cell membranes and is expressed as a percent of total fatty acids in the membrane.  The result is a simple modifiable marker for the risk of death from coronary heart disease.

The target HS-Omega-3 Index is 8% and above, a level that current research indicates is associated with the lowest risk for death from CHD. On the other hand, an Index of 4% or less (which is common in the US) indicates the highest risk.  Low levels are easily corrected through dietary changes or supplements and can quickly improve test results. Of course, this is just one of a number of risk factors that plays a role in CHD.  Risks associated with other factors such as cholesterol, blood pressure, diabetes, family history of CHD, smoking, or other cardiac conditions are completely independent of and not influenced by omega-3 fatty acids. Any and all modifiable risk factors – including the HS-Omega-3 Index—should be addressed as part of any global risk reduction strategy.

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Inflammation: From Discovery to Defense

Inflammation is the body’s appropriate and healthy immune response to an injury or infection.  Pull a muscle, catch a cold, or get a bee sting and your body responds with pain and swelling and a healing process begins.  But if the immune system goes awry and fails to shut off, inflammation may become chronic and cause permanent damage to the body.  Chronic inflammation refers to a maladaptive process that is believed to contribute to a variety of medical conditions including heart disease, arthritis, osteoporosis, diabetes, cancer, and Alzheimer’s disease. This kind of inflammation may not be so readily apparent, but can be detected by high levels of certain established biomarkers like C-reactive protein (CRP) and interleukin-6 (IL-6) in the blood. Reducing levels of these biomarkers has been a target for a number of nutrition studies. Omega-3s, L-carnitine, lycopene, astaxanthin, folic acid, CoQ10, resveratrol, and vitamins C and D are a few nutrients that are gaining attention as natural anti-inflammatories.  Perhaps the best studied are the omega-3 fatty acids; researchers have found that increased blood levels of the omega-3s DHA and EPA were associated with reduced levels of the inflammatory biomarker CRP.

Researchers have pointed to western diets and lifestyles as major culprits in the rise of chronic inflammation. Although these may appear hackneyed, the following healthful lifestyle choices are your best defense against inflammation:

  • Maintain a healthy weight.  Excess weight can definitely induce a pro-inflammatory state.  Doctors are concerned about your waistline because studies show that visceral fat, located deep in the abdominal area, causes more inflammation than general obesity.  Lose the weight and you will gain the benefits of reducing or even eliminating inappropriate inflammation.
  • Eat a diet low in saturated fats and rich in complex carbohydrates, including fiber-rich fruits, vegetables and whole grains.  Avoid trans fats and sugar that promote inflammation and incorporate the healthful fats, the omega-3 fatty acids, DHA and EPA, which can boast powerful anti-inflammatory properties.
  • Take an omega-3 supplement containing 1000 mg DHA+EPA. Increasing omega-3s DHA + EPA while maintaining low saturated and trans fats also helps all lipid parameters – lowers LDL and total cholesterol, raises HDL and decreases TG.
  • Exercise more.  While helping to maintain a healthy weight, exercise can decrease inflammation and CRP levels, as well as lower LDL, increase HDL, lower blood pressure and reduce your risk of heart disease, and on and on and on…
  • Don’t smoke or linger in smoke-filled areas.  Air pollution and, of course, smoking have been linked to an increased incidence of heart disease, asthma, and other inflammation-related conditions.
  • Reduce stress. At the very least make an effort to manage stress in all ways possible: set limits on the demands you face and give yourself regular time out, exercise, make proper sleep and nutrition a priority, seek out laughter and love.

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Differentiating Fish Oils Part 3 – DHA and EPA: The Dynamic Duo of Omega-3 Fish Oils

Reading a fish oil supplement label can be a daunting task. Understanding the difference between DHA and EPA, the active ingredients in fish oil, is even more complex. The reason for this complexity resides in the fact that our understanding of these two fatty acids is in its infancy. Still, let’s try to make some sense of what we’ve learned over the past decade or so.

Fatty acids are comprised of just three different atoms, carbon (the long backbone or skeleton of the fatty acid), hydrogen, and oxygen.  That’s it. The difference among the various fats lies in the length of the backbone (how many carbon atoms there are) and the number of “double bonds” between carbon atoms. Other than these two distinctions, the fatty acids are really the same. So, then why are there such great differences among the fats if they’re so similar, you might ask? It turns out that longer chains tend to be more biologically active, and more double bonds results in more twisted and misshapen molecules which can then take on characteristics akin to complex locks or keys. As signaling and communication between cells often occurs through a lock and key mechanism, the fatty acids with many double bonds turn out to be great candidates for this task.

EPA is shorter than DHA (perhaps a bit less biologically active) and has fewer double bonds (less effective as a lock or key). EPA tends therefore to serve more as a precursor for other molecules that can diminish inflammation, clotting, oxidation, and cell death. DHA is also a precursor for some wonderful molecules that cause reversal of inflammation and tremendous protection of nerve tissue. Additionally, DHA is actively incorporated in our cell membranes where it can help cells communicate with other cells.

Other attributes shared by these two omega-3s include: Lowering triglycerides; raising HDL: and lowering the risk of lethal heart rhythms during and following heart attacks. Our bodies contain far more DHA than EPA, and DHA lasts longer in our bodies than does EPA, but both of these fatty acids have very important roles to play, and should be emphasized in our diets.

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Differentiating Fish Oils Part 2: What’s in your Fish Oil?

So, now that you understand the different forms that fish oils come in, it would be helpful to know what you’re putting in your mouth when you swallow a fish oil soft gel.  To do this, you have to develop the skill of label-reading.  At first blush this may seem to be a simple task, one not worthy of a blog, but in truth deciphering labels can at times be anything but easy.  I am not suggesting that companies intentionally mislead consumers with marketing and catchy phraseology, but at times they certainly don’t go out of their way to clarify what’s being sold to you.  For instance, what does it mean when a label catches your attention with the bold statement, “1,000 mg of fish oil”? Are you to be comforted knowing that taking just one of these pills meets the American Heart Association’s recommendation for heart patients to take 1,000 mg of the essential omega-3s EPA+DHA daily? More often than not, the answer is NO.  That’s because fish oil does not equal EPA+DHA.  And it’s EPA+DHA that you’re after.  EPA and DHA are the active and beneficial ingredients in fish oil, not the other fats (which include saturated fats as well).  To be sure you are getting what you want and deserve, follow these few steps:

  1. Pay attention to only the “Supplement Facts
  2. Read the “Serving size” – how many soft gels does it take to get one serving? Mark that # down.
  3. Read the “Amount per serving” – how much EPA is there, and how much DHA is there in a single serving? Add the amounts of EPA + DHA per single serving. Write that # down. Ignore “other omega-3s’ or “Total omega-3s”
  4. Let’s say your goal is to get 1,000 mg daily of DHA+EPA. Take “1,000” and divide it by the number you got in step 3. For instance, if the number you arrived at is “500 mg”, then 1,000/500 is 2.  You must take 2 servings to get your 1,000 mg of DHA+EPA daily.
  5. But you must be sure how many soft gels make up a single serving! So, now multiply the answer you got in step 4 by the # you got in step 2. For our current example, this will give you the # of pills needed to get your 1,000 mg of DHA+EPA daily. As the serving size can be 1, 2 or even 3 pills, in the case we’ve constructed you might need to take 2, 4, or even six pills to get what you want! That is why this process is so important.

Remember, the more DHA+EPA there is per gram of fish oil, the more concentrated and pure the oil is.  The more pure the oil, the fewer unnecessary fats you are consuming.  Try to get the purest oils. Extra fat gives you extra and unnecessary calories, something most of us do not need these days.

I hope this has been clear and helpful for you. The next blog, Differentiating Fish Oils Part 3, will discuss the different ways our bodies utilize DHA and EPA.

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Differentiating Fish Oils: Part 1, The Form of the Oil

This series will succinctly describe various aspects of the omega-3 fish oils that cause doctors and their patients a great deal of confusion and consternation. We will begin with the form of the oil.

Fish oils come in four forms: Ethyl Ester (EE), Triglyceride (TG), Phospholipid (PL), and Free Fatty Acid (FFA). Most fish oils (including the prescription, Lovaza) come in the EE form.  In fact, the largest and most profound scientific studies to date have used EE omega-3s.  In nature, omega-3s are found in the TG and PL forms.  The problem is that in order for manufacturers to develop pills with highly concentrated important omega-3s, EPA and DHA (also known as the active ingredients in fish), they must first convert the omega-3s to the EE form.  Then these health-promoting omega-3s can be highly concentrated, and depending upon one’s preference, either EPA or DHA can be emphasized (to be discussed in a future blog). Some manufacturers chose to convert the oils back to the TG form (a process that requires the oils to be subjected to high temperatures for long periods of time – not good for the oils in some experts’ opinions).  Others convert the oils into the FFA form to try to enhance absorption.  The Krill oil producers leave the oil in its original PL form with the drawback being that only very small amounts of the key ingredients EPA and DHA can be delivered in each pill.  The Krill and TG contention is that these forms of omega-3s are more “natural” and thus better.  The reality is, however, that all the oils must be changed in our gut to FFA in order to be absorbed.  Thus, they are no longer PL, TG, or EE when they’re absorbed by our bodies.  They are all FFAs. Studies to date have shown this conversion to be an efficient process and up to 95% absorption can be expected when any of the forms are taken with food. In fact, the lion’s share of the current literature indicates that the form of the oil is probably not nearly as important as companies would like you to believe. The most important issue is how much EPA and DHA you are receiving when you swallow a pill or eat a fish.  That is what you need to look for (also the subject of another blog).

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Prevention, Wellness, and Health

A Preventive/Integrative Cardiologist’s blog: topical, trustworthy, vital, and concise information, so you can spend less time searching for answers and more time enjoying life.

As a cardiologist practicing and teaching a blend of conventional, complementary, and integrative medicine for the past two decades I have learned what people desperately yearn for — trustworthy, even-handed, open-minded, scientifically-sound, appraisals of the vast and oftentimes blinding volume of data at our fingertips.  And people need the answers to be concise. The internet is flooded with information, but what is real and what is apocryphal?  Even for well-studied physicians and scientists, separating the wheat from the chaff can be a herculean task.  This blog is something I have dreamt of starting for quite some time.  It begins now.  I vow to assess issues relating to health and wellness as well as prevention in the cardiovascular and other realms in a clean and unbiased fashion.  I promise to do my research – when called for, obtaining input from other experts in various disciplines – to provide you with relevant, vital, and concise information that will enable you to make more healthful and sound choices so that you can live longer, healthier, happier, and better lives.  I encourage your participation.

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Failure To Exercise Is Not An Option

How do I convince thee?

Let me count the ways…  Exercise improves heart and lung function, decreases resting blood pressure, decreases body fat, decreases total and LDL “bad” cholesterol, raises HDL “good” cholesterol, increases energy levels, increases tolerance to stress and depression, and controls or prevents the development of diabetes.  Even from the first day, you will feel better if you exercise.  Because you feel better, you will look better, and the world will look better to you.  With time, your body will respond by increasing muscle mass and tone and decreasing body fat.  You will be thinner, stronger, more limber and flexible, and your body will function better and be less vulnerable to orthopedic injury. You will be healthier and decrease your risk of cancer, heart disease and chronic illness.  Did I mention you will feel better?  The day will seem more sunny, your tasks will seem more manageable, you might even notice suddenly your “glass is half full.”  Tell me, where is the down side?  Before you even start with excuses, I will point out that they are just that, excuses – transparent attempts at procrastination – and I have used them all myself:  “it’s too hot, it’s too cold, it’s raining,” or my personal favorite:  “I don’t have time.” Well a wise man once said, “Those who think they have not the time for bodily exercise will sooner or later have to find time for illness.”

Those who think they have not the time for bodily exercise will sooner or later have to find time for illness.

Myriad studies have shown the health benefits of exercise and they all sound something like this:  Scientists at universities around the country as well as at the Centers for Disease Control and Prevention followed more than 74,000 women ages 50 through 79 for almost five years.  What they found was that women who walked briskly (or biked, swam easy laps, or danced) for just an hour and a half to 2 1/2 hours a week were 18 percent less likely to develop breast cancer during that 5-year period than women who were sedentary.  That comes to just a half hour three to five times a week.  Not too much to ask in order to reduce your risk of dying from cancer.  A quick glance at some more recent medical studies included the following titles:  Exercise reduces risk of recurrence and death in early stage colon cancer patients; exercise and stress management show physiological benefits for heart patients; a new New Year’s reason to work out:  exercise improves three measures of heart protection; exercise helps reduce symptoms of depression…and on and on it goes.

There are many, many research findings that support the role of exercise in disease prevention. What has occurred to me is that most people know this at least intuitively without quoting studies. They also know that cigarettes cause cancer, and so on.  It may just come down to making a commitment to ourselves – breaking old habits and making new choices.  I used to play a game with myself when I had trouble getting motivated to go to the gym.  I would promise myself that I only had to exercise for 15 minutes, but I had to go.  Invariably once I had begun exercising I felt better and wanted to keep going. (I only acted surprised.)  I worked through my usual routine and then gave myself a pat on the back; the feeling lasted well through the day.  For the person who’s just getting started keep this in mind:  anything that’s more than you did yesterday is good.  No, in fact, it’s great!  Getting started is always the hard part.  Enlist a friend or even a personal trainer or make an appointment with yourself that can’t be broken.  Just do it, and then tell me how you feel.

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Staying Healthy in a Bad Economy

Staying healthy in an unhealthy economy is a challenging yet essential task.  Most of us are trying to cut back on our expenses, but I read some people are putting off doctor’s visits and others even stopping prescription medications!  If you are tempted to take short cuts with your healthcare, be forewarned… it could end up costing you more.  My advice:  talk to your doctor and do whatever you can do to invest in your health in simple cost-effective ways so you will avoid the financial and emotional cost of illness.  Particularly in economic hard times:

Reduce stress.  Try exercise – guaranteed to relieve stress.  You can even exercise at home and save on gym fees and on gasoline; take a walk, jump rope, stretch. Take a deep breath and find an activity that gives you a mental break:  take an early morning walk on the beach and watch the terns scurry up and down the shore; lie down in the grass and watch the clouds like when you were a child; start a new book.  Be charitable, with kindness:  hold the door for someone or let someone go in front of you on the checkout line if they look harried or rushed.  You’ll feel better and it won’t cost you a thing.

Exercise.  This one bears repeating because it does even more than relieve stress to keep you healthy.  Exercise improves heart and lung function, decreases resting blood pressure, decreases body fat, decreases total and LDL “bad” cholesterol, raises HDL “good” cholesterol, increases energy levels, increases tolerance to stress and depression, and controls or prevents the development of diabetes.  Even with the first day of exercise you will feel better. With time, your body will respond by increasing muscle mass and tone and decreasing body fat.  You will be thinner, stronger, more limber and flexible, and your body will function better and be less vulnerable to orthopedic injury. You will be healthier and decrease your risk of cancer, heart disease and chronic illness.

Stop smoking or encourage someone you love to stop smoking.  It will save in exponential ways – money, air quality, health, and heartache.

Drink more water, less soda.  This is an easy way to save big on calories and improve your health. And, try filtered tap water instead of bottled “spring” water.  You will save money and the environment at the same time.

Avoid fast food and eat at home more. Try oatmeal, it is inexpensive and highly recommended to help you lose weight and improve overall health.  Create a small herb garden and add flavor to a recipe at a fraction of the cost of buying fresh at the market each time; it’s easy and it’s gratifying.  Buy meat or chicken in bulk at a wholesale store, freeze and cook later, or cook now and freeze so you can just warm it up when you’re short on time.  Don’t go food shopping when you’re hungry and you will avoid temptation and buying in excess.

Avoid fad diets and diet pills.  They will cost you money and they will cost your health. Adopt a more healthful way of eating for life.

Take appropriate nutritional supplements.  A good daily multivitamin with 100% of essential vitamins and minerals is a great foundation.  Research shows 80 to 90% of the population does not achieve the recommended daily value (RDV) for each vitamin and mineral each day, nor do they even come close.  And, keep in mind that the RDV levels for each nutrient are only intended to guard against severe nutrient deficiency diseases, but are not intended to serve as levels of vitamin and mineral intake that are optimal in regard to supporting biological functions, preventing degenerative diseases and maximizing our well-being and longevity.  Take fish oils and boost your omega-3 intake; beyond the protective effects demonstrated in heart disease and cancers, scientific evidence strongly indicates that the omega-3 fatty acids, DHA + EPA, may have potential benefits in the prevention and/or treatment of myriad health conditions.

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Study: Lifestyle Changes Could Prevent More Deaths from Colorectal Cancer Than Screening

Lifestyle Changes Could Prevent More Deaths from Colorectal Cancer Than Screening, according to a study published online April 4 in the European Journal of Cancer Prevention.  Researchers from the United Kingdom predict that “realistic” lifestyle modifications involving diet and exercise would lead to a 26% reduction in the number of cases of colorectal cancer in the British population. This would be expected to produce at least an equivalent decrease in the number of deaths, they add, and “this is considerably greater than what is likely to be achieved by the National Bowel Cancer Screening Program.” They previously estimated that this project, which involves 2 yearly screenings with fecal occult blood testing, would reduce colorectal cancer mortality in those screened by 13% to 15% over the next 20 years (J Med Screen. 2008:15:163-174).

The lifestyle modifications involved:

  • Reducing consumption of red and processed meat to less than 90 g/day
  • Increasing consumption of fruit and vegetables to at least 5 portions per day
  • Exercising for at least 30 minutes per day on 5 or more days a week, at least at “moderate intensity” (similar to brisk walking)
  • Restricting alcohol consumption to 3 units a day for men and 2 units a day for women (where 1 unit is equivalent to half a pint of beer; a single measure of spirits; 1 glass of wine; or a small glass of sherry, port, or something similar)
An added bonus from the lifestyle-modification approach is that it would also prevent deaths from other causes, including cancers of the breast and upper gastrointestinal tract, cardiovascular diseases, and diabetes, the researchers add.

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