In 2019, you were highly interested in the importance of omega-3 DHA during pregnancy, whether or not omega-3s EPA and DHA lower cholesterol, and the battle between omega-3 vs. omega-6. In order of popularity, the following are excerpts from some of your favorite blogs.
In order to give baby the best start, expectant mothers must ensure they are getting enough omega-3 DHA (short for “docosahexaenoic acid”) in their diets. During pregnancy, women need at least 200 milligrams daily of this powerful omega-3 fatty acid to support the development of baby’s brain, eyes and nervous system. Plus, getting that daily dose of DHA has been shown to prevent pre-term labor, increase birth weight, and support postpartum mood in new mothers.
However, the majority of moms-to-be are severely deficient in this essential nutrient. Research indicates that most women are only getting around 60 mg/day and that just 1 in 14 actually takes a DHA supplement.
It’s estimated that about 80% of women of childbearing age in the US have a DHA blood level of less than 5%, a suggested blood DHA target for pregnancy. Unpublished data from OmegaQuant found that in a study of 26 pregnant women in their third trimester (when the baby needs most of this nutrient) close to 50% had prenatal DHA blood levels less than 5%. In this particular population, taking 200 mg of DHA per day for 10 weeks within a highly controlled diet was enough to increase DHA levels in all of the women to at least 5%.
Since the human body is unable to make DHA efficiently from other omega-3 fatty acids, dietary intake is very important. Follow these guidelines to be sure you’re getting enough DHA to support a healthy pregnancy.
It is one of the most popular questions asked about omega-3s— do they lower cholesterol? The simple answer is no; they don’t lower cholesterol. But they do have an impact on other risk factors related to heart disease, such as triglycerides, blood pressure, and the Omega-3 Index.
Unfortunately there are articles out there that continue to say that omega-3s do lower cholesterol, so we would like to set the record straight.
First of all, let’s talk about what cholesterol is. Cholesterol is a fat-like substance produced by the body to help it make hormones as well as nutrients like vitamin D. It is produced by the liver and found all over the body, especially in the blood.
Cholesterol becomes problematic when there is too much low-density (LDL) lipoprotein in your arteries. Here it can form plaques, which narrow the arteries and impede blood flow. Lack of blood flow to the heart could eventually result in a heart attack or stroke.
Unfortunately our modern diets are rife with substances that can overwhelm the body. Cholesterol is one of them. The body makes all of the cholesterol it needs from the liver. Any additional cholesterol will combine with our body’s cholesterol to form plaque, which clogs the body’s arteries. When the situation gets out of control, doctors either order cholesterol-lowering medicines likes statins or surgical interventions like stents.
This has been standard of care for several decades. However, recent research is calling into question whether or not cholesterol levels should even factor into heart disease diagnosis and treatment.
Research published in August 2018 comprehensively reviewed current literature, disputing LDL cholesterol as one of the root causes of cardiovascular disease. So, even if omega-3s could lower cholesterol, it may not even matter.
“Heresy! It can’t be! I thought you guys were experts?!”
We are well aware that some might have that reaction to the idea that omega-6 fatty acids might actually NOT be the boogeyman that they’ve been portrayed as for so long. So this blog might start off sounding more like a science lesson, but in the end the goal is to help you understand the roles omega-3 and omega-6 fatty acids play in the body.
We hope you’ll come to understand that, although there is no question that omega-3s are good for you, the omega-6 cousins might be as well despite the constant stream of information coming out against omega-6s.
Most experts agree that you need both. After all, they are both “essential fatty acids.” However, experts seem to part ways when it comes to recommending how much of each you need, with many suggesting that our consumption of these fatty acids is out of balance. In other words, we consume too much omega-6 and not enough omega-3.
We spend a lot of time in this blog lauding the benefits of omega-3s, but the truth is omega-6 brings a lot to the table as well. And it may not deserve the bad reputation it has gained over the last decade or so. But in life, and in fatty acids, we always like to have a good guy and a villain, a white hat and a black hat. Unfortunately it’s not that easy, or rational, to label one “good” and the other “bad.”
While many people are aware of omega-3s, many are not sure exactly what they do. Let’s start with what they are first. There are three main omega-3 fatty acids: eicosapentaenoic acid (EPA), docosapentaenoic acid (DHA) and alpha linolenic acid (ALA).
Only ALA is considered “essential” because it cannot be made by the body and must come from the diet. The good news is most modern diets provide plenty of ALA, so there is no real need to get more. Some popular food sources of ALA include avocados, walnuts, flax and chia, as well as soybean oil.
A small portion of ALA will be converted to EPA and DHA in the body, but not enough that yields much protective benefit. In other words, consuming omega-3s EPA and DHA directly from fish like salmon or supplements is really the best way to obtain these types of omega-3s.
Although they are not necessarily considered “essential” like ALA, most modern research has focused on EPA and DHA because they seem to offer the most protective benefits for the heart, brain and eyes.
There is a lesser known omega-3 called docosapentaenoic acid (DPA), but the research on this fatty acid is still in its infancy regarding its particular health benefits.
How Do They Work?
On a cellular level, omega-3s alter the structure and function of cell membranes. The shape of the DHA molecule, in particular, actually alters the flexibility and fluidity when it gets incorporated into cell membranes throughout the body.
This changes the way that forces (i.e., chemicals) OUTSIDE the cell are sensed INSIDE the cell, and thus that changes how cells respond to a changing environment.
So when a “pro-inflammatory” molecule — called a “signal”… think of “smoke signals” between Native tribes — comes in contact with a certain type of cell, and “touches” the membrane, prompting that cell to make MORE inflammatory molecules, the now less sensitive membrane (because of the presence of DHA) does not communicate the signal to the inside of the cell so readily. This results in a “quieter and gentler” cellular response to these screaming inflammatory molecules.
EPA also is important because it can be converted into certain types of molecules that don’t “scream loudly” at the cell — or at least as loudly as their omega-6 cousins do — and thus from the OUTSIDE, they don’t knock on the cell’s “door” (membrane) as hard, resulting again in a softer intracellular response.
The human brain weighs about 1.5 kg or 3.3 lbs, and 60% of it is fat. In fact, it’s one of the fattiest organs in the human body. It’s also one of the most important organs, as it plays a role in just about every major body system.
But while most of us are busy focusing on reducing our fat intake, there’s one type of fat you don’t want to cut back on, and that’s omega-3 fatty acids — specifically EPA and DHA. They mostly come from marine sources like fish, as well as omega-3 supplements that contain fish oil, krill oil or algal oil. And they are among few nutrients actually found in the brain.
Omega-3 fatty acids regulate your brain’s structure and ability to perform. And EPA and DHA in particular are known to play a specific role in the structure and function of the brain, especially during the aging process. The pathways underlying their presence and uptake are crucial in understanding how they impact brain development.
INFOGRAPHIC: Omega-3s and Anxiety
DHA is already present within the brain and, compared with other tissues such as liver or plasma, in a very high concentration. In fact, roughly 30% of the “gray matter” that contains most of the neuronal cell bodies in the mammalian brain is comprised of DHA. It has been suggested that the brain maintains these high DHA levels primarily via the uptake of DHA from lipids in circulating blood. These lipids are said to cross through the blood-brain barrier, rather than possessing any active endogenous biosynthesis abilities, which is reportedly lower in the brain compared to other tissues.
Compared to DHA, brain EPA levels are considerably lower, with one study reporting EPA deficiencies 250–300 lower than DHA. This study, which looked at the cause of such differences in brain fatty acid levels, suggested that the low levels of EPA may be the result of its rapid β-oxidation upon its entry into the brain. Coupled with the fact that EPA and DHA have been found to enter the brain at similar rates, it is also likely that differential efficiencies in the metabolism and incorporation of these fatty acids into the blood and other tissues inadvertently impacts the uptake of EPA via these sources.
In previous blogs we have talked about the many ways you can increase your Omega-3 Index, including eating more fatty fish like salmon or taking an omega-3 supplement that delivers EPA and DHA. But knowing how much you actually need in order to achieve an optimal Omega-3 Index has only recently become a research focus.
In fact, a study published in August 2019 in the American Journal of Clinical Nutrition (AJCN) established a new way to calculate how much omega-3 EPA and DHA will likely be needed to reach a health protective Omega-3 Index (8-12%).
Until now, there has been very little guidance about what dose of EPA and DHA should be tested in a clinical study. And with the wide differences in study results in recent years, it is likely that dose played a central role in the relative success or failure of omega-3 studies. In other words, if the dose of EPA and DHA in a study wasn’t high enough to make an impact on blood levels (i.e. Omega-3 Index), there would most likely be no effect on the desired endpoint, leading to a neutral or negative result.
When it comes to cardiovascular disease (CVD) in particular, the literature supporting the benefits of omega-3s EPA and DHA has been mixed. On one hand, a 2018 meta-analysis concluded that current evidence does not support a role for omega-3s in CVD risk reduction.
On the other hand, three major randomized trials reported in late 2018 showed that omega-3s significantly reduced risk for vascular death, myocardial infarction, and major adverse cardiovascular events. The latter study was particularly compelling because it used 4 grams of EPA (as opposed to the usual 0.84 grams of EPA and DHA) in statin-treated patients and found a 25% risk reduction in CVD events.
According to Kristina Harris Jackson, PhD, RD, who is an author on this latest paper, “A low dose could make a study show no effect of EPA and DHA, which makes the literature more indecisive and the consumer more confused,” she said. “Hopefully, ensuring the dose of EPA and DHA is high enough to reach a target Omega-3 Index level will clarify whether or not EPA and DHA are effective.”
Earlier this year, a study published in Prostaglandins, Leukotrienes, and Essential Fatty Acids, showed that people likely need to eat more fish and take an omega-3 supplement to reach a cardioprotective Omega-3 Index level of 8% or higher.
Dr. Jackson was the lead author on this study, the goal of which was to answer the question: “What combination of non-fried fish intake and omega-3 supplement use is associated with a cardioprotective Omega-3 Index level (i.e., 8% or above)?”
In 2018, the American Heart Association (AHA) updated its 2002 recommendations regarding fish and seafood consumption from “…a variety of (preferably oily) fish at least twice a week” to “…1 to 2 seafood meals per week.”
“This apparent downgrade in the recommendation (i.e., removal of ‘preferably oily’ and ‘at least’) was made despite evidence that consuming fish more frequently (such as daily or multiple times per day) may impart even greater cardioprotection,” Dr. Jackson and her colleagues pointed out this paper.
Chances are you’ve heard of or may even know someone struggling with attention-deficit/hyperactivity disorder (ADHD), a brain disorder that makes it difficult to control impulses and be attentive for more than short periods of time. ADHD affects an estimated 8.4 percent of kids and 2.5 percent of adults, according to the American Psychiatric Association(APA).
While it occurs in both boys and girls, the rate of boys diagnosed with ADHD is three times higher than the number of girls diagnosed, and in the majority of cases it lasts throughout a person’s lifetime.
ADHD is often diagnosed in childhood by a clinical interview with a mental health professional. “Technically, in order to be diagnosed with ADHD, a child must have at least six ADHD symptoms of either inattention, hyperactivity-impulsivity, or both. In addition, these symptoms must be present for at least 6 months or longer, be present before the age of seven, and cause significant impairment or difficulties in two or more settings, such as home, school/work or social setting,“ says Leslie A. Hulvershorn, M.D., M.Sc andAssistant Professor of Clinical Psychiatry at Indiana University School of Medicine. Adults, meanwhile, are initially screened using the Adult ADHD Self-Report Scale.
While there is currently no lab test to diagnose ADHD, there is evidence that genetics play a large role in who is affected. According to the APA, three out of four children with ADHD have a relative with the disorder. Those born prematurely, with a brain injury, or with a mother smoking, using alcohol or having extreme stress during pregnancy are also at an increased risk for developing ADHD.
For those who receive a positive diagnosis, the National Institute of Mental Health recommends a combination of behavioral therapy and medication, particularly those with moderate to severe ADHD.
For children with ADHD, behavioral treatment usually consists of educating parents and teachers on how to provide positive feedback for desired behaviors and consequences for negative ones. Through this kind of coaching, parents and teachers can help children manage their attention, behavior, and emotions, and find the most effective ways to respond to the difficult behaviors associated with ADHD.
Likewise, adults with ADHD may benefit from psychotherapy and ADHD coaching, through which they can learn behavioral strategies to help bring routine, structure, and organization to everyday life.
When it comes to medication, the national organization, Children and Adults with Attention-Deficit/Hyperactivity Disorder(CHADD) notes both stimulants and non-stimulants have been shown to be helpful for both children and adults in activating the brain’s ability to pay attention, slow down, and use more self-control.
Stimulant medications are commonly used because they have been shown to be most effective for most people with ADHD, notes the Attention Deficit Disorder Association. Non-stimulant medications have also been shown to be effective and are typically used as alternatives for those who do not respond well to stimulants or if a non-stimulant is preferred. As with all medicines, children taking these drugs must be carefully monitored by their parents and doctors.