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Omega 3 Supplementation And Heart Disease Risk

April 15, 2020April 14, 2020 by Dr. Steve Chaney

How Can You Reduce Your Risk Of Heart Disease?

I understand your confusion. One month the headlines say that omega 3 supplementation reduces the risk of heart disease. The next month headlines claim that omega 3 supplements are worthless. What is the truth about omega 3 supplementation and heart disease risk?

Let me start by sharing the two of the most recent studies on the topic. They are both very large, well designed studies. However, the reason I selected these two studies is that they approached the relationship between omega 3 supplementation and heart disease risk in very different ways but came to the same conclusion.

The first study (Y Hu et al, Journal of the American Heart Association, Volume 8, Issue 19, 1 October 2019) was a meta-analysis of 13 randomized controlled clinical studies looking at the relationship between omega 3 supplementation and heart disease risk.

The second study (Z-H Li et al, British Medical Journal, BMJ2020;368:m456) looked at the association between habitual omega 3 supplementation and heart disease risk.

Each of these studies had strengths and weaknesses, but they complemented each other. The weaknesses of one study were the strengths of the other study.

How Were The Studies Done?

Study #1: The 13 studies included in the meta-analysis had a total of 127,477 participants (mean age 64, 60% male, mostly overweight) who were given either an omega-3 supplement or a placebo.

40% of the participants had diabetes.

72% of the participants were on cholesterol lowering drugs and a variety of other medications.

Participants were followed for between 3 and 7.4 years (average follow-up period was 5 years).

The dose of omega 3s ranged between 376 and 4,000 mg/day.

The major strengths of this study were:

All 13 studies included in the meta-analysis were randomized, placebo controlled clinical trials.

The meta-analysis had a very large number of participants (nearly 130,000), so it was possible to accurately measure even small effects of omega 3 supplementation on heart disease risk.

The major weaknesses of this study were:

Most of the participants were already on multiple drugs that provided many of the same benefits as omega 3s, so it was impossible to assess the full effect of omega 3 supplementation on heart disease risk.

The duration of the clinical trials included in this meta-analysis was short compared to the decades required for heart disease to develop.

Most of the participants already had heart disease or were at high risk of developing heart disease. The people in these studies were not representative of the general population.

Study #2: The data for this study were obtained from the UK Biobank study which enrolled 427,678 participants (mean age 56, 45% male) from 22 medical centers across England, Scotland, and Wales. None of the participants had been diagnosed with heart disease or cancer at the time of enrollment.

At enrollment the participants filled out a detailed online questionnaire concerning their lifestyle, diet, diseases, medications, and supplement use. Among the questions was whether they habitually used fish oil supplements (Yes or No).

The participants were enrolled between 2006 and 2010 and followed for an average of 9 years.

31% of the participants were already taking omega 3 supplements on a regular basis at the time they enrolled in the study. This was the omega 3 supplementation group. The remaining 69% was the control group.

Only 10% of the participants were taking statin drugs or aspirin, probably because none of them had been diagnosed with heart disease.

Around 10% of the participants had high blood pressure and were taking blood pressure medications.

Most of the participants were slightly overweight but only 4% had diabetes.

The main strengths of this study were:

Very few of the participants were on medications. That means that medications did not interfere with the effect of omega 3 supplementation.

The participants were already using omega 3 supplements at the time of enrollment and were followed for an additional 9 years. That means that the duration of omega 3 supplement use was much longer than in the first study.

The participants were healthy and free of heart disease at the beginning of the study. That means that the results of this study focused more on prevention than on treatment. It also means the results are more applicable to the general population.

The main weakness of this study was:

It was an association study, which cannot prove cause and effect. In contrast, the first study was based on randomized, placebo controlled clinical trials, which can prove cause and effect.

In short, the weaknesses of the first study were strengths of the second study and vice-versa.

Omega 3 Supplementation And Heart Disease Risk

Study #1: The results from the meta-analysis of randomized, placebo-controlled clinical trials were that omega 3 supplementation:

Reduced heart attacks by 12%.

Reduced overall heart disease risk by 7%.

Reduced deaths from heart disease by 8%.

Because of the large number of participants included in the meta-analysis, all these reductions were highly significant.

The risk reduction was linearly related to the dose of omega-3s, but the study did not allow estimation of an optimal omega-3 dose.

The authors concluded: “Marine [fish oil] omega-3 supplementation lowers risk for heart attack, overall heart disease risk, and heart disease death…Risk reductions appear to be linearly related to marine omega-3 dose.”

Study #2: This study showed that regular use of omega-3 supplements:

Reduced deaths from all causes by 13%.

Reduced deaths from heart attacks by 20%.

Reduced deaths from all types of heart disease by 16%.

Because of the large number of participants, all these reductions were highly significant.

This study did not collect data on omega-3 dose, so the study did not allow estimation of an optimal omega-3 dose.

The authors concluded: “Habitual use of fish oil seems to be associated with a lower risk of all cause mortality and heart disease mortality…,supporting their use for the prevention of mortality from all causes and heart disease. Future studies are needed to examine the extent to which the dose of fish oil supplements influences the ability to achieve a clinically meaningful effect.”

While these studies did not provide information on the optimal omega 3 dose, a previous study concluded that an omega-3 intake of 835 mg/day or higher is needed to achieve clinically meaningful reductions in heart disease risk.

How Can You Reduce Your Risk Of Heart Disease?

These two studies support the value of omega 3 supplementation for reducing heart disease risk. However, while risk reductions were highly significant, the magnitude of risk reduction was relatively small. That means we should think of omega-3 supplementation as part of a holistic approach to reducing our health disease risk. It is just one piece of the puzzle.

With that in mind, here is what the American Heart Association recommends for reducing your risk of heart disease:

If you smoke, stop.

Choose good nutrition.

- Choose a diet that emphasizes vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts.

- Choose a diet that limits sweets, sugar-sweetened beverages, and red meats.

Reduce high blood cholesterol and triglycerides.

- Reduce your intake of saturated fat, trans fat and cholesterol and get moving.

- If diet and physical activity don’t get those numbers under control, then medication may be the next step.

Lower High Blood Pressure.

Be physically active every day.

- Aim for at least 150 minutes per week of moderate-intensity physical activity per week.

Aim for a healthy weight.

Manage diabetes.

Reduce stress.

Limit alcohol.

Add in omega-3 supplementation to these recommendations and you have a winning combination.

The Bottom Line

Two major studies have recently been published on the relationship between omega 3 supplementation and heart disease. I felt it was important to evaluate these studies together because:

They are both very large, well designed studies.

They approached the relationship between omega 3 supplementation and heart disease risk in very different ways but came to the same conclusion.

They complemented each other. The weaknesses of one study were the strengths of the other study.

These studies showed that omega 3 supplementation:

Reduced heart attacks by 12-20%.

Reduced overall heart disease risk by 7%.

Reduced deaths from heart disease by 8-16%.

Reduced deaths from all causes by 13%

While these studies did not provide information on the optimal omega 3 dose, a previous study concluded that an omega-3 intake of 835 mg/day or higher is needed to achieve clinically meaningful reductions in heart disease risk.

For more details and the American Heart Association recommendations on what else you can do to reduce your risk of heart disease, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

What Supplements Help Mental Health?

January 14, 2020 by Dr. Steve Chaney

Do Omega-3s Reduce Depression?

Author: Dr. Stephen Chaney

We are in the midst of a mental health crisis. According to the latest statistics:

· 19% of adults in the United States have some form of mental illness.

· 16.5% of youth ages 6-17 have some form of mental illness.

· The 5 most commonly diagnosed forms of mental illness are anxiety, depression, post-traumatic stress disorder, bipolar disease, and ADHD.

Even worse, mental illness appears to be increasing at an alarming rate among young people. For example:

· Between 2005 and 2017 depression increased 52% among adolescents.

· Between 2002 and 2017 depression increased 63% in young adults.

· Between 1999 and 2014 suicides have increased 24% in young adults. In the past few years suicides have been increasing by 2% a year in this group.

Much has been written about the cause of this alarming increase in mental illness. The short answer is that we don’t really know. But the most pressing question is what do we do about it?

The medical profession relies on powerful drugs to treat the symptoms of mental illness. These drugs don’t cure the illness. They simply keep the symptoms under control. Plus, if you have ever listened closely to the advertisements for these drugs on TV, you realize that they all have serious side effects that adversely affect your quality of life.

My “favorite” example is drugs for anxiety and depression. You are told that one of the side effects is “suicidal thoughts”. That means that the very drug someone could be prescribed to prevent suicides might actually increase their risk of suicide. Why would anyone take such a drug?

If drugs are so dangerous, what about supplements? Do they provide a safe, natural alternative for reducing the symptoms of mental illness? Some supplement companies claim their products cure mental illness. Are their claims true or are they just trying to empty your wallet?

How is a consumer to know which of these supplement claims are true and which are bogus? Fortunately, an international team of scientists has scoured the literature to find out which supplements have been proven to reduce mental health symptoms.

How Was The Study Done?

This was a massive study (J. Firth et al, World Psychiatry, 18: 308-324, 2019. It was a meta-review of 33 meta-analyses of randomized, placebo-controlled trials with a total of 10,951 subjects. The clinical trials included in this analysis analyzed the effect of 12 nutrients, either alone or in combination with standard drug treatment, on symptoms associated with 10 common mental disorders.

To help you understand the power of this meta-review, let me start by defining the term “meta-analysis”. A meta-analysis combines the data from multiple clinical studies to increase the statistical power of the data. Meta-analyses are considered to be the gold standard of evidence-based evidence.

However, not all meta-analyses are equally strong. They suffer from the “Garbage-In, Garbage-Out” phenomenon. Simply put, they are only as strong as the weakest clinical studies included in their analysis.

That is the strength of this meta-review. It did not simply combine the data from all 33 meta-analyses. It used stringent criteria to evaluate the quality of each meta-analysis and weighted the data appropriately.

What Supplements Help Mental Health?

The strongest evidence was for omega-3 supplements. In the worlds of the authors:

· “Across 13 independent randomized control clinical trials in 1,233 people with major depression, omega-3 supplements reduced depressive symptoms significantly.”

o The average dose of omega-3s in these studies was 1,422 mg/day of EPA.

o The effect was strongest for omega-3 supplements containing more EPA than DHA and for studies lasting longer than 12 weeks.

o There was no evidence of publication bias in these studies. This is a very important consideration. Publication bias means that only studies with a positive effect were published while studies showing no effect were withheld from publication. That makes the effect look much more positive than it really is. The fact there was no evidence of publication bias strengthens this conclusion.

o Omega-3 supplements were more effective when used in combination with antidepressant drugs, but there was some evidence of publication bias in those studies.

· “Across 16 randomized control clinical trials reporting on ADHD symptom domains, significant benefits were observed for both hyperactivity/impulsivity and inattention.”

· Omega-3s had no significant effect on schizophrenia or bipolar disorder other than a mild reduction in depressive symptoms.

There was strong, but not definitive, evidence for folic acid and methylfolate supplements for depression.

· When used in conjunction with antidepressants both folic acid and methylfolate supplements “…were associated with significantly greater reductions in depressive symptoms compared to placebo, although there was large heterogeneity between trials.”

· The largest effects were observed with high dose methylfolate. In the words of the authors: “Two randomized control clinical trials examining a high dose (15 mg/day) of methylfolate administered in combination with antidepressants found moderate-to-large benefits for depressive symptoms.” However, to put this into perspective:

o 15 mg/day is 3,750% of the RDA. This is a pharmacological dose and should only be administered under the care of a physician.

o A smaller dose of 7.5 mg/day is ineffective.

o No comparison was made with folic acid at this dose, so we do not know whether folic acid would be equally effective.

· The authors concluded that there is emerging evidence for positive effects of vitamin D (>1,500 IU/day) for major depressive disorders and N-acetylcysteine (2-3 gm/day) in combination with drugs for mood disorders and schizophrenia. The term “emerging evidence” means there have been several recent studies reporting positive results, but more research is needed.

· The authors did not find evidence supporting the use of other vitamin and mineral supplements (E, C, zinc, magnesium, and inositol) for treating mental health disorders.

· The authors did not find enough high-quality studies to support claims about the effects of prebiotics or probiotics on mental health disorders.

Do Omega-3s Reduce Depression?

The evidence supporting the effectiveness of omega-3s in reducing symptoms of depression is strong. In the words of the authors: “The nutritional intervention with the strongest evidentiary support is omega-3, in particular EPA. Multiple meta-analyses have demonstrated that it has significant effects in people with depression, including high-quality meta-analyses with good confidence in findings…”

However, before you throw away your antidepressants and replace them with an omega-3 supplement, let me put this study into perspective for you.

· Depression can be a serious disease. If you just feel a little blue from time to time, try increasing your omega-3 intake. However, if you have major depression, don’t make changes to your treatment plan without consulting your physician.

· The best results were obtained when omega-3s were used in combination with antidepressants. This should be your starting point.

· Ideally, adding omega-3s to your treatment plan will allow your doctor to reduce or eliminate the drugs you are taking. That would have the benefit of reducing side effects associated with the drugs. However, I would like to re-emphasize this is a decision to take in consultation with your doctor. [My only caveat is if your doctor is unwilling to even consider natural approaches like omega-3 supplementation, it might be time to find a new doctor.]

· Finally, omega-3 supplementation is only one aspect of a holistic approach to good mental health. A healthy diet, exercise, supplementation, and stress reduction techniques all work together to keep your mind in tip-top shape.

The Bottom Line

There are lots of supplements on the market promising to cure depression and other serious mental health issues. Are they effective or are the claims bogus? Fortunately, a recent meta-review of 33 meta-analyses of high-quality clinical trials has answered that question. Here is their conclusion:

· The evidence is strongest for omega-3s and depression.

o The average dose of omega-3s in these studies was 1,422 mg/day of EPA.

o The effect was strongest for omega-3 supplements containing more EPA than DHA and for studies lasting longer than 12 weeks.

· There is fairly strong evidence for folate/folic acid supplements and depression, although there was large heterogeneity between trials.

· There is emerging evidence for vitamin D (>1,500 IU/day) and depression and N-acetylcysteine (2-3 gm/day) for depression and schizophrenia.

· Evidence for other supplements is currently inconclusive.

However, before you throw away your antidepressants and replace them with an omega-3 supplement, let me put this study into perspective for you.

· The best results were obtained when omega-3s were used in combination with antidepressants. That should be your starting point.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

How Much Omega-3s Do You Need?

March 5, 2019 by Dr. Steve Chaney

Can You Get The Omega-3s You Need From Diet Alone?

Author: Dr. Stephen Chaney

Two recent studies have provided strong evidence that omega-3s reduce the risk of heart attacks. However, both studies used high doses of omega-3s and did not do a dose-response analysis. That leaves you with several unanswered questions:

How much omega-3s do you need to significantly reduce your risk of heart attack?
Will that amount of omega-3s provide other health benefits?
Can you get that amount of omega-3s from diet alone?
Can you get that amount of omega-3s from supplementation alone?

Fortunately, a recent study (KH Jackson et al, Prostaglandins, Leukotrienes and Essential Amino Acids, 142: 4-10, 2019) has answered those questions. But, before we consider that article, we should look at a biomarker called “Omega-3 Index.”

What Is Omega-3 Index And Why Is It Important?

The Omega-3 Index is a measure of the ratio between the heart-healthy omega-3 fats (EPA + DHA) and all the other fats in red blood cell membranes. It is considered an excellent measure of our omega-3 status.

Dr. William S Harris, one of the top experts in the omega-3 field, first proposed the Omega-3 Index as a biomarker for cardiac health back in 2007. Based on multiple clinical and population studies, he proposed that an Omega 3 Index of 4% was associated with high heart attack risk, and an Omega-3 Index of 8% was associated with low heart attack risk. This has been supported by a recent meta-analysis of 10 clinical studies showing that an Omega-3 Index of 8% was associated with a 35% reduction in cardiovascular death compared to an Omega-3 Index of 4%.

Other studies suggest that an Omega-3 Index of 8% is associated with:

A slower rate of telomere shortening.
A lower risk of death from any cause.
Reduction in symptoms of depression.
Improved recovery from a heart attack.
Reduction in arthritis symptoms.
Reduced age-related brain shrinkage in B-vitamin treated subjects. (I have written about the synergistic relationship between omega-3s and B vitamins with respect to brain health in a previous issue of “Health Tips From the Professor.”

(Note: You will find references to these studies in the paper I have cited.)

For reference, most Americans have an Omega-3 Index between 4 and 6%. In contrast, in Japan, where the incidence of heart disease is much lower, the Omega-3 Index ranges from 6.8% to 9%.

How Was The Study Designed?

The data for this study were derived from 3458 individuals who 1) sent in a dried blood spot to a commercial laboratory for determination of Omega-3 Index between March 30, 2017 and January 15, 2018, 2) filled out a short questionnaire about fish intake and omega-3 supplement use, and 3) were older than 18.

With respect to fish intake, the possible responses were “none per week,” “every other week,” “every week,” “2 times per week,” and “3 or more times per week.”

With respect to omega-3 supplement use, those who reported taking an omega-3 supplement were asked what kind of omega-3 supplement they were taking. Those who said they were taking a flaxseed oil supplement were excluded from the analysis because flaxseed oil contains no EPA or DHA.

The characteristics of the population studied were as follows:

84% came from the United States. The remaining 16% came from 27 other countries.
The average age was 51 years and 40% of the respondents were male.
62% ate little or no fish. The exact breakdown of fish consumption was:
- 5% ate no fish.
- 9% ate fish every other week.
- 6% ate fish weekly.
- 2% ate fish twice a week.
- 8% ate fish three or more times a week.

52% took omega-3 supplements. Of those taking omega-3 supplements, 84% were taking fish oil supplements.

How Much Omega-3s Do You Need?

The correlation between omega-3 intake and Omega-3 Index in these individuals was:

No fish = 4.5%.
- No fish + supplementation = 6.6%.

Bi-weekly = 4.8%
- Bi-weekly + supplementation = 6.9%

Weekly = 5.1%
- Weekly + supplementation = 7.3%

Twice weekly = 5.7%
- Twice weekly + supplementation = 7.8%

3+ times per week = 6.5%
- 3+ times per week + supplementation = 8.6%

The authors said: “We found that those with the best chance of achieving a desirable Omega-3 Index were reporting the consumption of at least 3 fish meals per week and were taking an EPA + DHA-containing omega-3 supplement.”

The authors further concluded that an EPA + DHA intake of around 835 mg per day or higher would be required to achieve an average Omega-3 Index of 8%. This was based on two assumptions:

A 4 once serving of oily fish provides around 1,200 mg of EPA + DHA.
The average omega-3 supplement provides around 300 mg of EPA + DHA.

What Are The Limitations Of The Study?

The two biggest limitations of the study are the assumptions that a serving of fish provides 1,200 mg of EPA + DHA and a fish oil supplement provides 300 mg of EPA + DHA.

Their dietary survey did not ask what kind of fish the respondents were consuming. Some fish provide much less than 1,200 mg of EPA + DHA per serving. This could have caused the authors to overestimate the contribution that fish intake made to the Omega-3 Index in their study.
Some omega-3 supplements provide more than 300 mg EPA + DHA, and some people take more than the recommended number of omega-3 capsules. This could have caused the authors to underestimate the contribution of omega-3 supplements to the Omega-3 Index in their study.

The major implication of these limitations comes when we look at the standard deviation of the correlations between omega-3 intake and Omega-3 Index.

Some people consuming 3 or more servings of fish per week had an Omega-3 Index of well above 8%. This suggests that diet alone can allow you to reach an optimal Omega-3 Index. This conclusion is also supported by dietary studies in Japan (see below).
Some people taking omega-3 supplements had an omega-3 index of above 8% even in the group consuming no fish. This suggests that supplementation alone can allow you to reach an optimal Omega-3 Index as long as your total EPA + DHA intake is 835 mg/day or greater.

These limitations may also affect the calculation of how much EPA + DHA we need to reach an optimal Omega-3 Index. For example, the most widely used omega-3 calculator estimates that you would need 950 mg of EPA + DHA to increase your Omega-3 Index from 4% to 8%.

What Does This Study Mean For You?

At the beginning of this article I said that this study answered 4 questions:

How much omega-3s do you need to significantly reduce your risk of heart attack?
- This study estimated that around 835 mg/day of EPA + DHA is needed to reach an Omega-3 Index of 8%, which previous studies have shown to be associated with low heart disease risk.
- This is similar to the 950 mg/day estimate from a widely used omega-3 calculator.
- There is considerable individual variability, but 835 – 950 mg/day is a good target for most people. If in doubt, I recommend that you get your Omega-3 Index tested.

Will that amount of omega-3s provide other health benefits?
- The evidence is strongest for heart health, but this paper lists other studies suggesting that a high Omega-3 Index is associated with reduced risk of depression, arthritis, age-related brain shrinkage & cognitive decline, and death from all causes.

Can you get that amount of omega-3s from diet alone?
- In this study an optimal Omega-3 Index was achieved only in the group that consumed 3 or more servings of fish per week and took an omega-3 supplement. However, not all those fish were rich in EPA + DHA.
- Previous studies have shown that Japanese who consume 3 or more servings per week of oily fish, rich in EPA + DHA, have an Omega-3 Index of 6.8% to 9%. This shows us it is possible to reach an optimal Omega-3 Index from diet alone.

Can you get that amount of omega-3s from supplementation alone?
- Here the answer is clearly yes. Based on this and other studies, it would require in the range of 835-950 mg/day from supplementation to reach an optimal Omega-3 Index for most people.

Here are some other conclusions from the authors of the study:

“The average Omega3 Index in Japan ranges from 6.8 to 9.0%…So, yes, an Omega-3 Index of >8% is achievable by diet alone. But Japan is fairly unique…The average Omega-3 Index for Americans ranges from 4 to 6%. So, short of adopting the Japanese diet for a lifetime, it appears that taking an EPA + DHA supplement could be an important strategy for achieving a cardioprotective Omega-3 Index.”
They consider current recommendations for omega-3 intake to be inadequate. Their recommended intake of 835 mg of EPA + DHA per day is:
- “>3 times the EPA + DHA recommended by the Dietary Guidelines for Americans (250 mg/day).”
- “1.7 times the amount recommended by the Academy of Nutrition and Dietetics (500 mg/day).”
- “8 times higher than the typical EPA + DHA intake in the US (~100 mg/day).”
The American Heart Association currently recommends the consumption of 1-2 seafood meals per week.
The authors commented: “We do recognize that public health recommendations must balance what is ideal vs. what is practical for the public and must also take into consideration…potentially hazardous components of fish (mercury, PCBs) and the sustainability of the world’s fish supply.”
However, they considered the recommendation of the American Heart Association to be woefully inadequate. Based on their data, they concluded: “To achieve an Omega-3 Index of >8%, either adding an EPA + DHA supplement or increasing to 4-5 servings of fish/week would be necessary.”

Because of the high level of contamination of the world’s fish supply, my personal preference would be to add a high purity omega-3 supplement to my diet rather than consuming fish multiple times a week. I love salmon, but I try to limit myself to a salmon dinner no more than once a month.

The Bottom Line

A recent study looked at how much EPA + DHA you would need to achieve an optimal omega-3 status. The investigators used a measurement called Omega-3 Index, which has been shown to be an excellent measurement of omega-3 status. They asked how much EPA + DHA from diet plus supplementation was required to achieve an Omega-3 Index of 8%, which is associated with a low risk for heart disease. The key findings from this study were:

Around 835 mg/day of EPA + DHA is needed to reach an Omega-3 Index of 8%.
This is similar to the 950 mg/day estimate from a widely used omega-3 calculator.
There is considerable individual variability, but 835 – 950 mg/day is a good target for most people. If in doubt, I recommend that you get your Omega-3 Index tested.
The Japanese eat EPA + DHA-rich fish 3 or more times per week and have an Omega-3 Index of 6.9 to 9.0%, so it is clearly possible to achieve an optimal Omega-3 Index from diet alone. However, the American diet is so different from the Japanese diet that the authors concluded: “Short of adopting the Japanese diet for a lifetime, it appears that taking an EPA + DHA supplement could be an important strategy for achieving a cardioprotective Omega-3 Index.”
The American Heart Association currently recommends the consumption of 1-2 seafood meals/week. The authors consider this recommendation to be woefully inadequate. They said: “To achieve an Omega-3 Index of >8%, either adding an EPA + DHA supplement or increasing to 4-5 servings of fish/week would be necessary.”

Because of the high level of contamination of the world’s fish supply, my personal preference is to add a high purity omega-3 supplement to my diet rather than consuming fish multiple times a week. I love salmon, but I try to limit myself to a salmon dinner no more than once a month.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.