omega-3 fatty acids

Are Omega-3s Needed For Strong Bones?

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Why Are Omega-3s Needed For Strong Bones?

Author: Dr. Stephen Chaney

fish and fish oilOsteoporosis is one of the dreaded diseases associated with aging.

  • Over 50% of women and 25% of men will develop osteoporosis in their lifetime.

And the risk of osteoporosis is highest for Caucasians.

  • Over 40% of white women and 13% of white men will develop an osteoporotic fracture in their lifetime.

And osteoporotic fractures can be deadly. Bone fractures increase the risk of death 3-5-fold within the next few months. Moreover, the quality of life is diminished, and the risk of death is elevated for years after the fracture occurs.

So, if you are like many people, you are doing all you can to keep your bones strong so you will minimize your chances of developing osteoporosis. You probably even have a check list:

  • Resistance exercise (strengthens the bones you pull on)……Check
  • Walking (strengthens hip and leg bones)………………………Check
  • Adequate calcium & vitamin D (essential for strong bones)…Check
  • Magnesium & vitamin K (also important for strong bones)…..Check
  • Adequate protein (Muscle pulling on bone strengthens it)…..Check
  • Adequate omega-3s………………………………………………What!!!

You probably didn’t know about omega-3s. But recent research suggests they may also play a role in building strong bones and preventing osteoporosis. For example, studies show that omega-3s may influence bone metabolism by:

  • Enhancing absorption of calcium from the intestine.
  • Reducing the rate at which bone is broken down.
  • Increasing the rate at which new bone is built.

But large-scale population studies showing that omega-3 intake influences the risk of developing osteoporosis are lacking. The study ( Z Liu et al, Frontiers In Nutrition, 11: 1467559, 2023) I am discussing today was designed to fill that gap.

But before I describe the study, I should give you a quick review of bone metabolism.

Biochemistry 101: Bone Metabolism

bone metabolism osteoporosisTo truly understand osteoporosis and how to prevent it, you need to know a bit about bone metabolism. We tend to think of our bones as solid and unchanging, much like the steel girders supporting an office building. Nothing could be further from the truth. Our bones are dynamic organs that are in constant change throughout our lives.

Cells called osteoclasts constantly break down old bone (a process called resorption), and cells called osteoblasts replace it with new bone (a process called accretion). Without this constant renewal process our bones would quickly become old and brittle.

In short, our bones are not inert. They are in constant flux. If we exercise regularly and get enough calcium, vitamin D, magnesium, and vitamin K from our diet, bone metabolism looks like this as we age.

  • When we are young, osteoblast activity predominates, so accretion (the bone building process) exceeds bone resorption, and our bones grow in size and density.
  • When we are adults, osteoblast and osteoclast activity are in balance. Thus, bone accretion and resorption are in balance, and our bone density stays constant. The top portion of the picture above depicts what happens when osteoclast and osteoblast activity are in balance.
  • However, as we age osteoclast activity predominates, and we start to lose bone density. Eventually our bones look like Swiss cheese and break very easily. This is called osteoporosis. The bottom portion of the picture depicts this.

We should also think of our bones as calcium reservoirs.  We need calcium in our bloodstream 24 hours a day for our muscles, brain, and nerves to function properly, but we only get calcium in our diet at discrete intervals. Consequently:

  • When we eat our body tries to store as much calcium as possible in our bones.
  • Between meals, we break down bone material so that we can release the calcium into our bloodstream that our muscle, brain & nerves need to function.

If we lead a “bone healthy” lifestyle, all of this works perfectly. We build strong bones during our growing years, maintain healthy bones during our adult years, and only lose bone density slowly as we age – maybe never experiencing osteoporosis. We always accumulate enough calcium in our bones during meals to provide for the rest of our body between meals.

I should note that this is the current paradigm for bone metabolism. The study I am discussing today is asking whether omega-3 fatty acids should also be considered as part of a bone-healthy lifestyle.

How Was This Study Done?

clinical studyThe investigators used data from NHANES (National Health And Nutrition Examination Survey), an ongoing study to assess the health and nutritional status of adults and children in the United States. Specifically, this study combined data from participants from the 2005-2010, 2013-2014, and 2017-2018 NHANES surveys.

The participants included in the survey:

  • Were greater than 50 years old.
  • Had completed two 24-hour dietary recall surveys to determine the omega-3 content of their diet (The average omega-3 intake of the two surveys was used for this study).
  • Had a bone mineral density (BMD) test performed using dual-energy X-ray absorptiometry (DXA) scans.

Participants were excluded from the study if they had incomplete diet or bone mineral density data or if they had a disease that affects bone metabolism.

A total of 8,889 participants were included in the study. They were divided into 3 categories based on their bone density:

  • Normal bone density (4,421 participants)
  • Osteopenia (3,952 participants)
  • Osteoporosis (516 participants)

Finally, the participants were divided into quartiles based on their omega-3 intake, and omega-3 intake was correlated with bone density.

Are Omega-3s Needed For Strong Bones?

Healthy BoneThe study results were as follows:

  • Omega-3 intake was inversely related to bone density. Simply put, that means:
    • The highest intake of omega-3s was observed in the group with normal bone density, and…
    • The lowest omega-3 intake was observed in the osteoporosis group.

When the participants were divided into quartiles based on their omega-3 intake:

  • Participants with the highest omega-3 intake were 29% less likely to develop osteoporosis than participants with the lowest omega-3 intake.

When the investigators looked at subgroups, they found stronger effects of omega-3s on osteoporosis risk for women, people under 60, and non-smokers. Specifically:

  • Women with the highest omega-3 intake were 35% less likely to develop osteoporosis.
  • People under 60 were 49% less likely to develop osteoporosis.
  • Non-smokers were 36% less likely to develop osteoporosis.

The investigators concluded, “This study demonstrates a significant inverse relationship between dietary omega-3 fatty acid intake and osteoporosis risk, suggesting omega-3s play a crucial role in bone health. However, further longitudinal studies are needed to confirm these studies and refine dietary recommendations for osteoporosis prevention.”

Why Are Omega-3s Needed For Strong Bones?

QuestionsYou are probably thinking,

  • “Calcium and magnesium are part of bone structure. Vitamin D and vitamin K facilitate the incorporation of calcium into bone. So, it is logical that these nutrients would be important for strong bones.”
  • “But what role do omega-3s play? They aren’t incorporated into bone, and they don’t affect calcium metabolism.”

Here is what the authors said about that:

  • Omega-3s are anti-inflammatory. They decrease production of the pro-inflammatory cytokines that stimulate osteoclasts – the cells that break down bone.
  • EPA and DHA are also converted to prostaglandins that stimulate osteoblasts – the cells that build new bone.
  • Finally, the authors said, “Omega-3 fatty acids, especially EPA and DHA, have been shown to enhance calcium absorption in the gut – a process crucial for maintaining optimal bone mineral density…Omega-3s …do this by altering the lipid composition of cell membranes, thereby affecting calcium channels and enhancing calcium availability for bone tissue.”

Let me help you understand that statement.

  • While we might think of our cell membranes as rigid structures, they are quite fluid. The closest analogy I can think of is a large lake. You may not see any waves or ripples, but if a leaf drops on the surface it doesn’t stay in one place. It moves. We can think of calcium channels in our membrane like leaves on the water. They move across the cell membrane.
  • How fast they move depends on the fluidity of the cell membrane. This is determined by the lipids (fats) in the cell membrane, which in turn is determined by the fats in our diet. This is the one case where it is literally true that we are what we eat.
    • When we have lots of saturated fats in our cell membranes, fluidity is low, and calcium channels move slowly across the membrane.
    • When we have omega-3 fats in our cell membrane, fluidity is high, and calcium channels move quickly across the cell membrane.
  • Calcium channels work best when they cluster together, and this works best with highly fluid, omega-3-rich cell membranes.

What Does This Mean For You?

Question MarkThis study strongly suggests that omega-3s play a role in bone health, and they may be important for reducing our risk of osteoporosis. The authors concluded, “The findings suggest that omega-3 fatty acids play a critical role in bone health, supporting the need for dietary recommendations that encourage omega-3 consumption as a preventative measure against osteoporosis.”

However, this is the first study of its kind, which is why the authors said, “Further longitudinal studies are needed to confirm these findings.”

However, my biggest concern with the study is that it did not include information on the intake of the other nutrients essential for bone health (calcium, vitamin D, magnesium, and vitamin K). We don’t know at present the importance of omega-3s for preventing osteoporosis relative to dietary intake of other bone-healthy nutrients. For example:

  • Are omega-3s important for bone health when intake of calcium and/or the other bone-healthy nutrients are low?
  • Or are omega-3s equally important for bone health under all conditions?

However, the good news is that omega-3s have many proven health benefits such as heart health, controlling blood pressure, and reducing inflammation. If they are also important for bone health, we can consider it an unexpected benefit.

With that in mind, there are two important takeaways for you:

  • Omega-3s were most effective at preventing osteoporosis in people under 60. That is entirely consistent with what we know about preventing osteoporosis. The best prevention strategy is to build strong bones while you are young and maintain strong bones as long as possible in your adult years.
  • The optimal reduction of osteoporosis risk in this study was seen with an omega-3 intake of 1.86 g/d. While more studies are needed to define the optimal dose of omega-3s for reducing osteoporosis risk, this dose is within the “sweet spot” for the other omega-3 benefits I mentioned.

The Bottom Line 

A recent study asked whether omega-3 fatty acids reduce the risk of osteoporosis.

The study found:

  • Omega-3 intake was inversely related to bone density.
  • When the participants were divided into quartiles based on their omega-3 intake:
  • Participants with the highest omega-3 intake were 29% less likely to develop osteoporosis than participants with the lowest omega-3 intake.
  • When the investigators looked at subgroups, they found stronger effects of omega-3s on osteoporosis risk for women, people under 60, and non-smokers.

The investigators concluded, “This study demonstrates a significant inverse relationship between dietary omega-3 fatty acid intake and osteoporosis risk, suggesting omega-3s play a crucial role in bone health. This supports the need for dietary recommendations that encourage omega-3 consumption as a preventative measure against osteoporosis.”

For more information on this study, why omega-3s reduce osteoporosis risk, and what this study means for you, 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.

 _____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading Biochemistry textbooks for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 53 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

Natural Approaches For Controlling ADHD

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Are Natural Approaches Better Than Drugs?

Author: Dr. Stephen Chaney 

diet for children with adhdSeveral years ago, I came across a headline in our local newspaper that said, “Try Nutrition, Not Drugs, for ADHD”. The article made claims like “No good evidence exists to support the ADHD disease hypothesis” and “…on numerous occasions we have seen ADHD symptoms completely disappear without medication”.

As a scientist, I am always a little skeptical about bold claims that run counter to established scientific wisdom. However, the authors of this article implied that their claims were based on a 2012 article in Pediatrics, which is a highly respected journal in its field, so I decided to investigate the article (Millichap and Yee, Pediatrics, 129: 1-8, 2012).

The article was written by two pediatricians with extensive experience treating children with ADHD. The article turned out to be a thorough review of the literature on nutritional approaches for controlling ADHD. It did not approach the rigor of a meta-analysis study. Rather, it is what I refer to as an “interpretive review”. By that I mean that the clinical studies were interpreted in part based on their clinical experience in treating children with ADHD.

Interpretive reviews can be either good or bad, depending on the objectiveness of the reviewers. In this case, I was familiar with many of the clinical studies they reviewed and found their interpretations to be accurate, so I decided to share their conclusions with you. But first I should probably talk about our ADHD epidemic and ask two important questions:

  1. Is ADHD over diagnosed?
  1. Are drugs always the best solution for controlling ADHD symptoms?

Are Natural Approaches Better Than Drugs? 

Increase The ADHD epidemic.

  • ADHD has increased by 89% in the United States in just 25 years (1997-2022).
  • In 2022 11.5% of US children aged 3-17 were diagnosed with ADHD. That’s 7.1 million children.

Some experts claim that’s because of better diagnosis. But let me point out what many experts miss.

Is ADHD Over Diagnosed?

Perhaps we should be asking whether teachers and parents might be tempted to overestimate the severity of the symptoms.

For parents,

  • Parents don’t have the time they used to have to supervise their kids.
    • In most cases, both parents are working.
    • Some are working from home. In theory that could give them flexibility to take care of their children. But remote work often involves online meetings and strict deadlines that leave little time for their children.
    • And then there is social media. In today’s world, many parents are glued to their phones 24/7.
  • It’s easier to request a hyperactivity assessment, so that child can be put on drugs.

For teachers,

  • Class sizes are large, and there aren’t enough teachers’ aides.
  • They don’t have the time to deal with a child that requires extra attention.
  • It is easier to request an ADHD assessment, so that child can be put on drugs.

But there are other options. There are schools in which children with ADHD thrive, and many public schools have programs set up for ADHD children.

Why is the increase in ADHD diagnoses a concern?

drug side effectsThe answer is simple. The use of ADHD drugs has increased by 58% since 2012. Today over 50% of children diagnosed with ADHD are put on drugs. That’s a concern because:

  • Most of these drugs are stimulants.
  • Many are amphetamines.
  • They have serious side effects. For example:
    • Loss of appetite and weight loss.
    • Difficulty sleeping.
    • Upset stomach and nausea.
  • Many children don’t like how the drugs make them feel. They make them feel irritable, depressed, anxious, or tense.
  • They can be gateway drugs.
  • They lose effectiveness over time. So, unless you have figured out the cause of the problem, the symptoms will return.

Because of this many parents are searching for natural solutions.

Natural Approaches For Controlling ADHD 

The pediatricians reviewed all the major nutritional approaches that have been used over the years to control ADHD. Let me start by saying that they are not wild-eyed proponents of “a nuts and berries diet cures all”. In fact, they use medications as the primary intervention for most of their ADHD patients. They advocate dietary approaches when:

  • Medicines fail or there are adverse reactions (side effects).
  • The parents or the patients prefer a more natural approach.
  • There are symptoms or signs of a mineral deficiency (more about that below).
  • There is a need to substitute an ADHD-free healthy diet for an ADHD-linked diet (Simply put, if the child’s diet is bad enough, there are multiple benefits from switching to a healthier diet – a possible reduction in ADHD symptoms is just one of them.)

I will summarize their key findings below: 

Omega-3 Fatty Acids

Child Raising HandThe authors reported that many studies have shown that children with ADHD tend to have low levels of essential fatty acids, especially the omega-3 fatty acids. They cite several studies which showed significant improvement in reading skills and reductions in ADHD symptoms when children with ADHD were given omega-3 supplements but also noted that other studies showed no effect. They postulated that some children may benefit more from omega-3 supplementation than others.

They routinely use doses of 300-600 mg of omega-3s with their ADHD patients. They find that this intervention reduces ADHD symptoms in many children but does not completely eliminate the need for medications.

My Two Cents: I have recently reported) on a study that strengthens the association between omega-3 supplementation and a reduction in ADHD symptoms. Whether omega-3 supplements will help your child is anyone’s guess. However, it is a natural approach with no side effects. It is certainly worth trying.

Food Additives

The current interest in food additives and ADHD originated with the Feingold diet. The Feingold diet eliminated

food additives, foods with salicylates (apples, grapes, luncheon meats, sausage, hot dogs and drinks containing artificial colors and flavors), and chemical preservatives (e.g. BHA and BHT).

It was popularized in the 1970s when some proponents claimed that it reduced ADHD symptoms in 50% of the children treated. After clinical studies showed that only a small percentage of children benefitted from this diet, it rapidly fell out of favor.

However, Millichap and Yee pointed out that more recent studies have shown that the subset of children who responded to the Feingold diet were not a “statistical blip”. A recent review of the literature reported that when children with suspected sensitivities to food additives were challenged with artificial food colors, 65–89% of them displayed ADHD symptoms.

My Two Cents: I have recently reported) on more recent studies documenting the effects of artificial food colors on ADHD. The studies I reviewed in that article reported that up to 28% of children with ADHD were sensitive to the amount of artificial food colors in the typical western diet and that removing those food colors resulted in a significant improvement in ADHD symptoms. Plus, those studies were just looking at food colors – not the hundreds of other food additives in the average American child’s diet.

I consider food additives to be problematic for many reasons. Even if removing them doesn’t reduce their ADHD symptoms, eliminating as many of those food additives as possible is probably a good idea. It doesn’t need to be complicated. Just replacing processed foods and sodas with fresh fruits and vegetables and with low fat milk and natural fruit juices diluted with water to reduce their sugar content might make a significant difference in your child’s ADHD symptoms.

Food Sensitivities

Even natural foods can be a problem for children with food sensitivity, and it appears that there may be a large percentage of hyperactive children with food sensitivities. Millichap and Yee reported that elimination diets (diets that eliminate all foods which could cause food sensitivity) improve behavior in 76-82% of hyperactive children.

Even though this approach can be very effective Millichap and Yee don’t normally recommend it for their patients because it is difficult and time-consuming. The elimination diet is very restrictive and needs to be followed for a few weeks. Then individual foods need to be added back one at a time until the offending food(s) are identified. (They reported that antigen testing is not a particularly effective way of identifying food sensitivities associated with hyperactivity)

My Two Cents: I have previously reported on the link between food sensitivities and hyperactivity. I agree with Millichap and Yee that elimination diets are difficult and view this as something to be tried after all other natural approaches have failed. However, if there is a particular food that causes hyperactivity in your child, identifying it and eliminating it from their diet could just be something that will benefit them for the rest of their life.

Sugar

sugar cubesThis is a particularly interesting topic. Many parents are absolutely convinced that sugary foods cause hyperactivity in their children, but the experts are saying that clinical studies have disproven that hypothesis. They claim that sugar has absolutely no effect on hyperactivity.

Millichap and Yee have an interesting perspective on the subject. They agree that clinical studies show that a sugar load does not affect behavior or cognitive function in small children, but they point to numerous clinical studies showing that the reactive hypoglycemia that occurs an hour or two after a sugar load adversely affects cognitive function in children, and that some children are more adversely affected than others.

My Two Cents: Reducing intake of refined sugars in your child’s diet makes sense for many reasons, especially considering the role of sugar intake in obesity. If your child has a tendency towards reactive hypoglycemia, it may also reduce ADHD symptoms.

Iron and Zinc Deficiency

Millichap and Yee reported some studies suggested that iron and zinc deficiencies may be associated with ADHD symptoms and recommend supplementation with an iron or zinc supplement when there is a documented deficiency.

My Two Cents: A simpler and less expensive approach would be a children’s multivitamin to prevent the possibility of iron or zinc deficiency. Of course, I would recommend that you choose one without artificial colors, preservatives and sweeteners.

A Healthy Diet

Millichap and Yee closed their review by discussing a recent study in Australia that reported a significant reduction in ADHD symptoms in children eating “Healthy” diets (fish, vegetables, tomato, fresh fruit, whole grains & low-fat dairy products) compared to children eating “Western” diets (Fast foods, red meat, processed meats, processed snacks, high fat dairy products & soft drinks). This is the dietary approach, along with omega-3 supplementation, that they recommend most frequently for their patients.

My Two Cents: I wholeheartedly agree. In fact, if you and your family were to follow a “Healthy” diet instead of a “Western” diet it would likely have numerous health benefits. Plus, you are automatically removing ADHD triggers like food additives and sugar from your child’s diet.

The Bottom Line

This review of natural approaches for controlling ADHD symptoms (Millichap and Yee, Pediatrics, 129: 1-8, 2012) is both good news and bad news. The good news is that there are multiple natural approaches that can significantly reduce ADHD symptoms. These include:

  • Use of omega-3 supplements. They recommended 300-600 mg/day.
  • Removal of food additives (particularly food colors) from the diet.
  • Identification of food sensitivities and removal of those foods from the diet.
  • Reducing the amount of simple sugars in the diet.
  • Elimination of iron and zinc deficiencies if they exist (Iron deficiency is relatively common in American children. Zinc deficiency is not.) Alternatively, I recommend a children’s multivitamin to prevent iron and zinc deficiencies in the first place.
  • Eating a healthy diet rather than a Western diet. This also has the benefit of reducing the amount of food additives and sugars in the diet.

The bad news is that each of these approaches seems to work only in a subset of children with ADHD.

  • If you are a parent who is interested in a natural alternative to ADHD stimulant medications this means you may need to be patient and try several natural approaches until you find the one(s) that work(s) best for your child. The benefit of making the effort is that all these approaches will also improve the health of your child in other important ways, and none of them have any side effects.
  • Unfortunately, physicians with only about 10 minutes to spend with each patient (which is increasingly the medical model in this country), may not have time to explore natural options. Medications are much easier to prescribe. You may need to be the one who takes the responsibility of exploring natural alternatives for your child.

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.

 _____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 53 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

 

The Seed Oil Myths

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The Truth About Seed Oils 

Author: Dr. Stephen Chaney 

The Seed Oil Myths

Myth Versus FactsYou’ve seen the claims. “You should avoid all seed oils. They are toxic.”

Any time you see claims like, “Avoid all…[add the food villain of the day]” or “[a certain food] is toxic” your “truth-meter” should go on high alert. Claims like that are more likely to be hype than truth.

More specifically, the claims about seed oils are:

  • They are heavily processed.
  • They contain toxic ingredients.
  • They are genetically modified.
  • They cause inflammation and oxidative damage.
  • They increase your risk of inflammatory diseases, heart disease, and cancer.
  • A healthier option is to replace seeds oils with animal foods high in saturated fats.

Like any good food myth, there is a kernel of truth to each of these claims. In this article I will describe the kernel of truth associated with each of these claims, put them into perspective, and give practical guidelines for incorporating seed oils into your diet.

The topics I will cover are:

  • The truth about fats.
  • The truth about omega-6 fats.
  • The truth about saturated fats.
  • The truth about canola oil.
  • The truth about seed oils.

The Truth About Fats

The health authorities and media must think the American public is stupid. They oversimplify everything. They tell us:

  • Animal fats are saturated fat.
  • Olive oil is monounsaturated fat.
  • Vegetable oils are omega-6 polyunsaturated fat.
  • Fish oil is omega-3 polyunsaturated fat.

The truth is that every naturally occurring fat and oil is a mixture of all four kinds of fat. And each food contains a unique mixture of fats. The kernel of truth is:

  • Animal fats have a higher percentage of saturated fat than other fats and oils.
  • Olive oil has a higher percentage of monounsaturated fat than other oils.
  • Vegetable oils have a higher percentage of omega-6 polyunsaturated fat than other oils.
  • Fish oil has a higher percentage of omega-3 polyunsaturated fat than other oils.

 

But the full truth is that each food contains a unique mixture of fats. For example,

  • Meat and butter from grass-fed animals contain a greater percentage of omega-3 fats than meat and butter from animals which were fattened on corn.
  • Flaxseed oil has a higher percentage of omega-3 fats than other seed oils.
  • High-oleic sunflower oil has the highest percentage of monounsaturated fat than other seed oils.
    • Other vegetable oils with high monounsaturated fat content include olive oil, avocado oil, and canola oil. [Note: Although olive oil is the source of monounsaturated fat that we hear about most, avocado oil is equally high in monounsaturated fat and has a higher smoke point, which makes it a better choice for high-heat cooking.]
  • Walnuts have a higher percentage of omega-3 fats than other nuts.
  • Macadamia nuts and almonds have the highest percentage of monounsaturated fats than other nuts, with cashews and peanuts not far behind. Nut butters, of course, reflect the fat composition of the nuts.

The point I am making is that while myths are simple, the truth is much more complex.

Take Home Lesson: Every vegetable oil and every seed oil has a unique composition of fats. Each has its unique benefits and unique drawbacks.

That is something you will want to think about the next time you read an article about the dangers or the benefits of all seed oils. Every seed oil is unique. No generalization applies to all of them.

Biochemistry 101 – Essential Fats

ProfessorLet’s start with the most important point.

  • Omega-6 fats and omega-3 fats are essential. Simply put, that means:
  • We can’t make them.
  • They are essential for life.
  • We must get them from our diet.

If they are essential, the next question is, “Why do we need them?” Let me start with a little “Biochemistry 101” and talk about their role in cell membranes and cellular regulation.

Cell Membranes:

  • You might think of cell membranes as a solid protective armor around the cells, but nothing could be farther from the truth. A better analogy would be the ocean that covers vast areas of our planet. Our membranes are quite fluid.
  • And that membrane fluidity is important. Our cell membranes contain receptors like the cholesterol receptor and insulin receptor that must cluster together for cholesterol and insulin to be transported into the cell. Those receptors cluster best when cell membranes are very fluid.
  • Our membranes are most fluid when they contain high levels of polyunsaturated fats (For membrane fluidity it doesn’t matter if they are omega-6 or omega-3). Conversely, our membranes are less fluid when they contain high levels of saturated fats.
  • And here is the most important point. Because our bodies cannot make omega-6 and omega-3 polyunsaturated fats, this is the one time it is literally true that, “We are what we eat”. If our diets are high in saturated fats, our membranes are high in saturated fats. If our diets are high in polyunsaturated fats, our membranes are high in polyunsaturated fats.
    • And the ratio of omega-6 and omega-3 polyunsaturated fats in our membranes reflects the ratio of omega-6 and omega-3 polyunsaturated fats in our diet.

Take Home Lesson: Diets high in omega-6 and/or omega-3 fats help lower cholesterol levels and improve blood sugar regulation.

Cellular Regulation:

  • Our cells also use the polyunsaturated fats in our cell membrane to make hormone-like substances called prostaglandins and leukotrienes that exert profound effects on nearby tissues. [Note: For the sake of simplicity, I will just talk about prostaglandins for the rest of this article, but what I say applies equally to leukotrienes.]
  • The enzymes that make prostaglandins do not distinguish between omega-6 and omega-3 polyunsaturated fats. They just use whatever polyunsaturated fat they come across.
  • That’s important because the effects of omega-6 and omega-3 prostaglandins are often different and are sometimes opposite.
  • Here’s where the “We are what we eat” principle comes into play. The ratio of omega-6 and omega-3s in our diet determines the omega-6 and omega-3 content of our membranes. And that determines the type of prostaglandins our cells produce.

Take Home Lessons:

  • Some of the benefits of omega-6s are unique because they are dependent on omega-6 prostaglandins. These benefits cannot be duplicated by diets high in omega-3s.
  • Because some effects of omega-6 and omega-3 prostaglandins are opposite, we need to look closely at the omega-6 to omega-3 ratio in the diet to optimize the health benefits of these two essential polyunsaturated fats.

Now, with Biochemistry 101 behind us, we are ready to look at the truth about omega-6 fats.

The Truth About Omega-6 Fats

Assortment Of Salad Dressing Bottles

Let’s start by looking at the pros and cons of omega-6 fats. 

Pros Of Omega-6 Fats:

Cellular Health: Omega-6 and fats are important for maintaining proper membrane fluidity. And omega-6 prostaglandins also regulate cell metabolism and cellular repair mechanisms.

Heart Health: Omega-6s are associated with lower risk of heart disease. This is caused by:

  • Lower cholesterol levels due to proper membrane fluidity which allows clustering of cholesterol receptors.
  • More flexible endothelial cells lining our arteries, which helps lower blood pressure and prevent blockage of the arteries by blood clots. This is most likely due to more fluid cell membranes and the production of beneficial prostaglandins.
  • Some of these benefits are duplicated by omega-3 fats, but the American Heart Association stated in a recent Health Advisory (WS Harris et al, Circulation, 119, 902-907, 2009) that omega-6 fats are essential for some heart health benefits. They cannot be replaced by omega-3s.

Brain Health: Omega-3s get most of the press here, but experts feel that omega-6s play an important and independent role as well.

Fetal Growth and Development: Omega-6 fats are essential for normal neural development and growth. The mechanism(s) for this benefit are ill-defined.

Other Benefits:

  • Omega-6 fats support healthy skin, hair, and bones. The mechanisms for these effects are unknown, but most experts feel they are independent of omega-3 fats.
  • Omega-6 fats are also important for reproductive health. Most experts think this is due to the production of omega-6 prostaglandins.

Take Home Lesson: Omega-6 fats are essential for a healthy heart, a healthy brain, and normal fetal growth and development.

Cons Of Omega-6 Fats:

Oxidation: Omega-6 (and omega-3) fats are very susceptible to oxidation, especially at high temperatures. This can lead to free radical formation, which can promote the formation of cancer cells.

You may have seen the statement that omega-6 fats cause cancer. This is an oversimplification. A more accurate statement would be, “Improperly used, any polyunsaturated fat may increase cancer risk. But this is largely avoidable. Here are the precautions I recommend:

  • Choose your source carefully.
  • For seeds and nuts look for freshness. If they look or taste funny, throw them out.
  • For oils choose reputable brands and choose ones that use low-heat processing. Also, look for ones with minimal processing. They may be cloudy rather than clear, but they will also contain naturally occurring antioxidants and polyphenols.
  • Don’t overheat them.
    • Most vegetable oils are only suitable for use as salad dressings and other room temperature cooking.
    • The exceptions are vegetable oils with high smoke points – for example, olive oil for stir fries and avocado oil for higher temperature cooking.
  • Store them safely. Don’t give them a chance to become oxidized.
    • We store sunflower seeds and almonds in our refrigerator and walnuts in our freezer.
    • We buy unsaturated vegetable oils in small quantities (so they are used up quickly) and store them in the refrigerator.

Take Home Lesson: Improperly used, omega-6 fats, like any unsaturated fat, can become oxidized and form free radicals (the kernel of truth). Choose your source carefully. Don’t overheat them. Store them safely.

FlamesInflammation: This is the one you hear the most about. You have been told that omega-6 vegetable oils (seed oils) cause inflammation. As a blanket statement, it is mostly untrue. But it does have a kernel of truth.

Let’s start with the kernel of truth:

  • Omega-6 fats are inflammatory only when compared to omega-3 fats. You have also been told that omega-6 fats are inflammatory when compared to saturated fats. This is false, as I will discuss below.

Let me elaborate on the first statement with a little more Biochemistry 101 (If you haven’t guessed, that’s my favorite topic. Once a professor, always a professor).

  • Omega-6 fats are converted into one inflammatory prostaglandin. Omega-3 fats are converted into several anti-inflammatory prostaglandins (This is an example of some omega-6 and omega-3 prostaglandins having opposite effects).
  • Because of their opposite effects on inflammation, some experts say that the optimal ratio of omega-6 to omega-3 fats is in the range of 1:1 to 4:1. But the typical American diet is around 15:1.

If the omega-6 to omega-3 ratio is important (and not every expert agrees that it is), the statement that we should avoid omega-6-containing vegetable oils (seed oils) because they are inflammatory is mostly untrue.

  • Every omega-6 oil has a different omega-6 to omega-3 ratio. For example,
    • Corn oil has a 50:1 ratio and sesame oil has a 42:1 ratio. If you are just going by omega-6 to omega-3 ratios, you might want to avoid these.
    • Soybean oil has a 7:1 ratio and extra virgin olive oil has a 5:1 ratio. They are almost in the optimal range.
    • Canola oil has a 2:1 ratio. It’s in the optimal range.
    • And flaxseed oil is the clear winner with a 1:4 ratio.

But the truth is also much more complex than you have been led to believe.

  • The kernel of truth is that omega-6 fats can be converted to an inflammatory prostaglandin.
  • But omega-6 fats can also be converted to anti-inflammatory prostaglandins. And some omega-6 fats such as GLA are anti-inflammatory.
  • Human clinical studies find that omega-6 fats either have no effect on inflammation or decrease it slightly (A Poli et al, International Journal of Molecular Sciences, 24, 4567, 2023).

Take Home Lesson: Omega-6 fats are converted into one inflammatory prostaglandin (the kernel of truth). But they are also converted to anti-inflammatory prostaglandins. The net effect in the human body is a slight anti-inflammatory effect.

The Truth About Saturated Fats

You have been told that saturated fats are anti-inflammatory and decrease the risk of heart disease. For many Americans those claims are enticing because it means they don’t have to change their diet. But are the claims true?

You have been told that these claims are based on science. There are clinical studies behind them. Is that true?

The problem is that there are a lot of bad studies on saturated fats in the literature, and the Dr. Strangeloves of the world cherry pick the ones that support their beliefs.

If you want to compare the effect of different kinds of fat on either inflammation or heart health, you must make sure that all other components of the diet are the same. Too many of these studies have compared a whole food diet high in saturated fat with the typical American diet high in omega-6 fats. The results are predictable. Anything is better than the typical American diet.

In a previous issue of “Health Tips From The Professor” I discussed the criteria for a good study of fats. High quality studies must:

  • Show the subjects stick with the new diet for the duration of the study. Subjects find it difficult to adhere to a diet to which they are not accustomed long term and often revert to their more familiar diet. This requires either very close monitoring of what the subjects are eating or measurement of fat membrane composition to verify diet adherence, or both.
  • Carefully control or measure what the saturated fats are replaced with. In good studies only the fat composition of the diet changes. All other components of the diet remain the same.
  • Last two years or more. The fats we eat determine the fat composition of our cell membranes, and that is what ultimately determines both inflammation in our bodies and our risk of dying from heart disease. While it is true to say, “We are what we eat”, changing the fat composition of our cell membranes does not occur overnight. It takes 2 years or more to achieve a 60-70% change in the fat composition of cell membranes.
  • Measures multiple markers of inflammation or actual cardiovascular end points such as heart attack, stroke, and deaths due to heart disease.

When studies are done that meet these criteria the results are as follows:

Inflammation (A Poli et al, International Journal of Molecular Sciences, 24: 4567, 2023):

  • Replacing saturated fats with omega-6 fats reduces inflammation by 8%.
  • Replacing saturated fats with omega-3 fats reduces inflammation by 48%

Heart Disease (FM Sacks et al, Circulation, 136, Number 3, 2017):

  • Replacing saturated fats with omega-6 from decreased the risk of heart disease by 24%.
  • Replacing saturated fats with a mixture of both omega-6 and omega-3 fats decreased the risk of heart disease by 29%. This is equivalent to statin therapy, without the side effects.
  • When the replacement of saturated fats with omega-6 and omega-3 fats occurred in the context of a heart healthy diet such as the Mediterranean diet, heart disease risk was reduced by 47%.

The Food and Nutrition Board of the Institute of Medicine recommends that Americans not exceed 10% of calories from saturated fat.

  • Two thirds of Americans exceed this limit.

The Food and Nutrition Board recommends that omega-6 fats be around 5-6% of calories. Because omega-6 fats play an important role in heart health, the American Heart Association recommends they be at 5-10% of calories.

  • Americans get around 6.5% of their calories from omega-6 fats.

Take Home Lesson: Replacing saturated fat with omega-6 fats reduces both inflammation and heart disease risk. Adding omega-3 fats reduces both even more. So, bringing omega-6 and omega-3 into a better balance is a good idea. But omega-6 fats are essential and are at the recommended intake for most Americans, so don’t do this by cutting back on healthy omega-6 fats. Instead, add some more omega-3s.

The Truth About Canola Oil

There are a lot of things to like about canola oil:

  • It is an excellent source of healthy omega-6 fats.
  • It has a good omega-6 to omega-3 ratio (2:1), which makes it anti-inflammatory.
  • It is also a good source of monounsaturated fats and has a moderate smoke point, which makes it suitable for low heat cooking.

So, why is it so unpopular? Unfortunately, it suffers from a lot of undeserved myths. Each has a kernel of truth. But like a secret passed around the room, the myths have grown with each repetition, and the truth has become unrecognizable.

So, let’s try to separate the myths from the truth.

Myth: It is genetically engineered.

Truth: It was created by old-fashioned plant breeding.

 

Myth: Canola oil contains toxic ingredients.

Truth:

  • Rapeseed oil comes from the oilseed rape plant (a relative of mustard).
  • Rapeseed oil contains erucic acid and glucosinolates, both of which can be toxic in large amounts (the kernel of truth).
  • Baldur Stefansson from the University of Manitoba bred a “double low” variety the oilseed rape plant which produces an oil that contains <2% of both erucic acid and glucosinolates and is safe for human consumption. This new oil was named canola oil (from Canada and ola for oil). This was achieved by conventional plant breeding. Not genetic engineering.
  • Both cultivars of the oilseed rape plant are still grown. Rapeseed oil is used for industrial purposes, and canola oil is used for human consumption.
  • Canola oil is tightly regulated in Canada, the US, and the EU to <2% erucic acid.
  • 98% of the canola oil sold in the US is grown in Canada and the northern US.

Myth: Canola oil is unhealthy.

Truth: Because it is one of the least expensive omega-6 oils, canola oil is often found as an ingredient in unhealthy, highly processed, food (the kernel of truth). The solution is simple. Avoid unhealthy foods. Adding a different kind of fat to unhealthy foods is not going to make them healthier.

The Truth About Seed Oils

By now I have covered most of the myths about seed oils in my sections on omega-6 fats, saturated fats, and canola oil, but here is a quick review.

Myth: All seed oils are…[add your favorite derogatory term here].

Truth: Every seed oil has a unique composition of fats. Each has its unique benefits and unique drawbacks.

 

Myth: Seed oils are genetically modified.

Truth: The plants producing canola oil and high oleic sunflower oil have been modified (the kernel of truth), but they were modified by conventional plant breeding rather than genetic engineering.

 

Myth: Seed oils contain toxic ingredients. This myth is most often directed at canola oil.

Truth: Rapeseed oil contains components that can be toxic at high levels (the kernel of truth). However, the rapeseed plant has been bred to produce canola oil with safe levels of those components.

 

Myth: Seed oils are inflammatory, which increases your risk of inflammatory diseases and heart disease.

Truth: Seed oils contain omega-6 fats which can be converted into one inflammatory prostaglandin (the kernel of truth). But they are also converted to anti-inflammatory prostaglandins. The net effect in well done human clinical trials is a slight anti-inflammatory effect.

 

Myth: Seed oils cause oxidative damage, which increases your risk of cancer.

Truth: Seed oils (like any polyunsaturated fat) are susceptible to oxidation, especially at high temperatures. This can lead to free radical formation and oxidative damage (the kernel of truth). But this is only true when you use them improperly. The solution is to chose your source wisely, store them safely, and to not overheat them when cooking.

 

Myth: Saturated fats are healthier than seed oils. Replacing saturated fat with the omega-6 fats found in seed oils increases inflammation and heart disease risk.

Truth: Many studies in this area of research are poorly designed. Well-designed studies show that replacing saturated fat with the omega-6 fats found in seed oils reduces both inflammation and heart disease risk.

 

Myth: Omega-3 fats are healthier than the omega-6 fats found in seed oils, so we should replace seed oils with omega-3 fats.

Fact: Omega-3 fats are more effective than omega-6 fats at reducing inflammation and heart disease risk (the kernel of truth). However, omega-6 fats are essential for a healthy heart, a healthy brain, and normal fetal growth and development. We can’t make them, so we must get them from our diet. Americans are currently consuming the recommended amount of omega-6 fats. So, we should not decrease the amount of omega-6 fats in our diet. Instead, we would benefit from adding more omega-3s to our diet.

 

Myth: Seed oils are highly processed. High heat processing alters the oils. Processing also removes beneficial antioxidants and polyphenols from the oils.

Truth: This is mostly true. The solution is to choose your brands carefully.

  • For oils choose reputable brands and choose ones that use low-heat processing. Also, look for ones with minimal processing. They may be cloudy rather than clear, but they will also contain naturally occurring antioxidants and polyphenols.
  • It’s not easy to choose your source carefully. But this difficulty is not unique to seed oils. For example:
    • The term EVO is supposed to mean extra virgin olive oil was used, but cheaper oils are sometimes blended into the olive oil to save money.
    • If a company wishes to use the term “grass fed” on their product, they must file a certification with the USDA, but the USDA does not inspect to determine whether the certification is accurate.
    • Seed oils are also found as an ingredient in unhealthy, highly processed foods. The solution here is simple. Avoid unhealthy foods. Adding a different kind of fat to unhealthy foods is not going to make them healthier.

For more details about each of these Truth statements, read the article above.

The Bottom Line

There are many myths about seed oils. Each myth has a kernel of truth but is mostly false. In this week’s “Health Tips From the Professor” I discuss the myths and truths about seed oils. Because this is a complex subject, I have broken it down into individual topics that address one or more seed oil myths before talking about seed oil myths directly.

The topics I covered are:

  • The truth about fats.
  • The truth about omega-6 fats.
  • The truth about saturated fats.
  • The truth about canola oil.
  • The truth about seed oils.

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.

_____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 _______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.

Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

 

 

The News About Omega-3s Just Got Better

by

What Does This Study Mean For You? 

Author: Dr. Stephen Chaney 

good newsA recent meta-analysis (AA Bernasconi et al, Mayo Clinic Proceedings, 96: 1365-1375, 2021) of randomized clinical studies with over 150,000 patients showed that omega-3s reduced the risk of heart attacks by 13% and fatal heart attacks by 35%. Another major clinical study (T Chao et al, Nutrition, Metabolism and Cardiovascular Disease, 34: 537-547, 2024) with 30,000 patients found that omega-3s reduced all-cause mortality by 10%, cardiovascular mortality by 18%, heart attacks by 33%, and sudden cardiac death by 33%.

In short, the evidence that omega-3s reduce the risk of heart attacks and other forms of cardiovascular disease keeps getting stronger. However, the effect of omega-3s on heart failure is not as clear. Some studies suggest that omega-3s reduce the risk of heart failure and heart failure deaths. But other studies find little or no effect.

That’s unfortunate because heart failure is responsible for 45% of cardiovascular deaths and 14% of all deaths in the United States. In 2023 6.7 million Americans had heart failure, and that number is expected to increase to 8.5 million in 2030.

But numbers don’t tell the whole story. It is the trend in heart failure deaths that is truly concerning. Heart failure deaths per 100,000 Americans decreased by 20% between 1999 and 2012. Then the trend abruptly reversed. By 2021 heart failure deaths per 100,000 people was greater than in 1999. And the increase in heart failure deaths shows no signs of slowing down.

Nobody knows what is causing this rapid increase in heart failure deaths. But clearly the miracles of modern medicine are not working. And because the clinical studies on omega-3s and heart failure risk have been confusing, omega-3s are not currently recommended for heart failure patients.

This study (M A Jawad et al, Mayo Clinic Proceedings, 99: 1895-1904, 2024) was designed to clear up the confusion about omega-3s and heart failure risk.

How Was This Study Done?

clinical studyThis utilized data from the UK Biobank study. The UK Biobank study is an ongoing study that enrolled 502,366 subjects, aged 40-69, from the United Kingdom between April 1, 2007, and December 31, 2010. It regularly collects environmental, lifestyle, and genetic data on these individuals and tracks their health outcomes.

Within the study 273,033 participants had their blood levels of omega-3s determined by mass spectrometry. These measurements were used to calculate the Omega-3 Index (% of membrane fatty acids that are omega-3s) of these participants.

Of these participants:

  • 271,794 did not have a heart failure diagnosis at the time the omega-3 levels were determined. This group was used to evaluate the effect of omega-3s on the risk of developing heart failure.
  • 1,239 had a heart failure diagnosis at the time the omega-3 levels were determined. This group was used to determine whether omega-3s reduced the risk of death in heart failure patients.
  • 20,000 from this group had a repeat measurement of omega-3 levels around 4 years after the first measurement to determine the consistency of omega-3 levels. On average the repeat measurements were slightly lower, but the differences were small.

These participants were followed for an average of 13.7 years.

  • A diagnosis of heart failure was based on international diagnosis standards.
  • Deaths were identified by using the central death registry in the United Kingdom.

The News About Omega-3s Just Got Better

Omega-3s And Heart DiseaseThe data were clear. When participants with an Omega-3 Index in the top 20% were compared to those with an Omega-3 Index in the bottom 20%:

  • The risk of developing heart failure during the 13.7-year follow-up period was reduced by 21%.

When participants with a heart failure diagnosis prior to omega-3 measurement were compared in the same manner:

  • All-cause mortality was reduced by 48%
  • Cardiovascular mortality was reduced by 43%.

When the investigators looked at the effect of omega-3 supplementation in this population:

  • The risk of developing heart failure was 5% lower for those who reported omega-3 supplement use. I will discuss the reason for the discrepancy between comparisons based on omega-3 supplement use and comparisons based on blood levels of omega-3s below.

The authors concluded, “Higher plasma levels of marine omega-3 fatty acids were associated with a lower incidence of heart failure. Furthermore, among patients with preexisting heart failure, higher omega-3 levels were associated with lower risks of all-cause mortality and cardiovascular mortality. These findings suggest that increasing plasma omega-3 levels, whether by diet or supplementation, could reduce both risk for development of heart failure and death in those with prevalent heart failure.”

What Are The Strengths And Weaknesses Of This Study?

strengths and weaknessesThis was a very large, very well-done study. There is the usual caveat for this type of study, namely that it looks at associations and cannot prove cause and effect. However, it would be impossible to perform a double blind, placebo-controlled study with that many people for almost 14 years.

And heart failure does not happen overnight. Studies of the size and length are required to show meaningful effects of diet and/or supplementation on health outcomes like heart failure are not feasible.

Another major strength of this study is that it measured blood levels of omega-3s and showed those blood levels were relatively stable over time rather than relying on participants remembering what they ate and/or what supplements they used.

  • In terms of supplement use, studies like this one simply ask whether omega-3 supplements were used. They do not ask what the dose was, how frequently they were taken, the form of the omega-3 supplement (fish oil, EPA-only, DHA-only), and whether they were consumed with food or not (which affects absorption).
  • Studies that rely on diet recall and/or supplement use also have another weakness, namely individual differences in the absorption and utilization of omega-3 fatty acids. Simply put, two individuals getting the same dose of omega-3s from diet and supplementation may have different levels of omega-3s in their cellular membranes.
  • The authors felt it was these differences that explained why they saw a much stronger and more accurate effect of omega-3s on heart failure when they based their comparison on blood levels of omega-3s rather than omega-3 supplement use.

In short, this study significantly strengthens the evidence that omega-3s reduce the risk of heart failure and improve survival for those with heart failure.

What Does This Study Mean For You?

confusionHere are the take-home lessons from this study:

As I said above, this study significantly strengthens the evidence that omega-3s reduce the risk of heart failure and improve survival for those with heart failure. That means:

  • Optimizing your intake of omega-3s may be a good strategy for reducing your risk of heart failure. More importantly, optimizing omega-3 intake may also be a good strategy for improving your survival if you have been diagnosed with heart failure.
  • The authors said, “Because omega-3 is a well-tolerated over-the-counter nutrient…it is perplexing why this safe and affordable therapy…has not been widely incorporated into guideline-directed medical therapy for heart failure. Omega-3s…should be considered as add-on therapy to the standard regimen in the prevention and treatment of heart failure.” I agree.

But what is the optimum intake of omega-3s? This is what the authors had to say about that:

  • The top 20% of participants in this study had a blood Omega-3 Index of >5.45%, but this is not necessarily optimal.
  • Previous studies have suggested that an Omega-3 Index of 8% is the optimal target for reducing the risk of death from other forms of heart disease, and the authors feel this is also the optimal target for reducing the risk of heart failure.
  • The average American has an Omega-3 Index of 4-5%, which is associated with a high risk of heart disease.
  • Previous studies have indicated that an average intake of 1.4 g/day of EPA + DHA is required to move from an Omega-3 Index of 4% to 8%.

But the key word here is “average”.

  • None of us are average. We all absorb and retain omega-3s with different efficiencies. Many people will do great with 1.4 g/day. But some may need more to achieve an Omega-3 of 8%. And others will need less.
  • That’s why I recommend that you request blood tests of your Omega-3 Index and use those to guide you to an optimal 8% rather than relying on dosage of omega-3 supplements or frequency of omega-3-rich fish consumption alone.
  • However, I recognize that Omega-3 Index determinations are expensive and not all doctor’s offices are equipped to provide them. On average, an intake of 1-2 g/day of EPA + DHA is safe and likely effective at reducing risk of heart failure and other forms of heart disease. But it may not be optimal for you.

The Bottom Line 

Previous studies have shown that an optimal intake of omega-3s is likely to reduce the risk of heart attacks and deaths from heart disease. But the news about omega-3s just got better. A recent study strengthened the evidence that omega-3s also reduce the risk of heart failure and improve survival for those with heart failure.

The authors concluded, “Higher plasma levels of marine omega-3 fatty acids were associated with a lower incidence of heart failure. Furthermore, among patients with preexisting heart failure, higher omega-3 levels were associated with lower risks of all-cause mortality and cardiovascular mortality. These findings suggest that increasing plasma omega-3 levels, whether by diet or supplementation, could reduce both risk for development of heart failure and death in those with prevalent heart failure.”

For more details on this study and what it means for you, 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.

_______________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

________________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

Eating For A Healthy Heart

by

What Does This Mean For You?

Author: Dr. Stephen Chaney

You may remember the nursery rhyme, “Jack Sprat could eat no fat. His wife could eat no lean…” You may know people who fit these extremes. And in terms of diets these extremes might represent the vegan and keto diets in today’s world.

The nursery rhyme assures us that, “…between them they licked the platter clean.” But were their diets equally healthy? Which of them would have been more likely to live a long and healthy life?

And, since this is Heart Health Month, we might ask, “Which diet would have been better for their hearts?”

If you search Mr. Google – even with AI assist – you might be confused. That’s because AI bases its recommendations on the quantity of posts, not the accuracy of posts. And lots of media influencers recommend both diets, and just about every popular diet in between for heart health.

But what does good science say on the topic of heart healthy diets? Fortunately, a recent comprehensive review and meta-analysis (G. Riccardi et al, Cardiovascular Research, 118: 1118-1204, 2022) has answered that question.

How Was The Study Done?

clinical studyThe investigators reviewed 99 clinical studies with tens of thousands of participants that looked at the associations between foods or food groups and heart disease risk.

Most of the studies were “prospective cohort” studies in which:

  • Populations are divided into groups (cohorts) based on the foods they consume…
  • …and followed for a number of years (this is where the term “prospective” comes from)…
  • …and at the end of the study, the association between food and heart outcomes is measured.

However, the review also included several major randomized controlled clinical trials, including:

  • The DASH diet study.
  • The Lyon Diet Heart study.
  • The PREDIMED study.

Eating For A Healthy Heart

strong heartHere are the findings of the study. Most will sound very familiar. But you will note some subtle differences based on recent data.

The overall summary was that for a healthy adult population:

  • Low consumption of salt and foods of animal origin…
  • …and increased intake of plant foods…
  • …are associated with reduced heart disease risk.

Of course, we have known that for years. It’s when they broke the data down further that it became more interesting.

Foods Of Animal Origin:

  • Processed meats increase heart disease risk. A single serving of processed meat is associated with a 27% to 44% increased risk of heart disease. This is not new.
  • Unprocessed red meat is also associated with increased risk of heart disease, but this association is not as Steakconsistent as for processed meats. The authors noted that some of this may be due to differences in saturated fat content or cooking methods of the red meats included in individual studies.

But this analysis also showed that the effect of red meat on heart disease risk may be dose dependent. For example:

    • The studies they reviewed suggested that consuming ≥2 servings per day of red meat is associated with a 27% increased risk of heart disease. However, consuming <3 servings per week may not increase risk.
    • The idea that the effect of red meat on heart disease risk may be dose-dependent is novel. However, the authors said we also need to ask what replaces red meat in the diet. They postulated that when red meat consumption is decreased, it is often replaced with healthier protein sources.
  • White meat such as poultry does not appear to affect heart disease risk. This has been predicted by earlier reports, but this analysis strengthens those predictions.
  • Fish consumption decreases heart disease risk. This is not new. But this review added precision about recommended fish intake (2-4 servings/week) and a couple of caveats:
    • The heart benefits of fish may be due to their omega-3 content and may not apply equally to fish with lower omega-3 content.
    • The authors also expressed concerns about the sustainability of high-omega-3 fish populations. I would also add that our oceans are increasingly polluted, so contamination is another concern.
  • Egg consumption up to one egg/day does not appear to increase heart disease risk. This is consistent with the are eggs good for youcurrent American Heart Association recommendations.

However, the authors noted that the effect of eggs on serum cholesterol, and hence heart disease risk depends on several factors.

    • Genetics, obesity, and diabetes can make it more difficult to regulate serum cholesterol levels. For these individuals, eggs may need to be eaten only sparingly.
    • Diets low in saturated fat and high in fiber from plant foods help the body regulate serum cholesterol. Several studies suggest that eggs may decrease heart disease risk in the context of this type of diet.
  • Dairy: Neither low-fat nor high-fat dairy foods appear to influence heart disease risk. This is different from the standard recommendation to consume low-fat dairy foods. But it is in line with the trend of recent research studies on dairy and heart disease.

Once again, there were a couple of caveats:

    • There is increasing evidence that fermented dairy foods may decrease heart disease risk which may explain why certain high-fat cheeses and other high-fat fermented dairy foods appear to have a neutral or slightly beneficial effect on heart disease risk.
    • As with eggs the effect of high-fat dairy foods on heart disease risk may be influenced by genetics and diet context.

Foods Of Plant Origin: The effect of plant foods have been known for some time, and the most recent studies included in this analysis have not changed those conclusions.

  • Fruits and Vegetables consistently reduce heart disease risk in multiple studies. In each case, the optimal Vegan Foodsintake appears to be about 2 servings of each per day which provides an 18-21% risk reduction for vegetables and a 21-32% risk reduction for fruits.
  • Legumes (beans and peas) also consistently reduce heart disease risk in multiple studies. At the optimal intake of around 4 servings per week the risk reduction is around 14%.
  • Nuts also consistently reduce heart disease risk. At the optimal intake of around one serving (a handful) per day, the risk reduction is around 25%.
  • Cereals (grains) were divided into 3 categories:
    • Refined carbohydrates with a high glycemic index (e.g., white rice, white bread) are associated with increased heart disease risk in multiple studies probably due to their effect on blood sugar levels. And the increased risk is significant (Around 66% higher risk for every 2 servings).
    • Refined carbohydrates with a low glycemic index (e.g., pasta, corn tortillas) show an inconsistent effect on heart disease risk.
    • Whole grains are consistently associated with a lower heart disease risk. Two servings of whole grains per day are associated with a 25%-34% decreased risk.

Miscellaneous Foods:

  • Soft Drinks are associated with increased heart disease risk. One serving per day increases the risk by around 15-22% and recent evidence suggests that artificially sweetened soft drinks offer no heart health benefits compared to sugar sweetened soft drinks.
  • Coffee and Tea are both associated with decreased heart disease risk. For coffee the optimal benefit may occur at around 3 cups/day. Higher levels may have an adverse effect on heart disease risk.

Summary of Heart Health Recommendations

ScientistIf you are thinking that was a lot of information, the authors provided a numerical summary of their recommendations for a heart-healthy diet. They are:

  • Two servings per day of vegetables, fresh fruits, and whole grains.
  • One serving per day of nuts and seeds, low-glycemic index refined cereals, extra-virgin olive oil or non-tropical vegetable oils, and yogurt.
  • Four servings per week of legumes and fish.
  • No more than 3 servings per week of white meat, eggs, cheese, and milk.
  • No more than 2 servings per week of high-glycemic index refined starchy foods, red meat, and butter.
  • Only occasional consumption of processed meats.

What Does This Study Mean For You?

QuestionsOf course, nobody wants to follow a “diet by the numbers”. If you are like most of us, you want flexibility and you want to be able to eat some of your favorite foods. So, let me put these recommendations into a more “user friendly” form.

If you want a healthy heart:

  • Whole, unprocessed or minimally processed, plant foods are your friends.
  • Your heart-healthy foundation should be fruits, vegetables, whole grains, nuts and seeds, healthy plant oils, and legumes.
  • Your heart-healthy foundation can also include fermented dairy foods and low-glycemic index refined grains.
  • Your “go-to” beverages should be water, tea (both caffeinated and herbal teas), and coffee. You should avoid soft drinks and other sugar-sweetened or artificially sweetened beverages.
  • Once you have achieved a heart-healthy foundation you can add a few servings per week of white meat, eggs, cheese, and dairy, even high-fat dairy.
  • If you have good adherence to the heart-healthy foundation described above and no genetic or health issues that increase your risk of heart disease, you can probably eat more of these foods.
  • Conversely, if your adherence to the heart-healthy foundation is poor and/or you are at high risk of heart disease, you may wish to consume less of these foods.
  • If you have good adherence to the heart-healthy foundation, you can also add up to 1-2 servings of high-glycemic index refined carbohydrates, red meat, or butter per week. With red meat, you may want to consider it as a garnish that adds flavor to a plant-based meal rather than the centerpiece of the meal.
  • You should eat processed meats seldom or never.

The Bottom Line

A new comprehensive review and meta-analysis of 99 clinical studies with tens of thousands of participants has updated the correlation between foods and heart disease risk.

Many of the recommendations based on this analysis are identical to previous recommendations for a heart-healthy diet.

But there are some subtle changes to those recommendations based on the latest data.

For more details about this study and what a heart-healthy diet might look like for you, 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.

_______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Are Omega-3 Supplements Safe?

by

The Flaws And Blind Spots In This Study

Author: Dr. Stephen Chaney

Pendulum
Pendulum

Has the omega-3 pendulum swung again? The recent headlines are downright scary. For example:

  • “Fish Oil May Increase the Risk of Stroke and Heart Conditions.”
  • “Fish Oil Supplements May Cause Harm, Study Finds. Is It Time to Ditch Them?”
  • “Fish Oil Supplements May Lead to Heart Problems”.
  • “Regular Use of Fish Oil Supplements Might Increase, Rather Than Lessen, The Risk of First Time Heart Disease and Stroke Among Those in Good Cardiovascular Health.”

Yikes! That sounds bad. Should we be thinking about giving up our omega-3 supplements?

But wait. Just a few weeks earlier we were reading headlines about the benefits and lack of side effects from omega-3 supplements. That’s confusing. Which headlines are correct?

To answer these questions:

  • I will point out the flaws and blind spots in the study.
  • I will strip away the hyperbole and put the headlines into perspective.

How Was The Study Done?

clinical studyThe investigators made use of data from the UK Biobank Study. The UK Biobank Study is a large, long-term study in the United Kingdom which was designed to investigate the contributions of genetic predisposition and environmental exposure [including diet and supplementation] to the development of disease.

The UK Biobank Study enrolled 502,461 participants, aged 40-69 years, between January 1st, 2006 and December 31st, 2010. Participants were followed from entry into the program until March 31st 2021, an average of 11.9 years.

The current study excluded any participants who had a diagnosis of atrial fibrillation, heart failure, heart attack, stroke, or cancer at entry into the study, leaving 415,737 participants.

The participants were:

  • 55% women.
  • Average age of 56 years, with 83.4% of them below 65 years old at entry into the study.
  • 94.5% white.

The study was designed in a unique manner, in that it was designed to test the effect of omega-3 supplements on 6 specific transitions:

  • Primary prevention. This measured the transition of healthy (no diagnosed heart disease) people to either atrial fibrillation, major cardiovascular events, or death.
  • Secondary prevention. This measured the transition from atrial fibrillation to either major cardiovascular events or death.
  • Tertiary prevention. This measured the transition from major cardiovascular events to death.
  • Major cardiovascular events were further broken down to heart attacks, stroke and heart failure.

Participants were asked whether they used fish oil supplements when they entered the study and were categorized as either regular users or non-users. [Note: The users were not asked the dose or brand of fish oil supplements they used.]

Deaths were obtained from the national death registry and disease diagnosis from the National Health Service.

Are Omega-3 Supplements Safe?

omega-3 fish oil supplementHere is what the study found.

Primary Prevention – For healthy individuals (defined as having no diagnosed heart disease) using omega-3 supplements for an average of 11.9 years:

  • Increased the risk of atrial fibrillation by 13%.
  • Did not affect the risk of major cardiovascular events and death were unaffected by omega-3 supplementation.
  • When major cardiovascular events were broken down to their component parts, omega-3 supplementation:
    • Decreased the risk of heart failure by 8%.
    • Increased the risk of stroke by 5% (this was just barely statistically significance).
    • Did not affect the risk of heart attack.

Secondary Prevention – For individuals with atrial fibrillation omega-3 supplementation:

  • Decreased the risk of major cardiovascular events by 9%.
  • Decreased the risk of death by 8%.
  • When major cardiovascular events were broken down into their component parts, omega-3 supplementation:
  • Decreased the risk of heart attacks by 15%.
  • Had no effect on the risk of stroke or heart failure.

Tertiary Prevention – For people who suffered major cardiovascular events during the study omega-3 thumbs upsupplementation:

  • Decreased the risk of death by 8%.

Since this is a very complex set of data, I have coded positive results in green and negative results in red.

And as if these complexities were not enough, when the investigators broke these effects down by population groups:

  • Omega-3 supplementation decreased the transition from healthy to death for men (7% decrease) and participants older than 65 (9% decrease).

I will discuss the significance of these observations below.

The authors concluded, “Regular use of fish oil supplements might be a risk factor for atrial fibrillation and stroke among the general population but could be beneficial for [reducing] progression of cardiovascular disease from atrial fibrillation to major adverse cardiovascular events, and from atrial fibrillation to death.”

In short, they were suggesting that omega-3 supplements should be avoided by the general population because they have no positive benefits and might increase the risk of atrial fibrillation and stroke. But omega-3 supplements may be useful for those who already have heart disease.

Some of the articles you may have read about the study repeated this message. Others just emphasized the negative aspects of the study.

But is this message accurate? Let me start by discussing the flaws, blind spots, and hidden data in this study. Then I will summarize the 3 key findings of the study and tell you what they mean for you.

The Flaws, Blind Spots, And Hidden Data In This Study

flawsFlaws: As I said above, there were two major flaws in the study.

Flaw #1: The study did not identify the dose of supplement used. This is important because the increased risk of atrial fibrillation and stroke is primarily seen in clinical trials using high dose omega-3 supplements.

Flaw #2: This was an association study which cannot prove cause and effect. However, the authors of this study reported it as showing that omega-3 supplement use caused atrial fibrillation and stroke – and all the news reports on the study have repeated that claim.

Flaw #3: Other experts have pointed out that the authors inflated the risks associated with omega-3 supplementation by reporting relative risk rather than absolute risk. Let me try to simplify the distinction.

The risk of atrial fibrillation was 4.24% in the non-supplement users and 4.80% in the omega-3 supplement users. That is an absolute increase in risk of 0.56% (4.80% – 4.24%). This is the increase in risk you actually experience. In contrast, 4.80% is 13% greater than 4.24%, which is how relative risk is calculated.

In response to the questions you are probably thinking:

  • Yes, this is a perfect example of the Mark Twain quote, “There are lies. There are damn lies. And then there are statistics.”
  • Yes, all the percentages reported in this study are based on relative risk and are, therefore, inflated. However, I do not have access to their data, so I cannot tell you the absolute risk associated with their other observations.

Blind Spots: In their paper the investigators recommended against the use of omega-3 supplements to prevent heart disease because their data showed:

  • No benefit of omega-3 supplementation for preventing major cardiovascular events and deaths in a healthy population.
  • But did suggest an increased risk of atrial fibrillation and stroke in that same population.

However, their blind spot was in underestimating the difficulty of showing the benefit of any intervention in a healthy population. The example I always use is statin drugs. Statin Drugs:

  • Dramatically reduce the risk of a second heart attack and/or death in people who have already had a heart attack.
  • Reduce the risk of heart attacks in people who are at high risk of heart attacks.
  • Cannot be shown to reduce the risk of heart attacks in a healthy population.

This study suggests that omega-3 supplements are no different. In this study, omega-3 supplements:

  • Reduced the risk of death in people who had already experienced a major cardiovascular event like a heart attack or stroke.
  • Reduced the risk of major cardiovascular events and death in people with atrial fibrillation, which puts them at high risk for a heart attack or stroke.
  • Could not be shown to reduce the risk of major cardiovascular events or deaths in a healthy population.

Hidden Data: There are some important data that were buried in the text and supplemental figures but were Skepticignored in the concluding remarks of this study and all the articles written about it. For example:

  • The original study and all articles written about the study reported that omega-3 supplementation increased the risk of stroke in otherwise healthy individuals but ignored the observation that omega-3 supplementation decreased the risk of heart failure in that same group.

The second example of hidden data likely represents another blind spot of the authors. They concluded that omega-3 supplementation had no benefit for healthy individuals without asking whether omega-3 supplements might benefit higher-risk subpopulations within this group. To help you understand this statement let me start by giving you some perspective.

As I said above, statin drugs cannot be shown to reduce the risk of heart attacks in a healthy population. But when you include people at high risk of heart disease with healthy people in the dataset, you start to see a reduced risk of heart attacks.

Similarly, with supplements you often see no benefits with the general population, which is what is usually reported in the media. But when you look at higher risk groups within that population, the benefits of supplementation emerge.

This study is no different:

  • For healthy individuals, omega-3 supplementation had no effect on deaths during the 12-year follow-up period.
  • However, omega-3 supplementation reduced the risk of death by 9% for both men and people ≥ 65. These represent two groups with elevated risk of heart disease within the otherwise healthy population.
  • Once again, these data were completely ignored.

What Does This Study Mean For You?

This study made 3 major points:

Point #1: Let me start with the one you’ve heard the most about. The risk of atrial fibrillation and stroke associated with omega-3 supplementation is real. We should not ignore it.

But what this study and most of the reports on the study didn’t tell you is that the risk is dose dependent. The risk is primarily seen with high doses of omega-3s. While no one has done a comprehensive dose response analysis, I can tell you that these side effects are:

  • Seldom reported in clinical studies at doses of 1 gm/day or less.
  • Sometimes reported in clinical studies at doses of ≥2 gm/day.
  • Frequently reported in clinical studies at doses of ≥4 gm/day.

However, atrial fibrillation and stroke occur in a very small percentage of omega-3 users, even at 4 gm/day. At this point we have no idea why some people are susceptible to these side effects and others are not. More research in this area is clearly needed.

Until we know more about who is at risk, my recommendation for people who are trying to reduce the risk of heart disease is to rely on something called the Omega-3 Index to determine your individual omega-3 needs rather than using high-dose omega-3 supplements.

  • The Omega-3 Index measures the amount of omega-3 fatty acids in your tissues. It is determined by the amount of omega-3s you consume and how you metabolize them, so it is individualized to you.
  • An Omega-3 Index of 4% is associated with a high risk of heart disease, while an Omega-3 Index of 8% is associated with a low risk of heart disease. There is no evidence that more than 8% provides additional benefit.
  • Most importantly, it only takes 1-1.6 gm/day of omega-3s to raise your Omega-3 Index from 4% to 8%. At these doses your risk of atrial fibrillation and stroke is extremely small.

For example, a recent meta-analysis of 29 studies with a total of 183,292 participants reported that people with an 8% Omega-3 Index had:

  • Decreased risk of ischemic stroke (stroke due to blood clots) with no detectable increased risk of hemorrhagic stroke (stroke due to bleeding), and…
  • No detectable increased risk of atrial fibrillation.

I recommend getting your Omega-3 Index determined, and if it is low, increasing your omega-3 intake to get it into the 8% range. Some people go from 4% to 8% more rapidly than others, so you may need to repeat the test several times to optimize your Omega-3 Index.

If your health professional doesn’t have access to the Omega-3 Index test, you can order it from https://omegaquant.com (I have no financial stake in this company, but I know it as a reputable source of the Omega-3 Index test).

Does The Professor Plan To Reduce His Intake Of Omega-3 Fatty Acids? Three weeks ago, I shared thatprofessor owl my wife and I have been taking around 3 gm/day of omega-3 supplements for the past 40 years. Now that the association of atrial fibrillation and stroke with high dose omega-3 intake has been firmly established, some of you may be wondering whether we plan to decrease our intake of omega-3 supplements.

The answer is, “No”. Remember that the increased risk of atrial fibrillation and stroke is only seen for a small subset of people taking high-dose omega-3 supplements. If we were part of that subset, we would likely have experienced one of those side effects by now.

However, if you are considering omega-3 supplementation for the first time, you don’t know whether you are part of that subset or not. So, my advice remains the same. Rely on optimizing your Omega-3 Index rather than high-dose omega-3 supplementation.

Point #2: Healthy individuals (those with no symptoms of heart disease) do not benefit from omega-3 supplementation. As I pointed out above, this ignores data from their study, namely.

  • Omega-3 supplementation reduced the risk of heart failure in healthy subjects.
  • Omega-3 supplementation reduced the risk of death in higher risk groups within the healthy population (namely men and people 65 and older).

Confusion Clinical StudiesAs I discussed above, this is a pattern seen with statin drugs and most nutritional supplements. Simply put, you can’t show any benefit of statin drugs or most nutritional supplements in a “healthy” population, but you can show benefit when you focus on higher risk individuals within the “healthy” population.

The problem, of course, is that most of us don’t really know whether we are “healthy” or not. For millions of Americans the first indication that they are at risk from heart disease is sudden death from a heart attack or stroke.

With that in mind, I will leave the decision about whether you want to supplement with omega-3s up to you. But if you decide to supplement, I recommend you optimize your Omega-3 Index rather than using a high dose omega-3 supplement.

Point #3: People with heart disease benefit from omega-3 supplementation. This recommendation is becoming non-controversial, so I won’t comment further other than to say high dose omega-3 supplements are probably not needed unless prescribed by your health professional.

The Bottom Line

You have been asking me about recent headlines saying that omega-3 supplements may increase rather than decrease the risk of heart disease. So, I analyzed the study behind the headlines. The study makes 3 claims:

  • Omega-3 supplements increase the risk of atrial fibrillation and stroke when taken by healthy people.
  • Omega-3 supplements are of no benefit for healthy individuals.
  • Omega-3 supplements are beneficial for people who have heart disease.

In the article above I review the flaws, blind spots, and hidden data in the article and discuss what it means for you.

For more details about this study and what it means for you 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.

 ______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

 _______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Does EPA Reduce Migraine Frequency?

by

What Causes Migraines And The Role Of Omega-3s In Prevention

Author: Dr. Stephen Chaney

MigraineMigraines can be debilitating. And they affect millions of Americans. According to a recent survey 17.1% of women and 5.6% of men in the United States suffer migraine symptoms.

Symptoms range from frequent headaches to visual disturbances, nausea and vomiting, extreme light and sound sensitivity, brain fog, and debilitating pain. Sometimes all a migraine sufferer can do is retreat to a dark, quiet room and wait out the symptoms. This makes it virtually impossible to work, socialize, and interact with family.

For example, work absenteeism due to migraines is thought to cost US businesses up to $13 billion dollars annually. And, of course, there is no way to estimate the psychological cost of lost interactions with family and friends. And people who experience frequent migraines are more likely to suffer from depression, anxiety, and sleep disorders.

Medications can provide some relief from migraine symptoms, but they all have side effects. Various natural approaches for migraine relief have been proposed, but none of them are proven.

What Causes Migraines And The Role Of Omega-3s In Prevention

MigrainesOur understanding of migraines is complicated by the fact there appear to be multiple causes of migraines. It’s almost as if what we call “migraines” are really a variety of diseases with different causes but similar symptoms.

Migraines can be triggered by:

  • Hormonal fluctuations.
  • Weather changes.
  • Foods
    • The top 3 food triggers of migraines are caffeine, red wine, and chocolate.
    • Other common food triggers are artificial sweeteners, foods containing MSG, cured meats, aged cheeses, pickled and fermented foods, frozen foods, and salty foods.
  • Stress
  • Lack of sleep.
  • Certain drugs.
  • Missed meals.

Migraine triggers vary from person to person. And multiple neurophysiological pathways have been proposed to explain how each of these triggers progresses to a full-blown migraine.

To simplify a very complex subject, there are three main factors that influence each of these proposed pathways:

  • Susceptibility to migraines clearly runs in families.
  • 75% of migraine sufferers are women.
  • Inflammation.

Because inflammation plays a strong role in progression and severity of migraines, there has been a strong interest in the use of long-chain omega-3s like EPA and DHA as nutraceuticals to reduce the frequency and severity of migraines.

However, previous studies have had mixed results. Some have suggested that omega-3s reduce the risk of migraines while others have come up empty.

The authors of the current study (H-F Wang, et al, Brain, Behavior, and Immunity 118, 459-467, 2024) postulated that some previous studies failed to find a benefit of omega-3 supplementation because they were too short in duration, used a mixture of omega-3s, or were poorly designed.

They noted that high dose EPA alone had proven to be effective in reducing the risk of heart disease and depression. So, they performed a 12-week randomized, double-blind, placebo-controlled clinical trial with migraine sufferers using 1.8 grams of EPA per day.

How Was This Study Done?

clinical studyThis was a double-blind, placebo-controlled clinical trial, the gold standard for clinical studies. The investigators recruited 70 patients (15 men and 55 women) with episodic migraines (defined as migraines with or without aura occurring fewer than 15 days per month) from the neurology clinic of Kuang Tien General Hospital in Taiwan. The average age of the patients was 39 years old.

The subjects were randomly assigned to use either 1.8 gm/day of EPA or a soybean oil placebo for 12 weeks. Both were formulated with an orange flavoring to hide the taste difference. Neither the patients nor the physicians conducting the study knew who got the EPA and who got the placebo.

The patients filled out an extensive questionnaire about their migraines and related issues at entry into the study and at the end of 12 weeks. They were also asked to maintain headache diaries for at least 4 weeks prior to the study and for every 4 weeks of the 12-week study. They received training from the study coordinator on how to fill out the diaries and were encouraged to contact the coordinator if they had any questions about how to accurately fill out the diary.

The primary outcome of the study was the decrease in migraine frequency from baseline to 12 weeks. The study also assessed changes in:

  • Headache severity.
  • The need to use headache medicines.
  • Migraine-specific disability (The extent to which migraines resulted in disability).
  • Migraine-specific quality of life index (The extent to which migraines affected the quality of life).
  • Anxiety and depression (These are often side effects of chronic migraines).

While some of those outcomes appear to be overlapping, they are all well-established assessments used in migraine research. The questionnaire the doctors used was designed to provide a numerical rating for each of these outcomes.

Does EPA Reduce Migraine Frequency?

omega-3 fish oil supplementAs expected, there were no significant changes in the placebo group. But in the group taking 1.8 gm/day of EPA:

  • Migraine frequency decreased by 60%.
  • Frequency that headache medication was needed decreased by 45%.
  • Headache severity decreased by 14%.
  • Sleep quality increased by 17%, but that increase was not statistically significant.
  • Migraine-related disability decreased by 73%.
  • Migraine-related quality of life improved by 31%.
  • Anxiety and depression decreased by 53%.

These differences were statistically significant for the women in the study, but not for men – probably because of the small number of men in the study.

The study also assessed side effects from EPA supplementation in this group. Side effects were minimal and were not different from the placebo group.

The authors concluded, “High-dose EPA significantly reduced migraine frequency and severity. Improved psychological symptoms and quality of life in migraine patients, and showed no adverse events [effects], suggesting its potential for prophylactic use for migraine patients.”

They went on to say, “The results of this study may not only serve as a valuable reference for future large-scale randomized clinical trials to investigate the optimal dosing and components of omega-3 fatty acids for migraine prevention but also underscore the need for replication of these findings in adequately powered and controlled studies.”

In other words, this study needs to be confirmed by additional studies. And future studies need to determine the optimal dose of EPA and the optimal ratio of EPA to DHA.

What This Study Means For Us And For You

Question MarkThe topic of omega-3s and migraines is of special significance for us. About 40 years ago my wife and I started taking a high purity omega-3 supplement containing both EPA and DHA to control inflammation. We didn’t have noticeable inflammation at the time, but we both had parents who suffered from rheumatoid arthritis and wished to avoid their suffering later in life.

In just a few weeks the migraines my wife had been experiencing for years disappeared. That piqued my interest, so I searched the literature and found several studies showing that omega-3 fatty acids reduce migraine symptoms. I have followed the twists and turns of omega-3 – migraine research ever since, which is how I came across this study.

As for our original purpose in taking an omega-3 supplement, all I can say is that we are now in our 80s, and neither of us suffer from the rheumatoid arthritis that plagued our parents.

And for my wife the disappearance of her migraines was an unexpected side benefit.

This study is a strong validation of the effect of omega-3s on reducing migraine symptoms. However, it is not the end of the story. As the authors said:

  • It needs to be confirmed by larger, well controlled studies.
  • The optimal dose of omega-3s needs to be determined.
  • The optimal ratio of EPA to DHA and possibly other long chain omega-3s needs to be determined.

This study used 1.8 grams/day of pure EPA. My wife takes 3 grams of EPA and 2 grams of DHA each day. But we don’t know whether she would experience the same benefit from a lower dose or whether that is the optimal ratio of EPA to DHA. We do know that EPA and DHA have different health benefits, so we plan to continue taking a supplement that contains both.

And finally, as I said above, it is almost as if what we call migraines are really a cluster of diseases with similar symptoms. There are multiple migraine triggers and multiple proposed explanations of how these triggers lead to full-blown migraines.

So, we shouldn’t think of omega-3s as a magic bullet. Rather, we should think of them as one of many approaches that may provide you with some migraine relief.

The Bottom Line

A recent double-blind, placebo controlled clinical study with migraine sufferers reported that when they were given 1.8 gm/day of EPA for 12 weeks:

  • Migraine frequency decreased by 60%.
  • Frequency that headache medication was needed decreased by 45%.
  • Headache severity decreased by 14%.
  • Migraine-related disability decreased by 73%.
  • Migraine-related quality of life improved by 31%.
  • Anxiety and depression decreased by 53%.

The authors concluded, “High-dose EPA significantly reduced migraine frequency and severity. Improved psychological symptoms and quality of life in migraine patients, and showed no adverse events [effects], suggesting its potential for prophylactic use for migraine patients.”

They went on to say, “The results of this study may not only serve as a valuable reference for future large-scale randomized clinical trials to investigate the optimal dosing and components of omega-3 fatty acids for migraine prevention but also underscore the need for replication of these findings in adequately powered and controlled studies.”

In other words, this study needs to be confirmed by additional studies. And future studies need to determine the optimal dose of EPA and the optimal ratio of EPA to DHA.

For more details about this study and what it means for you 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.

 ______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance 

____________________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Do Omega-3s Reduce Osteoarthritis Pain?

by

How Do Rheumatoid And Osteoarthritis Differ?

Author: Dr. Stephen Chaney 

knee painThis week I am concluding my series on recent omega-3 advances by reviewing a meta-analysis that asks whether omega-3s are beneficial for people with osteoarthritis.

This is an important question because osteoarthritis affects around 32.5 million adults in the United States, and that number is increasing each year as our population ages. Osteoarthritis causes pain and disabilities that can significantly affect quality of life.

And the costs are high. Health care costs due to osteoporosis are around $140 billion/year. And when you include lost workdays, the annual cost is around $468 billion.

There are several medications for reducing symptoms of osteoarthritis. But they each have side effects and some patients cannot tolerate them. Joint replacement surgery is the final resort. But the recovery period is long, and the surgery isn’t always effective. For both reasons many patients with osteoarthritis are looking for natural solutions.

Most of the research on omega-3s and arthritis has been done with patients who have rheumatoid arthritis. Omega-3 supplements have been shown to reduce the pain, swelling of the joints, and inflammation associated with rheumatoid arthritis for many people with the disease.

Based on several dose-response studies, the NIH says the optimal dose is around 2.7 gm/day of EPA + DHA but cautions not to go above 3 gm/day without your doctor’s OK.

The evidence is less clear for omega-3s and osteoarthritis. Some studies suggest that EPA + DHA reduce the pain and inflammation associated with osteoarthritis. But other studies have come up empty. There is no consensus as to whether omega-3s are beneficial for people with osteoarthritis.

When there is disagreement between individual studies, a meta-analysis of the studies is often helpful. By pooling the data from multiple studies, a meta-analysis can smooth out some of the differences between the studies and accumulate enough data points to discover effects that would not have been statistically significant with the smaller data sets from individual studies.

With that in mind, the authors of this manuscript (W Den et al, Journal of Orthopaedic Surgery and Research, 18: 381, 3023) performed a meta-analysis on the data obtained from 9 double-blind, placebo-controlled studies looking at the effect of omega-3s versus a placebo on both pain and joint mobility in osteoarthritis patients.

How Do Rheumatoid And Osteoarthritis Differ?

While the causes of rheumatoid arthritis and osteoarthritis are very different, there are some underlying similarities between the two diseases that suggest both might benefit from omega-3 supplementation.

Rheumatoid Arthritis: Rheumatoid arthritis is thought to be an autoimmune disease, which means that our immune system attacks our cells rather than foreign invaders. It results in chronic inflammation that attacks our joints and can affect other tissues in our body.

It initially affects the lining of our joints which can result in painful, swollen joints. As the disease progresses it can also lead to bone erosion and joint deformity.

Osteoarthritis:Osteoarthritis is generally thought of as a “wear and tear” disease. It is associated with sports injuries and accidents. It is also associated with stress to particular joints due to repeated motions associated with either sports or a job. Obesity also increases wear and tear of the joints because it increases the load on the joints.

The wear and tear causes the cartilage that cushions the junction between bones to deteriorate. Eventually, the cartilage deteriorates to the extent that bone is grinding against bone, which can lead to bone loss and deformities.

Eventually, this results in an inflammation of the joint lining which causes pain and accelerates bone loss. It also causes deterioration of the connective tissue which holds bones together and connects them to muscle.

What Do These Diseases Have In Common? Inflammation is the common factor associated with both rheumatoid and osteoarthritis, and many studies suggest that omega-3s reduce inflammation. In the simplistic description of the two diseases I shared above, it sounds like inflammation occurs much earlier in the disease process for rheumatoid arthritis than for osteoarthritis. This might suggest that omega-3s could be more effective at reducing the symptoms and progression of rheumatoid arthritis than of osteoarthritis.

However, we know that the risk of developing osteoarthritis is increased by chronic inflammation caused by obesity, diseases like diabetes, and/or an inflammatory diet.

How Was This Study Done?

clinical studyThis study was a meta-analysis of 9 double-blind, placebo-controlled clinical studies looking at the effect of omega-3 fatty acids on the pain and loss of joint mobility associated with osteoarthritis. These studies were performed in countries from around the world and included a total of 2,070 participants.

The criteria for inclusion in the meta-analysis were:

1) The articles were written in English.

2) The studies had to be double-blind, placebo-controlled studies (The gold standard for clinical studies).

3) Patients with osteoarthritis were randomly assigned to an intervention group receiving omega-3 supplementation or a placebo group receiving olive oil or another plant oil.

4) The studies measured efficacy and safety outcomes including joint pain (efficacy), joint mobility (efficacy), and treatment-related adverse events (safety).

5) Patients in both the omega-3 and placebo groups were using medications to reduce osteoarthritis symptoms when they were enrolled in the study and were advised to continue with their prescribed medicines for the duration of the study.

The characteristics of the clinical studies included in this meta-analysis were:

  • Sample size (47-1221), Average = 230.
  • Mean age (55.9-68), Average = 63.
  • % men (13.8-45.1%), Average = 31%.
  • Omega-3 (EPA + DHA) dose (350 mg/day – 2,400 mg/day), Average = 1,085 mg/day.

Do Omega-3s Reduce Osteoarthritis Pain?

Question MarkWhen the data from all 9 studies were combined in a single meta-analysis, omega-3 (EPA + DHA) supplementation:

  • Reduced joint pain by 29% compared to the placebo.
  • Increased joint mobility by 21% compared to the placebo.
  • Was not associated with any adverse effects.

The authors concluded, “The results of the meta-analysis indicate that supplementation with omega-3 fatty acids is effective to relieve pain and improve joint function in patients with osteoarthritis, without increasing the risk of treatment-related adverse events. These findings support the use on omega-3 fatty acid supplementation as an alternative treatment for osteoarthritis.”

What Are The Strengths and Limitations Of This Study?

strengths and weaknessesStrengths:

  • All the studies included in this meta-analysis were randomized, double-blind, placebo-controlled studies (the gold standard for clinical trials).
  • All the individual studies that qualified for this meta-analysis found that omega-3 supplementation reduced joint pain and improved joint mobility. This improves confidence that the conclusions of the meta-analysis are correct. The meta-analysis simply improved the statistical significance of this conclusion by combining the data from the individual studies.

Limitations:

  • The biggest limitation was that the individual studies included in this meta-analysis were not performed under the guidelines of the “Fatty Acids and Outcomes Research Consortium” that I discussed in last week’s issue of “Health Tips From the Professor”.
    • The “Fatty Acids and Outcomes Research Consortium” guidelines harmonize the designs of individual studies, which strengthens the meta-analysis.
      • In contrast, the design of the individual studies within this meta-analysis was very different, which prevented the meta-analysis from being able to determine the optimal dose of omega-3 supplements and the minimum time required for omega-3 supplementation to significantly reduce the symptoms of osteoarthritis.
    • The “Fatty Acids and Outcomes Research Consortium” guidelines would have also required these studies to measure tissue levels of omega-3s (something called Omega-3 Index) at the beginning and end of each study. This was not done in any of these studies.
      • This is important because if a patient’s tissue levels of omega-3s at the beginning of the study were already in the optimal range, you would expect little additional benefit from supplementation for that patient.
  • All the individual studies were very small. This limits the ability of these studies to provide definitive conclusions. Unfortunately, this is probably unavoidable.
    • Double blind, placebo-controlled clinical studies are expensive. Only major pharmaceutical companies have the multi-million-dollar budgets required to conduct large double blind, placebo-controlled clinical studies that would provide more definitive evidence that omega-3 supplementation reduces the symptoms of osteoarthritis – and the follow-up studies that would determine the optimal dose of omega-3 supplements and the minimum time required to show an effect of omega-3 supplementation.
  • The patients in these studies were already taking medications to reduce their osteoarthritis symptoms prior to entering the study and were instructed to continue taking those medications during the study. This means that the studies were not asking whether omega-3s alone were effective at reducing osteoarthritis symptoms. They were asking whether omega-3 supplementation provided any additional benefits for people who were already taking medications to reduce symptoms.
    • Unfortunately, this is also probably unavoidable. Current guidelines consider it unethical to withhold the medical “standard of care” from any patient in a clinical trial.

What Does This Study Mean For You?

Questioning WomanThis study, while not definitive, strengthens the evidence that omega-3 supplements containing EPA + DHA may reduce joint pain and improve joint mobility for people with osteoarthritis. It also shows that the doses required to achieve these benefits are not associated with any significant side effects.

While large scale double blind, placebo-controlled clinical studies to confirm these conclusions would be nice, they are unlikely to occur for the reasons discussed above.

The investigators said, “[This study shows that] supplementation of omega-3 fatty acids is effective to relieve pain and improve joint function in patients with osteoarthritis…These findings support the use of omega-3 fatty acid supplementation as an alternative treatment for osteoarthritis.”

This might lead you to believe that omega-3 fatty acids can potentially replace medications for reducing osteoarthritis pain and loss of joint mobility. That may be true, but that is not what the study showed.

Patients in both the omega-3 and placebo group continued their prescribed medicines for osteoarthritis. In reality, the study only shows that omega-3s provide additional benefit for people already taking osteoarthritis medications. The effect of omega-3 supplements by themselves has not been tested and, as I discussed above, is not likely to be tested in the foreseeable future.

However, the use of omega-3 supplements may allow you to reduce or eliminate the medications you are on for osteoarthritis and may delay the need for joint replacement surgery. Of course, if you wish to reduce/eliminate your medications and/or delay joint replacement surgery, I recommend consulting with your doctor first.

Finally, this study provides no information on the optimal dose of omega-3s. Some studies suggest the dose of omega-3s needed to reduce osteoarthritis symptoms may be less than that required to reduce rheumatoid arthritis symptoms, but that evidence is weak.

In the absence of good dose response data, I recommend you aim for an omega-3 index of 8%. You will find a more detailed discussion of the Omega-3 Index and how to use it in last week’s “Health Tips From the Professor” article .

The Bottom Line

A recent meta-analysis looked at the effect of omega-3 supplementation on the pain and lack of joint mobility associated with osteoarthritis.

The study showed that omega-3 (EPA + DHA) supplementation:

  • Reduced joint pain by 29% compared to the placebo.
  • Increased joint mobility by 21% compared to the placebo.
  • Was not associated with any adverse effects.

The authors concluded, “The results of the meta-analysis indicate that supplementation with omega-3 fatty acids is effective to relieve pain and improve joint function in patients with osteoarthritis, without increasing the risk of treatment-related adverse events.”

For more details about the study and what it means for you, 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. 

_____________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

_______________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

The Good News About Omega-3s And Stroke

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How Do Omega-3s Affect The Two Types Of Stroke?

Author: Dr. Stephen Chaney 

strokeI am continuing my series on recent omega-3 breakthroughs. Last week I reviewed a study showing that the omega-3s EPA and DHA lowered blood pressure. Since high blood pressure is a major contributing factor to stroke risk, it only makes sense that EPA and DHA would also decrease the risk of strokes.

In last week’s article I mentioned that high blood pressure is called a silent killer. That is because the symptoms of high blood pressure are easy to ignore and often confused with other illnesses.

For many people the first indication they have a problem is when they have a stroke, which either kills them or forever impacts their quality of life. Let me share some statistics with you.

  • Every 40 seconds someone in the United States has a stroke. One in four adults over the age of 25 will have a stroke in their lifetime.
  • Every 4 minutes someone in the United States dies from a stroke. For many of them sudden death is the first indication they had a health problem.
  • The overall incidence of strokes has increased 60% in the last 20 years with most of that increase (65%) coming from younger adults (ages 20 to 45)
  • The cost of treatment, rehabilitation, and lost wages from stroke was $891 billion in 2020 and is projected to increase to $2.3 trillion in 2050.

Any way you look at it, the personal and financial costs of strokes are immense.

How Do Omega-3s Affect The Two Types Of Stroke?

There are two major kinds of stroke – ischemic stroke, which is caused by a thrombus (blood clot) in the carotid arteries leading to the brain, and hemorrhagic stroke, which is caused by bleeding from small blood vessels in the brain. Ischemic stroke accounts for around 85% of all strokes.

Ischemic strokes are caused by atherosclerosis, the buildup of fatty plaques in the walls of the carotid arteries, followed by the formation of a blood clot which lodges in the narrowed arteries. As you might expect, the prevention and treatment of ischemic strokes are similar to the prevention and treatment of heart attacks.

EPA and DHA have been shown to:

  • Reduce inflammation, which is associated with increased risk of heart disease and stroke.
  • Reduce blood pressure. High blood pressure damages the endothelial lining of blood vessels, which can lead to either build up of atherosclerotic plaque or rupturing of the blood vessels.
  • Reduce platelet aggregation and blood viscosity, which reduces the potential for inappropriate blood clots forming in the carotid arteries.

[When you cut yourself, you want a blood clot to form to stop the bleeding. That is an example of appropriate blood clot formation. However, when a blood clot forms within your arteries, it can prevent blood from reaching surrounding tissues. This is an example of inappropriate blood clot formation.]

  • Reduce the risk of atherosclerotic plaques rupturing. Rupturing of atherosclerotic plaques triggers blood clot formation, so this also decreases the risk of inappropriate blood clots forming in the carotid arteries.

Based on the known effects of EPA and DHA, it is not surprising that they would decrease the risk of ischemic strokes. But what about hemorrhagic strokes? Here the answer is not as clear cut.

  • In a previous clinical study 4 gm/day of purified EPA without DHA was associated with a slightly increased risk of bleeding events but did not increase the risk of hemorrhagic stroke.
  • High doses of pharmaceutical grade EPA have also been associated with a slightly increased risk of atrial fibrillation (Afib). In contrast, previous studies have shown that higher dietary intake of EPA + DHA are associated with a lower risk of Afib.

At present, we don’t know whether the increased risk of bleeding events and Afib are only seen at very high doses of omega-3s or are due to the use of pharmaceutical grade EPA without DHA and any of the other naturally occurring omega-3s.

However, this uncertainty has led some experts to warn that omega-3s may be a two-edge sword. They might increase the risk of hemorrhagic stroke while decreasing the risk of ischemic stroke. This uncertainty was part of the rationale for the study (JH O’Keefe et al, Stroke, 55: 50-58, 2024) I am describing today.

How Was This Study Done?

clinical studyThis study was a meta-analysis of 29 clinical studies looking at the effect of omega-3 fatty acids on the risk of both ischemic and hemorrhagic stroke. These studies were performed in 15 countries from around the world and included a total of 183,291 participants.

One major drawback of many meta-analyses is that each study in the meta-analysis is independently designed. Sometimes the studies are so different that it is difficult to fit them together in a coherent pattern.

A major strength of this meta-analysis is that all the studies were conducted within the “Fatty Acid and Outcome Research Consortium” which specifies a general protocol for the design of each study within that consortium.

For example, estimates of dietary omega-3 intake can be inaccurate and the uptake and utilization of both dietary and supplemental omega-3s vary from person to person. Because of that the Fatty Acid and Outcomes Research Consortium guideline specifies that studies rely on biomarkers of omega-3 levels in the body rather than the amount of omega-3s consumed.

The most frequently used biomarker was the percentage of omega-3s incorporated into the fatty portion of red blood cell membranes. Some studies used other biomarkers, such as the percentage of omega-3s incorporated into the fatty portion of plasma phospholipids or cholesterol-containing phospholipid particles (LDL and HDL for example).

In each case, the percentage of omega-3s is used to calculate something called an “Omega-3 Index”. Previous studies have shown that an Omega-3 Index of 4% or less correlates with a high risk of heart disease, and an Omega-3 Index of 8% or more correlates with a low risk of heart disease. In essence, this study correlated Omega-3 Index with the risk of stroke.

The Fatty Acids and Outcomes Research Consortium harmonized the studies included in this meta-analysis in several other ways, but the use of Omega-3 Index rather than omega-3 consumption was the most important.

Other key characteristics of the studies included in this meta-anaysis were:

  • The average age of participants was 65 years.
  • 82% of the participants were white and 53% were women.
  • The average length of follow-up was 14 years (range = 5-30 years).
  • 10,561 participants (5.8%) suffered a stroke during follow-up (78% ischemic, 11% hemorrhagic, and 11% unspecified).

The Good News About Omega-3s and Stroke 

good newsThe participants in these studies were divided into quintiles based on their Omega-3 Index. When those in the highest quintile (≥ 8%) were compared with those in the lowest quintile (≤ 4%):

  • Risk was reduced by 17% for total stroke and 18% for ischemic stroke. There was no effect on hemorrhagic stroke.

When the effect of individual components of the Omega-3 Index were analyzed:

  • For EPA + DHA risk was reduced by 17% for total stroke and 18% for ischemic stroke. There was no effect on hemorrhagic stroke.
  • For EPA risk was reduced by 17% for total stroke and 18% for ischemic stroke. There was no effect on hemorrhagic stroke. (You are probably starting to detect a pattern).
  • For DHA the results were only slightly different. Risk reduction was 12% for total stroke and 16% for ischemic stroke. There was no effect on hemorrhagic stroke.
  • For DPA, a minor component of the Omega-3 Index, there was no significant effect on total, ischemic, or hemorrhagic stroke.
  • There was a linear dose-response for the effect of EPA, DHA, and the two combined on the reduction in risk for both total and ischemic stroke.

When they looked at subgroups within the analysis, the results were the same for:

  • Age (<65 compared to >65).
  • Gender.
  • Studies that lasted less than 10 years and studies that lasted more than 10 years.
  • The presence of preexisting Afib.
  • The presence of preexisting cardiovascular disease.

The authors concluded, “In summary, this harmonized and pooled analysis of prospective studies showed that long-chain omega-3 levels were inversely associated with risk of total and ischemic stroke but were unrelated to risk of hemorrhagic stroke. Thus, higher dietary intake of DHA and EPA would be expected to lower risk of stroke.”

What Does This Study Mean For You?

Key Takeaways From This Study: The most important takeaway from this study is that reasonable amounts of EPA and DHA from either diet or supplementation are unlikely to increase your risk of hemorrhagic stroke (I will define reasonable below).

That is important to know because this and several other studies show that EPA and DHA decrease the risk of ischemic stroke, which accounts for around 85% of total strokes. This study shows you can reduce your risk of ischemic stroke without fearing that you will increase your risk of hemorrhagic stroke.

This study also reaffirms the importance of relying on Omega-3 Index rather than the dosage of omega-3s in a supplementation. Previous studies have shown there is significant individual variability in the uptake and utilization of dietary omega-3s.

Finally, this study shows you don’t need huge amounts of EPA and DHA to significantly decrease your risk of stroke and cardiovascular disease in general. An Omega-3 Index of ≥ 8% is sufficient to accomplish both.

How Much Omega-3s Do You Need? The authors of this manuscript are experts on the Omega-3 Index, and they estimated that:

  • To raise your Omega-3 Index from 5.4% (the median Omega-3 Index in these studies) to 8% would require about 1,000 mg/d of EPA + DHA.
  • To raise your Omega-3 Index from 3.5% (the lowest Omega-3 Index quintile in these studies) to 8% would require about 1,600 mg/d of EPA + DHA.

These intakes are well within the American Heart Association recommendations for reducing the risk of stroke and cardiovascular disease and are easily achievable from diet and supplementation.

But these estimates are based on averages, and, as I noted above, none of us are average. We differ in our ability to absorb and utilize omega-3s. So, I recommend relying on your Omega-3 Index rather than a dose of omega-3s that’s right for the average person but may not be right for you.

My recommendation would be to start with an Omega-3 test. If you are below 8%, start with the dosage of EPA + DHA the authors of today’s study recommended. Then retest in 6 months and adjust your dose based on the results of that test.

Question MarkHow Much Is Too Much? As I mentioned above, the dose response was linear for Omega-3 Index versus reduction in risk of total and ischemic strokes. So, the question becomes whether you might wish to increase your Omega-3 Index above 8% to achieve an even better reduction in stroke risk.

That is a very personal decision that only you can make but let me share some facts to help you make that decision.

  • As I mentioned above, a previous clinical trial showed an increased risk of bleeding events and Afib at a dosage of 4 gm/day of pure EPA. We don’t know whether that was because of the dose or the use of a formulation that contained only EPA without DHA and other naturally occurring long-chain omega-3s.
  • In that study the increase in bleeding events and Afib was observed in <5% of participants, which suggests that those side effects may be limited to certain high-risk individuals.
    • In this context, high risk might include individuals with preexisting Afib, individuals with a tendency towards excess bleeding, and patients on blood thinning medications.
    • However, only your physician knows all your risk factors. If you have health issues or are on medications, it is always a good idea to check with your physician before changing your omega-3 intake. And if you are considering high-dose omega-3 supplementation or exceeding an 8% Omega-3 Index, I strongly recommend that you consult with your physician first.

The Bottom Line

A recent study looked at the effect of omega-3 levels in red blood cells and other tissues (something called Omega-3 Index) on the risk of various types of stroke.

When individuals with an Omega-3 Index ≥ 8% were compared with those with an Omega-3 Index of ≤ 4%:

  • Risk was reduced by 17% for total stroke and 18% for ischemic stroke (stroke caused by blood clots in the carotid arteries). There was no effect on hemorrhagic stroke (stroke caused by bleeding from small blood vessels in the brain).

The authors concluded, “In summary, this harmonized and pooled analysis of prospective studies showed that long-chain omega-3 levels were inversely associated with risk of total and ischemic stroke but were unrelated to risk of hemorrhagic stroke. Thus, higher dietary intake of DHA and EPA would be expected to lower risk of stroke.”

This study represents an important breakthrough. There is good evidence that increased EPA + DHA from food and/or supplements reduces the risk of ischemic stroke. But some experts have cautioned it might also increase the risk of hemorrhagic stroke. This study puts that fear to rest.

For more details about the study and what it means for you, 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.

_______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance 

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

 

How Much Omega-3s Are Best For Blood Pressure?

by

What Does This Study Mean For You?

Author: Dr. Stephen Chaney

high blood pressureI am continuing my series on recent omega-3 breakthroughs. Today I am going to cover a recent systematic review and meta-analysis (X Zhang et al, Journal of the American Heart Association, 11: e025071, 2022) that analyzed 71 double blind, placebo-controlled clinical studies with 4,973 subjects to determine the optimal dose of omega-3s needed to lower blood pressure.

But first, I will cover why this study is so important.

High blood pressure is called a “silent killer”. For most of us our blood pressure creeps up year after year, decade after decade. Factors like inactivity, obesity, smoking, poor diet, and excess alcohol consumption speed the increase.

Unfortunately, the symptoms of high blood pressure – things like headaches, anxiety, fatigue, and blurred vision – are easy to ignore or confuse with other health problems. And if these symptoms are ignored long enough, the result can be sudden death due to a stroke or heart attack.

Alternately, the consequence could be things like congestive heart failure, kidney failure, vision loss, and memory loss that change your quality of life forever. And once the genie is out of the bottle, it can never be put back again. The damage is permanent.

Omega-3s are often recommended for keeping blood pressure in the normal range. In fact, in 2019 the FDA approved a qualified health claim stating, “Consuming eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids in food or dietary supplements may reduce the risk of hypertension (high blood pressure) and coronary heart disease.”

But the amount of omega-3s needed to reduce the risk of high blood pressure is uncertain. Previous studies have come up with conflicting results. That is the question the study I will discuss today was designed to answer.

How Was This Study Done?

Clinical StudyThe investigators included 71 studies published between 1987 and 2020 with a total of 4,793 subjects ranging in age from 22 to 86 years in their systematic review and meta-analysis. The studies were all randomized, placebo-controlled trials looking at the effectiveness of omega-3 intake (primarily in the form of food or supplements containing both EPA and DHA) at lowering blood pressure. The placebo used in these studies was olive oil or other vegetable oils.

The studies included in this meta-analysis:

  • Included omega-3 intake from both diet (mackerel, salmon, trout, or tuna) and supplements (fish oil, algal oil, or purified omega-3 ethyl esters).
  • Were conducted in populations from Europe, North America, Australia and other Pacific islands, and Asia.
  • Included subjects with normal blood pressure as well as those with high blood pressure.
  • Ranged in length from 5 to 52 weeks (the average was 10 weeks).
  • Included approximately equal numbers of men and women.

The meta-analysis excluded studies that:

  • Lacked a placebo.
  • Lasted less than 4 weeks.
  • Included blood pressure medications.
  • Included individuals with preexisting cardiovascular events.

The data from these trials was analyzed by a statistical method called a 1-stage cubic spline regression model. This is a recently developed statistical method which the investigators stated was superior to the statistical methods used in previous studies because it reduces the likelihood the results are influenced by investigator bias.

How Much Omega-3s Are Best For Blood Pressure?

Fish Oil and Blood PressureWhen the investigators combined the data from all 71 studies:

  • The maximum reduction in both systolic and diastolic blood pressure was observed between 2g/d and 3 g/d.
  • The dose response was non-linear. Doses above 3 g/d offered no additional benefit.

When the investigators looked at subgroups within the studies:

  • Reduction in blood pressure was seen in both subjects with normal blood pressure and those with high blood pressure.
    • However, reduction in blood pressure and the dose response were different in the two groups.
      • In subjects with normal blood pressure the dose response was non-linear with the optimum reduction between 2 and 3 g/d.
      • In subjects with high blood pressure the reduction in blood pressure was greater and the dose response was linear. The authors recommended a dose ≤ 3 g/d EPA + DHA for people with high blood pressure.
  • Subjects with hyperlipidemia had a greater reduction in blood pressure than subjects with normal lipid levels, and the dose-response was linear.
  • Subjects over the age of 45 had a greater reduction in blood pressure than subjects under the age of 45, and the dose response was linear.
  • There were no significant differences between:
    • Diet versus supplementation.
    • Type of omega-3 supplement (natural fish oil versus purified ethyl ester).
    • Sex.

The authors concluded, “This dose-response meta-analysis demonstrates that the optimal combined intake of omega-3 fatty acids for blood pressure lowering is likely between 2 g/d and 3 g/d. Doses of omega-3 fatty acid intake above the recommended 3 g/d may be associated with additional benefits in lowering blood pressure among groups at high risk of cardiovascular disease.”

I should probably explain the reasoning behind this conclusion.

  • 79% of the studies included in this meta-analysis were performed with subjects who had normal blood pressure. This group had a non-linear reduction in blood pressure with an optimal reduction between 2 and 3 g/d EPA + DHA.
    • Because of its size this group exerted a major influence on the results, which explains why the average results for the entire group showed a non-linear reduction in blood pressure with an optimal reduction between 2 and 3 g/d EPA + DHA.
    • Subjects with normal blood pressure and normal lipid levels are at low risk of cardiovascular disease. The high-risk groups (high blood pressure, high cholesterol and/or triglyceride levels, and over 45) all had a linear dose response suggesting that doses above 3 g/d EPA + DHA may be optimal.

The authors also said, “We found associations [between omega-3 intake and blood pressure] among both hypertensive (high blood pressure) and nonhypertensive (normal blood pressure) groups, suggesting that omega-3 fatty acids could be beneficial for controlling blood pressure even before the onset of hypertension.

This means that the intake of omega3 fatty acids could have implications on a person’s future risk of stroke, ischemic heart disease, and all-cause mortality.”

In other words, they are saying their data suggests that EPA + DHA intakes in the 2-3 g/d range may prevent high blood pressure and the effects it can have on our health.

What Does This Study Mean For You?

Question MarkThe authors of this study claim their data support a dose of 2-3 mg/d of EPA + DHA to prevent a future increase in blood pressure and all its associated health consequences. They also say that an EPA+ DHA dose ≥ 3g/d may be optimal for people who already have high blood pressure and/or other risk factors for heart disease.

I am not an expert on statistics, so I cannot evaluate the author’s claim that their statistical method was superior to the methods used in earlier studies that gave conflicting results.

However, their results are consistent with recommendations of several major health and government agencies.

  • For example, the European Food Safety Authority has said, “An intake of EPA and DHA of ~3 g/d is required to bring out the claimed hypotensive (blood pressure lowering) effect”.
  • The FDA has approved qualified health claims stating that consuming EPA and DHA in foods or dietary supplements may reduce the risk of hypertension (high blood pressure) and coronary heart disease but did not recommend a dose to achieve these results.
  • The American Heart Association has recommended ~ 1 g/d of EPA + DHA for patients with documented coronary heart disease and 2–4 g/day of EPA + DHA to lower triglycerides.
  • And the American Heart Association features this article on their website with the headline, “Consuming about 3 grams of omega-3 fatty acids a day may lower blood pressure.”

When we contrast that with the fact that the average American gets less than 100 mg/d of EPA + DHA from their diet it is obvious that many Americans would likely benefit from increasing the amount of EPA and DHA in their diet.

The Rest Of The Story

ProfessorThere are four additional points I would like to make:

  • In trying to explain the differences between dose response in high and low risk subjects, the authors said, “There could be mechanistic differences in bioavailability and efficacy of omega-3 fatty acid intake in these populations.”

In last week’s “Health Tips From the Professor” article I reviewed a study that measured individual differences in the utilization of EPA and DHA and concluded that a blood measurement called Omega-3 Index was a more reliable indicator of health outcomes than the dose of omega-3s consumed.

For that reason, I recommend personalizing your dose of EPA + DHA to reach an Omega-3 Index of 8%, which appears to be optimal for heart health and provides significant blood pressure reduction. This is an iterative process which will require frequent measurement of your omega-3 index and adjustment of EPA + DHA dose until you find the level of EPA + DHA supplementation you need to achieve an Omega-3 Index of 8%.

  • This study and similar studies measure the health benefits of the long chain omega-3 fatty acids EPA and DHA. Short chain omega-3s from nuts, seeds, and plant oils are healthy, but their conversion to EPA and DHA is very inefficient.
  • Both the FDA and American Heart Association recommend that doses of EPA + DHA above 3 g/d should be taken under a physician’s supervision because high doses can cause bleeding problems.

This is another reason for basing your intake of EPA + DHA on Omega-3 Index rather than on the dose recommended by a clinical study. Based on dozens of clinical studies, an Omega-3 Index of 8% appears to be safe unless you have a bleeding disorder or are on a blood-thinning medication (see below).

  • If you are on a medication to thin your blood, you should consult with your physician before increasing or decreasing your omega-3 intake because changes in dietary omega-3s can affect the optimal dose of medication they prescribe.

The Bottom Line 

A recent study looked at the dose of EPA + DHA needed to lower blood pressure.

  • The study concluded that a dose of 2-3 mg/d of EPA + DHA was optimal for preventing a future increase in blood pressure and all its associated health consequences.
  • It also concluded that an EPA+ DHA dose ≥ 3g/d was optimal for lowering blood pressure in people who already have high blood pressure and/or other risk factors for heart disease.
  • Based on previous studies, I recommend optimizing your omega-3 index rather than relying on a dose of EPA + DHA that may not be right for you.

For more details about this study and what it means to you 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.

 ______________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance 

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”. Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 45 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.

Health Tips From The Professor