The need for increased omega-3 intake through diet and/or supplementation has become increasingly clear. What health professionals and patients want to know is, "What is the best way to do this in each particular case?"
What Are the Major Omega-3 Fats?
Alpha-linolenic acid (ALA) is a plant source omega-3 essential fatty acid (EFA). It is "essential" because our bodies cannot make it. Two other omega-3 fats are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA, which are best provided by fatty fish in the diet several times a week, are both vital for health. EPA is not technically "essential" because our bodies make it from ALA, although conversion is not efficient and rates vary, based on many factors.1 However, DHA conversion from ALA is so poor that some authorities think it should be classified as "conditionally essential."2
ALA is found mainly in flax seeds and walnuts, and in flax, canola and soybean oils. Flax seeds and flax oil are the richest sources of ALA in the North American diet.3 EPA and DHA are found mainly in fatty fish such as herring, salmon, mackerel and bluefin tuna, and the fish oil supplements made from them. Marine algae, the base of the oceanic food chain, are rich sources of DHA but contain little EPA.
Do All Omega-3 Fats Have the Same Health Benefits?
Omega-3 fats are alike in some ways and different in others. ALA, EPA and DHA keep cell membranes flexible/elastic and block the actions of some compounds that cause inflammation and clotting.4 Chronic conditions like heart disease, diabetes, cancer and arthritis are marked by inflammation. Therefore, all omega-3 fats help reduce chronic disease risk by blocking inflammation. In a clinical study involving adults with moderately high blood cholesterol, eating a diet rich in ALA from walnuts, walnut oil and flax oil reduced the blood level of one marker of inflammation by 75 percent.5 In the Nurses Health Study, the greater the ALA intake, the lower the concentration of the inflammatory markers found in the blood.6
Still, it is generally recognized that EPA/DHA intake is more powerful in relation to cardiovascular disease and inflammatory joint disease.7-9 DHA is unique in its health effects. Because it helps the eye, brain and nervous systems develop properly, infants have a special need for DHA.10-11 Of note, supplementing the newborn with EPA displaces arachidonic acid, interfering with growth, so only DHA, not direct EPA supplementation is used in infant formulas.12-14 Aging adults may need DHA, too. A study of 815 elderly people living in Chicago found that those with the highest DHA intake had the most protection against Alzheimer's disease.15
Flax Facts
Flax seeds provide much more than the richest source of ALA. Flaxseed is approximately 38 percent oil, which is comprised mainly of alpha-linolenic acid, with lesser amounts of linolenic acid (LA, an essential omega-6 fatty acid) and oleic acid (an omega-9 fatty acid, as in olive oil); 28 percent fiber (approximately two-thirds insoluble); 20 percent protein with an amino acid profile similar to soybeans; 7 percent carbohydrates (simple sugars, lignans, phenolic acids and hemicellulose) with less than 3 percent net digestible carbs; 4 percent ash; 2 percent minerals (magnesium, potassium, calcium, iron, phosphorous, sodium, copper, zinc, manganese, selenium); 0.32 percent vitamins A, B1, B2, D, E, and niacin; 0.15 percent lecithin; 0.1 percent flavonoids; and 0.1 percent phytic acid.
Besides the omega-3 content, flax's most beneficial compounds are likely its lignans and fiber. Lignans are phyto-estrogens - plant compounds that can have estrogen-like actions. Through the actions of the lignans and ALA, flax blocks tumor growth in animals and may help reduce cancer risk in humans, likely by competing with toxic endogenous and xenogenous estrogens.16-17 The major lignan in flax is secoisolariciresinol glucoside (SDG), a phytochemical polysaccharide that is a powerful phytoestrogen chemically similar to the breast cancer drug, tamoxifen. Postmenopausal women consuming 5 or 10 grams of milled flax over seven weeks showed significant reductions in blood concentrations of the most potent estrogen, estradiol, and its less potent sister, estrone. This may be desirable for postmenopausal women who have a high risk of breast cancer.18
The SDG lignan also has antiviral, antibacterial, antifungal and immune-enhancing properties and is a potent antioxidant - 500 percent more powerful than vitamin E.18 SDG lignans have shown such extraordinary potential that they have been studied by the National Cancer Institute for their cancer-preventative properties. A controlled study by the Queen Elizabeth II Medical Centre in Perth, Australia concluded, "There is a substantial reduction in breast cancer risk among women with high intake (as measured in excretion) of phytoestrogens, particularly the isoflavonic phyto-estrogen equol and the lignan enterolactone (a metabolite of SDG)."19 And University of Wales College of Medicine researchers in the U.K. determined the concentrations of lignans in prostate fluid and concluded high levels of lignans and related plant estrogens may, in part, be responsible for lower incidences of prostate cancer in men from Mediterranean and Asian countries.20
Flax has been shown to lower blood cholesterol levels and help reduce the risk of heart attacks and stroke, likely related to fiber content, but partly through the actions of ALA,23 which may be especially important to vegetarians and people with low intakes of fatty fish. In a cohort of more than 45,000 U.S. men followed for 14 years, each 1g/day increase in dietary ALA intake was associated with a 16 percent reduction in the risk of CHD.24 Moreover, in those who ate little or no seafood, each 1g/day increase in dietary ALA intake was associated with a 47 percent reduction in the risk of CHD. In a cohort of more than 76,000 U.S. women followed for 10 years, those with the highest ALA intakes (approx. 1.4 g/day) had a risk of fatal CHD that was 45 percent lower than women with the lowest intakes (~0.7 g/day).21 Findings from the Health Professionals Follow-up Study of 45,722 men indicated that each gram of ALA in the daily diet was associated with a 47 percent lower risk of heart disease among men with low intakes of EPA and DHA (<100 mg per day).24 Flax's insoluble dietary fiber promotes laxation, while the soluble fibers promote intestinal health and glycemic control.22 Fortunately, flax has a nutty, cereal-like taste that makes incorporation into the diet pleasant.
Why Eat Fish?
Fish is valued for its high-quality protein and nutrient content, especially vitamins D and B12. But only fatty fish is prized for its high EPA/DHA content. Populations with high fish intakes, such as the Japanese and Inuit, have low rates of many of the common diseases of aging, including heart disease. Multiple clinical studies have shown the oils of fatty fish, EPA and DHA, to be of benefit to the cardiovascular system, brain and visual function, immune function, skin health, inflammatory modulation and joint health.25-26 As ALA conversion to EPA is poor to moderate, depending on many variables, and conversion to DHA is minimal, it is generally thought that regular twice-weekly fatty fish oil consumption, or fish oil supplementation, is the best way to enhance EPA/DHA status.27
Several factors inhibit conversion (via elongation enzymes) of short-chain ALA to its long-chain metabolites, EPA and DHA including:
Is It Safe to Eat Fish?
The American Heart Association warns, "Some species of fish may contain significant levels of methylmercury, polychlorinated biphenyls (PCBs), dioxins and other environmental contaminants. These substances are present at low levels in fresh waters and oceans, and they bioconcentrate in the aquatic food chain such that levels are generally highest in older, larger, predatory fish and marine mammals."28 The U.S. Environmental Protection Agency actually posts an advisory on fish consumption.29 Nonetheless, federal health agencies in Canada and the United States conclude that the benefits of eating fish outweigh concerns about traces of mercury and PCB and dioxins in fish. However, both countries advise pregnant and nursing women, women who may become pregnant and young children to avoid eating certain fish.30-31
What About Fish Oil Supplements?
Fish oil capsules are the most concentrated form of omega-3 fats. Although few contain mercury, some may contain polychlorinated biphenyls (PCBs). PCBs are chemicals used in industrial processes and may cause cancer in humans. Consumers who follow the label recommendation on some fish oil supplements can take up to 43 percent of the daily upper limit of PCBs. Consumers who take fish oil capsules and eat PCB-contaminated fish may increase their risk of PCB toxicity.32
The biggest problem with deterioration in the quality of fish oil is rancidity. The main cause of rancidity is oxidation. The most common analytical assessments of oxidation are provided in terms of peroxide value (PV), anisidine value (AV), and totox value. However, perhaps the best and certainly the easiest test is the "taste test." If the oil tastes or smells bad, it probably is, regardless of what the tests say.33 Because of the lipid peroxidation, it is generally recommended to take physiological doses of vitamin E when supplementing with fish oils.34-35 Therapeutic dosages of over 3 g/day (900 mg EPA/DHA), recommended in heart disease or RA, may increase a tendency to hemorrhage and interfere with immune function. The AHA therefore recommends physician guidance at such levels.36
Besides safety concerns, the main factors to consider are taste and texture with fish oils, as well as difficulty swallowing, fishy aftertaste and "fish burps."37 We should not forget that fish is the major dietary source of vitamin D and is absent from most fish oils. Cod liver oil has vitamin D, but usually too much vitamin A.38 As recent studies suggest that consuming more vitamin D3 may lower the risk of death from any common disease of aging, especially colon and breast cancer; this is an important omission.39-40
Vegan DHA
DHA produced from algae is a good vegetarian source. Algae is the only vegetarian source that provides a meaningful DHA amount. DHA is the only omega-3 shown to provide brain, eye and heart health benefits. Today, DHA can be produced with excellent sensory characteristics in a controlled environment, is sustainable due to overfishing and eliminates the risk of oceanic contamination such as PCBs and dioxins. Along with flax, marine DHA is being used more often to fortify breads, cereals, juices, eggs, dairy products and functional foods.
Omega-6 to Omega-3 Ratio
Omega-6 fatty acids, specifically LA and arachidonic acid (AA) are also essential. However, in many ways they act opposite to omega-3 fatty acids. Specifically, they tend to promote inflammation and clotting. They also compete with enzymes that help ALA be converted to EPA and DHA. It has been estimated that the ratio of omega-6 to omega-3 fatty acids in the diet of early humans was perhaps as low as 1-to-1.39 Today, the ratio in the typical Western diet is now 10-to-1 or even higher, due to increased use of vegetable oils rich in LA, full-fat diary and grain-fed meats high in AA, and declining fish consumption.42
The Functional Food Solution
In view of the widespread reluctance of the public to consume sufficient amounts of fish and (to a lesser extent), fish oil supplements, functional foods containing flax, EPA and/or DHA are becoming increasingly important sources of these nutrients.
Presuming good taste, texture and ease of mixing, an interesting functional food supplement would be a combination of stabilized flax seed, marine DHA, synergistic vitamins D3, E and the B complex.43 New technologies now make it possible to combine specially stabilized crushed flaxseeds with EPA and/or DHA, the natural rich antioxidants in the flax, like gamma-tocopherol and SGD lignan, stabilizing the fish oils. Functional foods that combine flax with vegetarian DHA and synergistic vitamins, together with an effort to lower omega-6 fats from LA vegetable oils (corn, safflower, sunflower), AA-rich, full-fat dairy and grain-fed animal fats, trans fats and rancid deep-fried fats, and alcohol moderation may help return our omega-3/omega-6 dietary ratios closer to those of our ancestors. This can be done in a scientifically efficacious, highly compliant, vegetarian, safe and environmentally sustainable way.
References
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