A new report on the quality of omega-3 and -6 fatty acid supplements made from seed oils was recently released by ConsumerLab.com. Only 11 of 17 products selected for testing met quality criteria for freshness and labeling. Continue reading
The New York Times reports, “Many women take fish oil supplements during pregnancy, encouraged by obstetricians, marketing campaigns, or the popular view that a key fish oil ingredient — docosahexaenoic acid, or DHA — is beneficial to a baby’s cognitive development.” However, a study published “in the Journal of the American Medical Association suggests that the DHA supplements taken by pregnant women show no clear cognitive benefit to their babies.” What’s more, researchers “found no evidence that DHA can reduce postpartum depression, except perhaps for women already at high risk for it.”
“In the new study, 2,399 women at the midpoint of their pregnancies were divided into two groups,” the Los Angeles Times reports. “One took a daily capsule of 800 mg of DHA derived from fish oil until giving birth; the other took an identical capsule filled with vegetable oil.”
Then, “six weeks and six months after each woman delivered her baby, researchers had her complete a psychological inventory to check for symptoms of depression.” Next, when the babies were about 18 months old, investigators subjected them to comprehensive batteries of tests to measure their cognitive ability.
The Wall Street Journal reports that the study authors found no evidence that the fish oil supplements prevented new mothers from postpartum depression or enhanced cognitive development in their babies. However, the study indicated that 800 mg of fish oil daily appeared to decrease the chances of developing postpartum depression by about four percent in women who already had a history of clinical depression. This was not considered a statistically significant difference, however.
According to a report in Bloomberg News, an editorial accompanying the study “said pregnant women shouldn’t give up eating low-mercury fish or taking recommended doses of fish oil, as the mineral does help prevent preterm labor and may have benefits not shown in the study.”
“The study did find that significantly fewer infants from the DHA group spent time in the neonatal intensive care unit, compared to infants in the control group — something that researchers attributed to fewer preterm births in the DHA group,” HealthDay reported. “DHA supplementation was associated with a ‘small to modest increase in the duration of gestation,’ they reported.”
WebMD reported that, despite the study’s conclusions, the authors “concede that further work is needed to determine the benefits of DHA for women with a history of depression or those at risk of delivering prematurely,” a concession echoed by the authors of the accompanying editorial.
Fish, krill, and algal oil supplements now account for approximately $1 billion in sales in the U.S. To help consumers choose among products, ConsumerLab.com selected 24 of the best-selling oil supplements and tested them for EPA and DHA, contamination, freshness, and, if applicable, proper release by enteric coatings. Amazingly, nearly 30% of the fish oil supplements that they selected for testing failed to meet minimum quality standards.
As discussed in the news release below, ConsumerLab found PCBs in all fish oil supplements (including krill and algal oil supplements) but typically at extremely low levels (addressing questions raised by the California lawsuit in March that I discussed here).
ConsumerLab also we found that price is not an indicator of quality with fish oil and that a person need not pay more than about 6 cents a day to get a good product (as I discuss in another blog, here); they also point out that the term “pharmaceutical grade” on products is meaningless; and they note out that actual amount of omega-3’s will range from less than 20% to over 80% of the “fish oil” shown on the front label, so you need to read the Supplement Facts carefully.
Here are more details from the ConsumerLab press release:
Softgels and Liquids for Adults, Children and Pets Tested, Including Krill Oil and Algal Oil Supplements
White Plains, New York – Tests of fish, algal and krill oil supplements revealed quality problems with 7 out of 24 products selected by independent testing organization ConsumerLab.com.
Three products contained less of the omega-3 fatty acids EPA and/or DHA than claimed, spoilage was detected in one of these products as well as in two others (including a children’s supplement), an enteric-coated product released its ingredients too early, and a supplement for pets exceeded the contamination limit for PCBs.
Seventeen other products passed testing as did 15 products similarly tested through ConsumerLab.com’s voluntary certification program. ConsumerLab.com’s report is now available online to its members.
ConsumerLab.com reported these additional, notable findings:
- Labels on some products included terms such as “pharmaceutical grade” and “tested in FDA approved laboratories,” which are meaningless as there is no basis for either claim.
- A krill oil supplement that failed for both spoilage and low omega-3 levels claimed to be quality assured under GMPs (good manufacturing practices).
- Another “krill oil” supplement contained more fish oil than krill oil.
- Most products met ConsumerLab.com’s strict contamination limit for dioxin-like PCBs of 3 picograms per gram (3 parts per trillion). However, one product (a pet supplement) slightly exceeded this limit with 3.14 picograms per gram. However, this exposure is still very small compared to that from fish meat — a small serving (3 ounces) of fatty fish such as salmon may easily provide 170 picograms of dl-PCBs as well as a significant amount of mercury. Trace amounts of dl-PCBs were found in all supplements, despite claims on some of being free of contaminants. There was no detectable mercury in any of the supplements.
- The cost to obtain 100 mg of EPA and/or DHA from fish oil ranged from about 1 cent to 15 cents among fish oil supplements, and was about 30 cents from krill or algae oils. A fairly standard daily dose of 500 mg of EPA + DHA from a quality-approved product could be had for as little as 6 cents. Higher prices were not associated with higher quality.
- Concentrations of EPA and DHA ranged from less than 20% to over 80% of the marine oil content listed on front labels — which is why consumers should specifically look for the amounts of EPA and DHA which typically appear on side labels.
“Supplements providing EPA and/or DHA are a great alternative to fish as a source of beneficial omega-3 fatty acids, as they typically have far fewer contaminants, cost less, and are more convenient to obtain. But products vary in quality, strength, odor-reduction, and price, so you need to choose carefully,” said Tod Cooperman, M.D., ConsumerLab.com’s president.
Consumption of EPA and DHA appears to reduce the risk of coronary heart disease and may be helpful in the treatment of rheumatoid arthritis, other inflammatory diseases, and psychiatric illness. EPA and DHA may also reduce the risk of certain cancers and macular degeneration. Fish oil supplements are given to pets to help maintain their coats and skin.
U.S. sales of fish oil supplements in 2009 were $976 million, up 20% from the prior year, according to Nutrition Business Journal. A recent survey by ConsumerLab.com showed that fish oil had become the most commonly used supplement among people who regularly use supplements, exceeding, for the first time, the use of multivitamins. Seventy four percent of respondents reported using a fish oil supplement.
The new report includes test results, quality ratings, comparisons and reviews of products from the following brands: Advocare, CardioStat (Amerifit), Carlson, CVS, Dr. Sears, Finest Natural (Walgreen), Garden of Life, Kirkland (Costco), Life Extension, Liquid Solutions, Master Omega, Natrol, Natural Factors, Nature Made, New Chapter, Nordic Naturals, NOW, NSI (Vitacost), Olympian Labs, OmegaBrite, Origin (Target), PregnancyPlus, Puritan’s Pride, Quest Longevity (Canadian), Res-Q, Solgar, Source Naturals, Spring Valley (Walmart), Swanson, Trader Joe’s, The Simpsons, Vital Nutrients, VitalOils (VitalRemedyMD), Vitamin Shoppe, Vitamin World, Weil, Wellements, and 1-800-PetMeds. The report also includes information about dosing, side-effects, cautions, reduced-odor products, and proper storage of fish oil.
In addition to the products reviewed, two krill oil ingredients by Enzymotec USA have been tested and approved for quality through ConsumerLab.com’s Raw Materials Testing Program.
ConsumerLab.com is a leading provider of consumer information and independent evaluations of products that affect health and nutrition. The company is privately held and based in Westchester, New York. It has no ownership from, or interest in, companies that manufacture, distribute, or sell consumer products.
They taste like butter and offer a boost of heart healthy omega-3 fatty acids, but these omega-enhanced margarines may NOT actually help your heart, according to new research from the Netherlands. Now, before you read the details, this study examined only older patients (age 60 – 80) living in the Netherlands and thus may not be applicable to the general United States population or to younger people as our diets, lifestyles, and risk factors differ. That said, this new study of almost 5,000 patients who had previously had a heart attack, eating a daily serving of omega-3 charged margarine had NO effect on the likelihood of a second heart attack. In other words, it didn’t help or hurt. So, what should you do? Here are the details from ABC News:
Margarines containing different types of omega-3 fatty acids were tested, one with EPA-DHA, one with ALA and another with both, were tested against a placebo, omega-free margarine.
Patients ranged from age 60 to 80 and were already on medicine to control their blood pressure and cholesterol. After more than three years on this margarine meal-plan, researchers saw no association between eating omega-supplemented margarine and a reduced risk of second cardiovascular event such as heart attack or stroke.
Previous research shows that giving an EPA-DHA supplement to patients with cardiovascular disease reduces their chance of dying from the disease by as much as 20 percent, authors note in the study, but supplementing with margarine didn’t seem to cut it.
This doesn’t mean that those at cardiovascular risk should give up on getting extra Omega-3 fatty acids or pass on margarine, experts say. It’s just about getting the right amount of good fats from the right places.
Omega Enhancement – Myths Busted
Peanut butter, margarine, cheese, baby food, even eggs – you name it and manufacturers are pumping omega-3 supplements into it. But is eating these omega enhanced items actually healthy for your heart?
This study would suggest no, but experts say that it’s not where you get your EPA-DHA omega 3’s, it’s how much you get and how it fits into your diet.
One of the reasons that the Netherlands study may not have seen a benefit was that the dose of omega-3 fatty acid was too low. Researchers were shooting for a daily intake of 400 mg of EPA-DHA and 2 g of ALA, but past research suggests that a therapeutic dose is closer to 850 mg of combined EPA-DHA per day.
Don’t Pass on Omega-3s
“I recommend that all of my cardiac patients [with] significant coronary artery disease&take EPA/DHA at a dose of 800-1000 per day. To get this dose, most require a supplement, either one, two or three capsules of an over the counter supplement depending on the concentration,” says Dr. Carl Lavie, medical director of Cardiac Rehabilitation and Prevention at John Ochsner Heart and Vascular Institute.
Similarly, Dr. Dean Ornish, founder and president of the Preventive Medicine Research Institute at University of California, San Francisco, recommends a fish oil supplement that contains one gram of combined EPA-DHA per day.
On the other hand, the dose given by the study’s EPA-DHA margarine was roughly similar to that provided by two servings of fish a week, the current recommended amount for heart health, so the dose received by subjects was not insignificant, says Alice Lichtenstein, director of the Cardiovascular Nutrition Laboratory at Tufts University.
Another potential reason that the margarine seemed to have no effect is that the patients had been heart attack-free for a couple to several years, which means they were already at relatively low risk of another heart attack, says Lavie. Given the lower risk, it might be hard to gauge the effects.
What’s more, these results can only speak to the effects of a modest supplementation of omega-3s for patients who, like the subjects, have had a previous heart attack and are now being rigorously treated for heart disease, experts point out.
“These results don’t say anything about what omega-3 fatty acids could do for prevention [of a heart attack] or for someone whose heart disease is not as well managed,” says Lichtenstein.
Fish Still Best Bet and Margarine Over Butter
Research on the heart-protective benefits of omega-3 supplements remains inconsistent, though some studies show benefit and these supplements are often suggested to patients with heart disease.
Research on the consumption of fish on the other hand, has shown a strong connection between a diet rich in fish and a decreased risk of heart disease and cardiovascular complications such as heart attack or stroke, experts say.
“Every time we try to isolate a nutrient and supplement it we get disappointed,” says Lichtenstein, “but we consistently see results with those who eat fish on a regular basis.”
One shouldn’t “make a conclusion that fish aren’t important. In general, those who consume fish versus [those who don’t] seem to have less coronary heart disease,” agrees Dr. Robert Eckel, professor of medicine at the University of Colorado School of Medicine.
That said, if eating fish a few times a week is hard for you to do, supplements are still advised, Lavie adds, because “very few people eat enough fish.”
Similarly, when choosing something to spread on your bread, margarine is still a better choice than butter, doctors say, as long as it is low in saturated fat and trans fatty acids. Though Ornish says if you can trade the margarine for olive or canola oil, even better.
Soybean and canola oil contain ALA and have lower saturated fats than other oils, even olive oil, notes Lichtenstein, so these are a good fat to have in moderation.
Krill oil is now being promoted as a better alternative to fish oil supplements. Krill are tiny shrimp-like crustaceans.
Promoters say that krill oil provides similar cardiac benefits as fish oil, but with fewer capsules and no fishy taste.
However, krill oil supplements contain less of the omega-3s EPA and DHA than fish oil supplements. Nevertheless, manufacturers claim krill oil is better absorbed because the omega-3s are in a phospholipid form.
According to the experts at the Natural Medicines Comprehensive Database, “Preliminary evidence shows that a specific krill oil product (Neptune Krill Oil NKO, Neptune Technologies & Bioresources, Inc) can lower cholesterol and triglycerides.”
“But,” they add, “overall there’s much better evidence that fish oil can lower triglycerides and cardiovascular risk.”
Furthermore, krill oil usually costs more than fish oil.
So, the NMCD recommends to prescribers, “For now, advise patients to stick with fish oil. Recommend taking it with food or trying an enteric-coated product if fishy taste is a problem. Suggest krill oil only for healthy people who want to add these omega-3s to their diet but can’t tolerate fish oil.”
All the talk about the benefits of omega-3s has parents asking whether CHILDREN should take fish oil supplements. Omega-3s are important for neurodevelopment … and they’re now showing up in many prenatal vitamins, infant formulas, and foods. Fish oil supplements for kids are often promoted as improving visual acuity, brain function, or intelligence.
But, according to the experts at the Natural Medicines Comprehensive Database, “there’s no proof that omega-3 supplements make kids ‘smarter’…or have any cognitive benefit in most kids.”
In fact, according to the NMCD, “… many of these claims will be removed … due to pressure from the feds.”
The NCMD recommends this to physicians and healthcare professionals who care for kids:
- Tell parents that most kids don’t need fish oil supplements.
- Instead, suggest that kids eat about 4 oz/week of fatty fish … such as canned light tuna, salmon burgers, etc. This provides about 250 mg/day of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA).
- Supplements may be worth a try for kids who don’t get enough omega-3s from diet … especially those with behavioral or psychiatric disorders as preliminary evidence suggests fish oil MIGHT benefit kids with ADHD symptoms … autism … depression … or those at high risk for psychosis.
- Reassure parents that most fish oil supplements don’t contain mercury or harmful levels of PCBs. To be safe, suggest a “USP Verified” or “ConsumerLab” product.
- Tell parents NOT to use cod liver oil, as it has too much vitamin A.
- Tell parents NOT to use flaxseed, as it doesn’t contain the same omega-3s as fish oil.
The amount of fish oil one has to take each day depends upon why one is taking it. Here are some diseases and the amount of the effective daily doses of total fish oil or EPA and DHA (the most active components of fish oil) needed for each disorder (according to the experts at the Natural Medicines Comprehensive Database): Continue reading
Fish oil (omega-3 fatty acids) have been shown effective in treating high levels of triglycerides and in preventing primary and secondary cardiovascular disease. Now comes a new study showing that the fatty acid found in fish oil (EPA) has shown promise in the prevention of colorectal cancer in patients with familial adenomatous polyposis. The study was a randomized study. Although the study was performed in patients with a genetic predisposition to colorectal cancer, the benefits might also extend to non-inherited, or sporadic, colon cancer. Here are the details from MedPage:
An omega-3 polyunsaturated fatty acid significantly reduced both the number and size of rectal polyps in patients with familial adenomatous polyposis, a randomized trial found.
Six months of treatment with the free fatty acid formulation of eicosapentaenoic acid (EPA) led to a decrease in mean number of polyps from 4.13 at baseline to 3.61, a 12.4% decrease, according to Nicholas J. West, MBBS, of St. Mark’s Hospital in London, and colleagues.
In contrast, six months of placebo treatment resulted in an increase from 4.50 polyps at baseline to 5.05, which represented a 9.7% increase, the researchers reported online in Gut.
Familial adenomatous polyposis is an autosomal dominant disorder in which affected individuals are predisposed to colorectal cancer, and prophylactic removal of the colon is recommended.
In younger patients, the procedure generally undertaken is colectomy with ileorectal anastomosis, but the remnant of rectal tissue remains susceptible, so patients must undergo routine endoscopic surveillance.
In the past, patients also were given chemoprevention with cyclo-oxygenase (COX)-2 inhibitors, but the recognition that these drugs have cardiovascular toxicity limits their long-term use today.
Strong preclinical evidence suggests that certain polyunsaturated fatty acids are active against colorectal cancer, but typical fish oil supplements are associated with adverse effects such as dyspepsia.
So a new, enteric-coated, free fatty acid formulation which is released and absorbed primarily in the small intestine was used to evaluate the potential efficacy of EPA for prevention of colorectal cancer in post-colectomy patients.
A total of 55 adult patients with familial polyposis were randomized to receive 2 g EPA per day or placebo.
After six months the difference between the change in polyp number between the EPA and placebo groups was −1.06 (95% CI −1.78 to −0.35, P=0.005), with an overall decrease of 22.4% (95% CI 5.1 to 39.6%, P=0.012).
In addition, the sum of polyp diameters decreased by 12.6% in the EPA group and increased by 17.2% in the placebo group — an overall difference of 29.8% in polyp size (95% CI 3.6 to 56.1, P=0.027).
Video endoscopy determined that EPA treatment was associated with a modest improvement in the global rectal polyp burden (+0.09), compared to overall worsening with placebo (−0.34). The difference was statistically significant (P=0.011).
There also was a mean 2.6-fold increase in rectal mucosal EPA levels associated with the active treatment.
Two patients in the placebo group withdrew because of abdominal pain, nausea, and rash, while one patient in the EPA group withdrew because of nausea and epigastric discomfort.
The most common adverse event in both groups was diarrhea, which may reflect a post-colectomy lack of physiologic control of fecal water, the investigators suggested.
Nausea was reported by nine patients receiving EPA and by three receiving placebo.
Patients reported no bleeding episodes, and there were no serious adverse events attributable to the treatment.
The antineoplastic activity demonstrated in the study “is almost certainly a combination of regression of existing adenomas and prevention of de novo tumor growth,” the researchers concluded.
Comparison of these findings with those from previous studies of chemoprevention in familial polyposis with the COX-2 inhibitor celecoxib found that the magnitude of effect was “remarkably similar.”
The authors said the data also suggest a role for EPA in chemoprevention of sporadic colorectal neoplasia.
The mechanisms by which EPA inhibits neoplastic activity remain uncertain, although both COX-dependent and COX-independent mechanisms of action have been described, including antioxidant effects and alteration of T cell and colonocyte membrane ‘lipid raft’ functions.
Aside from antineoplastic activity, omega-3 polyunsaturated fatty acids have beneficial cardiovascular and antiplatelet properties.
“Therefore, it is possible that EPA [free fatty acid] treatment may combine [colorectal cancer] chemopreventative efficacy with cardiovascular benefits, which is a particularly attractive therapeutic strategy for middle-to-old age populations relevant to secondary prevention of sporadic colorectal neoplasia,” the investigators asserted.
I will have patients who, from time to time, ask about the various controversies that are swirling around concerning the differing claims of milk producers. What are the facts, and the myths, about milk? How do you decide between cow’s, goat’s, soy, almond, rice, or hemp milk? What are the pros? What are the cons? Continue reading
In 1999, a study revealed that the preservative thimerosal, a mercury-containing compound present in many vaccines, caused several infants to have levels of mercury in their blood that exceeded guidelines recommended by the Environmental Protection Agency (EPA). Preservatives are used in vaccines to reduce the risk of contamination by bacteria once the vial is opened. Exposure to high levels of mercury, especially in the developing child before birth, is associated with neurological disturbances. Therefore, parents began to fear that thimerosal may cause neurological difficulties, like autism. When this study was first described, physicians, scientists, and public health officials quickly assessed the situation and found that: