The New Science of Fish Oil by HealthMasters Online Naturopath Kevin Tresize ND

The New Science of Fish Oil by HealthMasters Online Naturopath Kevin Tresize ND

Omega-3 fatty acids are essential for cellular health and function. As well as attenuating acute inflammation,6 they are required for foetal neurodevelopment,7 can prevent cognitive and mood disorders8 and minimise cardiovascular risk and all-cause mortality in adults.9 Despite this, 80% of adults do not meet the recommended daily intake (RDI) of 500 mg of omega-3.

Interestingly, even this modest RDI is difficult to achieve without supplementation; only 10% of adults successfully meet it through diet.10 Fish oils are a valuable therapeutic source of omega-3 for patients. Natural healthcare Practitioners can significantly reduce patients’ risk of morbidity and mortality by simply assessing and treating omega-3 deficiency.

Take The Omega-3 Index Test

I find that quantifying patients’ omega-3 status is clinically relevant for all patients, however testing is especially useful in cases of suspected deficiency, at times of increased demand (e.g. during preconception, pregnancy and breastfeeding), and in children and the elderly.

The Omega-3 Index test is a sensitive and relevant gauge of omega-3 status, measuring the eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content of red blood cells (RBCs).11 Expressed as a weight percentage of total RBC fatty acids, the result of this test accurately reflects tissue levels and is responsive to omega-3 supplementation.

The test therefore allows Practitioners to select an appropriate omega-3 dose for the individual depending on the degree of deficiency, and enables monitoring of the patient’s response to treatment.

The Omega-3 Index test is a simple, non-invasive finger prick test which can be performed at home or in clinic by Practitioners, making it a beneficial tool for clinical decision-making and patient motivation.

The Omega-3 Index test may be contrasted with the omega-6:omega-3 ratio (where an elevated ratio has been associated with disease risk). This test is based on the premise that dietary omega-6 is inflammatory and disease promoting; however, while animal studies suggest that this may be the case,12 research confirming this in humans is inconclusive. The observed increase in disease risk is likely to be due to omega-3 deficiency and consequently, testing omega-3 status will be more clinically meaningful.

More information on the Omega-3 Index Test.

The ‘Good Oil’ About Fish Oil

Fish oil’s anti-inflammatory benefits are well-established, with research supporting the use of fish oil in inflammatory conditions such as rheumatoid arthritis.13, 14 Emerging research has also uncovered novel benefits of fish oil, such as effects on gut microbiota composition.15

Higher total serum omega-3, and DHA levels, are correlated with greater microbial diversity, as well as increased levels of the short chain fatty acid-producing Lachnospiraceae family, independent of fibre intake.16

Mounting evidence indicates that fish oil reduces health risk at all ages and stages of life. Supporting the very youngest of patients, fish oil is associated with a lower risk of preterm birth. A recent Cochrane review of 70 randomised trials found that supplementing EPA and DHA in pregnancy lowers the risk of preterm birth before 34 weeks’ gestation by 42%, and before 37 weeks’ gestation by 11%. EPA and DHA also lower the risk of small for gestational age babies.17

In older adults, fish oil improves mild cognitive impairment, and also reduces beta-amyloid secretion, a key pathological process associated with Alzheimer’s disease. Additionally, EPA and DHA reduce cytokine secretion in neural cells, providing a neuroprotective effect that enhances brain cell survival.19

A meta-analysis of 15 trials also found that DHA improved episodic memory in adults with mild memory impairment.20 Recent research continues to highlight the many clinical benefits of fish oil and correcting omega-3 deficiency.

 A Fish Bone Of Contention

Recent media coverage has created confusion by calling into question the usefulness of fish oil in reducing cardiovascular risk. Most reports have been based on a 2018 Cochrane review21 which concluded that fish oil supplementation does not reduce mortality, nor the incidence of cardiovascular events. However, on analysis, a number of confounding factors limit the accuracy of this conclusion.

Firstly, fish oil doses (in individual studies) were not personalised according to baseline omega-3 intake or status i.e. the same dose was administered to all patients, even if insufficient to raise levels to the minimum required to produce therapeutic effects in the individual.22

Secondly, the review included studies with inadequate doses to produce the therapeutic outcomes being measured. For example, 3 g/day of fish oil is required for antihypertensive effects; including lower doses in the review may lead to inaccurate conclusions about the effectiveness of fish oil in hypertension.

Lastly, the quality of fish oil was not considered; oxidised fish oils do not have the same lipid-lowering benefits as high quality fish oils, for example,23 and can even be detrimental to health by increasing free radical damage.

The findings of this review do not, therefore, negate the extensive evidence that supports the effectiveness of fish oil for cardiovascular risk reduction. Fish oil decreases well-established cardiovascular risk factors, such as high triglycerides,24, 25 total cholesterol and LDL cholesterol,26, 27 and coronary atherosclerosis.28, 29

Moreover, clinical trials have shown benefits in those with elevated cardiovascular risk, reducing major coronary events in patients with high cholesterol,30 and decreasing cardiovascular mortality in survivors of myocardial infarction.31

Maximum Quality For Maximum Benefit

Using High Purity, Low Reflux, Concentrated Fish Oil allows access to high quality, non-oxidised fish oil at concentrated doses, ensuring patients receive therapeutic doses to achieve clinical results. Fish oils are pure and fresh, undergoing nitrogen flushing which minimises oxidation (evidenced by anisidine and peroxide levels below industry standard).

With an emphasis on sustainability, Metagenics' fish oil is sourced from small, pelagic fish with short lifespans that do not allow significant toxin accumulation. Additionally, the raw materials undergo molecular distillation to purify heavy metals and contaminants, which also helps mitigate oxidation. With the benefit of Omega-3 Index testing, Practitioners can personalise fish oil dosages for individual patients and conditions, for optimal outcomes.

A Vital Nutrient For Health And Vitality

Omega-3 is essential for reducing inflammation, and supporting cardiovascular health, mood, neurological health, pregnancy and cognition; patients who do not meet the RDI are at risk of significant future morbidity. Using the Omega-3 Index test, you can attenuate this risk by assessing and addressing deficiency and supporting patients in times of increased need. High quality, non-oxidised fish oils deliver therapeutic doses of omega-3 to patients for best results.

HealthMasters Onlin Naturopath Kevin Tresize ND

HealthMasters Online Naturopath Kevin Tresize ND

  1. Garcia-Larsen V, Ierodiakonou D, Jarrold K, Cunha S, Chivinge J, Robinson J, et al. Diet during pregnancy and infancy and risk of allergic or autoimmune disease: a systematic review and meta-analysis. PLoS medicine. 2018 Feb 28;15(2):e1002507. doi: 10.1371/journal.pmed.1002507.
  2. Keet C. Getting to the root of the food allergy “epidemic”. J Allergy Clin Immunol Pract. 2018 Mar 1;6(2):449-50. doi: 10.1016/j.jaip.2018.01.009.
  3. Payahoo L, Ostadrahimi A, Farrin N, Khaje-Bishak Y. Effects of n-3 polyunsaturated fatty acid supplementation on serum leptin levels, appetite sensations, and intake of energy and macronutrients in obese people: a randomized clinical trial. J Diet Suppl. 2018 Sep 3. 15(5)596-605. doi: 10.1080/19390211.2017.1360975.
  4. Yan JH, Guan BJ, Gao HY, Peng XE. Omega-3 polyunsaturated fatty acid supplementation and non-alcoholic fatty liver disease: a meta-analysis of randomized controlled trials. Med. 2018 Sep;97(37). doi: 10.1097/MD.0000000000012271.
  5. Jump DB, Lytle KA, Depner CM, Tripathy S. Omega-3 polyunsaturated fatty acids as a treatment strategy for nonalcoholic fatty liver disease. Pharmacol Ther. 2018 Jan 1;181:108-25. doi: 10.1016/j.pharmthera.2017.07.007.
  6. Calder PC. Omega-3 fatty acids and inflammatory processes. Nutrients. 2010 Mar;2(3):355-74. doi: 10.3390/nu2030355.
  7. Kawakita E, Hashimoto M, Shido O. Docosahexaenoic acid promotes neurogenesis in vitro and in vivo. Neuroscience. 2006;139(3):991-7. doi: 10.1016/j.neuroscience.2006.01.021.
  8. Harris WS, Tintle NL, Etherton MR, Vasan RS. Erythrocyte long-chain omega-3 fatty acid levels are inversely associated with mortality and with incident cardiovascular disease: the Framingham Heart Study. Journal Clin Lipidol. 2018 May 1;12(3):718-27. doi: 10.1016/j.jacl.2018.02.010.
  9. Harris WS, Tintle NL, Etherton MR, Vasan RS. Erythrocyte long-chain omega-3 fatty acid levels are inversely associated with mortality and with incident cardiovascular disease: the Framingham Heart Study. Journal Clin Lipidol. 2018 May 1;12(3):718-27. doi: 10.1016/j.jacl.2018.02.010.
  10. Meyer B. Australians are not meeting the recommended intakes for omega-3 long chain polyunsaturated fatty acids: results of an analysis from the 2011–2012 national nutrition and physical activity survey. Nutrients. 2016 Mar;8(3):111. doi: 10.3390/nu8030111.
  11. Harris WS. The omega-6: omega-3 ratio: a critical appraisal and possible successor. Prostaglandins, Leukot Essent Fatty Acids. 2018 May 1;132:34-40. doi: 10.1016/j.plefa.2018.03.003.
  12. Kaliannan K, Wang B, Li XY, Kim KJ, Kang JX. A host-microbiome interaction mediates the opposing effects of omega-6 and omega-3 fatty acids on metabolic endotoxemia. Sci Rep. 2015 Jun 11;5:11276. doi: 10.1038/srep11276.
  13. Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007;129(1-2):210-23. doi: 10.1016/j.pain.2007.01.020
  14. Lee Y, Bae S, Song G. Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Arch Med Res. 2012;43:356-362. doi: 10.1016/j.arcmed.2012.06.011.
  15. Menni C, Zierer J, Pallister T, Jackson MA, Long T, Mohney RP, et al. Omega-3 fatty acids correlate with gut microbiome diversity and production of N-carbamylglutamate in middle aged and elderly women. Sci Rep. 2017 Sep 11;7(1):11079. doi: 10.1038/s41598-017-10382-2.
  16. Menni C, Zierer J, Pallister T, Jackson MA, Long T, Mohney RP, et al. Omega-3 fatty acids correlate with gut microbiome diversity and production of N-carbamylglutamate in middle aged and elderly women. Sci Rep. 2017 Sep 11;7(1):11079. doi: 10.1038/s41598-017-10382-2.
  17. Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega‐3 fatty acid addition during pregnancy. Cochrane Database Syst Rev. 2018(11). doi: 10.1002/14651858.CD003402.pub3.
  18. La Rosa F, Clerici M, Ratto D, Occhinegro A, Licito A, Romeo M, et al. The gut-brain axis in Alzheimer’s Disease and omega-3: a critical overview of clinical trials. Nutrients. 2018 Sep 8;10(9):1267. doi: 10.3390/nu10091267.
  19. La Rosa F, Clerici M, Ratto D, Occhinegro A, Licito A, Romeo M, et al. The gut-brain axis in Alzheimer’s Disease and omega-3: a critical overview of clinical trials. Nutrients. 2018 Sep 8;10(9):1267. doi: 10.3390/nu10091267.
  20. Yurko-Mauro K, Alexander D, Van Elswyk M. Docosahexaenoic acid and adult memory: a systematic review and meta-analysis. PLoS One. 2015;10(3):1-18. doi: 10.1371/journal.pone.0120391.
  21. Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, et al. Omega‐3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018(11). doi: 10.1002/14651858.CD003177.pub4.
  22. Superko HR, Superko SM, Nasir K, Agatston A, Garrett BC. Omega-3 fatty acid blood levels: clinical significance and controversy. Circulation. 2013 Nov 5;128(19):2154-61. doi: 10.1161/CIRCULATIONAHA.113.002731.
  23. Rundblad A, Holven KB, Ottestad I, Myhrstad MC, Ulven SM. High-quality fish oil has a more favourable effect than oxidised fish oil on intermediate-density lipoprotein and LDL subclasses: a randomised controlled trial. Br J Nutr. 2017 May;117(9):1291-8. doi: 10.1155/2013/464921.
  24. Leslie M, Cohen D, Liddle D, Robinson LE, Ma DW. A review of the effect of omega-3 polyunsaturated fatty acids on blood triacylglycerol levels in normolipidemic and borderline hyperlipidemic individuals. Lipids Health Dis. 2015;14(53):1-18. doi: 10.1186/s12944-015-0049-7.
  25. Cleland LG, Caughey G, James M, Proudman SM. Reduction of cardiovascular risk factors with longterm fish oil treatment in early rheumatoid arthritis. J Rheumatol. 2006;33:1973-1979. PMID: 16881100.
  26. Cleland LG, Caughey G, James M, Proudman SM. Reduction of cardiovascular risk factors with longterm fish oil treatment in early rheumatoid arthritis. J Rheumatol. 2006;33:1973-1979. PMID: 16881100.
  27. Satoh N, Shimatsu A, Kotani K, Sakane N, Yamada K, Suganami T, et al. Purified eicosapentaenoic acid reduces small dense LDL, remnant lipoprotein particles, and C-reactive protein in metabolic syndrome. Diabetes Care. 2007;30(1):144-6. doi: 10.2337/dc06-1179.
  28. Von Schacky C, Baumann K, Angerer P. The effect of n-3 fatty acids on coronary atherosclerosis: results from SCIMO, an angiographic study, background and limitations. Lipids. 2001;36:S99-102. PMID: 11838000
  29. Erkkilä AT, Matthan N, Herrington D, Lichtenstein AH. Higher plasma docosahexaenoic acid is associated with reduced progression of coronary atherosclerosis in women with CAD. J Lipid Res. 2006;47(12):2814-2819. doi: 10.1194/jlr.P600005-JLR200.
  30. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, et al. Japan EPA lipid intervention study (JELIS) Investigators. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369(9567):1090-1098. doi: 10.1016/S0140-6736(07)60527-3.
  31. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, et al. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction. Time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation. 2002;105:1897-1903. PMID: 11997274.

The New Science of Fish Oil by HealthMasters Online Naturopath Kevin Tresize ND

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