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TalkingNutrition

Providing perspectives on recent research into vitamins and nutritionals

take-care-of-your-heart

Omega-3s are Part of a Healthy Life

By Michael McBurney

Is it a wasted effort to try to increase your omega-3 status? Controversy garners attention but let’s examine history. Peter Whoriskey took on a difficult topic trying to reconcile two interdependent dietary considerations.  First, in challenging dietary guidance to reduce fat intake, the impact of reducing fat consumption cannot be separated from a proportional increase in calories as carbohydrate or protein (when calorie intake is kept constant). The pros and cons of consuming carbohydrate versus fat are still being studied. The second challenge is understanding the role of dietary fat type (saturated fat, monounsaturated, and the polyunsaturated fats – n-3 (omega-3) and n-6 (omega-6) on health.

Fatty Acid Balance. For decades , diets were abundant in saturated and trans fatty acids with inadequate amounts of polyunsaturated fats. Cell membrane composition reflects the type of fats we eat. Replacing saturated fats with polyunsaturated fats reduces coronary heart disease (CHD) events. Shifting the saturated:polyunsaturated ratio of membranes  changes membrane fluidity and the function of proteins (nutrient transporters, insulin receptors) embedded within and/or across these membranes.  Changing the omega-3 content in our diet and cells of our body influences inflammatory responses and disease processes. As people were advised to consume more polyunsaturated fats, the American diet became overwhelmingly rich in omega-6 fatty acids, primarily linoleic acid (LA) from plant sources with a dearth of omega-3 fatty acids, especially eicospentaenoic  (EPA) and docosahexaenoic (DHA). Thus a recommendation in 2002 for therapeutic doses of omega-3 fatty acids to rebalance the omega-6:omega-3 ratio. 

Drugs or Nutrition.  Early randomized controlled trials (RCTs) demonstrated health benefits of omega-3 supplementation. What changed in later years?  In Harvard Health Publications, Peter Wehrwein reports statin usage by persons over 65y increased from a few percent to 50% of men and 40% of women in 2002. Between 1997 and 2007, CHD deaths fell from ~1,800 to ~1,250 per 100,000 and the proportion of the population with total cholesterol concentrations >240mg/dL fell 50%. Indeed, a meta-analysis of omega-3 supplementation and cardiovascular disease events reported 13 of 20 RCTs involved lipid lowering prescription drugs and 9 specifically continued statin usage.

Statins appear to inhibit omega-3 metabolism. According to self-reported 24h dietary intake records (an unreliable estimate for energy intake), statin users may also eat few calories, and calories from fat, than non-users.  Is it reasonable to expect nutrients to affect heart disease outcomes in individuals whose  risk factors (blood pressure and cholesterol) are being controlled by prescription medicines?

Statins may reduce risk of cardiovascular events but statin use also carries increased risk of diabetes mellitus. The most common reason for discontinuing statins is muscle pain and/or weakness. Drug manufacturers are selling FDA-approved pharmacologic doses of omega-3s and statins to reduce CVD risk factors. Why wouldn’t you also choose to increase your dietary intake of omega-3s?

Carbohydrate or Fat. Fat adds mouth feel and flavor to foods. With the introduction of low-fat health claims and heart-check programs, sweetness became a primary driver of taste.  Without doubt, we need to eat more dietary fiber found from complex carbohydrates. By consuming whole grains, the diet will contain more fiber, vitamin E found in the germ, and B vitamins found in the husk and germ. These essential nutrients are needed to maintain healthy cells and bodies.

Health can be limited by a lack of essential nutrients – vitamins, long-chain fatty acids, amino acids, and minerals. The addition of a limiting essential nutrient to a deficient or suboptimal diet can have a profound impact. However, the goal is nutritional adequacy. People have choices. Nutrition and/or medication. In this context, omega-3s should be part of a nutritional goal of balance and moderation.

Citations

Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: A systematic review and meta-analysis of randomized controlled trials. 2010 PLoSONE doi: 10.1371/journal.pmed.1000252

Clandinin MT, Cheema S, Field CJ, Garg ML, Venkatraman J, Clandinin TR. Dietary fat: exogenous determination of membrane structure and cell function. 1991 FASEB J 5(13):2761-2769

Calder PC. The role of marine omega-3 (n-3) fatty acids in inflammatory processes, atherosclerosis and plaque stability. 2012 Mol Nutr Food Res doi: 10.1003/mnfr.201100710

Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. 2002 Biomed Pharmacother doi: 10.1016/S0753-3322(02)00253-6

Blasbalg TL, Hibbeln JR, Ramsden CE, Majchrzak SF, Rawlings RR. Changes in consumption of omega-3 and omega-6 fatty acids in the United States during the 20th century. 2011 Am J Clin Nutr doi: 10.3945/ajcn.110.006643

de Lorgeril M, Salen P, Defaye P, Rabaues M. Recent findings on the health effects of omega-3 fatty acids and statins, and their interactions: do statins inhibit omega-3? 2013 BMC Med doi: 10.1186/1741-7015-11-5

Wehrwein P. Statin use is up, cholesterol levels are down: Are Americans’ hearts benefitting? 2011 Harvard Health Publications, Posted April 15, 2011, 9:47am

Rizos EC, Ntzani EE, Bika E, Kostapanos MA, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular events: a systematic review and meta-analysis. 2012 JAMA doi: 10.1001/2012.jama.11374

Sugiyama T, Tsugawa Y, Tseng C-H, Kobayashi Y, Shapiro MF. Different time trends of caloric and fat intake between statin users and nonusers among US adults. 2014 JAMA Intern Med doi: 10.1001/jamainternmed.2014.1927

Brugts JJ, Yetgin T, Hoeks SE, Gotto AM, Shepherd J, Westendorp RGJ, de Craen AJM, Knopp RH, Nakamura H, Ridker P, van Domburg R, Deckers JW. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomized controlled trials. 2009 Br Med J doi: 10.1136/bmj.b2376


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