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Understanding Fatty Acids: Omega 3 and Omega 6 Stephen Alajajian, Dietetic Intern Fish and heart health In the 1970’s it was discovered that the Inuit had low rates of cardiovascular disease despite eating a high-fat diet. Their diet consisted mainly of fatty fish. A similar phenomenon was observed among the Japanese. Presentation Outline Omega-3 Fats: definition, function, benefits, chemical structure, food sources Omega-6 Fats: “ Ratio of n-6/n-3: importance of, optimal ratio, distortions in the American diet, limitations The bottom line: dietary recommendations Choosing fish oil supplements Summary What are omega-3 fats? Polyunsaturated fats found primarily in fatty fish, grass-fed animal products and some plants Essential to proper functioning of the body Must be obtained by diet Anti-inflammatory Beneficial for cardiovascular health Also called n-3 fats Include ALA, EPA and DHA What is the function of omega-3 fats? Important component of gray matter in the brain and of sperm Role in vision Cell membrane component, contribute flexibility Precursor to messenger molecules called eicosanoids which can help to reduce inflammation What are eicosanoids? Comprised of prostaglandins, leukotrienes and thromboxanes Fatty acids of 20 carbon length “Hormone-like” messenger molecules synthesized and active within a cell Perform various functions such as: lowering blood pressure, gastric secretion, raising body temperature, constricting bronchi, etc. Eicosanoids and Omega-3’s Omega-3 fatty acids act as precursors to eicosanoids that decrease inflammation For example, the eicosanoids produced lower blood pressure, decrease body temperature, prevent platelet aggregation (and thus inhibit blood clotting), and down-regulate the immune system This is what is meant by their “anti-inflammatory” effects What are the benefits of omega-3? Cardiovascular benefits (hypolipidemic and antithrombotic) Slows progression of rheumatoid arthritis Decreases blood pressure Beneficial for psoriasis (skin condition) Effectiveness in the prevention and treatment of autoimmune diseases such as lupus and ulcerative colitis Essential for a healthy pregnancy Deficiencies correlated with depression Potential benefits for cancer, kidney disease and other conditions How do omega-3’s prevent atherosclerosis? Antithrombotic (prevent platelets from sticking together – worsening plaque) Lower triglyceride levels Lower LDL levels (only at high doses, > 10 g/day) Reduce the release of pro-inflammatory cytokines which are involved in plaque formation Why are they called “omega-3”? A fatty acid is a long chain of carbon atoms bonded to each other and to hydrogen Omega means “end” Omega 3 has a double bond on the 3rd carbon from the end of the chain Omega 6 fatty acids have a double bond on the 6th carbon from the end Why are they called “omega-3”? Note: the entire fatty acid is not shown. What about ALA, EPA and DHA? ALA is the plant form of omega-3, made in the chloroplasts of green plants such as grass and kale Animals convert ALA into EPA and DHA which are found in fish and grass-fed animal products Once converted, EPA and DHA play functional roles in the body as previously discussed EPA is the precursor to the omega-3 derived eicosanoids ALA, DHA and EPA Plant sources such as: flax seed and green leafy vegetables Inefficient conversion in humans Marine sources Eicosanoid production, attenuates inflammation Marine sources Component of cell membranes, gray matter of brain, sperm, role in vision, etc. Best food sources of EPA and DHA BEST FISH SOURCES: salmon, mackerel, sardines, bluefish, tuna GOOD FISH SOURCES: herring, anchovy, pilchard, butterfish, rainbow trout Range-fed meats, eggs and dairy (vs. grain fed) Wild fish are higher in Omega-3’s and lower in Omega-6’s compared to farm-raised fish (some studies show omega 3 content about 1.5 X greater in wild fish) Omega-3’s: Wild vs. cultured fish Best sources of Omega-3’s: ALA Ground flax seed, chia seed, hemp seed, pumpkin seed, dark green leafy vegetables such as kale, collard greens and swiss chard, spirulina. Advantage: fewer contaminants Disadvantage: less efficient conversion to EPA and DHA Omega-6 fatty acids Like Omega-3’s, absolutely essential in the diet for physiological functioning Like Omega-3’s, polyunsaturated (multiple double bonds) Also a component of cell membranes Also a precursor to eicosanoids Found ubiquitously in the American diet in the form of vegetable oils, also found in virtually all nuts and seeds Comparison of oils NOTE: Every fat or oil contains some of each kind of fat. Olive oil is not pure monounsaturated fat. Butter is not pure saturated fat. Flax is not pure n-3 fat. Why does the ratio of n-6/n-3 matter? Linoleic and arachidonic acid (n-6) are converted into eicosanoids that promote inflammation by gearing up the immune system NSAIDS (Aspirin and Ibuprofen) suppress these eicosanoids Too much omega-6 compared to omega-3 causes inflammatory eicosanoids to predominate Cell membranes reflect dietary intake. Too much n-6 and too little n-3 leads to rigid, inflexible membranes. What should the n-6/n-3 ratio be? Highly speculative Hunter-gatherer estimates: between 3:1 to 1:1 Some recent research suggests 4:1 may be an effective ratio for promoting health 4:1 prevention of cardiovascular disease 2-3:1 suppressed inflammation in rheumatoid arthritis 5:1 beneficial effect on asthma What is the n-6/n-3 ratio in the US? Population n-6/n-3 Ratio Paleolithic 0.79:1 Greece prior to 1960 1.00-2.00:1 Japan 4.00:1 Rural India 5-6.1:1 United Kingdom and northern Europe 15.00:1 United States 16.74:1 Urban India 38-50:1 Source: Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother. 2008;56(8):365-79. Why is the American ratio so high? Ubiquitous use of vegetable oil (cottonseed oil, soybean oil, corn oil, sunflower oil) in processed foods Grain-fed animal products contain significant amounts of arachidonic acid (an omega-6) Low intakes of fish, leafy green vegetables and grassfed animal products Production-driven agricultural practices What are some limitations of the n-6/n-3 ratio? Unclear what the optimal ratio should be Difficult to measure in an individual (food labeling does not specify, oils contain some of each and the ratios vary) Critics contend that the ratio is of little use and has not been conclusively shown to correlate with inflammatory markers May encourage people to avoid healthful foods that contain omega-6 Omega-6 fats are not bad Have been shown to lower LDL cholesterol (the “bad cholesterol”) Linoleic acid converts to gammalinoleic acid (GLA) before it converts to arachidonic acid and GLA is a precursor to a class of eicosanoids which are antiinflammatory Not black and white The bottom line American diet is out of balance (n-6 to n-3) which may shift the body towards a state of inflammation Increase intake of fatty fish (DHA and EPA) and plant sources of omega-3’s (ALA) Choose grass-fed, free range animal products when possible Continue eating healthful whole food sources of omega-6 including whole nuts, seeds and avocado Decrease total omega-6 intake by minimizing processed foods made with vegetable oils, including margarine and fried restaurant food Omega 3’s: How much is enough? No RDA for omega-3’s or omega-6’s AHA: eat fatty fish 3.5 oz 2x/week OR up to 3g/day in supplements WHO: 0.3-0.5g/day European Food Safety Authority: 2-4g/day to lower triglycerides, 3g/day to lower BP Estimated US intake: 0.1-0.2g/day (2011) vs. Japan (2g/day) Anyone taking anticoagulants or with a vitamin K deficiency should exercise caution Choosing a supplement In summary Omega-3’s have many health benefits Best sources are fatty fish, grass fed animal products, ground flax seeds and leafy greens Too many n-6’s compared to n-3’s may tilt the body towards a state of inflammation Increase low-mercury fatty fish in the diet for n-3’s and choose grass-fed animal products Choose whole food sources of n-6’s like nuts and seeds instead of vegetable oils Consider an omega-3 supplement References Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81(2):341-54. Gómez candela C, Bermejo lópez LM, Loria kohen V. Importance of a balanced omega 6/omega 3 ratio for the maintenance of health: nutritional recommendations. Nutr Hosp. 2011;26(2):323-9. Gropper, Sareen S. Smith, Jack L. Groff, James L. (2004). Advanced Nutrition and Human Metabolism. Belmont, CA: Thomson Learning. Harvey, Richard A., Ferrier, Denise R. (2005). Biochemistry, 34d. Ed. Baltimore, MD: Lippincott Williams & Wilkins. Pauline D. Watson, DO, Parijat S. Joy, MD, Chileshe Nkonde, MD, MRCP, Scott E. Hessen, MD, Dean G. Karalis, MD. Comparison of Bleeding Complications with Omega-3 Fatty Acids + Aspirin + Clopidogrel--Versus--Aspirin + Clopidogrel in Patients with Cardiovascular Disease. The American Journal of Cardiology. 2009;104(8):1052-1054. Pitchford, P. (2002). Healing with whole foods: Oriental traditions and modern nutrition. Berkeley, Calif: North Atlantic Books. Simopoulos AP. Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr. 1991;54(3):438-63. Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother. 2008;56(8):365-79.