Fish Oils: ethyl ester or triglyceride or...?

Most fish oils today are molecularly distilled, changing them from their natural triglyceride forms to ethyl ester (esterified) forms.

Anything stronger than a natural strength fish oil (up to about 30% EPA+DHA combined) is typically concentrated by molecular (vacuum) distillation to allow vaporizing at low temperatures, in the process converting to the ethyl ester form. This allows separation of the fatty acid constituents in order to add back some of the desired omega-3 fatty acids in order to concentrate them up to 60% or higher levels of the oil. This is accomplished by removing undesired fractions that were separated by the distillation, such as cholesterol, triglycerides, and various other fatty acids.

Because of the warming oceans, the naturally occurring amount of omega-3 fatty acids in most fish have declined from historically about 30% to somewhat less. Due to this change, most fish oil supplements containing 180 mg. of EPA and 120 mg. of DHA (300 mg. combined in a 1,000 mg. fish oil capsule) now need to spike the potencies by adding additional EPA and DHA fractionated from the original oils by molecular distillation. It is now unusual to find even a low strength fish oil capsule that is not at least partially molecularly distilled into ethyl ester forms. 

Some of these distilled oils are then partially reconverted to a triglyceride form in a process called reconversion that involves adding back 20% or more triglycerides to the esterified fatty acids to try to reattach the triglycerides to the fatty acids with enzymes. This imperfectly produces a highly processed combination of both triglyceride and mono-and-diglyceride forms of omega-3 with many of the original oil’s natural constituents deliberately removed (cholesterol, omega-6, omega-9, stearates, et al). This newly engineered combination is called a reconverted triglyceride form (rTG) containing typically at least 60% triglyceride form fatty acids that’s distinct from the original triglyceride (TG) form, but is as far from the original triglyceride form as can be produced by intentional chemical manipulation. Numerous brands offer this rTG form and inaccurately call it a natural triglyceride form, when it is in fact far removed from that oil.

This is done because of a prevailing and largely disproven belief that the natural triglyceride form is best. That's certainly untrue for cardiology and the form has recently been shown to be largely irrelevant to absorption and efficacy in general. 

Is Canola Oil Better than Olive Oil for Cardiovascular Health?

Canola oil has less oleic (omega-9) and more ALA (omega-3) than olive oil and been shown to:

• improve lipid measurements greater than olive oil in human subjects in a randomized, double-blinded trial: http://www.ncbi.nlm.nih.gov/pubmed/8399091

• improve cardiovascular health more than olive oil in a rat model: http://www.ncbi.nlm.nih.gov/pubmed/7722678

Fish Oil: Excerpts from a magazine interview with me

The balance of fatty acids in the body can promote inflammatory or non-inflammatory states. Higher amounts of omega-3 fats in the diet have been shown to modulate inflammation and keep it within healthy ranges. The various cellular and tissue damage that can occur from chronic inflammatory states are certainly not healthful. This basic mechanism of action implies a wide-ranging and powerful effect of omega-3 fats to support wellness. Additionally, these fats are part of brain and nerve structures, so they help to maintain the health of those tissues, as well.

Omega-3 and omega-6 fats have been called “essential fatty acids” since the body can’t manufacture them from other fats, as it typically can for other types of fat. The optimal ratio of omega-6 to omega-3 fats is somewhere between 1:1 and 3:1. The common American diet has been estimated to be over 15:1, a marked deviation from a healthy norm.

The benefits of most other non-omega-3 fatty acids in fish oil are not well-defined in the scientific literature. Fish oil naturally contains a range of fats, including cholesterol, triglycerides, and stearic acid. The ones that are considered less desirable, cholesterol and triglycerides, are sometimes removed from fish oils to further concentrate the omega-3 portion and allow higher strengths in fewer capsules.

All natural oils contain various mixtures of fatty acids in varying amounts. Omega-9 fats are best known as being abundant in Olive Oil, and are considered non-inflammatory and especially healthy if substituted for most omega-6 fats that are pro-inflammatory. Some natural oils are fairly well balanced, such as flax and hemp seed oils, or walnut oil. Others, like fish oil, tend to be predominantly omega-3. Most vegetable oils are mostly omega-6 fats and their predominance in the modern diet has been blamed for some of our poor health.

Some consumers do know about various sources of fish oil, and some have advantages or disadvantages. For example salmon is a favored source of omega-3 fats, though salmon oil typically contains less than other common fish oils. Traditional fish sources may be better accepted by those who won’t or can’t eat shellfish. The fisheries in Norway and Peru are among the best managed traditional fisheries on earth.

Krill, a small crustacean shellfish, is a unique source of omega-3 fats since krill also naturally bonds the fatty acids to phospholipids, which are essential for cell membranes and which enhance the bioavailability of the oil. Krill oil also contains the powerful antioxidant pigment astaxanthin, which is responsible for the color of shrimp and salmon. Krill is considered the best managed fishery in the world, with trained observers on each boat monitoring the harvest. The krill harvest limit can be rapidly adjusted to support a healthy population, and the total world harvest (most of which goes into pet foods) is only a fraction of the allowable sustainable harvest level.

Essential fatty Acids (EFAs) interview, Natural Products Marketplace magazine, January, 2011

The awareness of EFAs, especially the Omega-3 fatty acids EPA and DHA, is large and growing larger. The accumulating mountain of evidence and the endorsement by popular health “gurus” assures continued growth in this important product category. As the benefits of specific fatty acids for regulation of various healthy body functions – such as inflammatory processes, hormonal health, and maintaining brain/nerve/cellular structures – becomes even more well known, more and more people recognize the potential for EFAs to positively affect their health.

While there are combination products that deliver Omega-3, Omega-6, and Omega-9 fatty acids together, the focus has been more on specific sources such as fish or flax, along with some more unusual ones. Of course, natural oil sources are not comprised of a single fatty acid. For example, natural fish oil can not only supply EPA and DHA but also originally supplies ALA, cholesterol, triglycerides, and other fatty acids; though many of these components can be removed during processing to provide purer and stronger materials that are richer in EPA and DHA to require far fewer capsules to reach desired levels of these two fractions. Flax oil is best known as a vegetarian source of the omega-3 fatty acid ALA (alpha-linolenic acid), but ALA levels are only about 55% of the total; flax oil also contains about 19% omega-9 as oleic acid, 14% omega-6 as linoleic acid, and 12% saturated fats. The conversion of ALA to EPA is a significant metabolic hurdle. Women do this conversion better than men; people who consume the most omega-6 in their diets have a more difficult time converting ALA to EPA. Typically between 5% and 15% of ALA converts to EPA and about 2% to 5% of ALA converts to DHA, making flax a much more dilute and less certain source of EPA-DHA.

Fish oil is subject to environmental concerns related to both sustainability and contaminants. Manufacturers audit their suppliers and set strict identity/safety specifications to assure the quality of products.

Most fish oils are molecularly distilled to remove contaminants, manufactured under strict quality assurance standards, and screened to be free of potentially harmful levels of contaminants and heavy metals, such as mercury, PCB’s, dioxins, and others.

Other types of EFAs include Flax seed oil, Evening Primrose Oil, Pumpkin seed oil, Black Currant seed oil, Wheat Germ oil, Castor Oil, and Virgin Coconut Oil.

Purity, potency, and freshness are always the challenges with EFAs.

The trend is toward more concentrated products of higher purity that allow people to get their EPA and DHA with smaller quantities of capsules or less volume of liquid. Liquids and smaller capsule sizes allow more children and seniors to enjoy the benefits of fish oils, while high strength capsules better hit the main demographic in between.

All fish oil supplements are typically hundreds of times safer than eating a serving of fish in relation to environmental factors; and typical esterified products have the added benefit of being free of cholesterol and triglycerides, which are undesirable food components for those with high cholesterol. By far, most of the studies proving the health benefits of supplemental fish oils have been with the esterified (ethyl ester) form, rather than the triglyceride form found in cold water fatty fish. There is very strong science supporting the use of this form.

Esterified fish oils also have been shown to sustain human serum levels better than the triglyceride form, over both a 24-hour period and a one-month period, which better supports a healthy heart rhythm. Notably, the most concentrated products are available only as esterified fatty acids. The ability of a consumer to get the 1-3 grams daily of EPA + DHA recommended by many health experts is enhanced by modern formulas that concentrate these essential fatty acids into fewer capsules and smaller serving sizes with fewer undesirable components, thus increasing customer compliance with a healthy nutritional protocol.

Both triglyceride and esterified ethyl ester fish oils are available in the marketplace, and both forms have their advocates. In the body, both forms must first be digested, stripping off the triglycerides or ethyl esters and leaving only free fatty acids that can be readily absorbed. These free fatty acids are then combined with triglycerides present in the liver before entering general circulation; so the circulating form will actually be the triglyceride form, no matter which form of fish oil one consumes. Both forms provide great value and important nutrients for the consumer; but the triglyceride form has no more proven value than the ethyl ester form, despite some excessive marketing claims.

Natural Health: Ten Predictions for the Year 2008

Natural Health: Ten Predictions for the Year 2008 By Neil E. Levin, CCN, DANLA 12/10/2007 The New Year will bring more proof of antioxidant benefits for human health. Recent research shows that antioxidants help to maintain healthy brain functions during aging, protect brain and nerve cells, and prevent hormones and cholesterol fractions from oxidizing to become more harmful forms. Look for an expanded understanding of the benefits of these synergistic nutrients in 2008. 2008 will provide more proof of omega-3 fatty acids’ benefits. For example, DHA helps to maintain healthy balances of cholesterol fractions and protects the brain and nerves. EPA helps normalize cell membranes and cellular health. These essential fats are typically very low in the American diet, so dramatic results could occur in clinical trials providing these nutrients to participants. There will be more safety scares regarding popular prescription and Over-The-Counter drugs, creating new safety warnings and label cautions. Since the most popular medications are typically blocking or inhibiting natural body functions (calcium channel blockers, cholesterol production inhibitors, serotonin re-uptake inhibitors, stomach acid production inhibitors, etc.) rather than dealing holistically with the causes of problems that create body imbalances (lack of optimal levels of nutrients, environmental chemicals and metals, chronic stress - lack of deep sleep, low fiber - high carbohydrate diets, etc.), major side effects from such drugs are inevitable. Side effects from pain medications will become more evident, increasing the number of people looking for safer alternatives. Herbs and spices are the major natural alternatives with some scientific evidence of efficacy. The market for organic and local foods will continue to grow at amazing levels. This will put pressure on the regulatory, farm and grocery industries to manage these products and segregate them to maintain their integrity. That contrasts with the increased reliance on genetically engineered corn to produce ethanol that raises food costs and increases the use of farm chemicals. And there is much evidence that non-genetically engineered foods are both environmentally and nutritionally superior to their modified cousins, while natural farming techniques are proving superior to chemical and genetically engineered farming in terms of managing fuel and seed costs, water use, improving both crop yields and selling prices, etc. Millions of farmers around the world have already weaned themselves from the chemical-genetic “green revolution” to use appropriate local farming techniques and have actually been more successful as a direct result of truly “green” practices. America has begun to awaken to the benefits of local and organic foods in terms of freshness, reducing the use of fossil fuels for transportation and demonstrable benefits to local economies. Watch for these trends to accelerate in 2008. Blood pressure and blood sugar concerns will continue to grow, along with a medical backlash attacking natural strategies to manage these concerns. However, science will also continue to amass evidencing the positive health benefits of natural products to help people maintain already healthy blood levels, in contrast with the poor symptom management that is a characteristic of pharmaceutical or surgical interventions used to “correct” chronic biological imbalances. These issues dovetail with current obesity and cardiovascular concerns and are part of the same syndrome related to chronic stress and poor diets. Positive reports of the benefits of higher levels of vitamin D will continue to proliferate, though with some bias against the synthesized vegetarian/vegan form of vitamin D2 versus D3 from fish oil or sheep lanolin. Health authorities will be pressured to raise both the recommended Daily Value and the Upper Limit of vitamin D to five times the current levels. Research will continue to accumulate regarding the health benefits of whole grains and whole foods, as will reports of people allergic or sensitive to gluten, corn, and other grains. More mainstream processed groceries will have whole food options in 2008. This is a good trend, though with cautions for the sensitive minority. There will be continuing claims that “dietary supplements” are illegally contaminated with steroids or other pharmaceutical drugs. These claims will typically be self-serving and defensive, made primarily by athletes accused of cheating by using banned substances. Beyond the obvious fact that legitimate supplement manufacturers do not have illegal substances on hand and that GMP (Good Manufacturing Practices certification) quality manufacturing protocols would avoid inadvertent contamination, these accusations are a barometer of how “unregulated” the mainstream media and the public thinks dietary supplements are. While there are plenty of regulations written specifically to regulate supplements, and even the FDA claims that it has adequate regulatory authority, somehow certain medical authorities and journalists like to pretend otherwise; perhaps to have a handy punching bag to deflect attention from the well-documented hundreds of thousands of deaths caused annually from pharmaceuticals and medical errors. In any case, expect more of this blame game in 2008. With a presidential election campaign under full swing, no meaningful legislation regarding health care or Medicare will be passed in 2008. There will be a narrow window of opportunity for such measures in 2009 with a new Congress and Administration. Natural health advocates will continue to press for meaningful use of nutrition to combat the major causes of disease and illness in America, with probably little impact against the lobbying might of the medical and pharmaceutical interests. The wild card is if, by some miracle, the insurance industry finally notices that their costs could be contained by the use of targeted nutrition such as the use of calcium and vitamin D to prevent osteoporosis, antioxidants to prevent age-related macular degeneration and oxidative-related glaucoma that affect vision and impact seniors’ independence, omega-3 fats to prevent coronary heart disease, the use of fiber to manage healthy cholesterol levels, etc. That could swing the pendulum towards the use of natural products to control healthcare costs. But I’m not betting on it happening in 2008, though I hope that they wise up soon enough to manage the recently overactive increases in medical costs. There will be additional, unjustified health scares about essential nutrients in 2008. Especially beware of “meta-analyses” that mix unrelated studies and magnify the number of variables using often-flawed statistical models. Some probable targets: · Kava (a few unrelated, anecdotal reports of liver problems) · Folic acid (a few reports of higher cancer levels despite a lot of cellular data indicating the opposite, creating a backlash against re-fortification of refined foods) · Vitamin E (continued championing/publicity of questionable meta-analyses over more rigorous blood-level studies will continue the inexplicable controversy over the safety of this essential nutrient that most Americans are reportedly deficient in.) · Beta-Carotene (again, blood level studies and total antioxidant studies repeatedly show its safety, but studies measuring only administration of certain doses to sick populations that may be deficient in antioxidants create a conflicting picture.) · DHEA (this adrenal hormone has been vilified as a “steroid”, but is no more so than vitamin D. No less an authority than physician and US Senator Tom Coburn has sent a letter to his colleagues informing them that he has reviewed the issues and urging them to avoid a ban of this natural product, which is useful in anti-aging strategies but not for bodybuilders. Efforts by leading senators (including presidential candidates Clinton and McCain) to ban DHEA are ongoing.

Nutrients for Joint Health

Nutrients for Joint Health By Neil E. Levin, CCN, DANLA Most people know that glucosamine sulfate and chondroitin sulfate are important components of joint health. They help to form spongy tissues (like articular cartilage) that hold moisture and cushion the body’s joints, protecting them from excessive wear and tear. But this takes time. Some people notice a change in joint function within days, but more typically over several weeks. Studies show that these substances help to maintain distances between joint structures over many months, a key measure of joint integrity as these structural components may slowly collapse if not nourished. This particular effect has been accepted as evidence-based by conventional physicians at a medical joint health center associated with a major university hospital. People with osteoarthritis typically may have low levels of glucosamine and chondroitin sulfates, as well as MSM, and may benefit by supplementing to restore normal levels of these soft tissue nutrients. MSM is a safe form of the mineral sulfur that may preserve joint function and structures. In order to affect joint health on a short-term basis, it may be useful to supplement the diet with herbs that inhibit the activity of the enzymes that are involved in normal inflammatory processes. These herbs may mediate COX-2 or 5-LOX enzymes. COX-2 is also the target of some widely used drugs. Some of these herbs are safe, common spices like turmeric, ginger, cayenne and the enzyme bromelain. While drugs may offer similar yet faster COX-2 inhibition, herbs can also modulate 5-LOX activity. The safety profiles and beneficial side effects associated with nutrients and herbs can be preferable to the known side effects of drugs. The antioxidant components in the herbs also improve the body's ability to repair tissues by stimulating collagen formation. A diet high in animal fat is implicated in joint problems, and experts frequently recommend that sufferers reduce their intake of most animal fats. It is important to take natural healthy essential fats, especially Omega-3 fats (cold water fatty fish, fish oil, flax seeds, flax oil) and Omega-6 fats CLA and GLA from vegetable oils. All fish oils are well-filtered and/or molecularly distilled to remove environmental contaminants and heavy metals. A low-fat, gluten-free vegetarian diet has been helpful if maintained for several months, but does not produce fast results and is best combined with other approaches, such as supplementation. Wheat and milk are often implicated in immune reactions, and it is sometimes best to avoid them, at least while addressing the problems. Joint problems have also been linked to leaky gut and maldigestion of food, leading to the body’s immune cells attacking undigested proteins. This trains immune cells to recognize food proteins as invasive organisms and respond to them aggressively, leading to food sensitivities that are not classic allergies. Since some undigested or partially digested proteins may be similar to body tissues, maldigestion could partially explain why the body sometimes attacks its own tissues. If so, there are aids to proper digestion that should be considered. Good digestion is a tool to prevent immune reactions to food and the human gut should serve as an immune barrier to pathogens in food. Take time to smell and think about your food before you eat. Avoid stress or distractions during meals. Carefully chew food to a liquid before swallowing, and even chew liquids to enhance contact with digestive enzymes in saliva. If necessary, take a high quality plant enzyme or a milk-digestive enzyme. In some cases, more stomach acid is needed to digest proteins (and minerals). HCl and Pepsin supplements do this, but sometimes much larger amounts of acid than normal are recommended by health professionals (600-2400 mg), which do have risks if you don’t need that much acid, so these high doses must be taken under medical supervision. A traditional home test to determine whether more acid would help digestion is to mix a tablespoon of (preferably raw and organic) apple cider vinegar into a glass of (pure) water and drink with a meal. If it helps digestion, you may need more acid. It may not noticeably help if you require very much acid, though. A tablespoon of raw honey can also be added to this beverage to enhance digestion, also making it taste more like apple juice. If it helps, this can be taken daily with meals. Some digestive enzymes like Bromelain and Serrazimes (serratopeptidase) can be taken between meals to help control substances associated with temporary joint discomfort. A protective layer of probiotics - acidophilus, bifidus and other “friendly bacteria” - actually lines healthy GI tracts like chain mail, preventing leakage of undigested food remnants from the gut that provoke immune responses. It is wise to supplement with healthy bacterial supplements such probiotic products. Fairly high doses of Vitamin E have been shown to help maintain joint health, but I recommend taking the full Vitamin E Complex containing eight forms of natural Vitamin E compounds, not just the alpha tocopherol. Other antioxidants are important to maintain joint health. These include the minerals selenium and zinc, vitamins A, C, E and many plant compounds. GliSODin® raises body levels of key antioxidant enzymes, such as SOD and glutathione. Celadrin® products may help to maintain joint mobility, taken orally or topically applied, and contain acetylated fatty acids from beef fat. MicroLactin™ is a milk protein fraction that helps prevent certain immune cells (cytokines) from overwhelming an area and maintaining a prolonged reaction. Time and patience may be required to find a program that works for any individual’s joint health. Many supplements work best over weeks, months or years. Stretching and gentle exercise often help people, so should be part of any comprehensive program. Yoga and Tai Chi, and variants such as water Ai Chi, are low-impact activities that aid posture and build muscle strength. Glucosamine, Chondroitin and MSM (methylsulphonylmethane, an organic form of sulfur found in all living organisms) are three of the most popular and effective nutrients for supporting joint health. There are other formulations of Glucosamine, including a vegetarian version from fungal fermentation. Studies have shown that these nutrients provide dietary components that support healthy joint structure and function. Look for substances, forms and potencies successfully used in clinical studies. REFERENCES: Chan PS, Caron JP, Orth MW. Effect of glucosamine and chondroitin sulfate on regulation of gene expression of proteolytic enzymes and their inhibitors in interleukin-1-challenged bovine articular cartilage explants. Am J Vet Res. 2005 Nov;66(11):1870-6. Chan PS, Caron JP, Rosa GJ, Orth MW. Glucosamine and chondroitin sulfate regulate gene expression and synthesis of nitric oxide and prostaglandin E(2) in articular cartilage explants. Osteoarthritis Cartilage. 2005 May;13(5):387-94. Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999 May;25(2):379-95. Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Altern Med Rev. 1998 Feb;3(1):27-39. Bijlsma JW. [Glucosamine and chondroitin sulfate as a possible treatment for osteoarthritis] Ned Tijdschr Geneeskd. 2002 Sep 28;146(39):1819-23. Ameye LG, Chee WS. Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence. Arthritis Res Ther. 2006;8(4):R127. Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters RF. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis Cartilage. 2006 Mar;14(3):286-94. Ebisuzaki K. Aspirin and methylsulfonylmethane (MSM): a search for common mechanisms, with implications for cancer prevention. Anticancer Res. 2003 Jan-Feb;23(1A):453-8. Parcell S. Sulfur in human nutrition and applications in medicine. Altern Med Rev. 2002 Feb;7(1):22-44. Bruyere O, Pavelka K, Rovati LC,et al. Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies. Menopause. 2004 Mar-Apr;11(2):138-43.

Neil to be on radio Monday 7/23

Neil will be interviewed about omega-3 oils on Healthy Talk Radio with Deborah Ray. http://www.healthytalkradio.com/

Omega-3 fats, depression and mood disorders

Studies do show the potential benefits, and also evidence the good tolerability, of omega-3 fats in mood disorders. While these nutrients may not be a "cure" or even a drug-like treatment, their protective effects in these patient groups has been fairly well established: "Biological marker studies indicate deficits in omega-3 fatty acids in people with depressive disorders, while several treatment studies indicate therapeutic benefits from omega-3 supplementation. A similar contribution of omega-3 fatty acids to coronary artery disease may explain the well-described links between coronary artery disease and depression." Parker G, et al. Omega-3 fatty acids and mood disorders. Am J Psychiatry. 2006 Jun;163(6):969-78. Review. Erratum in: Am J Psychiatry. 2006 Oct;163(10):1842. PMID: 16741195 "Five of six double-blind, placebo-controlled trials in schizophrenia, and four of six such trials in depression, have reported therapeutic benefit from omega-3 fatty acids in either the primary or secondary statistical analysis, particularly when EPA is added on to existing psychotropic medication. Individual clinical trials have suggested benefits of EPA treatment in borderline personality disorder and of combined omega-3 and omega-6 fatty acid treatment for attention-deficit hyperactivity disorder. The evidence to date supports the adjunctive use of omega-3 fatty acids in the management of treatment unresponsive depression and schizophrenia." Peet M, Stokes C. Omega-3 fatty acids in the treatment of psychiatric disorders. Drugs. 2005;65(8):1051-9. Review. PMID: 15907142 "The preponderance of epidemiologic and tissue compositional studies supports a protective effect of omega-3 EFA intake, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in mood disorders. Meta-analyses of randomized controlled trials demonstrate a statistically significant benefit in unipolar and bipolar depression (p = .02). The results were highly heterogeneous, indicating that it is important to examine the characteristics of each individual study to note the differences in design and execution. There is less evidence of benefit in schizophrenia. EPA and DHA appear to have negligible risks and some potential benefit in major depressive disorder and bipolar disorder, but results remain inconclusive in most areas of interest in psychiatry...Health benefits of omega-3 EFA may be especially important in patients with psychiatric disorders, due to high prevalence rates of smoking and obesity and the metabolic side effects of some psychotropic medications." Freeman MP, et al. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry. 2006 Dec;67(12):1954-67. Review. PMID: 17194275