DATE: 13 Sep 2007, 12:20 am / MOOD: Full of life
The Government's Big Fish Story
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Scientists worldwide are praising a nutrient so powerful that it
may help combat dozens of diseases. But don't expect an endorsement
from our policy makers: They say we can do without.
By Sabrina Rubin Erdely and Denny Watkins, Men's Health
When Randal McCloy was rushed to West Virginia University Ruby
Memorial Hospital's intensive-care unit, he was practically dead.
The 27-year-old coal miner had spent 41 hours buried 2 ½ miles
underground after an explosion in the Sago, West Virginia, mine
where he'd been working. His 12 oxygen-starved colleagues had all
perished.
"As far as we know, he survived the longest exposure to carbon
monoxide poisoning," says Julian Bailes, M.D., the neurosurgeon
assigned to the case. McCloy was in a coma and in deep shock, his
heart barely beating, one of his lungs collapsed, his liver and
both kidneys shut down. Even if he somehow managed to pull through,
doctors predicted McCloy would be severely brain damaged, since the
carbon monoxide had stripped the protective myelin sheath from most
of his brain's neurons. "It's very difficult to come back from a
brain injury," says Dr. Bailes. "There's no drug that can help
that."
While McCloy was being given oxygen infusions in a hyperbaric
chamber, Dr. Bailes was struck by inspiration: He ordered a daily
dose of 15,000 milligrams (mg) docosahexaenoic acid (DHA) and
eicosapentaenoic acid (EPA) for the miner. In layman's terms?
"Fish oil," says Dr. Bailes.
Several weeks passed. Then, unexpectedly, McCloy emerged from his
coma. This in itself was amazing, but he wasn't done. In the weeks
that followed, he stunned even the most optimistic experts by
recovering his memory and gradually regaining his ability to walk,
talk, and see, a turnaround that many in the medical field called
miraculous.
Although Dr. Bailes believes the hyperbaric chamber may have worked
some magic on the myelin, he thinks much of the credit belongs
elsewhere. "The omega-3s helped rebuild the damaged gray and white
matter of his brain," says Dr. Bailes, who now takes his own
medicine, swallowing a fish-oil supplement each morning. On his
orders, McCloy, still recuperating at home, continues to take fish
oil daily. "I would say he should be on it for a lifetime," says
Dr. Bailes. "But then, I think everybody should."
Maybe what fish oil needed all along was a better publicist. After
all, this isn't the medical community's first infatuation with
omega-3s. Back in 1970, a pair of Danish researchers, Hans Olaf
Bang and Jørn Dyerberg, traveled to Greenland to uncover why the
Eskimo population there had a low incidence of heart disease
despite subsisting on a high-fat diet. Their finding: The Eskimos'
blood contained high levels of omega-3s, establishing the first
link to heart health. But even though this discovery spurred
additional omega-3 research throughout the '70s and '80s, the
public remained more interested in other nutrients--none of which
had the unfortunate words "fish" or "fatty" in their names.
There are three types of omega-3s: DHA and EPA, found in fish and
marine algae (which is where the fish get them), and
alpha-linolenic acid (ALA), which is found in plants, seeds, and
nuts. All three have health benefits, but those attributed to DHA
and EPA have sparked renewed interest in recent years. Studies show
that this tag team may not only reduce a person's risk of heart
disease and stroke but also possibly help prevent ailments as
diverse as arthritis, Alzheimer's disease, asthma, autoimmune
disorders, and attention-deficit/hyperactivity disorder--and those
are just the A's. Researchers are now exploring if these
multifunctional fats can, among other things, ward off cancer and
even make prison inmates less violent. It's enough to make omega-3
geeks downright giddy.
"Omega-3s are fantastic!" says Jing X. Kang, M.D., Ph.D., a Harvard
University researcher who made the news by genetically engineering
pigs to produce omega-3s in their meat. "Not just for your heart
but also for brain function, immunity function, women's health,
children's health--I'm amazed at how important they are."
In fact, some experts argue that omega-3s should be labeled
essential nutrients as necessary to health as, say, vitamins A and
D. "They're involved in the metabolism of each individual cell,"
says Artemis P. Simopoulos, M.D., a physician and the president of
the Center for Genetics, Nutrition and Health in Washington, D.C.
"They're part of your body's basic nutrition."
But while some see omega-3s as a nutritional no-brainer, others
find them surprisingly controversial. "Omega-3s are way, way
overhyped," says Marion Nestle, Ph.D., M.P.H., a professor of
nutrition and public health at New York University and the author
of What to Eat. "The research so far has been mixed. I'll grant
that they're healthy, but I don't think if you don't eat them
you're going to die of a heart attack."
The government has been equally cautious. So far, the Food and Drug
Administration has issued only a tepid statement that "supportive
but not conclusive research" indicates that DHA and EPA are good
for your heart. And the Food and Nutrition Board--the scientific
panel that, funded mostly by federal money, creates Daily
Recommended Intakes (DRI) for essential nutrients--has shrugged off
the issue altogether. It crowned ALA essential, but ignored DHA and
EPA. "We didn't feel the data were sufficient," says Linda Meyers,
Ph.D., director of the board. It's precisely the sort of comment
that leaves omega-3 researchers flabbergasted.
"They're in the Dark Ages," says Bill Lands, Ph.D., a retired
National Institutes of Health (NIH) biochemist who has written
extensively about omega-3s and is widely considered the field's
elder statesman. "The science was very clear 15 years ago. But
they're not interested in science. All they're interested in doing
is preserving the status quo, when they could be saving lives."
I stare down at the fish lying on the laboratory countertop. It
stares back with one dead eye. Hours ago it was swimming in the
Chesapeake Bay with 2 million of its brethren; tomorrow they'll all
be squashed in a giant screw press to make 10,000 gallons of oil
destined for fish-oil capsules and omega-3 fortified foods.
"Not very glamorous, is he?" says Jane Crowther, senior director of
Omega Protein's Health and Science Center. It's hard to disagree:
I've come to the nation's largest fish-oil refinery, in Reedville,
Virginia, and now that I'm face to fin with what a poster on the
wall calls "MENHADEN...THE WONDERFISH!" I'm not exactly awestruck.
Bony, oily, and without much meat, the menhaden isn't even
considered edible by most people. And yet, hidden inside is a
substance that some anthropologists claim was critical to our very
evolution; without it, they say, we'd still have brains like
chimps'.
Ask most scientists and they'll tell you that Stone Age man evolved
on the African savannas, developing his big, complex brain as a
result of all the animals he'd hunt and eat. But most scientists
would be wrong, according to Michael Crawford, Ph.D., who, along
with researchers from the USDA, conducted a 2002 study challenging
the prevailing theory, which he calls "a load of rubbish."
Crawford, the director of London's Institute of Brain Chemistry and
Human Nutrition, argues that many other savanna mammals also
subsisted on meat, but none developed our megabrains. "And with
their strong jaws and sharp teeth, they were far better equipped to
eat flesh than we were," he says. Yet relative to their growing
bodies, those animals' brains actually shrank, while man's brain
expanded from a 1-pound processor to a 3-pound supercomputer.
What were we dining on that the rest of the Paleolithic crowd
wasn't? Crawford has a three-letter answer: DHA. "The human brain
is soaking in DHA," he says. "It is the only substance that
supports that level of neural development and cognitive function."
And lo and behold, paleontologists have found evidence that early
man lived along the coasts of southern Africa, leaving behind
mounds of fossilized shells and other table scraps. Crawford points
out that catching fish would have been a heck of a lot easier than
snaring four-legged prey. Children and pregnant women could wade in
and collect mollusks themselves, feeding young brains in the
process. Studies show that DHA helps secure the connections between
brain cells, especially in utero, when pregnant women can increase
their babies' IQs by as many as six points.
While the savanna-versus-seashore debate will continue (Emory
University researchers recently fired their own scientific salvo at
Crawford's theory), no one can dispute that we're veritable
meat-eating machines today. The average American ate only 16.2
pounds of fish in 2005, but consumed 195 pounds of meat. And
although our livers can manufacture tiny amounts of DHA and EPA
when we eat lots of ALA-rich nuts and seeds, these aren't exactly
our favorite foods, either.
Changing agricultural techniques have worsened the situation. The
natural omega-3 contents of meat, milk, and eggs have plummeted now
that our livestock no longer graze on ALA-rich grass, instead
consuming corn, wheat, and other grains that are loaded with
another group of fatty acids, called omega-6s. In fact, the
disappearance of omega-3s from our diets has coincided with an
upsurge in omega-6s, mainly in the form of cereals, grains, and
processed foods made with hydrogenated oils. Dr. Simopoulos
estimates that in caveman days, we ate an equal amount of the two
types, but that the average American now eats 16 times more
omega-6s than omega-3s.
"That's what's really killing us," says Lands. "The balance of 6
and 3 got out of whack." These two types of fatty acids have a
biochemical yin-and-yang relationship: While omega-3s reduce our
body's inflammation response, omega-6s encourage it. Each fatty
acid is crucial: For example, if your inflammatory response is too
weak, you won't be able to fight infection properly. And in theory,
the push and pull should create perfect balance. Instead, the
excess of omega-6s in our diets may have left us in a perpetual
state of inflammation.
"The reason you take ibuprofen and Celebrex and all those
nonsteroidals is to prevent the manufacture of these inflammation
molecules in the first place," says Joseph Hibbeln, M.D., a
neuroscientist with the NIH. "The mental picture I have is of the
Dutch boy with his finger in the dike, where the finger is
expensive pharmacology, and the flood is omega-6s."
Andrew McGeehin had limped for the past half century. "Stupid
football," mutters the 83-year-old resident of Allentown,
Pennsylvania. He tore up his right knee in his 30s, and despite
surgery and drugs, the pain gradually became enough to wake him at
night. Finally, McGeehin's orthopedist, Thomas Meade, M.D.,
suggested that he take an omega-3 supplement.
"I wasn't expecting much. But I figured I'd tried everything else,"
says McGeehin, who began swallowing fish oil along with his usual
dose of the anti-inflammatory drug Voltaren. One week later,
McGeehin was startled to realize that the stiffness in his knee was
gone. He was able to walk with the easy, fluid stride of a younger
man.
"Dr. Meade must be a genius!" McGeehin says today, though Dr. Meade
himself explains it more modestly: "I read the literature. There's
a plethora of evidence supporting the benefit of omega-3s for joint
pain." He cites a 2006 University of Pittsburgh study of 125 people
with neck and back pain, in which 60 percent of participants
reported having less pain after taking omega-3s. And clinical
studies on rheumatoid arthritis suggest that patients who take a
daily dose may be able to cut back on their meds.
Indeed, in the 2 years in which Dr. Meade has been recommending
omega-3s to his patients, he's seen a major shift in his orthopedic
practice. "I almost never prescribe anti-inflammatories now," he
says. "My staff kids me that I'll put us out of business with fish
oil."
Omega-3s act as a sort of internal ice pack, in part because they
spur our bodies to produce several inflammation-lowering
substances. "Omega-3s work along the same biochemical pathway as a
COX-2 inhibitor, such as Vioxx, but farther upstream," says Dr.
Meade, meaning that omega-3s treat the underlying problem rather
than the symptoms. And emerging research indicates that this
powerful ability to ease inflammation is one of the ways omega-3s
may help prevent a number of ailments, including...
Heart attack and stroke.
Cardiologists now believe that chronic inflammation triggers the
release of artery-blocking plaque. In the most definitive study to
date, published in the Lancet, heart-attack survivors who took 900
mg fish oil daily were 30 percent less likely to die of a second
heart attack, and 20 percent less likely to suffer a stroke, than
those who skipped the supplement.
Omega-3s can guard your arteries in other ways, too, since they
also lower triglycerides and make vessels more elastic. Add
in their ability to improve electrical communication between
cardiac cells, thereby preventing arrhythmia, and you can see why
omega-3s are a standard part of cardiac care in Europe. If you have
a heart attack in Italy, France, Britain, or Spain, the hospital
will even send you home with a prescription for Omacor, a
"medication" that's superpurified DHA and EPA.
Alzheimer's disease.
Though not yet conclusive, research suggests that runaway brain
inflammation may cause Alzheimer's disease. In a 2007 study
published in the American Journal of Clinical Nutrition, elderly
men who consumed 350 mg DHA and EPA daily experienced less
cognitive decline than those who swallowed only 15 mg a day. And
researchers at the Rush Institute for Healthy Aging, in Chicago,
found that people who ate fish at least once a week were
significantly less likely to develop Alzheimer's disease than those
who ate more turf than surf.
Prostate cancer.
It's estimated that chronic inflammation is the culprit in 20
percent of all cancers, and that may include many cases of prostate
cancer. In a 2003 Harvard study that tracked nearly 48,000 men over
12 years, researchers discovered that the men who ate fish three
times a week were 25 percent less likely to develop metastatic
prostate cancer than those who dined on less. However, a recent
(and hotly debated) study review in the Journal of the American
Medical Association says clear proof of cancer protection is still
lacking.
Depression.
Could fish be the ultimate mood food? Ohio State University
researchers recently analyzed samples from 43 older adults
and found that a high omega-6 to low omega-3 ratio corresponded to
elevated inflammation and more symptoms of depression. This and
previous research suggest that eating more fatty fish or
supplementing with omega-3s could help us beat the blues.
In the world of nutrition, few events make a scientist's palms
sweat as much as the release of a newly revised DRI list.
Before the Food and Nutrition Board announced its most recent DRI
for fatty acids, in 2002, some experts were optimistic that
omega-3s would make the cut, given the research strides made over
the previous decade. Instead, DHA and EPA were nowhere to be
found--snubbed yet again by the larger scientific community. Even
worse, the new DRI recommended that adults continue eating 10 times
as many omega-6s as omega-3s, a ratio that practically gave omega-3
researchers a heart attack.
But Alice Lichtenstein, D.Sc., a Tufts University public-health
professor who was on the panel that voted DHA down, doesn't see
what all the fuss is about. "There just wasn't enough data to go
on," she says. "What's out there is a little difficult to
interpret."
Part of the problem she's referring to is that some studies didn't
account for the amount of omega-6s that research participants
consumed (too much blunts the effects of omega-3s), and other
supplement studies didn't adjust for how much fish their
participants ate. The differences make the studies hard to compare.
"It's all over the place," says Sharon Akabas, Ph.D., codirector of
the master's program at Columbia University's institute of human
nutrition, which held a symposium on this very problem. "It's like
dealing with a moving target." Also, since most omega-3 research
has focused on curing the sick, no one has yet pinned down how much
DHA and EPA keeps healthy people well. Without that magic number,
the Food and Nutrition Board says, its hands are tied.
The board's cautious approach is typical of how slow our government
is to accept scientific change, say advocates of omega-3s. For
example, although the World Health Organization endorsed adding DHA
to infant formula back in 1994, it took the FDA until 2002 to
approve the move. "Fifty-nine countries added DHA to infant formula
before we did," says Dr. Simopoulos. "Mexico and China were ahead
of us! And that's because our government is 20 years behind when it
comes to the science."
Nevertheless, Meyers insists that the Food and Nutrition Board is
just being thorough. "Anything in nutrition is going to lead to
controversy," she says. "No matter the issue, some people will say
we don't go far enough and others will say we go too far."
Perhaps, but it's revealing that even though important studies have
come out since the board's 2002 list, it has no plans to revisit
the status of DHA, despite the fact that at least one panelist has
changed her mind. "There's a growing consensus that we should be
eating more DHA for sure, as well as EPA," says Penny
Kris-Etherton, Ph.D., a Penn State University professor of
nutrition. "I would like to see stronger dietary recommendations
than we currently have."
Columbia's Akabas agrees, which is why her Institute of Nutrition
has come out with a bold endorsement. "We think the whole U.S.
population would benefit from an upward shift in omega-3 intake,
and we don't see any downside," she says. "So our recommendation is
to not wait until the research becomes definitive. It's time to
examine the development of a DRI."
One group that isn't waiting around for the blessing of the Food
and Nutrition Board is the food manufacturers. Companies are
already adding fish oil--minus the fish odor--to everyday products
such as yogurt, frozen pizza, and orange juice. Most recently,
Hormel Foods announced that it was entering this arena by
partnering with a North Carolina research firm. What this also
means, however, is that our government's greatest nutrition minds
are being scooped by the maker of Spam.
Pick the Perfect Fish-Oil Supplement
Purity
When Consumerlab.com tested 41 fish-oil supplements, none was found
to contain unsafe levels of mercury, PCBs, or dioxins. One
explanation is that many brands are now molecularly distilled to
remove any possible contaminants.
Dosage
Ignore the total milligrams (mg) of fish oil, and focus instead on
the combined eicosapentaenoic acid (EPA) and docosahexaenoic acid
(DHA). You want a supplement that contains at least 500 mg per dose
or serving. If you're on thinners, talk to your doctor about
the best dosage.
Form
Your choice is basically capsules or a liquid. They're equally
effective at delivering omega-3s to your bloodstream, so go with
the form you think you'll take on a daily basis.
Fish Burp
Some people experience this as their stomachs dissolve the fish-oil
capsule. Beat the burp by buying enteric-coated capsules or
freezing regular capsules. Either strategy will cause the fish oil
to be released in your intestine instead, says William Harris,
Ph.D., a professor of medicine and biomedical sciences at the
University of South Dakota.
Ratio
The ratio of EPA to DHA used in research varies, but most
supplements are made with a 3:2 split. This translates to 300 mg
EPA and 200 mg DHA in a 500 mg supplement.
Source
Any fish oil will do, be it from mackerel or menhaden, salmon or
sardines. Supplements made from algae oil contain only DHA, and
those made from flaxseed oil have alpha-linolenic acid (ALA), only
a little of which can be converted into EPA and DHA by your body.
Antioxidants
Once inside your body, omega-3s can quickly lose their power due to
oxidation. Look for vitamin E, a.k.a. tocopherol, an antioxidant
that can neutralize free radicals.
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