A common question from many patients is “what type of supplements do I take and why?” Ultimately, I believe that we should eat a healthy diet, however I think that it is important to supplement our diet in some ways.
I support the use of Omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Omega-3 fatty acids are long chain PUFA (polyunsaturated fatty acids) and are dietary fats with many health benefits. There is considerable on-going research to the effects/benefits of EPA and DHA dietary supplementation. EPA and DHA are necessary for proper fetal development. DHA is found in all cell membranes with especially high concentration in brain and retina tissue.
EPA and DHA are produced by water plants (e.g. marine algae) and found in marine animals. Good sources of EPA and DHA are fish, fish oils, eggs and organ meats. Another omega-3, ALA (alpha linolenic acid) is found in many land plants (green leafy vegetables, nuts, flaxseed and flaxseed oils, canola oil), but ALA must be converted to EPA and DHA by enzymes. However, research has shown that it is only a small percentage is actually converted. This makes it a less optimal source for dietary supplementation.
Our current diets are higher in saturated fatty acids and low in omega-3 fatty acids. It is thought that our low intake of dietary EPA and DHA is associated with increased inflammatory processes, poor fetal development, generalized cardiovascular health and the risk of the development of Alzheimer’s disease. (American Society for Nutrition) We normally eat about 300 mg per day in our diet. Recommendations are for greater than 2400 mg per day and greater than 2700 mg per day for a more anti-inflammatory effect (e.g. rheumatoid arthritis).
Chronic inflammation is a significant health concern. We normally think of arthritis and degenerative diseases, however we now understand that chronic inflammation is associated with increased cardiovascular disease. EPA and DHA are thought to have anti-inflammatory effects as well as reduction of oxidative stress. Studies have shown that people taking EPA and DHA had a significant reduction in CRP (C-Reactive Protein), a marker for chronic inflammation especially important in evaluation of cardiac risk factors. EPA helps to decrease inflammatory responses in the body. DHA is present in large amounts in neuron cell membranes where it is involved in the normal function of the nervous system. DHA is also required in the production of a family of compounds called resolvins which helps decrease inflammation in the brain, especially inflammation caused by injury to brain tissue caused by decreased blood flow.
Patients with arthritis, especially Rheumatoid arthritis, may find improvement in pain, swelling and morning stiffness. EPA and DHA also modify through gene expression our body’s lipid metabolism, lowering triglycerides. They have been recommended by the American Heart Association for patients with elevated cholesterol.
It is especially important to note that it is definitely better to acquire the higher amounts of DHA, EPA and ALA through your normal diet, but the reality is that most people (including myself) are not able. Therefore, dietary supplementation is recommended. It is also important to understand that all supplements are not the same. It is important to make sure that the supplements are tested for BCPs and mercury (as they come from seafood). There is also a vital difference in how the supplements are prepared. The vast majority of products available on the market are in ethyl ester form. It is cheaper for companies not to convert the ethyl esters back to their natural triglyceride state. Of the companies that do convert, they usually convert only some and sell a mixture of both ethyl ester and triglycerides. I personally use the products from Designs for Health as they are 90 to 100% triglyceride bound omega-3 fish oils (reported 40-50% higher than industry standard). The importance is that it is up to 100% more bio-available than the ethyl ester from, translation you absorb more. It is also easier to digest and absorb.
My favorites are OmegAvail HiPo, which has a higher concentration of EPA for arthritic conditions, and OmegAvail Ultra for more equal ration of EPA and DHA. These both are produced by Designs for Health, which we carry in office. Both have lipase, which also aid in digestion.
Krill Oil has a high phospholipid content. This is different than the PUFAs. It is thought that the phospholipids aid in the absorption of the powerful antioxidant astaxanthin, which improves cardiovascular health, and supports skin and eye health. It also has some anti-inflammatory properties. I recommend XanthOmega™ Krill Oil Softgels (Designs for Health).
Several scientific reviews have been performed to evaluate the safety of Omega-3 supplementation. In general, side effects were minor and primarily gastrointestinal in nature (generally diarrhea). Remember, that it is always important to discuss the addition of a supplement with your physician. Want to know more, you are always encouraged to talk with me or for additional reading see below.
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