Omega-3 fatty acids

Fish

Best source of EPA and DHA; 2-3 oz servings/week

Omega 9

use in place of saturated fats to improve lipids

Dosing DHA and EPA

3 oz twice weekly

Calamari oil

More DHA than EPA; low contaminants

How far in advance of surgery should one discontinue use of omega-3s?

10-14 days before surgery

AHA dosing recommendations of EPA/DHA to decrease TGs

2-4 g/day of EPA and DHA

What does FDA recommended as a limit of omega-3's per day?

3g (less than 2 g from supplements); greater than 3 g may increase bleeding risk

Number one dietary supplement in the US since 2007

Fish oil; omega 3 fatty acids

ALA sources

Flaxseed, nuts, green leafy vegetables, chia seeds, hemp oil, black currant seeds, plant oils (rich in Mediterranean diet; not studied in CVD)

What can high dose of omega-3s do to the immune system?

May cause suppression

Algal oil

More DHA than EPA; expensive; low contaminants; vegetarian

Greenland eskimos

Very decreased death rate from heart disease than Americans and Danes with similar amounts of dietary fats; Eskimo diet is primarily fat form whales, seals, and high (high omega 3 FA)

Rx omega-3 products

-Lovaza -Epanova -Vascepa -Omtryg (Tend to be more expensive)

Which patients should limit the consumption of omega 3 fatty acids?

-clotting disorders -taking anticoagulant/antiplatelet drugs -undergoing surgery

What are the heart healthy effects of fish oil seen in CVD?

-lower triglycerides -moderate increase in HDLs -anticoagulant/antiplatelt effect -decrease homocysteine levels -decrease blood pressure -anti inflammatory effects -decrease risk of ventricular arrhythmia -endothelial protection -slow progression of atherosclerosis

Which fatty fish are quality sources of omega 3 fatty acids?

-salmon -mackerel -herring -lake trout -sardines -albacore tuna

2015-2020 dietary guidelines for Americans state what about fish in the diet?

-strong evidence shows that eating patterns that include seafood are associated with reduced risk of CVD -consuming about 8 oz/week of seafood variety providing about 250 mg/day EPA and DHA is associated with fewer cardiac deaths in both healthy individuals and those with preexisting CVD

Recommended amount of ALA for birth to 12 months

0.5 g (as total omega 3's)

Recommended amount of ALA for children 1-3

0.7 g

Recommended amount of ALA for children 4-8

0.9 g

Recommended amount of ALA for girls 9-13

1 g

What are the 3 omega-3 fatty acids?

1. ALA 2. EPA 3. DHA

What is an important counseling point fro Rx omega-3 products?

1. Don't crush or chew 2. Adhere to dietary restrictions

Sources of omega 3 fatty acids

1. Fish 2. Krill oil 3. Algal oil 4. Calamari oil 5. Flaxseed, nuts 6. Green leafy vegetables 7. Chia seeds 8. Hemp oil 9. Black currant seeds 10. Plant oils

Omega 3

DHA, EPA, ALA

Where are EPA and DHA mainly found?

In fish and other seafood

In which patients do both EPA and DHA have triglyceride lowering properties most evident?

Those with triglycerides > 500 mg/dL

FDA qualified health claim for food and dietary supplements that contain DHA and EPA

"Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease"

Where is ALA mainly found?

In plant oils such as flaxseed, soybean, and canola oils

Recommended amount of ALA for teen boys 14-18

1.6 g

What are some practical issues with fish oil supplements?

1. Fish oil deteriorates 2. Develops unpleasant taste and odor

Recommend amount of ALA for teen girls 14-18

1.1 g

Recommended amount of ALA for women

1.1 g

Recommended amount of ALA for boys 9-13

1.2 g

Recommended amount of ALA for breastfeeding teens and women

1.3 g

Recommend amount of ALA for pregnant teens and women

1.4 g

Recommended amount of ALA for men

1.6 g

What does AHA recommend to decrease TG levels?

At least 2 servings (3 oz) of fatty fish weekly to decrease TG levels (300-500 mg EPA/DHA)

how is fish oil effective in hypertriglyceridemia?

Dose dependent effect (fish) to decrease triglyceride levels 20-50% at 3-6g daily

Fish oil for hypertriglyceridemia

Effective; very high level of clinical evidence supporting product use for a specific indication

What are some products enriched with omega-3 fatty acids?

Eggs from chickens fed algal oil (about 150 mg of DHA)

How many people take fish oil/omega 3 fatty acids?

Estimated 8% adults and 1% children

Krill oil

Lacks fishy taste; phospholipids may increase absorption; expensive

Fish oil for cardiovascular disease

Likely effective

Omega 6

Linolenic acid and arachiodonic acid are major ones; benefit when substituted for saturated fat (veg oils, soy, nuts)

Are omega 6 needed in supplementation?

No because there is lots in diet

Is omega 9 essential?

No; body can manufacture when needed

What omegas can cause mediators of inflammation, vasoconstriction, platelet aggregation?

Omega 6