Society is loosening its grip on the misguided notion that all fats are bad, leaving beneficial fats in a good position to make real progress on the mounting health issues facing the American public. The federal government and various public health organizations have boosted awareness of good fats by updating dietary guidelines and supporting research into the benefits of essential fatty acids (EFAs). The forerunners of this movement—manufacturers of EFA products—have paid particular attention to product quality and environmental issues, in addition to undertaking persistent EFA educational efforts.

All fats are not created equal. Essentially, there are saturated and unsaturated fats. Saturated fats feature a chain of carbon atoms with single bonds that are “saturated” with hydrogen. However, unsaturated fats contain at least one double bond—monounsaturated if only one such bond, polyunsaturated if two or more such bonds. The human body can manufacture many fats, including cholesterol and both saturated and unsaturated fatty acids, but it cannot make certain polyunsaturated fatty acids (PUFAs), hence the category of essential fatty acids (EFAs). PUFAs are called omega fats and are differentiated by the position of the first double bond relative to the omega (Greek for “last”) end of the carbon chain; for instance, omega-9 fats have their first double bond after the ninth carbon from the omega end.

While the body can make omega-9s (such as oleic acid), it cannot manufacture omega-3 and omega-6 fatty acids, which are rooted in linoleic acid (LA) and alpha linolenic acid (ALA), respectively. LA is found in sunflower, safflower, corn and other vegetable oils, while ALA is most abundantly found in flaxseed. These EFAs can be converted in the body to other beneficial fatty acids; LA can convert to gamma linoleic acid (GLA), which is also found in evening primrose, borage and black currant oils, which then converts to arachidonic acid (AA); while ALA can convert to eicosapentaenoic acid (EPA) and then docosahexaenoic acid (DHA), both of which are found pre-formed in fish oil.

In the body, GLA, AA, EPA and DHA conversion relies heavily upon various enzymes, and there are limits on how much of each can be made. For example, ALA is a long chain of 18 carbons and three double bonds, while EPA has 20 carbons and five double bonds. In order to convert ALA to EPA, the body must add two carbons and two double bonds to the chain. For this it employs various enzymes, including desaturase to add bonds and elongase to add carbons. A number of situations can affect this process. Omega-6 and -3 EFAs compete for the same enzymes for conversion to beneficial fatty acids, rendering the conversions susceptible to the ratio of omega-6s to -3s.

“When the ratio of LA to ALA is 4-to-1, ALA is desaturated and elongated to EPA,” explained Artemis Simopoulos, M.D., president of The Center for Genetics, Nutrition and Health, Washington D.C., and author of The Omega Diet. “But in the United States, the ratio of LA to ALA is 16-to-1; therefore, ALA is slow to desaturate and elongate to EPA.” Also, desaturase enzymes can be blocked in alcoholism (fat is processed in the liver) and diabetes (reduced enzyme activity).

“Healthy individuals with a well balanced diet can convert approximately 10 percent of consumed ALA into the longer chain omega-3s EPA and DHA,” said Ellen Markham, director of education and training of Spectrum Organic Products.

The end result of the conversions of LA and ALA are longer-chain EFAs that produce numerous eicosanoids—prostaglandins, leukotrienes and thromboxane—that regulate inflammation, immunity, respiratory constriction, blood clotting, blood pressure and other important health functions. The eicosanoids from omega-6 are distinct from eicosanoids produced by omega-3s. “Just as the balance of T-helper and -suppressor cells is important to proper immune function, the balance of omega-6 and -3 eicosanoids is important to numerous bodily functions,” said Herb Joiner-Bey, N.D., author of The Healing Power of Flax. “You want blood to clot, but not too inappropriately; and you want white blood cell leukotrienes to generate inflammatory response in respiratory mucus membranes or the gastrointestinal (GI) tract, but not to the point of developing asthma or inflammatory bowel disease (IBD).” He noted the issue of omega-6 to -3 ratio is still a controversial issue, but placed the ideal ratio between 4-to-1 and 1-to-1. “Certain lab research, which involved incorporating genes in cells to move EFA balance, shows the whole process stops at 1-to-1,” he said. “Omega-6s are not bad; we just consume too much of them. We need to balance AA and EPA on the cell membranes.”

The science of EFAs has been around for many decades, but the knowledge of beneficial fats is just now beginning to reach the greater American public. “Within the dietary supplement arena, there appears to be a clear confusion regarding omega-3, -6 and -9 fats, in terms of which are needed and why, and what is the best source,” said Barbara Apps, consultant for Coromega Co. “Although most Americans are aware that fish is good for them, the awareness of the term ‘omega-3’ and what it means is considerably less.” She noted many health food consumers assume fish and flax oil supplements are interchangeable sources of omega-3s; instead, flax provides ALA while fish delivers pre-formed longer-chain EFAs.

However, educational and marketing efforts appear to be slowly sinking in. “According to the Food and Drug Administration (FDA) 2004 Health and Diet Survey, about half of American consumers are not only familiar with the terms ‘trans fat’ and ‘omega-3 fatty acids’, but understand that both types of fat have an impact on developing heart disease,” Markham remarked.

Many experts, including Trish Duncan, the marketing director for Omega Nutrition, cite pending 2006 federal trans fat labeling as a welcome educational opportunity. “The typical North American diet is high in hydrogenated or trans fats and still quite lacking in good quality, unrefined fats,” she said. “The new government regulations regarding trans fat labeling is an important step and will hopefully help to increase awareness and encourage consumers to seek out healthier oil alternatives.”

Corinna Benoit, national sales manager for Nordic Naturals, agreed mandatory trans fat labeling, which many companies already voluntarily provide, will help consumer confusion; however, she noted there is still much work to be done in the area of EFA awareness, and it is the responsibility of manufacturers and retailers alike to further this educational quest. “The good news is that the mainstream media reports regularly now on the research and benefits of using omega 3 fatty acids, and these ‘good fats’ are starting to be accepted by many Americans and practitioners,” Benoit said.

Public health experts have stepped in to further promote the importance of proper dietary EFA intake. The U.S. Department of Health and Nutritional Services, the National Institutes of Health (NIH) and the World Health Organization (WHO) have all issued recommendations for increased omega-3 intake. More specific guidelines for omega-3 intake have been recommended by the American Heart Association (AHA), American Institute for Cancer Research and the Arthritis Foundation. Just his past year, the U.S.

Department of Agriculture (USDA) added a recommendation of omega-3 intake to its revised Food Pyramid. However, one of the bigger boosts to manufacturers and retailers came by way of FDA approval of a health claim for omega-3 intake and coronary heart disease (CHD): “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease. One serving of [name of food] provides [x] grams of EPA and DHA omega-3 fatty acids.” In unveiling the new claim, FDA recommended consumers not exceed more than a total of 3 g/d of EPA and DHA omega-3 fatty acids, with no more than 2 g/d from a dietary supplement. The agency has also approved the addition of DHA to infant formula, for the healthy development of the fetus (brain and eyes).

Still, more can be done, especially on the regulatory level. “The government can go further by providing clear guidelines about omega-3 fats, and make them a more prominent feature of the food guide pyramid,” Markham suggested. “An ideal situation would be reimbursement by the federal government for omega-3 fish oil supplements for select health conditions.”

In fact, a recent study commissioned by the Dietary Supplement Education Alliance and conducted by The Lewin Group, a prominent Washington firm, concluded daily intake of 1,800 mg of omega-3s could reduce the occurrence of CHD among adults over 65, avoiding more than 384,000 hospitalizations and physicians’ fees, netting $3.1 billion in savings between 2006 and 2010. This research has given fuel to initiatives in Congress to approve tax exempt status (via health and flexible spending accounts) for certain supplements eligible for existing FDAapproved qualified health claims.

Fat Science

A catalyst for this momentum of EFA awareness and acceptance has been continued research. As evidenced by the FDA qualified health claim, the effect of omega-3s on CHD is a staple in EFA research. In 1960, scientists investigated the low CHD death rate among Greenland Eskimos, finding mortality from CHD (based on a 20-year follow-up) was more than 50-percent lower among those who consumed at least 30 g of fish per day, compared to those who did not eat fish.¹ This area of research has since blossomed.

In 2005, Harvard researchers found consumption of tuna or other broiled or baked fish is associated with decreased risk of ischemic stroke, while fried fish or fish sandwiches were linked to higher stroke risk.²

Simopoulos counted two recent heart disease studies as some of the most exciting EFA research of the past year. In the one study, Harvard Medical School researchers studied the antiarrhythmic effects of omega-3 fats in fish oil, randomly assigning fish oil or olive oil supplements for 12 months to patients at high risk for fatal ventricular arrhythmias.³ The results provided evidence that regular daily intake of fish oil EFAs may significantly reduce potentially fatal ventricular arrhythmias by as much as 30 percent.

In the other study, conducted at Brigham and Women’s Hospital, Boston, intake of ALA was inversely associated with risk of sudden cardiac death (SCD), but had no significant effect on other CHD death, including heart attack.⁴ Researchers showed ALA resulted in a 38-percent to 40-percent reduction in SCD risk.

Arrhythmia and CHD mortality have been hot areas of EFA research. In one 2005 study, fish oil supplementation failed to reduce risk of certain arrhythmic events in patients with implanted cardioverter-defibrillators (ICDs) and previous arrhythmic episodes.⁵ However, a similar study, which found 1.5 g/d of marine EFAs did not decrease premature ventricular complexes in patients with arrhythmia, concluded fish oil decreased heart rate significantly, possibly lowering risk of SCD.⁶

In a similar vein, supplementation with omega-3 EFAs from either fish oil or soy oil in elderly patients was shown to increase heart rate variability (HRV), a measure of cardiac function.⁷ Reduced HRV is associated with increased mortality and arrhythmic complications in patients who have had a heart attack or those at high risk for CHD.

On CHD mortality, researchers from Finland investigated the association of dietary LA and total PUFA intake with cardiovascular and overall mortality, finding total fat was not related to CHD death, while men with the highest levels of LA had a lower mortality rate than men with the lowest LA intakes.⁸ Serum and dietary LA and PUFA levels were also inversely related to overall mortality. A similar study comparing statin drugs with EFA supplements found the risk ratios for cardiac mortality decreased by 22 percent for statin drugs and 32 percent for omega-3 fatty acids.⁹ Gretchen Vannice, R.D., research coordinator for Nordic Naturals, praised a similar 2005 study, in which a systematic review found fish oil more favorably impacted risk of cardiac mortality than did statin drugs.¹⁰

While fish oil has dominated research on EFAs and heart health, Markham reported some of the most exciting recent research has shown the benefits of ALA alone on cardiovascular disease. “These findings were not just due to ALA’s ability to convert to EPA and DHA,” she noted. “Penny Kris-Etherton from Penn State University noted a diet high in ALA (from flaxseed) resulted in a 30-percent reduction in risk of CHD.”

Kris-Etherton, Ph.D., distinguished professor of nutrition sciences, and her colleagues from Penn State assessed inflammatory markers, lipids and lippoproteins in hypercholesterolemic subjects fed diets low in saturated fat and cholesterol, and high in PUFAs, varying ALA and LA.¹¹ They discovered both the ALA and LA diets decreased C-reactive protein (CRP) and intercellular cell adhesion molecule-1 (ICAM-1), but ALA led to a greater reduction of vascular cell adhesion molecule-1 (VCAM- 1) and E-selectin, compared to LA. They concluded ALA and LA can similarly decrease serum total cholesterol, LDL cholesterol and triglycerides, while ALA alone appears to decrease CVD risk by inhibiting vascular inflammation and endothelial function beyond lipid-lowering effects.

This effect on inflammation has carried over into research on EFAs and immune problems, including cancer. A late 2004 review revealed omega-3 fatty acids may be an effective, nontoxic adjunct to conventional cancer treatments and alternative therapy for patients who are not candidates for standard toxic cancer therapies.¹² Among the possible mechanism of action behind this effect was modulation of both eicosanoid production and inflammation. Kris-Etherton and her research team confirmed this mechanism of action in a 2005 study, which indicated PUFAs possess anti-inflammatory effects in human mononuclear leukemic THP-1 cells, including inhibition of NF-kappaB activation via activation of PPARgamma.¹³

Joiner-Bey said the highlights of EFA research were findings that EPA and ALA could be instrumental in prevention of a number of cancers, including breast and colon cancers. “We are now seeing ALA from flaxseed oil helps reduce metastasis relative to breast cancer, but recent research has also found inhibition of development of colon cancer tumors in lab animals nourished with ALA and induced with known carcinogens,” he said. However, he added there are other possible mechanisms of action not associated with anti-inflammatory prostaglandins. “There are other things going on besides the production of local hormones, but scientists do not yet fully understand these other actions,” he reported.

One recent study reported EPA and DHA from fish oil demonstrated strong anti-breast cancer properties, especially when combined with propofol, a popular general anesthetic-sedative reported to have anticancer properties.¹⁴ The researchers concluded, “It is possible that these conjugates provide a mechanism, whereby propofol can be retained in cell membranes for a longer duration and therefore enhance its anticancer effects.”

A review by Simopoulos, published in 2005, reported recent intervention studies in breast cancer patients indicate omega-3s, particularly DHA, increase the response to chemo-preventive agents.¹⁵ She further noted DHA and EPA decrease cell proliferation and, in patients with colorectal cancer, favorably modulate the balance between colonic cell proliferation and apoptosis.

Yet another recent study found oral administration of omega-3 fatty acids to cancer patients for five days prior to surgery may improve preoperative nutritional status, as well as preoperative and postoperative inflammatory and immune responses.¹⁶ The immune system is responsible for the inflammation response that can cause various other health problems, such as asthma, IBDs and rheumatoid arthritis.

Excess production of eicosanoids by omega-6 AA has been implicated as a biochemical trigger for inflammation associated with asthma. Omega-3 supplementation has been indicated to suppress some of these leukotrienes, and epidemiological evidence suggests fish consumption can benefit lung function and asthma prevalence.¹⁷ Two influential factors of asthma in children are sensitivity to dust mites and the preventive effect of omega-3 EFAs. Scientists from Australia, where asthma is the leading cause of morbidity in children, found omega-3 supplementation may curb development of allergic sensitization and airways disease in early childhood.¹⁸ Additional studies by this research team provided evidence a diet of decreased omega-6s and increased omega-3s can help protect children from symptoms of asthma,¹⁹ in addition to showing higher plasma concentrations of omega-3s correlates to reduced asthma symptoms, including wheeze, nocturnal coughing, bronchodilator use and doctor visits.²⁰

In related respiratory research, EFAs have been shown to reduce pulmonary inflammation, increase oxygenation and improve clinical outcomes in cases of acute respiratory distress syndrome (ARDS),²¹ especially in athletes.²² Another respiratory condition, pneumonia, which involves inflammation of aveoli triggered by infection, can be inhibited by omega-3 EFAs. In one recent study, researchers found pneumonia risk decreased 4 percent and 31 percent for every 1 g/d increase in LA intake and ALA intake, respectively, while EPA and DHA supplementation had no significant effect.²³

Inflammation is also central to development and progression of rheumatoid arthritis (RA), which has been modulated by EFAs in numerous clinical trials. Fish oils have been shown to control prostaglandins and other inflammatory components,²⁴ and has significantly improved RA symptoms, including tender and swollen joints, morning stiffness, joint pain, fatigue and grip strength.²⁵ Most recently, 24 weeks of supplementation with a combination of fish oil and olive oil proved more beneficial than fish oil alone in improving symptoms of RA, including join pain intensity, handgrip strength, duration of morning stiffness, onset of fatigue and other motor activities.²⁶

“Individuals often need to consume higher doses initially, and then reduce levels for maintenance,” Vannice noted. “Meaningful relief [from RA] is generally felt within four to six weeks of supplementation, with optimal improvement at four to five months.”

Other EFAs have also been shown effective: GLA inhibited pro-inflammatory IL-1 and TNFalpha;²⁷ evening primrose oil addressed inflammation causes of RA, reducing pain and morning stiffness.²⁸ borage seed oil reduced prostaglandins and leukotrienes, as well as AA oxygenation in RA;²⁹ and black currant oil, which contains both GLA and ALA, decreased inflammatory prostaglandin activity.³⁰ On the subject of bone and joint health, a low omega-6-toomega- 3 ratio has been linked to improved bone mineral density (BMD),³¹ and EFAs have been found to inhibit osteoclast generation and activation.³²

Still other inflammatory conditions have benefited from EFA supplementation. This past year, researchers from England discovered dietary supplementation with fish oil plus vitamins A, C, E and selenium altered the EPA and DHA composition and inflammatory function of circulating mononuclear cells Crohn’s disease (CD), a GI inflammatory condition associated with bone disease.³³ And, the severity of atopic dermatitis, inflammation of various skin cells, has been improved by both omega-3 fish oil and omega-6 soybean oil.³⁴

Inflammation is only one aspect of eye health EFAs might modulate, as omega-3 long-chain PUFAs may be protective against ischemia-, light-, oxygen-, inflammatory- and age-associated pathology of the vascular and neural retina.³⁵ In other eye research, an increased ratio of omega-6 to omega-3 consumption significantly increased the risk of dry eye syndrome, while higher consumption of tuna reduced the risk.³⁶

In fact, EFAs comprise the infrastructure of lipid-rich eye cells and can promote retinal development in fetuses and children. Researchers from Texas A&M University, College Station, found long chain PUFAs enrich plasma DHA, leading to improved visual performance in an animal study.³⁷ They reported preformed dietary PUFAs were more effective than ALA in raising plasma DHA during perinatal development and improving visual performance. Other researchers reported DHA supplementation in breastfeeding mothers increases infant plasma phospholipid DHA levels, improving not only eye development but also brain development in offspring—as assessed by the Bayley Psychomotor Development Index at 30 months of age.³⁸

Omega-3 supplementation in growing and developing children was one of the most exciting areas of EFA research this past year, according to Doug Bibus, Ph.D., director of Lipid Technologies and faculty member of the Center for Spirituality and Healing at the University of Minnesota. “Last year we again repeated our earlier findings that school age children have very low levels of omega-3 fatty acids in their blood, among some of the lowest levels we have tested in healthy persons,” he said. “Clearly deficits of these vital nutrients can have a negative impact on learning and behavior but may also begin to predispose our nations’ youth to disease at a much earlier age.”

Supplementation with omega-3 EFAs during pregnancy can lower the risk of premature birth and increase the length of pregnancy and birth weight by altering the balance of eicosanoids involved in labor and promote fetal growth by improving placental blood flow.³⁹ While experts have known EFAs can support brain development in fetuses and infants, DHA and other fatty acids can continue to improve development during and after birth.⁴⁰

Researchers from the University of Alberta found infant formula containing DHA from algal oil and AA from fungal oil improved growth and development in preterm babies.⁴¹ They noted the formula with DHA led to growth-by-weight results that rival term infants, while both EFA formulas were associated with better growth-by-length and improved mental and coordination development, per Bayley development scores.

In addition to fetal brain development, Bibus was equally enthusiastic about research on EFAs and adult neurological issues, especially depression and various psychiatric disorders—although such research is still in its infancy. Depression may be associated with an imbalance of EFAs in the brain, specifically between arachidonic acid (AA) and omega-3 EFAs, according to one recent study.⁴² The effect of EFAs on bipolar disorder may be due to its ability to reduce irritability associated with the condition, according to one study.⁴³ The researchers further suggested EFAs may alleviate the irritability component of different clinical conditions including schizophrenia and borderline personality disorder. A possible mechanism behind these benefits to mental health could be the ability of omega-3s, even in low doses, to impact levels of norepinephrine,⁴⁴ a neurotransmitter involved in the formation and function of dopamine and serotonin in the brain, as well as function of various organs and vascular function in the central nervous system. This action might also be behind research success by EFAs on developmental coordination disorder (DCD),⁴⁵ Attention Deficit Hyperactivity Disorder (ADHD) and other related disorders marked by inattention, hyperactivity and disruptive behaviors.⁴⁶

Retailing Quality EFA Products

The science of EFAs and their many health benefits is only one part of the potential success of this retail category. EFAs are liquid at room temperature, which leaves them vulnerable to numerous threats to their quality.

“EFA oils are very delicate and sensitive to the effects of heat, light and oxygen,” Duncan explained. “To preserve the valued nutrients, EFA oils must be processed at low temperatures (cold-pressed) with restricted exposure to light and oxygen.” She said Omega Nutrition uses its Omegaflo® process, which involves processing flax oil at low temperatures and packaging the oils in complete exclusion of light, oxygen and reactive metals using opaque bottles. She added refrigeration is the optimal storage for EFA products.

In ensuring freshness and quality of its flax oils, Spectrum Organics utilizes a proprietary three-step organic filtration process to eliminate potential airborne impurities, such as mold or mildew. “Our EFA oils are packaged in argon flushed, 100-percent opaque black bottles, and we ship all of our liquid flax oils refrigerated,” Markham said.

According to Benoit, liquid fish oil products should also be refrigerated after opening, helping them stay fresh for about two to four months. Because of its sensitivity to heat, liquid fish oil should not be used for cooking. “Encapsulated products do not require refrigeration and will keep for roughly the same period of time,” she said, adding it is important to store any EFA products away from direct sunlight and high temperatures. “Nordic Naturals uses a nitrogen exclusive manufacturing, encapsulating, and bottling process which enables us to maintain the integrity of the fish oil right as it was in the fish itself.”

Joiner-Bey, who advocates using flaxseed oil as food—on salads and oatmeal, for example—while using fish oils as supplements, noted, “While refrigeration does slow down the degradative process, any opened oil needs to be used within 30 days to avoid rancidity.” He added Barlean’s only makes the oil after the retailer orders it, basically delivering two-day-fresh oils, as opposed to having them pre-made and sitting in a warehouse for weeks or months.

In manufacturing its fish oil products, the Coromega emulsion stabilizes the omega-3 fatty acids, further protecting them from oxidation and rancidity, according to Staci Eisner, Coromega scientific advisory board member. “We’ve also conducted real-time stability monitoring of our product over years of room temperature storage.” On packaging, she noted some fish oil capsules in large bottles can suffer prolonged exposure to oxygen during the months the capsules are being consumed. Coromega is packaged under nitrogen in single-serve opaque packages, thus minimizing exposure of the omega-3 oils to light and oxygen.

In the EFA market, freshness goes hand-in-hand with taste. “Many fish oils cause an unpleasant ‘repeat’ or fishy taste and fishy burps,” Benoit said. She reported while Nordic Naturals flavors its fish oil products, they would not taste fishy without the flavoring, because they are already held to strict, third-party-verified freshness standards. Other companies, including Coromega, also flavor their fresh fish oils.

Fish oils are also plagued by environmental issues including contamination of fish supply and over-fishing certain species. Environmental Defense (www.oceansalive.org) is an organization intent on tracking and reporting on the environmental practices and products quality of fisheries and fish oil suppliers and manufacturers. In 2005, the group conducted a survey to see which major U.S. producers of fish oil supplements purify their products to reduce or remove contaminants like mercury, PCBs and dioxins. Of the 75 companies that volunteered quality assurance information, the majority most purify their fish oils to stringent safety standards. Coromega, Nordic Naturals, Spectrum Organics, Health From The Sun, and Ocean Nutrition Canada all won top ratings.

“Coromega fish oils come from a variety of types of fish, primarily sardines and anchovies,” said Eisner. “Our fish are harvested in the clean, unpolluted waters of the rich fisheries off the coast of Peru.” The company is also routinely tested by third party certifiers, such as NSF International and no significant levels of contamination have ever been found, according to Eisner.

According to Markham, Spectrum fish oil comes from non-threatened species of wild-caught, small, plankton-feeding fish (anchovies, mackerel and sardines) that are low on the food chain. “Harvesting these types of fish also ensures that our oil tests below acceptable limits of harmful contaminants set by the Council for Responsible Nutrition and other advisory agencies,” she added.

Retailers have a huge responsibility to help their consumers understand the benefits of EFA products, as well as to ensure consumers are provided the highest quality EFA products available. The best manufacturers of these products are eager to share information on not only the latest research and the details of their quality processes, but also on recommended dosages and benefit timelines. For instance, Joiner-Bey, who has been a health care practitioner, noted EFA products are not magic bullets, but take a while to manifest in a noticeable benefit. It takes time for the ratio of EFAs to adjust at the cell membrane level.

He also recommended one tablespoon of flaxseed oil per 100 pounds of body weight (adjusted down for children), and recommended any high quality fish oil that would provide at least 500 mg/d to 1,000 mg/d of EPA and DHA. “We have answers that retailers and consumers just don’t know about or seek out, thus the major educational gap,” he added said. “It is going to take a cultural revolution and educational shift to really push awareness of EFAs into all corners of the population.”