Benefits and Risk of Omega-3 Fish Oil

1. Benefits and Risk of Omega-3 Fish Oil Presented By: Daniel Knausz Advisor: Dr. Bill Grimes April 18, 2008

2. Background on Omega-3 Fatty Acids • Fish Oil is extracted from the flesh of fish. It is primarily composed of two fatty acids known as Docosahexaenoic Acid (DHA) and Eicosapentaenoic Acid (EPA) and also contains smaller portions of Alpa-Linolenic Acid (ALA). • EPA and DHA acids are considered normal constituents of some human tissues, including brain cells, retina, adrenals, and sex organs; all the most active tissues in the body.

3. Background on Omega-3 Fatty Acids • These acids were given their name when researchers found that they were essential to normal growth in young children, thus they are defined as “Essential Fatty Acids.” • These acids can not be absorbed through the body, so it is up to our diet to determine the amount of Omega- 3 fatty acids in which we consume.

4. Background on Omega- 3 Fatty Acids • EPA and DHA are precursors to eicosanoids and provide an anti-inflammatory effect throughout the body • These fatty acids are used in the formation and fluidity of cell membranes, which help with maintenance of blood pressure and heart rate, nervous system function, and in hemostatic regulation, consisting of blood clotting and thromboxane production. • . EPA is a long chain fatty acid. It is the single vital nutrient that controls communication between nerve cells and the brain. • DHA is another long chain fatty acid. It is known as the building block of the brain cells since it is the most important component that makes up the brain

5. Background on Omega- 3 Fatty Acids • EPA and DHA fatty acids are more commonly found in cold water fish such as salmon and tuna. • This is one of the main reasons why people agree that these fish are good for our overall health • Omega-3 fatty acids can be purchased at any retail store and do not require a prescription or a medical practitioner referral. It is not expensive, usually ranging from $7 to $12 and usually come in capsules that contain 1000mg.

6. Background on Omega- 3 Fatty Acids • It can be taken up to three times daily and is usually more effective after a meal. The gel or capsule is usually enteric coated which protects the substances inside the capsule until it reaches the small intestine where it is readily absorbed. • Although, excess amounts of fish oil is harmful to the body, Fish oil supplements do not contain any form of mercury, according to the manufactures of the drug.

7. Prescription Fish Oil Supplements • There is currently one omega-3 medication that does require a prescription. This medication is generally used for those who have high triglyceride levels and its action is to significantly lower these unwanted levels • The medication is called Lovaza (Omega-3 acid ethyl ester), previous known as Omnicor, and is made up of a unique blend of EPA and DHA. These two substances are the main contributors to the lowering of triglyceride levels. • This medication is naturally derived and is also FDA approved. Lovaza does not have any drug abuse or withdrawal effects. • Lovaza capsules come in a 1G dose. The daily recommended dose is 4G per day. It can be taken as a single dose of 4 capsules or can be taken at two separate occasions that include 2G per dose. It is recommended that this product be taken with meals

8. Prescription Fish Oil Supplements • This drug is estimated to cost patients $300 per month if the patient does not have any health insurance. • Common makeup of Prescription Lovaza

9. Common problems with low intake of fatty acids • Some of the problems that can occur with low intake of Omega- 3 fatty acids include: dry, itchy skin, as well as coarse, bumpy patches on the skin, soft broken nails, dry, dull hair, and allergies. • Other problems can cause poor brain function and brain development in children.

10. Common Uses for Fish Oil • Heart problems, cholesterol, arthritis, and diabetes are some of the major conditions in which fish oil provides some form of benefit or improved health. • Fish oil supplements seem to have an anti-arrhythmic effect on the heart as well as prevent cardiac arrest. In doing this, fish oil can help lower the mortality rate of those individuals having heart complications • Fish oil can benefit the heart because the EPA and DHA that make up the supplement helps to prevent plaque deposits and blood clots inside arteries.

11. Common Uses for Fish Oil • Fish oil improves the ability of muscle cells to take up glucose in the presence of insulin. • This proves to be beneficial to those with type II diabetes.

12. Common Uses for Fish Oil • Fish oil helps with cholesterol by lowering levels of LDL while also increasing levels of HDL • This may limit the amount of prescription anti-hyperlipidemic drugs that a person might have to take in their lifetime. • Fish oil has been shown to influence cholesterol by altering the production and catabolsim rates of HDL apolipoproteins. • The high rates of HDL can lead to a decrease in atherosclerosis by eliminating excess cholesterol from arterial cells.

13. Common Uses for Fish Oil • Fish oil has been shown to have anti-inflammatory effects, especially the Eicosapentaenoic acids (EPA). They can improve overall function in joints as well as limit the amount of other anti-inflammatory drugs that a patient must consume with conditions such as arthritis or other inflammatory disorders such as Inflammatory Bowel Disease.

14. Common Uses for Fish Oil • Fish oil has been shown to have effects in dealing with certain psychological disorders. • It has been found that omega- 3 fatty acids are known to have membrane enhancing capabilities in brain cells. • They cause more production of two neurotransmitters, serotonin and dopamine. • This allows patients to focus better on tasks that are at hand without as many distractions. The effects of Serotonin have been shown to help individuals better deal with stress and other activities.

15. Common Uses for Fish Oil • Fish oil has also been shown to have a number of beneficial benefits on the brain • It has been shown that 60% of the brain is made up of a structural fat, which has a high number of DHA in it, and the brain requires a regular intake of good fats such as the ones from omega-3 fatty acids. • Low intake of omega-3 fatty acids can lead to conditions such as ADHD, dyslexia, depression, aggression, Alzheimer’s Disease, or other dementia.

16. Common Uses for Fish Oil • The fatty acids that make up fish oil have proven to be effective in autistic patients with those individuals taking the supplement improving in language and learning skills in at least 8 different testing areas. • Possible benefits to autistic patients showed decreases in hyperactivity in their behavior

17. Common Uses for Fish Oil • There have also been a number of small trials where fish oil has been proven to be effective in treating children with ADHD • In these studies, it was documented that students had a increase in school performance as well as a decline in restlessness. • This can benefit a child because Fish Oil has minimal side effects compared to the neuro stimulatory drugs that are usually prescribed for ADHD.

18. Common Uses for Fish Oil • There have also been studies that indicate that Fish Oil relates to the risk of cancer. • It has been shown to help prevent three of the most common cancers, which are breast, prostate, and colon. • Omega- 3 Fish oil may stop the alteration of a normal cell to a cancerous mass, they may inhibit unwanted cellular growth, and cause apoptosis of cancer cells.

19. Possible Contraindications to Fish Oil Use • Possible contraindications include those who are allergic to fish or have developed a hypersensitivity to fish products. • Any person that has a bleeding problem or who is currently taking warfarin or another anticoagulant therapy should probably not take this supplement. • Fish oil has been shown to lower blood pressure; those individuals who usually have low blood pressure should not take this supplement because it may lead to severe hypotension. • Some patients may also complain of skin rashes, in this event, the patient should stop taking the supplement. • Many patients will complain of a fishy aftertaste with the supplement and should be encouraged to take it with meals.

20. Conclusion • . There will be many patients who encounter their medical professionals to decide if this supplement is right for them • Fish Oil will be one of the main supplements that will be debated in a number of medical studies. • Providers should educate their patients about the overall benefits that can come from this alternative supplement as well as assess their risk • . Many people do not realize that the fatty acids that are found in fish oil are essential to our overall health. As healthcare providers, it is up to us to inform our patients about the valuable source of energy and nutrients that this supplement can offer.

21. References • American Heart Association, “Fish and Omega-3 fatty acids” Available at: http://www.americanheart.org/presenter.jhtml?identifier=4632 Accessed on: October 22, 2007 • Amminger GP, Berger GE, Schäfer MR, Klier C, Friedrich MH, Feucht M, “Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study,” Department of Child and Adolescent Neuropsychiatry, Medical University of Vienna, Vienna, Austria, 2007, Available at: http://www.ncbi.nlm.nih/gov/pubmed16920077?ordinalpos, Accessed on: February 6, 2008 • Barre, Douglas Edward, “The role of consumption of alpha-linolenic, Eicosapentaneoic and Docosahexanaeoic acids in Human Metabolic Syndrome and Type 2 Diabetes, A Mini Review,” Journal of Oleo Science, 2007, Available at: http://www.jstage.jst.go.jp/article/jos/56/7/319/_pdf, Accessed on: February 16, 2008 • Bauer, Joy, “Understanding and improving your Cholesterol,” NBC Today, October 2007, Available at: http://www.msnbc.msn.com/id/21072785/, Accessed on: February 18, 2008 • BBC News Report, Serhan, Dr. Charles, “Oily fish helps cut inflammation” 2005, Available at: http://news.bbc.co.uk/2/hi/health/4325679.stm Accessed on: October 22, 2007 • Biro, Andy MD, MSC, CCFP, “Clarifying Omega-3 fatty acid recommendations” Can FAM Physician, September 2006, Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17279211 Accessed on: October, 29, 2007 • Donadio JV, Bergstrahl EJ, Bibus DM, Grande, JP, “Is body size a biomarker for optimizing dosing of omega-3 polyunsaturated fatty acids in the treatment of patients with IgA nephropathy, Clinical Journal of American Society of Nephrology, 2006, Available at: http://cjasn.asnjournals.org/cgi/content/full/1/5/933 Accessed on: October 20, 2007 • Fishoil4health, Fish oil with Omega-3 fatty acids DHA and EPA, Available at: http://www.fishoil4health.com/ Accessed on: February 18, 2008 • Genuis, S.J., “time for an Oil Check: The role of essential Omega-3 fatty acids in maternal and pediatric health” Journal of Perinatology, 2006, Available at: http://www.nature.com/drugdisc/index Accessed on: October 20, 2007 • Harris, W.S., Isley, W.L., “Clinical Trial Evidence for the Cardioprotective of Omega-3 fatty acids,” Current Atherosclerosis Rep, 3: 174-197, 2001, Available at: www.fishoildirect.com/research.html Accessed on: February 18, 2008 • Holub, Bruce J., “treating Hypertiyglyceridemia” Canadian Medical Association Journal, September 11, 2007, Available at: • http://www.cmaj.ca/cgi/content/full/177/6/604 Accessed on: October 29, 2007 • Hooper, Lee, “Risks and benefits of Omega 3 fats for mortality, cardiovascular disease, and cancer”, British Medical Journal, 332: 752-760, April 2006, Available at: http://bmj.bmjjournals.com/cgi/reprint_abr/332/7544/752.pdf Accessed on: October 20, 2007

22. References • Maclean, Catherine H., MD, PhD, “Effects of Omega 3 fatty acids on cancer risk” Journal of the American Medical Association, January 2006, Available at: http://jama.amaassn.org/cgi/content/short/295/4/403 Accessed on: October 20, 2007 • MedlinePlus Herbs and supplements, Omega-3 fatty acids, fish oil, alpha-linolenic acid, Available at: http://www.nlm.nih.gov.medlineplus/druginfo/natural/patient-fishoil.html Accessed on: February 6, 2008 • Men’s Health, Complete Guide to Men’s Health, American Medical Association, 2001, pp. 43-49 • Mozaffarian, Dariush MD, Rimm, Eric B ScD, “Fish Intake contaminants and human health” Journal of the American Medical Association, October 18, 2006: Available at: http://jama.ama-assn.org/cgi/content/full/296/15/1885 Accessed on: October, 29, 2007 • Nordic Naturals, “Fish oil holds promise for those with Type II Diabetes”, 2006, Available at: http://www.hopegoss.com/frame.shtml?http://www.fishoilblog.com/, Accessed on: February 18, 2008 • Norris, Karen P. PharmD, “An evidenced-based medicine approach to the appropriate selection of supplementation with omega-3 fatty acids” Nordic Naturals, Inc., June 1, 2007, Available at: • http://www.powerpak.com/index.asp?page=courses/105467/disclaimer.htm&lsn_id=105467 Accessed on: February 10, 2007 • Pejic, RN, Lee, DT, “Hypertriglyceridemia,” Journal of the American Board of Family Medicine, 2006, Available at: http://www.jabfm.org/cgi/reprint/19/3/310, Accessed on: February 18, 2008 • Penny M. Kris-Etherton, PhD, RD; William S. Harris, PhD; Lawrence J. Appel, MD, MPH, for the Nutrition Committee, “Fish Consumption, Fish Oil, Omega-3 fatty acids, and Cardiovascular disease” American Heart Association, 2002, Available at: http://circ.ahajournals.org/cgi/content/full/106/21/2747 Accessed on: October 20, 2007 • Product Review, Omega-3 fatty acids (EPA and DHA) from fish/marine oils, Consumer lab, 2005, Available at: http://www.consumerlab.com/results/omega3.asp Accessed on: October 21, 2007 • Reliant Pharmaceuticals, Lovaza patient Information, Available at: http://www.omacorrx.com/ Accessed on: February 17, 2008 • Schubert, Charlotte, “Secret of Fish Oil’s health effects revealed” Nature Journal, Available at: http://www.nature.com/news/2005/050307/full/news050307-8.html Accessed on: October 28, 2007 • Svensson M, Schmidt EB, Jørgensen KA, Christensen JH OPACH Study Group., “N-3 fatty acids as secondary prevention against Cardiovascular Events in patients who undergo Chronic Hemodialysis: A Randomized, Placebo-controlled Intervention Trial, Clinical Journal of American Society of Nephrology, June 2006, Available at: http://cjasn.asnjournals.org/cgi/content/full/1/4/780 Accessed on: October 22, 2007 • Takahata K, Monobe K, Tada M, Weber PC., “The benefits and risks of n-3 polyunsaturated fatty acids” Faculty of Agriculture, Okayama University, Japan, November 1998, Available at: http://www.jstage.jst.go.jp/article/bbb/62/11/2079/_pdf Accessed on: October 21, 2007 • Terry P, Wolk A, Vainio H, Weiderpass E., “Fatty fish consumption lowers the risk of Endometrial Cancer” American Association for Cancer Research, January 2002, Available at: http://cebp.aacrjournals.org/cgi/content/full/11/1/143 Accessed on: October, 29, 2007 • University of Maryland Medical Center, Omega-3 fatty acids, Available at: http://www.umm.edu/altmed/conssupplements/omega3fattyacidscs.html Accessed on: October 21, 2007

23. References • Wang C, Harris WS, Chung M, “n-3 fatty acids from fish or fish oil supplements benefit cardiovascular outcomes in primary and secondary prevention studies: a systematic review, American Journal of Clinical Nutrition, 2006, 84: 5-17 • Wataru Matsuyama, MD, PhD; Hideo Mitsuyama, MD; Masaki Watanabe, MD, PhD; Ken-ichi Oonakahara, MD; Ikkou Higashimoto, MD, PhD; Mitsuhiro Osame, MD, PhD and Kimiyoshi Arimura, MD, PhD: “Effects of omega-3 polyunsaturated fatty acids on Inflammatory markers in COPD” American College of Chest Physicians, 2005, Available at: http://www.chestjournal.org/cgi/content/full/128/6/3817 Accessed on: October, 29, 2007 • Young GS, Conquer JA, Thomas R, “Effect of randomized supplementation with high dose olive, flax or fish oil on serum phospholipid fatty acid levels in adults with attention deficit hyperactivity disorder,” Reproduction, Nutrition, Development Sciences Journal, 2005, Available at: http://rnd.edpsciences.org/index.php?option=article&access=doi&doi=10.1051/rnd:2005045, Accessed on: February 6, 2008

24. Questions?