Omega 3 fatty acids an untapped resource for improving health
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Omega-3 Fatty Acids: An Untapped Resource for Improving Health. R. Curtis Ellison, MD Professor of Medicine & Public Health Director, Institute on Lifestyle & Health Boston University School of Medicine Boston, MA,. Omega-3 Fatty Acids. * Certain plants contain alpha-linolenic acid (ALA)

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Omega-3 Fatty Acids: An Untapped Resource for Improving Health

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Omega 3 fatty acids an untapped resource for improving health

Omega-3 Fatty Acids: An Untapped Resource for Improving Health

R. Curtis Ellison, MD

Professor of Medicine & Public Health

Director, Institute on Lifestyle & Health

Boston University School of Medicine

Boston, MA,


Omega 3 fatty acids

Omega-3 Fatty Acids

* Certain plants contain alpha-linolenic acid (ALA)

(plankton, flaxseed, canola oil, soy bean oil)

* When fish eat plankton, ALA is changed into

“fish oils” (EPA and DHA)

* Humans get omega-3 from fish or fish oils (EPA,

DHA), or from plants, especially canola oil (ALA)


Omega 3 fatty acids chd

Omega-3 Fatty Acids & CHD

Many studies have shown that fish consumption decreases coronary heart disease (CHD)

Many studies have shown that taking fish oils decreases CHD, especially sudden death

Limited studies on ALA, but ALA has potential advantages over fish oils


Diet coronary heart disease chd

Diet & Coronary Heart Disease (CHD)

Before WWII, CHD uncommon

In 1950’s-60’s, CHD became an “epidemic,” killing 2 million/yr in US

Stimulated research on CHD by epidemiologists


Epidemiologists what do epidemiologists do

Epidemiologists?What Do Epidemiologists Do?

We count bodies!

400 dead bodies in one group

200 dead bodies in another group


What else do epidemiologists do

What Else Do Epidemiologists Do?

We try to determine what

is causing the difference?

(Are differences in diet explaining the differences

in deaths between the two groups?)


The seven countries study

The Seven Countries Study

* Cohorts of healthy men recruited in 7

countries (Greece, Italy, Yugoslavia, Holland, Finland, USA, Japan)

*Diet and other lifestyle factors assessed,

laboratory tests done in early 1960s

* Subjects followed over > 25 years


Coronary heart disease seven dietary factors ulbricht and southgate lancet 1992

Coronary Heart Disease: Seven Dietary Factors(Ulbricht and Southgate, Lancet, 1992)

Dietary Promoting Factors?

Saturated fatty acids

* Hypercholesterolemic Fatty Acids

(12:0, 14:0, 16:0)

* Thrombogenic Fatty Acids

(14:0, 16:0, 18:0)


Lowering saturated fat cvd results from 27 randomized trials

Lowering Saturated Fat & CVD: Results from 27 Randomized Trials

Total mortality RR = 0.98 (0.86-1.12)

CV mortality RR = 0.91 (0.77-1.07)

CV events RR = 0.84 (0.72-0.99)

BMJ 2001;322:757-63


Coronary heart disease seven dietary factors ulbricht and southgate lancet 1991

Coronary Heart Disease: Seven Dietary Factors(Ulbricht and Southgate, Lancet, 1991)

Protective Factors

Polyunsaturated Fatty Acids, n-6 Series

18:2 – linolenic acid

Polyunsaturated Fatty Acids, n-3 Series

18:3 – alpha-linolenic acid

20:5 – eicosapentanoic acid (EPA)22:6 – docosahexanoic acid (DHA)

Monounsaturated Fatty Acids

18:1 – oleic acid

Dietary Fiber

Antioxidants


Seven countries study review by professor serge renaud

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Seven Countries StudyReview by Professor Serge Renaud

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Fatty acids from cholesterol esters

Fatty Acids from Cholesterol Esters


The lyon diet heart study professor serge renaud

The Lyon Diet Heart StudyProfessor Serge Renaud

•A clinical trial of post-MI patients comparing

a Cretan-based “Mediterranean diet” with the

usual diet advised, a low-fat & cholesterol diet.

•Used a Canola-oil based margarine to replace

butter; urged use of olive or canola oil instead of

vegetable oils high in linoleic acid.


The lyon diet heart study the six dietary commandments

The Lyon Diet Heart StudyThe Six Dietary Commandments

- More bread

- More vegetables and legumes

- More fish

- Less meat (beef, lamb, pork), replaced by poultry

- No day without fruit

- No more butter and cream, replaced by supplied margarine made from canola oil.


The lyon diet heart study results

The Lyon Diet Heart StudyResults

• Trial stopped early by Monitoring Board because of unacceptably higher CVD rates in control group (low-fat diet).

•Mediterranean alpha-linolenic acid rich diet in the secondary prevention of coronary heart disease. De Lorgeril M, Renaud S, Mamelle N, et al. Lancet 1994;343:1454-9.

• Cretan Mediterranean diet for prevention of coronary heart disease. Renaud S, de Lorgeril M, Delaye J, et al. Am J Clin Nutr 1995;61:1360S-7S.


The lyon diet heart study cvd recurrence during 27 mth follow up

The Lyon Diet Heart StudyCVD Recurrence During 27-mth Follow Up


The lyon diet heart study intake of foodstuffs g day

The Lyon Diet Heart StudyIntake of Foodstuffs (g/day)


The lyon diet heart study plasma fatty acids at 8 weeks

The Lyon Diet Heart StudyPlasma Fatty Acids at 8 Weeks


Omega 3 fatty acids an untapped resource for improving health

The Lyon Diet Heart StudyCardiac Death and Non-fatal MI(46 months follow up)

Cretan diet 0.28 (95 % C.I. 0.15-0.53)

18:3 (n-3)*0.20 (95 % C.I. 0.05-0.84)

* 18:3(n-3) plasma levels at 2 months, adjusted for age,

sex, smoking, cholesterol, BP, other risk factors


Ala and chd studies showing protective effects

ALA and CHDStudies Showing Protective Effects

Proc Soc ExpBiolMed 1992;200:177-82.

Prospective study in 6,250 men (death )

BMJ 1996;313:84-90. Prospective study in health

professionals (non-fatal MI )

Am J Clin Nutr 1999;69:890. Prospective study

in 70,000 nurses (cardiac death )


Dietary linolenic acid and coronary heart disease

Dietary Linolenic Acid and Coronary Heart Disease

The NHLBI Family Heart Study

Luc Djoussé, James S. Pankow

John H. Eckfeldt, Aaron R. Folsom

Paul N. Hopkins, Michael A. Province

Yuling Hong, R. Curtis Ellison


Odds ratio of chd by linolenic acid intake men

Odds Ratio of CHD by Linolenic Acid Intake (Men)


Odds ratio of chd by linolenic acid intake women

Odds Ratio of CHD by Linolenic Acid Intake (Women)


Odds ratio of chd by fish intake

Odds Ratio of CHD by Fish Intake


Clinical trials showing that n 3 fatty acids prevent chd

Clinical Trials Showing that N-3 Fatty Acids Prevent CHD

Intervention trials demonstrate the inverse association between n-3 fatty acids and CHD without changes in serum cholesterol

Risk Ratio

N N-3 Cardiac Death Non fatal MI

DART 2,000 Fish 0.701.00

GISSI 11,000 Fish oil 0.80 0.96

Lyon 600 Canola oil 0.24 0.27

India 1,000 Mustard oil 0.33 0.47


Advantages of canola oil over fish oils for preventing chd

Advantages of Canola Oil Over Fish Oils for Preventing CHD

* Many people do not like to eat fish

* The usual fried fish consumed in US has very

low levels of fish oil (and who likes mackerel?)

* Increasing concerns about organic chemical

contamination of fish and fish oil

* Data are beginning to show better protection

against CHD from ALA rather than fish oils


Time to change to a mediterranean type diet with canola oil

Time to Change to a Mediterranean-type Diet with Canola Oil?

Yes!


Mediterranean type diet

Mediterranean-type Diet

* A diet that is preferable to the very low-fat diets of the American Heart Association

* Preferable to the very low-carbohydrate diets (Atkins, South Beach, etc.)

* Canola Oil and canola oil-based margarine belong on the Med-Diet (avoid trans fats!)


Is the mediterranean type diet acceptable in north america

Is the “Mediterranean-type Diet” Acceptable in North America?

  • Our Institute developed such a diet

  • Used olive oil and canola oil-based margarine

  • Tested in people in Boston on a strict low-fat diet following heart surgery

  • Tested among African-Americans with heart disease in South Carolina


Testing a med diet in south carolina comments from 27 african american subjects

Testing a Med-Diet in South CarolinaComments from 27 African-American Subjects

“ I was very pleasantly surprised how

delicious the meal was.”

“ It contained more fats and oils that my

current diet, so the meal was a treat!”

“ This diet is something I can live with.”


Summary

Summary

* Diet affects the risk of CHD and death

* The “Mediterranean-type diet” seems to

be the healthiest option

* Canola oil & canola oil-based margarine:

key components of this “Healthy Diet”


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