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Omega-3 Fatty Acids Fact Sheet No. 9.382 and Nutrition Series|Health

by L. Bellows, J. Clifford, K. Niebaum, and M. Bunning (6/2015) What are Omega-3 Fatty Acids? by decreasing arrhythmias, blood clot Quick Facts formation, blood , growth rate Omega-3 fatty acids are components of atherosclerotic build-up, blood pressure • The three main omega-3 fatty of in we eat. The term omega and , not to mention they and number three refer to the chemical acids are: alpha-linolenic acid may improve the function of artery cells. (ALA), structure of the . The 2010 U.S. Dietary Guidelines Advisory (EPA) and There are three main omega-3 fatty Committee concluded moderate evidence acids: shows that consumption of two servings of (DHA). 1. Alpha-linolenic acid (ALA) is the most seafood per week (4 oz per serving), which • ALA comes from plants. EPA and common omega-3 fatty acid in the western provide an average of 250 mg per day of DHA come from . DHA may diet. It comes from plants, and is found in long-chain n-3 fatty acids, is associated with vegetable , primarily flaxseed, , reduced cardiac mortality from coronary be available in certain fortified canola and soybean oils. ALA is a dietary heart disease or sudden death in persons foods (eggs, milk). essential fatty acid; we must eat it because with and without heart disease. our bodies require ALA but cannot make • The most potent health Primary prevention of coronary heart it and use it to form the functionally disease benefits come from EPA + DHA essential omega-3 fatty acids, EPA and DHA. For healthy adults without prior heart (a combination of EPA and Although the American diet contains the disease, omega-3 fatty acids (EPA + DHA). Evidence is compelling recommended amount of ALA, it is not DHA) may reduce the risk of death from well converted to EPA and DHA. Therefore, for heart health and infant cardiac events. ALA also appears to have a brain development. Emerging preformed EPA and DHA are required for protective effect for the heart. Higher ALA research suggests benefits optimal health in most people, especially intake is associated with a reduced risk of during periods of rapid growth and heart disease, especially in populations for many other conditions development such as pregnancy and in the with low levels of fish consumption. including perinatal depression first year of life. Secondary prevention of coronary heart and protection against 2. Eicosapentaenoic acid (EPA) and disease dementia in the elderly. 3. docosahexaenoic acid (DHA) are known For adults with established coronary as the “long-chain” or marine omega-3 fatty heart disease who have a high risk of • Consuming 1-2 servings of fish acids since they are mainly found in fish subsequent cardiovascular events, omega-3 per week (4 ounces/serving), and fish oils. EPA and DHA have the most fatty acids (EPA + DHA) may reduce the risk potent health benefits of the omega-3 fatty supplementing with fish and non-fatal heart attacks, non-fatal strokes choosing fortified foods are the acids. Unfortunately, they are especially low and death from . best ways to add EPA + DHA to in the American diet, and since conversion The strongest evidence relates to the of ALA to EPA and DHA is poor, increasing prevention of sudden cardiac death (due to your diet. intake of EPA and DHA has the potential to arrhythmias), which claims approximately significantly improve health. 500,000 lives per year in the United States. Omega-3 fatty acids stabilize the heart’s © Colorado State University What are the benefits of rhythm and prevent potentially fatal, erratic Extension. 9/10. Revised 7/15 rhythms. including omega-3 fatty acids extension.colostate.edu Lowering blood triglycerides. in your diet? It is well established that omega-3 fatty Strong evidence for heart health acids from fish lower blood triglycerides. The biggest benefits from including Triglycerides (TG) are fats in your blood; omega-3 fatty acids in your diet relate to their presence in blood is normal. heart disease. Omega-3s protect the heart *July, 2015, reviewed and revised by Colorado State University Jessica Clifford, Research Associate and Extension Specialist and K. Maloney, graduate student in the Dept of . Original publication by L. Bellows and M. Bunning, Colorado State University Extension food and nutrition specialists and assistant professors, food science and human nutrition: M. MacDonald, graduate student and intern 9/2010 High levels (TG ≥ 150 mg/ dL), however, may be a risk factor Table 1. Dietary Recommendations for heart disease, especially in Omega-3 fatty acid AND (Academy for Nutrition and AHA combination with high LDL (bad) Dietetics (American Heart Association) or low HDL (good) ALA (g/2000 cal) 1.3 - 2.7 g - cholesterol. EPA and DHA lower EPA + DHA (mg/day) 500 mg 2 fish servings*/week triglycerides in your blood by (equals about 500 mg/day) decreasing your body’s ability to *A serving is considered 4 ounces. make triglycerides. High levels (TG ≥ 150-499 Table 2. Recommendations for Populations: AHA Scientific Statement* mg/dL) call for diet and lifestyle modifications, including eating Population AHA Recommendation two servings of oily (dark People without documented heart disease Eat a variety of fish (preferably oil) 2x/week, meat) fish per week. Very high include oils and foods rich in ALA triglycerides (TG ≥ 500 mg/dL) People with documented heart disease Consume ~1 g EPA + DHA per day, preferably from require an amount of that fish; use supplements with physician supervision is difficult to achieve with diet, People who need to lower triglycerides Table 2-4 g EPA + DHA per day provided as a and supplementation is needed. capsule under physician supervision A dose of 2-4 grams of EPA + DHA *Kris-Etherton, Harris, Appel, Circulation, 2002;106:2747-2757. per day given as capsules may lower very high triglycerides by 20 percent to 50 percent. Triglycerides neurotransmitter function. DHA is can come down significantly mg of DHA per day during pregnancy and also a major fatty acid in the retina. as well as quickly. All treatment lactation. Infants acquire DHA from their should be provided under medical mothers. It accrues rapidly in the supervision. brain during the third trimester Emerging Research for Many Hypertension. and the first six weeks of life. DHA Hypertension is the diagnosis Other Health Benefits naturally occurs in human milk, and Emerging research indicates that of high blood pressure (blood omega-3 supplementation during the benefits of omega-3 fatty acids may pressure 140/90 mmHg); it is an pregnancy and lactation increases extend well beyond heart health and independent risk factor for heart levels of DHA in breast milk as well maternal/infant health. Omega-3 fatty disease. Studies show that a high as the infants. Since FDA approval in acids may be of benefit in conditions level of supplementation with 2001, infant formula is supplemented ranging from rheumatoid arthritis and EPA + DHA (4-6 g/day) slightly with DHA to support optimal brain lupus, from major depression and bipolar reduces blood pressure. Since and eye development. disorder to crohn’s disease and ulcerative dietary and lifestyle modifications The significance of DHA for brain colitis, from Alzheimer’s disease and as well as medications are effective and eye development is widely schizophrenia to eczema and cancer. at lowering blood pressure, recognized, and evidence has A few notable and promising areas are omega-3 supplementation may emerged to demonstrate that DHA highlighted below. have a limited role in managing supplementation during pregnancy, hypertension. DHA and Alzheimer’s Disease. lactation or infancy improves mental Alzheimer’s disease is the most and visual development in infants. common cause of dementia in elderly DHA and Maternal/ Emerging research suggests that adults. Research suggests that lower DHA Infant Nutrition and DHA supplementation reduces the levels are a risk factor for Alzheimer’s, Infant Development risk for early premature birth. possibly because DHA may inhibit the DHA is important for The Institute of Medicine (IOM) progression of the disease. It is unknown, the structure, growth and recommends a daily intake of however, if DHA supplementation can development of the fetal central 1.4 g/day of alpha-linolenic acid help treat the disease in humans. On- nervous system and retina. during pregnancy and lactation going clinical trials are investigating the Comprising roughly 30 percent but currently there is not a effect of DHA supplementation on the of the fetal brain’s weight, DHA Recommended Dietary Intake genesis and progression of Alzheimer’s. is a major part of fetal neural for EPA or DHA. However, the Rheumatoid Arthritis. tissue, and it maintains good European Perilip Group of clinicians Rheumatoid arthritis is a chronic and experts in omega-3 research, disease that involves inflammation of currently recommend at least 200 the joints. Studies have demonstrated Table 3. What are the best sources of omega-3 fatty acids? that fish oil supplementation decreases Oils, Nuts, Seeds and Other* the number of painful/tender joints, pain Content of ALA in commonly consumed oils, nuts, and other foods intensity, duration of morning stiffness Oil ALA (g/Tbsp) Nuts ALA (g/oz) Seeds ALA (gTbsp) and even the need for anti-inflammatory medication. Due to weaknesses in the Flaxseed 7.2 2.5 Flaxseeds 2.4 current research, however, better studies Walnut 1.4 Pecans 0.3 Pumpkin Seeds 0 are needed to confirm these benefits. Canola 1.3 Peanuts 0 Sunflower 0 Seeds Soybean 0.9 Pistachios 0 Fortified Foods Many foods in the marketplace are Corn 0.2 0 being fortified with omega-3 fatty acids. Olive 0.1 Cashews 0 Other Keep in mind the following: Sunflower 0 Hazelnuts 0 Tufu (1/2 cup) 0.4-0.7 • What kind of omega-3 fatty acids have Pine Nuts 0 Soybeans (1/2 0.5 been added to the food is important. cup) You are interested in alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and Table 4. Fish (DHA). Since omega-3 fatty acid source Content of EPA + DHA in 37 commonly consumed types of fish* and content varies by brand, make Fish mg/3 oz serving Fish mg/3 oz serving sure to read labels carefully or contact the manufacturer. Atlantic Salmon 1825 Blue Crab 403 (farmed) • How much ALA, EPA and/or DHA is in the food is also significant. Look at Pacific Herring 1807 Halibut 395 the label to determine exactly how Atlantic Herring 1712 Oysters (farmed) 374 many milligrams you are getting Atlantic Salmon (wild) 1564 King Crab 351 per serving. Know the serving size Bluefin Tuna 1279 Walleye 338 portion. Fortified foods frequently Pink Salmon (wild) 1094 Dungeness Crab 335 have surprisingly small quantities of Coho Salmon (farmed) 1087 Scallops 310 omega-3 fatty acids. • Consider whether any additional Sockeye Salmon (wild) 1046 Skipjack Tuna 278 cost is worth the kind and amount of Mackerel (canned) 1046 Mixed Shrimp 267 fortification. Chum Salmon (canned) 999 Clams 241 • Your goal should be to meet the Rainbow Trout (farmed) 981 Yellowfin Tuna 237 dietary recommendations of ALA, Coho Salmon (wild) 900 Light Chunk Tuna 230 EPA and DHA. Often the best way Sardines 835 Catfish (wild) 201 to do this is to eat the foods that are naturally high in these omega-3 fatty White Tuna 733 Catfish (farmed) 151 acids, such as fatty fish. Shark (raw) 711 Cod 134 Swordfish 696 Mahi-Mahi 118 Fish Oil Supplementation Sea Bass 648 Tilapia 115 Similar to fortified foods, it is Pollock 460 Orange Roughy 26 important to read the label to understand Flat Fish 426 how many milligrams of EPA and DHA are in each capsule. *Harris et al., 2008. Curr Atheroscler Rep. 10:503-509 Another useful measure of the quality of the supplement is the concentration of omega-3s in each capsule. A concentration of <50% is low; Table 5. Common Fortified Foods and Omega-3 Content you may not be getting a good value for Fortified food and Total omega-3 ALA (mg) EPA (mg) DHA (mg) your money and consuming unneeded serving size fatty acids (mg) additional calories. A concentration ≥ 50% Milk (8 oz) 32 32 is better. Determining the concentration Orange Juice (8 oz) 50 30 20 is best illustrated by example: • In a typical fish oil supplement, the DHA Egg (1 egg) 100-150 48 2 100-150 serving size is 1 - 2 softgels. Yogurt (4 oz) 16-32 16-32 Smart Balance Spread 352 320 32 (EPA + DHA) • If two softgels contain 780 mg EPA • Check local advisories about the and 400 mg DHA, then each softgel safety of recreationally caught fish for FDA. 2004. What You Need to Know About contains 390 mg EPA and 200 mg environmental contaminants, such Mercury in Fish and . Food DHA, for a total of 590 mg omega-3s as PCBs and dioxins, which occur and Drug Administration. Retrieved per capsule. in polluted waterways. Removing January 28, 2010. • The front of the supplement indicates skin and surface (especially back that each capsule is 1000 mg; 410 mg fat) before cooking seafood will Giuseppe, R., Roggi, C., & Cena, H. (2014). of other fats have been added to 590 minimize the exposure to these N-3 LC-PUFA supplementation: Effects mg omega-3s to make a 1000 mg contaminants. Information on on infant and maternal outcomes. Eur softgel. Therefore, the concentration advisories can be found at www.epa. Journal of Nutrition, 53(5), 1147-54. of omega-3s in each capsule = (590 gov/fishadvisories/. mg/1000 mg) x 100 = 59%. Fish oil supplements are typically Harris WS, Kris-Etherton PK. “The Truth For vegetarians, EPA and DHA purified and free of harmful levels of about PUFAs: Omega-3 and Omega-6.” supplements made from are mercury, PCBs and dioxins. Food & Nutrition Conference & Expo available. Many of these softgels are is not the best supplement for pregnant [Conference]. Denver. 19 Oct. 2010. gelatin capsules, but several true vegan mothers due to high levels of A. brands are available (check the label). Overall, the benefits of eating fish Harris WS, Kris-Etherton PM, Harris KA. They tend to be more expensive than and shellfish have been shown to far Intakes of long-chain omega-3 fatty other brands of DHA and/or fish oil. outweigh potential risks. Consumers acid associated with reduced risk for can safely eat cooked seafood regularly, death from coronary heart disease in Safety provided they eat a variety and follow healthy adults. 2008; 10: 503-509. Concerns exist about environmental local advice for recreationally-caught fish. toxins, including mercury, polychlorinated Harvard School of Public Health. biphenyls (PCBs) and dioxins, that may References 2010. Omega-3 Fats: An Essential contaminate seafood. Fish and shellfish AHA. 2014. Fish 101. American Heart Contribution. Retrieved January 20, are an important part of a healthy diet. Association. Retrieved January 3, 2015. 2010 from http://www.hsph.harvard. They contain high-quality , edu/nutritionsource/what-should- essential , and are low in Cicero, A., Derosa, G., Gregori, V., Bove, you-eat/omega-3-fats/index.html. saturated fats and high in omega-3 fatty M., Gaddi, A., & Borghi, C. (2010). acids. It is recognized that nearly all fish Omega 3 Polyunsaturated Fatty Acids Koletzko B, Lien E, Agostoni C, Bohles and shellfish contain mercury. While Supplementation and Blood Pressure H, Campoy C, Cetin I, Decsi T, the low levels are not a concern for the Levels in Hypertriglyceridemic Dudenhausen JW, Dupont C, Forsyth majority of healthy people, there are a Patients with Untreated Normal-High S, Hoesli I, Holzgreve W, Lapillonne few species of fish that contain higher Blood Pressure and With or Without A, Putet G, Secher NJ, Symonds M, levels that may harm an unborn baby or Metabolic Syndrome: A Retrospective Szajewska H, Willatts P, Uauy R. The young child’s nervous system. Therefore, Study. Clinical and Experimental roles of long-chain polyunsaturated the EPA and FDA advises women who Hypertension, 32(2), 137-144. fatty acids in pregnancy, lactation and may become pregnant, pregnant women, infancy: review of current knowledge nursing mothers and young children to Eilander A, Hundscheid DC, Osendarp and consensus recommendations. do the following: SJ, Transler C, Zock PL. Effects of n-3 Journal of Perinatal Medicine. • Avoid eating shark, swordfish, king long chain polyunsaturated fatty 2008;36(1):5-14. mackerel and tilefish (also known as acid supplementation on visual and golden bass or golden snapper) since cognitive development throughout Kris-Etherton PM, Harris WS, Appel LJ. they contain high levels of mercury. childhood: A review of human studies. Fish consumption, fish oil, omega-3 • Limit albacore (“white”) tuna to 6 , and fatty acids, and cardiovascular disease. ounces per week; albacore has more Essential Fatty Acids. 2007;76:189-203. Circulation. 2002;106:2747-2757. mercury than canned chunk light tuna. Farvid, M., Ding, M., Pan, A., & Sun, Q. Kromhout, D. (2012). Omega-3 fatty acids • Eat up to 12 ounces a week of various (2014). Dietary and and coronary heart disease. The final fish and shellfish that are lower in Risk of Coronary Heart Disease: A verdict? Current Opinion in , mercury, such as shrimp, canned light Systematic Review and Meta-Analysis 23(6), 554-559. tuna, salmon, pollock and catfish. of Prospective Cohort Studies. Circulation. Leaf, A. Prevention of sudden cardiac P. (2006). Plasma death by n-3 polyunsaturated fatty Docosahexaenoic Acid Content And Risk acids. Journal of Cardiovascular Of Dementia And Alzheimer Disease: The Medicine. 2007;8S:S27-S29. Framingham Heart Study. JAMA, 63(11), Oregon State University. 2010. Linus 1545-1550. Pauling Institute Micronutrient Information Center: Essential Fatty Wall, R., Ross, R., Fitzgerald, G., & Stanton, C. Acids. Retrieved January 26, 2010. (2010). Fatty Acids From Fish: The Anti- inflammatory Potential Of Long-chain Mahan, KL and Escott-Stump, S. Krause’s Omega-3 Fatty Acids. Nutrition Reviews, Food & Nutrition Therapy. 12th edition. 280-289. St. Louis, MO. Saunders Elsevier. Whelan, J, Jahns L, Kavanagh K. 2009. Purdue Research Foundation. 2010. Docosahexaenoic Acid: Measurements Omega-3 Fatty Acid Content of Food in foods and dietary exposure. Products (Natural and Enriched). Prostaglandins Leukot Essent Fatty Acids. Retrieved January 26, 2010. 81: 133-136.

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