I like Dr. Oz.
But the popular TV doctor is off-target with his message on Omega 3 supplements.
To be fair, Dr. Mehmet Oz has done a lot for America’s health. He has a wonderful way of explaining complex medical symptoms and diagnoses to everyday TV watchers.
The problem with Dr. Oz and Omega 3 Supplements:
- He favors DHA Omega-3 over EPA Omega-3. He actively instructs his followers to avoid EPA.
- He believes EPA is not ‘really effective.’
- He believes EPA can cause increased bleeding.
Avoiding EPA entirely may be harmful, especially to Americans and those eating western diets – I’ll explain why in just a minute.
It’s true that DHA and EPA have slightly different roles in your body.
DHA is a STRUCTURAL Omega-3. That means the body uses it to build body parts, especially in fetus and children.
EPA on the other hand, acts as a ‘lubricant.’ It works through all stages of life to reduce inflammation and several diseases associated with it.
DHA is critical for pregnant women and children. Most of the Omega-3 in the brain, eyes, heart and other very active tissues is DHA.
DHA must be consumed by pregnant women to ensure proper development of the fetus. Research has shown that children of women who avoided fish during pregnancy had much lower IQ points than women who ate fish and consumed Omega-3 supplements during pregnancy.
Well, my argument with Dr. Oz is not with DHA and pregnancy, so let’s take that off the table.
My issue with his advice is the avoidance of EPA, an entire fatty acid!
All Omega-3 supplements should ideally provide BOTH DHA and EPA. A prenatal omega-3 supplement could have very high DHA and low EPA levels. That’s OK.
And an anti-inflammatory or anti-depressant focused Omega-3 supplement could have a high EPA to DHA ratio.
Looking at Nature for Answers
Most fish oils naturally have more EPA than DHA. More than 90% of all fish oil sold in the world contains more EPA than DHA.
Salmon has roughly equal parts EPA and DHA. Tuna oil is the rare exception with more DHA.
Looking at Science for Answers
In the last decade, a lot of research has focused on the separate roles of DHA versus EPA. Here are some of the findings:
- EPA key role in the body is to keep pathological inflammation under control
- EPA Omega-3 controls disease by reducing inflammation, after all, diabetes, obesity, arthritis are all inflammation related diseases
- EPA regulates your immune responses
- EPA protects the heart, brain and nervous system
- EPA must be constantly provided to the body because it is found in EVERY CELL in your body
Recent clinical trials show:
- EPA has been shown to moderate the onset and symptoms of Alzherimer’s
- EPA has been shown to moderate autoimmune disorders
- EPA can reduce symptoms of mood disorders like depression and schizophrenia
- EPA has some of the best evidence for reducing cardiovascular disease
It’s no wonder that EPA is being looked at as a new active pharmaceutical ingredient.
EPA-based Rx drugs on the way
High-purity EPA concentrates are being investigated as new ‘drugs’ by several pharmaceutical companies. Epadel and Miraxion are two EPA-based drugs in development.
Omthera Pharmaceuticals is entering Phase III Clinical Testing with Epanova, its EPA-based drug. Pfizer recently spent $800 million to conduct Phase III testing of a new drug.
May be it is a little cheaper to develop a new drug based on EPA fish oil, but are all these pharmaceutical companies wrong?
Phase I Clinical Trials test for safety.
Phase II Clinical Trials prove efficacy.
Phase III confirms efficacy and dosage.
Why would these pharma companies spend millions of dollars on Phase III testing an EPA-based drug if EPA was ineffective?
It’s not that EPA is ineffective. But rather DHA has a undesirable side effect of raising LDL (Bad) cholesterol.
Yet Another EPA-only Drug
Amarin’s new Vascepa drug was recently introduced to the market – talk to your doctor. The clinical trials for this drug were very positive. Vascepa is a triglyceride-reducing drug that’s 96% EPA Omega-3 from fish oil. Amarin specifically chose to leave out DHA from their formula because of its LDL-raising effects. Read more here.
Percent Change in LDL Cholesterol after 600 mg each of EPA, DHA or Placebo (Olive oil)
In this study, 110 healthy people were given olive oil or EPA or DHA for 6 weeks. 600 mg of DHA Omega-3 showed about 14% increase in LDL Cholesterol.
Source: Gillies, P. “The New Science of Omega-3 Fatty Acids: Differential Nutritional Pharmacology” Texas Human Nutrition Conference, Texas A&M University, February 2010.
EPA helps with Depression. DHA does not.
More than a dozen clinical trials have used EPA exclusively to show that it can treat depression as well as prescription medications.
The landmark Oxford-Durham trials used high-EPA fish oil to reduce childhood learning and behavioral problems.
- American Journal of Psychiatry. 2003. 160:996-998 concluded that DHA was no more effective in treating major depression than placebo. See reference here. And read full study here.
- Schizophrenia Research. 2001. 49(3): 243-251 showed that EPA was superior to DHA in treating schizophrenia. See reference here.
- Archives of General Psychiatry. 2002. 59: 913-919 showed that adding EPA to the regimen of prescription drugs yielded better results than drugs alone. See reference here.
- Journal of American College of Nutrition. 2009 Oct;28(5):525-42. says EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. See reference here.
- Journal of Clinical Psychiatry. 2010 Jun 15. The efficacy of omega-3 supplementation for major depression: a randomized controlled trial. See reference here.
EPA is for more than just mood health
Before you think EPA’s role is only mood related, let me point you to the JELIS Study (Japan EPA Lipid Intervention Study), the first primary intervention trial with an Omega-3 and the first (of many) to show a benefit with EPA alone (as opposed to EPA + DHA). EPA showed a remarkable reduction in ‘cardiovascular events’ in almost 19,000 patients. And remember, the patients were Japanese, a population that already gets a lot of Omega-3 in from the regular diet.
Another study from the University of Oslo, Norway concluded that EPA, and not DHA, is primarily responsible for the triglyceride-lowering effect of fish oil. Source: Rambor et al. Eicosapentaenoic acid is primarily responsible for hypotriglyceridemic effect of fish oil in humans.
Lipids. 1996 Mar;31 Suppl:S45-9.
Natural Conversion of DHA to EPA and Back
Our bodies are capable of converting DHA to EPA using enzymes, but it is not an efficient conversion. Conversion of EPA to DHA is far less efficient or even completely absent due to the requirement of an elongase enzyme followed by beta-oxidation. There are several metabolic factors that influence these elongation and retroconversion steps. Sources: Hansen et al. Lipids. 1998 Feb;33(2):131-8, Grimsgaard et al. Am J Clin Nutr. 1997 Sep;66(3):649-59. Read full paper here.
A study conducted at the University of Guelph by the renowned Dr. Bruce Holub estimates that only 9.4% of DHA is retroconverted into EPA. Source: Conquer & Holub. Dietary docosahexaenoic acid as a source of eicosapentaenoic acid in vegetarians and omnivores. Lipids. 1997 Mar;32(3):341-5.
The same authors conducted a similar study, this time, using Algae-DHA. Again, they found that 11 to 12% of DHA was retroconverted to EPA. Source: Conquer JA, Holub BJ. Supplementation with an algae source of docosahexaenoic acid increases (n-3) fatty acid status and alters selected risk factors for heart disease in vegetarian subjects. J Nutr. 1996 Dec;126(12):3032-9. Read full article here.
Both these studies suggest that if you took just DHA, only a tenth of it would be converted to EPA. That’s not enough if you are seeking benefits that only EPA seems to provide, such as mood support.
The new science of Nutrigenomics says that foods are messengers. They convey messages to our body. And tell it what to do – gene expression. A study conducted at the University of Bergen in Norway says that (at least in rats), EPA and not DHA activates the genes that helps reduce triglycerides. Source: Willumsen et al. Lipids. 1996 Jun;31(6):579-92.
It is far more efficient to just take preformed EPA and DHA together.
The American Diet NEEDS EPA Fish Oil
Our bodies are designed to thrive on equal parts Omega-3 and Omega-6.
Unfortunately, due to the presence of omega-6-rich corn oil and soy (vegetable) oil in almost all our foods, we now eat 25, 30 or even 50 times more Omega-6 than Omega-3.
This is a formula for disaster. Why? Because the byproducts of Omega-6 (ARA) cause inflammation in tissues and organs. This contributes to several diseases like obesity, diabetes, high triglycerides, heart disease and depression.
Given our pro-inflammation diet, we MUST have EPA to ‘cool’ down the inflammation. EPA supplementation alone is not the answer – this new study suggests reducing Omega-6 works slightly better. Source: Wiet et al. Lipids. 2010 Aug;45(8): 683-92.
Another famous doctor, Dr. Barry Sears, outlined exactly how and when you’d get sick by looking at your ARA to EPA ratio. See his book, The Omega Rx Zone. Harper Collins. Check out page 95.
With the growing mountain of new scientific evidence supporting the benefits of EPA, I’m finding it very hard to believe that EPA is ‘not really effective.’
OK, how about EPA and excessive bleeding, you say?
Well, the American Journal of Cardiology just published a paper from scientists at Drexel University that says high-dose fish oil by itself or even if combined with aspirin ‘is safe and does not increase risk of bleeding.’
Again, the bleeding argument is old.
When Jorn Dyerberg, the ‘father’ of Omega-3 first discovered that Eskimos were protected from heart diseases from their high Omega-3 levels, he also noticed increased incidences of nosebleeds.
What most people (including Dr. Oz, I presume) don’t know is that the average Eskimo (or Inuit) consumes 13,000 mg of Omega-3. Americans average 100 mg.
You’d have to eat 43 (yes forty three!) retail-grade fish oil pills every day for a long time to equal Eskimos in nosebleeds.
Can you say the same thing about the safety of Tylenol, Aspirin or any of the other OTC drugs whose safety we take for granted?
Dr. Oz and Algae-based Omega-3 Supplements
He claims that algae-derived DHA give you “DHA’s perks without the fishy burps that fish oil capsules may cause.”
DHA, regardless of where it comes from, is extremely sensitive to oxygen, light, heat and metals. All these things cause oxidation (rancidity.) And oxidation causes DHA (or EPA) to smell.
It does not matter if the DHA (or EPA) comes from fish or algae. If it is poorly handled or stored, it will spoil. It will stink and it will make you burp. Period.
If you don’t believe it, go to Walmart and buy a Spring Valley DHA 900 mg made with algae-DHA. Or talk to my wife who took one pill and gagged.
Algae-based DHA is neither more nor less susceptible to rancidity than fish oil based Omega-3 supplements.
Algae is a great source of DHA. After all, that’s where fish get it from! In the not-too-distant future, we will run out of fish to feed our expanding population – so algae-sourced DHA & EPA is the sustainable future of Omega-3 supplements. But for now, making EPA from algae is still very tricky.
Doctor Oz, it hurts your TV audience when you disparage EPA. That bugs me. May be it bugs me more because I’m associated with OmegaVia, a high-EPA formula. But I don’t tell people to avoid DHA! On the contrary, I encourage it.
But I see recently that you’ve been warming up to EPA.
What Other Experts are Saying…
In the last week, I spoke to three doctors about this and got four different opinions.
But here are a few public opinions:
Diabetes: Dr. Oz, How Did You Get It So Wrong?
Dr. Sears, a Doc of a Different Stripe
Overall, I think, Dr. Oz has done a tremendous job informing and educating. I respect and look up to him for that. But I see that he is warming up to EPA, noting in a recent YouDocs newspaper column that “EPA is getting its due.”
Nutritionally, America is SO off-balance, that any national awareness Dr. Oz brings to Omega-3 (DHA or EPA), will improve our well-being and reduce our health care costs drastically.