by Marion Nestle

Currently browsing posts about: Omega-3-fats

Sep 28 2020

Industry-sponsored studies of the week: two on omega-3 supplements

I.  Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition, Troesch B, et al.  Nutrients 2020;12(9):2555.

Conclusion: The evidence to date indicates that the provision of DHA and EPA through capsules, oral nutrition supplements, or enteral or parenteral formulas can help to regulate the inflammatory environment in a number of medical conditions and that this is linked in many cases to improved function, clinical course and outcomes.

Funding: DSM Nutritional Products Ltd. provided financial support to organize and invite experts to participate as discussants, based on their expertise on the role of DHA and EPA in aging as well as different medical conditions, as well as financial support for the development of this review.
Conflicts of Interest: B.T. and I.W. are employed by DSM Nutritional Products Ltd.; M.E. acts as an advisor for DSM, received travel reimbursement from DSM and is a member of the Scientific Board of PM International and President of the Gesellschaft für angewandte Vitaminforschung; A.L. received consulting fees from BBraun, DSM, Nutricia and Smartfish and received honoraria for independent lectures from Abbott, Baxter, BBraun, Fresenius Kabi, Nestlé Health Science, Nutricia and Smartfish; Y.R. received travel reimbursement from DSM; AW receives speaker fees from Baxter Germany, Berlin Chemie, BBraun Melsungen AG, DSM, Ethicon, Falk Foundation Fresenius Kabi Deutschland GmbH, Medtronic and research grants from Baxter, Danone and Mucos; P.C.C. acts as a consultant for DSM, BASF, Danone/Nutricia, Cargill, Smartfish and Fresenius Kabi. A.D.S. has no conflict to declare.
Comment: DSM Nutrition Products is a major seller of dietary supplements, with a highly vested interest in demonstrating the benefits of the supplements it sells.  Evidence on the benefits of omega-3 fatty acid supplements tends to vary enormously.  Some studies, like this one, find benefits.  Other studies do not (see, for example, this, this, or this).  Could funding source have something to do with these differences?  I think yes.  
Before I had a chance to post this one, a reader, Dr. Eliška Selinger, who teaches science methods and nutrition in Prague, sent yet another example, this one not yet published.II.  Effect of Omega-3 Dosage on Cardiovascular Outcomes: An Updated Meta-Analysis and Meta-Regression of Interventional Trials. Aldo A. Bernasconi, PhD; Michelle M. Wiest, PhD; Carl J. Lavie, MD; Richard V. Milani, MD; and Jari A. Laukkanen, MD, PhD.  Article in press Mayo Clin Proc. n XXX 2020;nn(n):1-10 n https://doi.org/10.1016/j.mayocp.2020.08.034

Objectives: “To quantify the effect of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids on cardiovascular disease (CVD) prevention and the effect of dosage.”

Conclusion: “Cardiovascular disease remains the leading cause of death worldwide. Supplementation with EPA and DHA is an effective lifestyle strategy for CVD prevention, and the protective effect probably increases with dosage.”

Potential Competing Interests: “Dr Bernasconi is an employee of the Global Organization for EPA and DHA Omega-3s (GOED), a 501(c)6 not-for profit trade association. GOED’s goals are to increase consumption of omega3s to adequate levels around the world and to ensure that the industry is producing quality omega-3 products that consumers can trust. Dr Wiest has been a guest speaker with travel sponsored by DSM Nutritional Products and the Global Organization for EPA and DHA Omega-3s (GOED); and has received funding from GOED to conduct a meta-analysis on omega-3 fatty acids. Dr Lavie has been a speaker for Amarin Corporation on Vascepa, has consulted for DSM Nutritional Products, and has made an omega-3 educational video at the American Heart Association meeting on November 14, 2016, for the Global Organization for EPA and DHA Omega-3s and also gave a presentation at a GOED-hosted omega-3 conference in Barcelona, Spain, in February 2020. The remaining authors report no potential competing interests.”

Grant Support: “This study was supported by a grant from the Global Organization for EPA and DHA Omega-3s (GOED), Salt Lake City, UT.”

Comment: The Global Organization for EPA and DHA Omega-3s “represents the worldwide EPA and DHA omega-3 industry…Our mission is to increase consumption of EPA and DHA omega-3s…”   Omega-3 fatty acids are essential to human health and are widely available from green leafy vegetables (in the form of ALA) as well as from fish (EPA and DHA).   ALA is converted in the body to EPA and DHA.   The benefits of omega-3 supplements, as I just explained, are not well established.  This trade association for EPA and DHA supplements funded this study to demonstrate the benefits of these products.  Caveat emptor.

Nov 27 2019

Food options for Thanksgiving? Omega 3-enriched farmed grasshoppers!

I was interested to see this announcement from the University of Eastern Finland about new research suggesting a way to improve the nutritional quality of fats from….edible grasshoppers!

Until I read this account, I did not know that

  • Long-horned grasshoppers are widely consumed as snacks in parts of Africa.
  • More than 2,000 insect species are known to be eaten by humans.
  • Raising edible insects requires less space and water and has lower greenhouse emissions than meat production.
  • In some places, overexploitation of insect resources is a problem.
  • Feeding omega-3 fatty acids to grasshoppers to finish off their growth (as is done with farmed salmon) improves their essential fatty acid levels.

This research was done for a doctoral dissertation and published in the Journal of Economic Entomology.  It must have been a lot of fun to do.

Yum?

Aug 12 2019

Industry-funded study of the week: Unilever

A low-fat spread with added plant sterols and fish omega-3 fatty acids lowers serum triglyceride and LDL-cholesterol concentrations in individuals with modest hypercholesterolaemia and hypertriglyceridaemia.  Blom AM, et al.  European Journal of Nutrition.  2019;58(4):1615–1624.

Purpose: “to investigate the triglyceride (TG) and LDL-cholesterol (LDL-C) lowering effects of a spread [i.e., margarine] with added plant sterols (PS) and fish oil as compared to a placebo spread.”

Conclusions: “Four-week consumption of the intervention spread led to significant and clinically relevant decreases in serum TG, LDL-C and other blood lipid concentrations.”

Funder: The study was funded by Unilever BCS Research and Development Vlaardingen, the Netherlands.

Conflicts of interest: of the authors, four are employed by Unilever.

Comment: Unilever makes margarines with plant sterols and fish oils.  You might buy them if they control blood lipid risk factors for heart disease.  This is in-house company research aimed at proving the benefits of a Unilever product, which is what so many other companies do.

But Unilever was one of the few Big Food companies that sponsored basic research (and maybe it still does?).  As I describe in my book, Unsavory Truth, Unilever was the sponsor of the basic research that demonstrated the harmful effects of trans-fat on disease risk.

Jun 25 2019

FDA approves qualified health claim for omega-3s

I love the FDA’s qualified health claims for food products because they are so patently ridiculous.

These are health claims so poorly supported by science that the FDA insists on a disclaimer.

What’s their point?  Companies can use them for marketing and put the disclaimer in tiny print.

The latest is the FDA’s response to a petition from the Global Organization for EPA and DHA Omega-3s, which asked the FDA to approve these health claims:

  • EPA and DHA help lower blood pressure in the general population.
  • EPA and DHA reduce BP, a risk factor for CHD (coronary heart disease).
  • EPA and DHA reduce the risk of CHD.
  • Research shows that EPA and DHA may be beneficial for moderating BP, a risk factor for CHD.
  • Convincing scientific evidence indicates that EPA and DHA help lower blood pressure in the general population, with comparable reductions to those achieved with other diet and lifestyle interventions.

Not a chance.

The FDA did its own review of the literature and quite sensibly concluded that evidence supporting such claims is too weak to take seriously.

Instead, the FDA said that

In light of the above considerations, FDA intends to consider the exercise of its enforcement discretion for the following qualified health claims [with my emphasis in red]:

  • Consuming EPA and DHA combined may help lower blood pressure in the general population and reduce the risk of hypertension. However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.
  • Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease). However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure. However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.
  • Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by reducing the risk of hypertension. However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.
  • Research shows that consuming EPA and DHA combined may be beneficial for moderating blood pressure, a risk factor for CHD (coronary heart disease). However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.

In order to use these claims, the products would have to contain at least 0.8 g EPA and DHA (combined total).

Absurd as all this may seem, the approval of qualified claims is considered a win for the omega 3 industry.

Why does the FDA allow such claims?  Because Congress said it had to permit claims even if evidence was insufficient to back them up [but see below].

Sigh.

Correction: A Twitter correspondent, Ilene Heller (@foodcop819), reminds me that the courts, not Congress, forced the FDA to allow qualified health claims on First Amendment grounds.  In 1990, Congress forced the FDA to allow health claims in general as part of the nutrition labeling act.  In 1994, Congress passed the dietary supplement act that essentially deregulated these products and allowed “structure/function” claims for them.  Food companies wanted to use them too.  Whenever the FDA objected that science didn’t support the claims, supplement companies took the FDA to court.  In 2003, the FDA gave up: We have lost 8 of 10 First Amendment decisions, and doing business the way we were doing it was unsustainable” (New York Times, July 6, 2003).  The so-called qualified health claims are the absurd result.

Jul 12 2018

Food Navigator’s collection of articles on “healthy fats”

Fat remains in the news.  Which ones are health, and which not?  FoodNavigator-USA collects its articles on the topic.  My thoughts:  Beyond that, food fats are mixtures of monounsaturated, polyunsaturated, and saturated fatty acids, of the omega-3, -6, and -9 varieties.  And then there are the hydrogenated trans-fats.  These variations make fats complicated.

One attribute of fats is not complicated: fat has 9 calories/gram compared to 4 for protein and carbohydrate.  A tablespoon of oil, butter, lard, or tallow has about 100 calories.  If you are concerned about energy balance, watch out for fat calories (and the other ones count too).

FoodNavigator’s Special Edition: Healthy fats
Fat – we are told – is back. But what kind of fat, and can you have too much of a good thing? Is the science changing on saturated fats? Is whole milk a better choice, or should we stick to low fat dairy? Is coconut oil as healthy as some marketers make out, and is the pressure off to reduce fat now all eyes are on added sugar?  Get the lowdown on fat in this special edition…

Aug 8 2011

It’s time for some Q and A’s

I’ve just turned in the copy-edited manuscript of Why Calories Count: From Science to Politics (pub date March 2012) and now have time to catch up on some questions:

Q. I was recently given to read a book titled “The China Study” which is based on research conducted in 1970’s in China by Dr. Colin Campbell. His main conclusion is that eating dairy and meat causes cancer. His resolution is that a plant-based diet (i.e. vegan) is the (only?) healthy diet for humans. This book has made strong enough of a point to convince several of my friends to “convert” to a vegan diet in order to save their health. Could you share some comments on the validity of the research and conclusions this book presents with regards to detrimental effects of dairy and meat on human health?

A. Campbell makes a forceful argument based on his interpretation of the research and on case studies of people whose diseases resolved when they became vegans. And yes I’ve seen Dr. Campbell’s new movie, Forks over Knives. The first half is a terrific introduction to how the current food environment promotes unhealthy eating.  The second half promotes Dr. Campbell’s ideas about the hazards of meat and dairy foods.

Whether you agree with these ideas or not, the film is well done and worth a look.

Some scientists, however, interpret the research as demonstrating that people are healthier when they eat dairy foods.  For example, the enormous consensus report on diet and cancer risk from the American Institute for Cancer Research and the World Cancer Research Fund concluded in 2007 that eating lots of red meat and processed meat is convincingly associated with an increased risk of colorectal cancer (but no others).

On the other hand, they found dairy foods to be associated with a decrease in the risk of colorectal cancer.  They found limited and less convincing evidence that dairy foods might decrease the risk of bladder cancer but increase the risk of prostate cancer.

How to make sense of this?  These are two food groups in the diets of people who consume many kinds of foods and who do many things that might increase or decrease cancer risk.  Given this complexity, one food or food group seems unlikely to have that much influence on cancer when considered in the context of everything else people eat and do.

Nutrition research, as I am fond of saying, is difficult to do and requires interpretation. Intelligent people can interpret the studies differently depending on their point of view.

The new Dietary Guidelines say to cut down on saturated fats. Those are most plentiful in meat and dairy foods (plant foods have them, but in smaller amounts). Pretty much everyone agrees that plant-based diets promote health/  But whether they have to be 100% plant-based is highly debatable.

The new USDA MyPlate food guide suggests piling plant foods—fruit, vegetables, and grains—on 75% of your plate so the argument is really about what goes on the remaining 25%, what USDA calls the  “Protein” section. You can put beans in that quarter if you don’t want to eat red meat, poultry, or fish.

Q. I’d love to hear your take on the recent walnut flap [accusations that the FDA now considers walnuts to be drugs].  I suspect walnuts got caught with such offenders as Pom, Froot Loops, and Juicy-Juice, but I’d love to find out what the FDA actually said about this. For some odd reason I don’t believe the article is presenting the whole truth.

A. This is a health claims issue. The FDA is not saying walnuts are drugs. It is saying that Diamond Walnut is claiming walnuts as drugs on package labels. How so?

The labels say the omega-3 fatty acids in walnuts may help lower cholesterol; protect against heart disease, stroke and some cancers (e.g. breast cancer); inhibit tumor growth; ease arthritis and other inflammatory diseases; and even fight depression and other mental illnesses. These are disease claims for which the FDA requires scientific substantiation.

The company’s petition did not provide that substantiation so the FDA issued a warning letter. In general, you should be skeptical any time you see a nutritional factor advertised for its ability to prevent or treat such a broad range of problems.

Q. A question about sugar and how it is counted: My books say: 4 g = 1 teaspoon = 15 calories. My Illy Caffe says 10 g of sugar, but 50 calories. Ingredients: coffee, sugar, potassium bicarbonate, potassium citrate. If the drink is 50 calories, shouldn’t it say 12 g or more for the sugar listing?

A. Sugar should be the only ingredient that has calories in this coffee but I’ve seen calorie lists that say 5 calories per gram for sugars. Food companies have some leeway in the way they compute calories. Illy may be using a method that gives 5 rather than 4. But the difference between 40 and 50 is hardly measurable and I wouldn’t worry about amounts this small, annoying as imprecise figures may seem.

Mar 8 2011

Omega-3s in infant formula: time for a close look

The FDA just announced that it is planning to research health claims on infant formulas such as “supports brain and eye development.’’ The FDA wants to:

assess women’s understanding of and response to various statements on infant formula labels. The study results will be used to help the Agency to understand the role that certain types of statements on infant formula labels have in influencing formula choice….The study will focus on purchase choice, perceived similarity of the formula to breast milk, and perceived likelihood that the formula has certain health benefits.

Translation: the FDA thinks that claims for omega-3 fatty acids—DHA, in this case—on infant formulas mislead mothers into thinking the formulas are better than breast milk.

Despite lack of evidence for benefits, infant formula makers have been so successful in marketing the addition of these omega-3 fatty acids that you can hardly buy a formula without them.

I was in Ecuador a few months ago and saw this sign:

The idea?  Omega-3’s will make your kid smart.

My book, What to Eat, has a chapter on infant formula and baby food. Here are some relevant excerpts:

Infant formulas cause controversy and are endlessly contentious for three important reasons. Formulas are (1) largely unnecessary (most mothers can breast feed their infants), (2) not as perfect as breast milk for feeding babies, and (3) more expensive than breast feeding.

Breast milk is nutritionally superior to formula, but from a marketing standpoint it has one serious disadvantage: it is free. Beyond one-time purchases of breast pumps, storage bottles, or special clothing, nobody makes money from it.

For mothers who cannot, should not, or do not want to breast feed, formula is a socially and nutritionally acceptable substitute. But formula companies do not only promote formulas to mothers who must use formula. In subtle and not-so-subtle ways, they promote the use of formulas to all pregnant women and new mothers.

I go on to explain that because formula is the sole food for infants, its composition is highly regulated. Therefore, all infant formulas have the same composition, and all virtually indistinguishable.

Competition for market share explains why formula companies want to put distinctive nutrients in their formulas–especially nutrients considered “conditional.” A conditional nutrient is one that might have some benefits under some circumstances. Even if the health benefits are minimal or questionable, they can be used in advertising.

That is the principal reason why so many formulas now have fatty acids added—omega 6 arachidonic acid (ARA) and omega-3 docosahexaenoic acid —the same one that is in fish oil. These two fatty acids are normally present in breast milk, and there is some evidence, weak and questionable as it may be, that they support infant brain development and vision.

Formula makers got the FDA to agree that ARA and DHA are normal components of food (which they are) and, therefore, are Generally Recognized As Safe (GRAS). This means that companies could add ARA and DHA to infant formulas without having to prove that either of them really did anything useful or beneficial.

I then explain that the FDA apparently agreed to the GRAS petition with some reluctance, as indicated by its answer to the question, “What is the evidence that addition of DHA and ARA to infant formulas is beneficial?”

The scientific evidence is mixed. Some studies in infants suggest that including these fatty acids in infant formulas may have positive effects on visual function and neural development over the short term. Other studies in infants do not confirm these benefits. There are no currently available published reports from clinical studies that address whether any long-term beneficial effects exist.

My interpretation of the proposed research study is that the FDA thinks the addition of ARA and DHA may discourage mothers from breastfeeding and may unnecessarily cause them to buy more expensive formula.

If you agree, tell the FDA you think the study is a great idea, and the sooner it gets going, the better.

You can file comments at http://www.regulations.gov.  Refer to Docket No. FDA–2011–N–0098]

Dec 15 2010

FTC goes after kids’ vitamin claims (yogurt, too!)

In its continuing effort to crack down on companies making deceptive claims that omega-3 promotes healthy brain and eye development in children, the FTC has just announced deceptive advertising charges against NBTY, a marketer of children’s vitamins.

In February, the FTC  issued warning letters to 11 companies that make products like this one (“pediatrician recommended,” yet).

The FTC said the companies had better get busy and make sure they are not violating the law by “making baseless claims about how the supplements benefit children’s brain and vision function and development.”

The FTC cautioned the companies to make sure they had:

“scientific evidence to support claims that their products boost, improve, enhance, or support brain and vision function and development in children…[and]claims relating to intelligence, cognitive function, learning ability, focus, mood, memory, attention, concentration, visual acuity, and eye health.”

Now, the FTC has reached a settlement with the companies for $2.1 million in refunds, not only because of the unsupported health claims but also because the products did not contain the advertised amount of omega-3’s (see legal complaint):

the multivitamins featured characters such as the Disney Princesses, Winnie the Pooh, Finding Nemo, and Spider-Man.  Product packaging and print ads promoting the vitamins had bold graphics highlighting that the products contained DHA, but in reality, the products allegedly had only a trace amount of DHA.

While the vitamins’ packaging touted the purported health benefits of 100 milligrams of DHA, a daily serving of the Disney and Marvel multivitamins for children ages four years and older contained only one thousandth of that amount (0.1 mg or 100 mcg), according to the FTC’s complaint.

The settlement:

  • Bars NBTY, NatureSmart, and Rexall Sundown from misrepresenting the amount of any ingredient contained in any product.
  • Bars them from misrepresenting that any ingredient, including DHA, promotes brain or eye health or provides any other health benefit, unless the claim is true and backed by competent and reliable scientific evidence.
  • Specifies that any violations could subject the NBTY, NatureSmart, and Rexall Sundown to civil penalties.
I wonder if the FTC is taking a look at the DHA “brain development” claims for Nestlé’s Juice Juice?  Just a thought.
This just in: The FTC announces a settlement with Dannon Yogurt to stop making unsubstantiated, exaggerated health claims for activia.  Dannon may no longer claim that:
  • Any yogurt, dairy drink, or probiotic food or drink reduces the likelihood of getting a cold or the flu (unless FDA says it’s OK)
  • Activia yogurt will relieve temporary irregularity or help with slow intestinal transit time, unless the ad conveys that three servings of Activia yogurt must be eaten each day.
  • Any other yogurt, dairy drink, or probiotic food or drink will relieve temporary irregularity or help with slow intestinal transit time unless the company has two well-designed human clinical studies that substantiate the claim.
  • The health benefits, performance, or efficacy of any yogurt, dairy drink, or probiotic food or drink, unless the claims are backed by competent and reliable scientific evidence.

The FTC wants science to back up health claims.  What a concept!