Renew You Challenge

Let’s start this week off right!

Weekly challenge (I mean opportunity!) to help set you off on the right foot and in the right direction for bringing health to your week. You could even add it to your calendar. Join us!

The development of allergies in infants is influenced by different factors. A too-clean environment is one factor. Lack of breastfeeding is another factor. Diet, both of the infant and the mother, is yet another factor. In a recent study, mothers’ diets during pregnancy were evaluated for a link to the development of allergies in infants.

Researchers found that if the mother’s diet contained omega-3 polyunsaturated fatty acids (PUFAs) like those found in fish, walnuts and flaxseed, the babys’ guts developed differently. The PUFAs help to improve how gut immune cells respond to gut bacteria and other foreign substances in the gut. This highlights the complementary action of omega-3s with gut bacteria. The result? A reduction in the risk of allergy development in children.

Studies have shown that fish oil and walnut oil supplementation during pregnancy help reduce allergy risk in their children, and now this new study shows why. “The end result is that the baby’s immune system may develop and mature faster—leading to better immune function and less likelihood of suffering allergies,” stated Dr. Gaelle Boudry one of the study’s researchers.

It is well known that omega-3 fish oil—particularly DHA—is important for brain development of the fetus during pregnancy. This new study adds to the understanding of the benefits of omega-3s. This week, if you or someone you know is pregnant, be sure you’re getting enough omega-3s. A concentrated, purified fish oil supplement is a great way to get your omega-3s, just be sure to clear it with your doctor.

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According to the Centers for Disease Control (CDC) 12 percent of children aged 2 to 19 years are obese—triple the number it was in 1980. This increase is attributed, in part, to the Standard American Diet (SAD), a poor diet high in refined carbohydrates, bad fats, and sugar, and low in high-fiber foods like whole grains and fruits and vegetables.

A recent study takes a look at fat intake of pregnant women and fat accumulation in their children by age 3. Specifically, the study looked at the status of two types of polyunsaturated fatty acids (PUFAs)—omega-6 and omega-3. These fats are both essential to the diet. The Standard American Diet is very high in the omega-6 fatty acids, found in vegetable oils and grains like corn. Omega-3 fatty acids, however, are not consumed in adequate amounts, creating an imbalance in the ratio of omega-6 to omega-3s.

Omega-3 fatty acids, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) found primarily in fish, promote optimal development of the fetal brain and immune system. Many women in the U.S. do not consume enough of these beneficial omega-3s. In a study published in the American Journal of Clinical Nutrition, researchers assessed mid-pregnancy intake of omega-3 and omega-6 fatty acids and tested plasma fatty acid levels of the mother and umbilical cord fatty acid levels of the infant to determine omega-3 status. At age 3, body mass index (BMI) and skin fold measurement were taken to determine obesity in the children.

The odds of obesity in 3-year-olds were two to four times higher when cord blood had a high ratio of omega-6 to omega-3 fatty acids. When maternal intake of omega-3s was higher, or when the omega 3/6 ratio was closer to recommended levels, the odds of childhood obesity were lower.

It has long been known that omega-3s, especially DHA, are necessary for brain development of the fetus and infants. The study also found that only three percent of mothers consumed the recommended 200 mg of DHA per day in the last month of pregnancy, when DHA is most rapidly transferred from the mother to fetus. This study is building the evidence that omega-3 fatty acids provide a variety of benefits for infants and children that go beyond brain and eye development.

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The immune system is a complex organization of coordinated responses to “foreign” invaders in the body. Foreign invaders include microbes—bacteria, fungus, parasites and viruses—as well as toxins and even food. As a matter of fact, one major role of the immune system is to not respond to food. As is seen with food allergies, however, the immune system is not always successful at this. Food allergies involve an overactive immune response to certain foods, which would normally be recognized as harmless. 

The immune system is comprised of two main branches: the innate immune system and the adaptive immune system. The innate immune system, also known as cell-mediated immunity, involves an immediate non-specific immune response, often against pathogens. The adaptive immune system, also called humoral immunity, involves a delayed, specific, organized response involving the production of antibodies that later recognize invading microbes so that a more effective immune response can be mounted. The innate immune system involves the production of cells called T helper 1 (Th1) cells, and adaptive immunity involves the production T helper 2 (Th2) cells. T helper cells are lymphocytes, a type of white blood cell. They are like the messengers of the immune system, sending signals that stimulate various immune responses.

Th1 and Th2 responses are joined by another type of T helper cell known as Th17. Th17 and Th1 responses are both associated with over-active immune responses, as is seen in autoimmune conditions, in which the body mistakenly attacks its own tissues. Both these responses produce inflammation by way of cytokines, the immune equivalent of hormones. These three types of T helper cells are all regulated and balanced by cells known as T regulatory cells, or Tregs.¹

Are you confused yet? Think of all these T cells as a four-way seesaw.  Th1 and Th17 are on two prongs of one end, and Th2 and Tregs are on two prongs of the other. When all is well, this seesaw is in balance, like a harmonized symphony responding appropriately to that which the body comes into contact.  If out of balance, you may see higher levels of Th1 and Th17, an indication of underlying autoimmunity as is seen with type 1 diabetes, celiac disease, rheumatoid arthritis, psoriasis, multiple sclerosis and systemic lupus erythematous. In contrast, higher levels of Th2 and Tregs are characteristic of allergic conditions like asthma, food allergies and hay fever, and with immune suppression.

How can we balance immunity? Well, probiotics are one solution. Since over 70 percent of the immune system is in the gut, probiotics are in the right terrain for immune system communication. Probiotics help balance immune response.  Gut bacteria essentially “prime” the immune system,² educating it so that it responds appropriately to what passes through the digestive tract—and to what may ultimately pass through the small intestine and into the body.

Omega-3 fatty acids also affect immunity, largely by helping to balance the inflammatory response—an important aspect of immunity. You see, inflammation is a necessary physiologic occurrence.  But too much inflammation spells trouble.  The omega-3 fatty acids EPA and DHA found in fish oil help to quell inflammation at the right time.  They help stimulate the production of resolvins, chemicals knows to help “resolve” inflammation—or end it at the appropriate time.³ 

Further, the proper digestion of food is necessary so the immune system doesn’t have to work too hard.  When food is not broken down properly, undigested food particles can aggravate the gut, causing inflammation and even leaking through a permeable intestine (also known as leaky gut) and entering circulation where yet more inflammation is triggered, in a downward spiral of excess inflammation (which is at the basis of most, if not all, chronic disease).

Also important is regular bowel elimination, which can be attained by the consumption of dietary fiber—at least 35 grams per day. A diet rich in fruits, vegetables and whole grains is essential, and a fiber supplement can help reach 35 grams, which can be difficult to obtain through diet alone.

In essence, the HOPE Formula—High-fiber, Omega Oils, Probiotics and digestive Enzymes—can help improve digestive health and improve immune balance. Brenda and I have been recommending this formula for years for many good reasons. With the HOPE Formula, there is hope that your health will improve. 

References

1. Cooke A, “Th17 cells in inflammatory conditions.” Rev Diabet Stud. 2006 Summer;3(2):72-5.
2. Round JL and Mazmanian Sk, “The gut microbiota shapes intestinal immune responses during health and disease.” Nat Rev Immunol. 2009 May;9(5):313-23.
3. Serhan CN and Savil J, “Resolution of inflammation: the beginning programs the end.” Nat Immunol. 2005 Dec;6(12):1191-7.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Omega-3 fatty acids are wonder nutrients that offer many benefits to the body, from head to toe. Now, even the mouth is included in the long list of body areas that function better after intake of omega-3s.

A recent study found that a moderate, daily intake of the omega-3s DHA and EPA (found in marine sources, usually fish oil) was associated with up to a 20 percent decreased risk of gum disease (periodontitis).

Gum disease is an inflammatory disease that is caused by microorganisms like the bacteria Streptococcus mutans, Candida albicans and Porphyromonas gingivalis. Usually antibiotics are prescribed in an effort to eliminate these bacteria, but other treatments have been used that target the inflammation of gum disease, like scaling and root planing (ouch!) and in extreme cases surgery.   

Omega-3s are most known for their anti-inflammatory effects, so it is not surprising that they would help quell inflammation in the mouth. Additionally, this study also found that omega-3 fatty acids also demonstrated antibacterial activity against oral pathogens.

The mouth is the very beginning of the digestive tract, and the bacterial balance in the mouth is proving to be more important than previously thought. In fact, gum disease is also associated with the development of heart disease! Everything is connected, folks, and it all goes back to the gut!

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Omega-3 fatty acids from fish oil are high in EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). These fatty acids have been associated with heart health, joint health, brain health, gut health… the list goes on and on. The two often go hand in hand, and for most conditions, researchers don’t know the perfect ratio of EPA to DHA. But for infant health, DHA is the fatty acid that shines.

DHA is most concentrated in the brain and the retina, which is why it’s been found to be helpful in these areas of the body. In infants, DHA has been found to help improve brain development when pregnant mothers get high amounts, and when infants receive it from breast milk or supplemented formula.

Two new studies add to the science behind DHA for new mothers. One study in preterm infants found that high doses of DHA in baby formula or breast milk resulted in greater growth rate of the head, which was associated with increased mental development—both important factors when considering pre-term infants who are at a developmental disadvantage.

The second study found that pregnant women who took fish oil high in DHA had fewer symptoms common to postpartum depression. Considering 25 percent of new mothers experience postpartum depression, this is good news. More studies will be done to determine just how and why DHA works in this way, but the results are promising. Fish oil supplements are a great source of DHA, but look for a formula that has IFOS (International Fish Oil Standards) certification to ensure that you’re getting the purest fish oil.

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The American Heart Association (AHA) released a scientific statement this week on triglycerides and cardiovascular disease. In the statement, certain lifestyle factors—diet and exercise—were considered with regard to their effects on lowering triglycerides. Almost one-third of Americans have high triglycerides. Since 1976, average triglyceride levels have risen alongside the growing epidemic of obesity, insulin resistance, and type 2 diabetes, all of which can lead to cardiovascular disease. 

The AHA statement recommends the optimization of nutrition-related practices, which can result in a marked triglyceride-lowering effect ranging between 20% and 50%.  They recommend the following:

• Weight loss
• Reducing simple carbohydrates
• Increasing dietary fiber
• Eliminating trans fats
• Reducing fructose (mainly high-fructose corn syrup)
• Reducing saturated fats
• Eating a Mediterranean-style diet (high in fresh fruits and vegetables, high fiber, lean meats, healthy fats)
• Consuming marine-derived omega-3s

These recommendations are right on, and in line with what I have been recommending for years—not just for a healthy heart, but for overall health and well being. 

The statement made a point of talking about the importance of marine-based omega-3s.  Here’s a quote:

“Non–marine-based PUFAs [like canola, flaxseed, walnuts] have not demonstrated consistent reductions in triglycerides; this may reflect very low conversion rates of alpha-linolenic acid [ALA]…to the active triglyceride-lowering omega-3 compounds EPA and DHA.”

While ALA is a great source of omega-3s, it takes many complex steps in the body to convert it to the heart-healthy DHA and EPA, which are naturally found in fish oil.  Further, they state:

“Because the amount needed for significant triglyceride lowering (2 to 4 g) is difficult to attain through diet alone on a daily basis, supplementation with capsules may be needed.”

That’s why I recommend fish oil supplements—it’s not easy to get all that EPA and DHA from eating fish alone.  And then you have to worry about the contaminants found in fish… (that’s another blog).

I know that for a while now, the AHA has been recommending EPA and DHA fish oil for high triglycerides.  It’s nice to see this statement together with other recommendations for supporting heart health.  Cardiovascular disease is such a huge problem in this country, and it can largely be avoided by incorporating the lifestyle changes mentioned above. 

Right on AHA!

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It is well-known that fish is a healthy food. Even the American Heart Association recommends at least two servings of fish every week for heart health. Unfortunately, not everyone is aware of the differences in omega-3 levels in fish.

For example, a woman who eats tilapia three times per week may think she is getting plenty of omega-3s, when in reality tilapia is much higher in omega-6 than omega-3! Or a man who eats a large portion of fried fish twice a week may think he is in the clear, but fish used for frying tends to be lower in omega-3s and high in fat.

On the other hand, eating spicy tuna sushi rolls a few times a week may give you plenty of omega-3s, but what about the mercury content of that tuna? Fish that are higher up on the food chain (especially albacore tuna) concentrate toxins like mercury, and those toxins end up on your plate.  

What’s a person to do? How can you protect your heart by eating the right fish in the right ways? It’s not easy, but it can be done. Honestly, your best bet is probably sardines, as it is a small fish (low in toxicity) with a high omega-3 level. But let’s face it, sardines aren’t exactly high on the list of big cravings. Another good option is wild salmon, baked or grilled. Try it sprinkled with lemon and laced with dill. Yum!

But if you have more serious heart concerns and need more than the minimum recommended two servings of fish per week (which is equal to about 500 mg daily of the combined omega-3s EPA and DHA), then you’ll probably have to eat far more fish than you can stomach. This is where a good fish oil supplement comes in. A high-potency, concentrated fish oil can give you plenty of omega-3 in one softgel. Look for a fish oil that has the IFOS seal (International Fish Oil Standards), which exceeds world standards for purity. This ensures you are getting a pure fish oil, without all the toxins. Not all fish oil meets these standards.

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There have been several epidemiological studies which support the fact that individuals at risk for cardiovascular and heart disease benefit from the consumption of plant omega-3s (alpha linolenic acid—ALA), and fish-derived omega-3 fatty acids (especially EPA and DHA). There are numerous mechanisms by which these omega-3 oils help prevent heart and blood vessel disease, including:

 1. Decrease dangerous ventricular arrhythmias (heartbeat irregularities), especially fatal arrthymias

2. Prevent blood clotting

3. Lower triglycerides

4. Slow the production and growth of atherosclerotic calcium plaques (hardening arteries)

5. Prevent overall inflammation, which damages blood vessel lining (endothelium)     

6. Promote nitric oxide-induced endothelial relaxation, which in turn…

7. Helps to lower blood pressure.

Prospective clinical studies have shown that the combination of EPA and DHA in the range of 500 mg to 1800 mg per day significantly reduces subsequent cardiac and all-cause mortality. For maximum benefit, it is also important to consider the omega-3 essential fatty acid linolenic acid (essential means it cannot be made by the body, and must be obtained from the diet or supplementation) which is the precursor for producing EPA and DHA in plants and fish. The beneficial intake is about 1500 mg to 3000 mg daily.

The above data supports the recommendation made by the AHA Dietary Guidelines to include at least two servings of fish per week and include plant-based oils from walnuts and flaxseeds, high in linolenic acid.¹

However, due to environmental concerns of toxins in fish (PCBs in farm-raised fish, and mercury in wild fish), I think it is wise to consider getting most of your daily EPA and DHA from molecularly distilled fish oil, which is purified to remove these harmful toxins.

Since there can be issues with high doses of fish oil (most common is over-thinning of the blood), it would be a good idea to do a special blood test (annually) to determine the levels of all major oils in the red blood cell membranes. This test can be very valuable in determining whether you have too much, too little, or just the right amount of omega-3 and omega-6 oils, as well as the proper ratio of these oils. Keeping the balance right is key in preventing most illnesses, especially those due to inflammation, a factor involved in most all diseases.

 P.M. Kris-Etherton, et al., “Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease.” Circulation. 2002 Nov 19;106(21):2747-57.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.  

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 There is a definite connection between having a healthy heart and consuming Omega-3 fatty acids (especially EPA and DHA) found in fish oils.  Though many studies on the heart benefits of fish oil exist, we need look no further than this month’s issue of the American Journal of Clinical Nutrition. In this edition there are no fewer than four articles pointing to the amazing heart-healthy benefits of fish oils.

 The first article shows that taking larger doses of EPA and DHA significantly lowers triglyceride levels in healthy people with hypertriglyceridemia (high triglycerides).  This is not new news, however. The American Heart Association recommends two to four grams of EPA/DHA daily for people with high triglycerides.¹   Chronically high levels of triglycerides promote heart disease.

The second article points out how dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults.² Since the heart is our most important muscle, it would certainly apply to the heart as well as to skeletal muscle.  Simply by preventing skeletal muscle wasting (sarcopenia), it will benefit the heart.  Loss of skeletal muscle, or sarcopenia, will decrease mobility and exercise tolerance, and gradually lead to chronic low grade inflammation and elevated blood sugar—both of which negatively impact the heart health.

The third article suggests that omega-3 and soy isoflavone supplementation provide an effective means of reducing arterial stiffness.³ Arterial stiffness is an indicator of poor function of the inner lining of arteries (endothelium) which eventually leads to arterial narrowing and clotting of the arteries (atherosclerosis).  As this process continues, congestive heart failure, heart attacks, and arrhythmias are likely to occur.

The fourth article refers to the Mediterranean diet (high in EPA and DHA from fish), which reduces endothelial damage and improves the regenerative capacity of endothelium.⁴ They point out again that endothelial dysfunction is a fundamental step in the atherosclerotic disease process. 

These articles are part of a growing body of evidence on the many ways fish oil can help maintain a healthy heart.

1. A.C. Skulas-Ray, et al., “Dose-response effects of omega-3 fatty acids on triglycerides, inflammation, and endothelial function in healthy persons with moderate hypertriglyceridemia.”Am J Clin Nutr. 2011 Feb;93(2):243-52.
2. G.I. Smith, et al., “Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial.” Am J Clin Nutr. 2011 Feb;93(2):402-12.
3. M.P. Pace, et al., “The effects of dietary and nutrient interventions on arterial stiffness: a systematic review.” Am J Clin Nutr. 2011 Feb;93(2):446-54. Epub 2010 Dec 8.
4. C. Marin, et al., “Mediterranean diet reduces endothelial damage and improves the regenerative capacity of endothelium.” Am J Clin Nutr. 2011 Feb;93(2):267-74. Epub 2010 Dec 1.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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A recent study published in the Journal of the American Medical Association (JAMA) found that DHA supplementation in patients with mild to moderate Alzheimer’s did not slow the rate of cognitive and functional decline. The headlines that sprung from this study include: “No Benefit for DHA in Alzheimer’s Disease,” “DHA Does Not Slow Progression of Alzheimer’s,” and so on.

The problem with this study is obvious to me. First, they should have measured baseline DHA/EPA levels in the red blood cell membrane (RBC). This gives a better picture of long-term levels of DHA/EPA in the body, due to the slow turnover of these cells. This test is available from Genova Diagnostics. Johns Hopkins also offers a much more extensive one.

Next, there is always the problem of bad bacteria oxidizing the omega-3s in the gut. If this is occurring, the omega-3s will not be beneficial and may even be even harmful. A comprehensive stool analysis (CSA) or Stool Effect test (Metametrix) would be in order at the onset to make sure the omega-3s are being well received at the gut level. If gut imbalance exists, rebalancing the gut with probiotics is recommended.

There is still a chance of oxidation of omega-3s even after they are absorbed in blood, so oxidative blood markers like lipid peroxides, hsCRP (highly sensitive C-reactive protein), hemoglobin A1C, fibrinogen, and 8OHDG (measures oxidative stress to DNA) would be good to know. If there is a lot of intravascular oxidative stress, this certainly could mean there is some oxidation of the omega-3s. This is why some data supports combining antioxidants with omega-3s to minimize oxidation.

Before taking any measures of DHA in the red blood cell membranes, the first step should be cleaning up the gut and reversing or at least decreasing inflammatory markers as mentioned above.

A follow-up RBC membrane analysis near or at end of study would be crucial. If adequate repletion of omega-3s is not found you may be able to assume in all likelihood the brain has not gotten its fair share of omega-3s either. We can’t be certain, however, since the brain could preferentially take up omega-3s over blood, but I tend to doubt it since the blood would see the omega-3s first.

This study looked at patients who had already been diagnosed with Alzheimer’s, but we know that the development of Alzheimer’s begins long before symptoms appear. Studies looking at fish oil supplementation BEFORE symptom onset have found a protective effect. Additionally, EPA is an important omega-3 also found in fish oil, but not used in the current study.

In addition, there are some small studies and anecdotal cases about the value of the saturated fat coconut oil reversing Alzheimer’s. It is thought this fat may be absorbed as a fuel by the brain, rather than glucose and may decrease insulin resistance in brain. Insulin resistance in the brain (also known as type 3 diabetes) is a major factor in all neurodegeneration, and especially Alzheimer’s disease.

I also think a person who has cleaned up vascular inflammation and gut issues could do well with stem cells for Alzheimer’s. I know of at least one woman who is doing quite well after stem cell therapy for her Alzheimer’s.

This was a typical medical study looking at one product and one end point. They found that when taking a lot of DHA, blood level and cerebrospinal fluid increased and yet, people with a significant degree of Alzheimer’s did not improve. That does not mean that fish oils are not beneficial for the brain. DHA is the most abundant fat in the brain, and resulted in positive effects when administered to patients with mild Alzheimer’s disease.1

Single nutrients (and for that matter most drugs) ARE NOT MAGIC BULLETS! Medical researchers need to take a systems biology approach—think whole symphony orchestra, not just the piano player (regardless of how well he/she plays). The role of diet, digestive health, stress reduction, inflammation reduction, detoxification of heavy metals and fat soluble toxins, adequate sleep, good elimination, moderate exercise, and psycho-emotional-spiritual balance all play a role in a person’s overall health. We need a symphony—not just a piano player—to make truly complex and beautiful music just as we need a symphony of nutrients to sustain a biochemically balanced person!

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

1. T. Hartmann, et al., “ Alzheimer’s disease: the lipid connection.” J Neurochem. 2007 Nov;103 Suppl 1:159-70.

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