Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Omega-3 are potent free radical scavengers, and stimulate both mitochondrium Q10 Circle and Co Q10 Synthesis.
- Sergio Stagnaro (2 January 2004)
-
Physical activity
- Bengt Kayser (2 January 2004)
-
Fish oil , but also Cretan-Mediterranean food
- Axel Ellrodt (4 January 2004)
-
Algae as a source of "fish" oil
- Matthew D Barber (6 January 2004)
-
Omega 3 fatty acids: Confounding with less milk?
- Jeffrey J. Segall (6 January 2004)
-
to fish or not to fish
- olga n garrard (13 January 2004)
-
Omega 3 fatty acids and cardiovascular disease
- Gilbert De Bruycker (12 February 2007)
-
Re: Omega 3 fatty acids and cardiovascular disease
- Todd L. Miller, Todd Miller (8 June 2008)
|
|
|||
|
Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8 16037 Riva Trigoso (Genova)Italy.
Send response to journal:
|
Sirs, notoriously, all authors agree with the use of fish or fish oil supplements after myocardial infarction (1), as well as in people at “real” risk of coronary heart disease, recognized now-a-days rapidly and easily at the bed-side with the aid of Biophysical Semeiotics (2, 3) (See webb site HONCode 233736, www.semeioticabiofisica.it, Practical Application). Although the mechanisms by which fish oils confer their benefits are not fully understood, a more accurate research in the large letterature on omega 3 fatty acids action mechanisms could certainly help excellent authors, like Din JN. Et al (1), to enlighten this particular aspect of treatment with fish or fish oil, as I described previously, already 11 years ago (4, 5). As a matter of fact, among the well-known effects of omega-3 (antiarrhythmic, antithrombotic, antiatherosclerotic, anti-inflammatory, improves endothelial function, lowering blood pressure lowering triglyceride concentrations) there are other essential, underlying actions mechanisms, unfortunately “overlooked also by the above -mentioned colleagues: free radical scavenger action and potent stimulation of both mitochondrial Q10 Circle and Co Q10 synthesis (4, 5). These effects, in my opinion, play a primary role in action mechanisms of omega-3, and account for the reason they are useful in a lot of diseases, including also IMA, CAD, and CAD prevention, obviously necessarily associated with other therapeutic measures, first of all, diet, etimologically speaking, i.e., proper food, physical exercise, a.s.o. 1) Din J.N., Newby D.E., Flapan A:D. Omega 3 fatty acids and cardiovascular disease—fishing for a natural treatment BMJ 2004;328:30-35 (3 January), doi:10.1136/bmj.328.7430.30 2) Stagnaro-Neri M., Stagnaro S., Deterministic Chaos, Preconditioning and Myocardial Oxygenation evaluated clinically with the aid of Biophysical Semeiotics in the Diagnosis of ischaemic Heart Disease even silent. Acta Med. Medit. 13, 109, 1997 3) Stagnaro Sergio. A clinical efficacious maneouvre, reliable in bed-side diagnosing coronary artery disease, even initial or silent, as well as "heart coronary risk". 3rd Virtual International Congress of Cardiology, FAC, http://www.fac.org.ar/tcvc/marcoesp/marcos.htm 4) Stagnaro-Neri M., Stagnaro S., Acidi grassi W-3, scavengers dei radicali liberi e attivatori del ciclo Q e della sintesi del Co Q10. Gazz. Med. It. – Arch. Sc. Med. 151, 341 (Infotrieve)1992 5) Stagnaro-Neri M., Stagnaro S., Proprietà antiossidante degli acidi grassi W-3. Gazz. Med. It. – Arch. Sc. Med. 151, 27, 1992. Competing interests: None declared |
|||
|
|
|||
|
Bengt Kayser, Professor Faculty of medicine, University of Geneva, 1211 Geneva 4, Switzerland.
Send response to journal:
|
Sir, I read with interest your review on omega 3 fatty acids and cardiovascular disease. It is clear that there is a role for these fatty acids in the prevention and treatment of cardiovascular disease. I was, however, astonished that you did not even once mentioned the tantamount importance of regular physical activity for the prevention and treatment of cardio-vascular disease. But the evidence is there, a sedentary life style is a major risk factor for the development of cardiovascular and other disease. It is a combination of regular physical activity and adequate nutrition that is needed. In order to give the reader an integrated view of the topic, in a review on one particular aspect of nutrition one should at least once mention the great importance of the other determinant, regular physical activity, which on the basis of our evolutional history is perhaps even more 'natural' as eating a diet rich in oily fish. Sincerely, Bengt Kayser Competing interests: None declared |
|||
|
|
|||
|
Axel Ellrodt, Emergency Department American Hospital of Paris , 63 Bd V Hugo - 92902 Neuilly sur Seine , France.
Send response to journal:
|
Sir, This is another timely review that again stresses the availability of powerful prevention means very much cheaper than more widely marketed drugs (statins, powerful antiaggregant drugs...). In addiction, it seems likely that the side effects should be markedly less severe and prevalent with omega-3 fatty acids than with those drugs! Physicians should be more aware and it is a nice choice of the BMJ to publish this review. The authors restricted their review to the marine source elongated omega-3 fatty acids. But alpha-linolenic acid (ALA) is easily available, and specifically as they wrote, in canola (rapeseed) oil, soybean oil, in some vegetable, and even in Alpine Swiss cheese (1) (as Pr Kayser modestly did not mention in his e-letter). Moreover, ALA sources are less likely to be contaminated with mercury. The question of the possibility of hypervitaminosis D with a diet too rich in fish oil was not addressed by the authors: is there a risk or not, and what would be the threshold ? I'd also like to ask the authors about the omega- 3 contents of fish obtained from aquaculture rather than wild. Whereas the Lyon study's impressive results have never been reproduced (nor proved erroneous) (2-4) we should remember that the "Cretan diet" prescribed in that study is not too uneasy to achieve in a western country, is palatable, is easy to adhere to, and that all pieces of evidence (experimental, epidemiologic, therapeutic) (2-6) point to the high likeliness that this is a very protective diet against coronary disease and probably cancer or more (7). The "Cretan diet" of that study is easy to reproduce and includes frequent fish meals. It seems highly unlikely that the Lyon-study-like Cretan- Mediterranean diet (published 1994) bears any risk except for the pharmaceutical , meat, sunflower and milk industries, therefore … 1- Hauswirth CB, Scheeder MR, Beer JH. High {omega}-3 Fatty Acid Content in Alpine Cheese. The Basis for an Alpine Paradox. Circulation. 2003 Dec 15 2-de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, Guidollet J, Touboul P, Delaye J. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994 Jun 11;343(8911):1454-9. 3-Leaf A. Dietary prevention of coronary heart disease: the Lyon Diet Heart Study. Circulation. 1999 Feb 16;99(6):733-5. http://circ.ahajournals.org/cgi/content/full/99/6/733 4- Leaf A, Kang JX, Xiao YF, Billman GE. Clinical prevention of sudden cardiac death by n-3 polyunsaturated fatty acids and mechanism of prevention of arrhythmias by n-3 fish oils. Circulation. 2003 Jun 3;107(21):2646-52 5-Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS, Manor O, Pella D,Berry EM. Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Lancet. 2002 Nov 9;360(9344):1455-61. 6-Sandker GN, Kromhout D, Aravanis C, et al. Serum cholesteryl ester fatty acids and their relation with serum lipids in elderly men in Crete and The Netherlands. Eur J Clin Nutr 1993; 47: 201-08. 7-de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.Circulation. 1999 Feb 16;99(6):779-85. http://circ.ahajournals.org/cgi/content/full/99/6/779 Competing interests: None declared |
|||
|
|
|||
|
Matthew D Barber, Specialist registrar in general surgery Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU
Send response to journal:
|
Editor- Concern about depletion of fish stocks will not be addressed by supplementing animal feed with fish oil as suggested by Din et al (1), as this requires the harvesting of wild fish to provide the fish oil. Fish farming does not provide a solution as farmed fish contains less omega 3 fatty acids, this being dependent on what they are fed – usually wild caught fish products (2). However, the original source of the long chain omega 3 fatty acids found in fish are the chloroplasts of marine algae and phytoplankton at the bottom of the food chain (3). In the marine environment the polyunsaturated fatty acids may provide the degree of desaturation needed to keep cell membranes fluid in cold water. Rather than genetically modifying terrestrial plants to produce eicosapentaenoic and docosahexanoic acid, it is possible to culture marine algae industrially to provide the “fish” oil while leaving the fish alone (4). If using cod liver oil as a source of fish oil it is important to remember that this contains a relatively high concentration of vitamin A producing a risk of toxicity (5). 1. Din JN, Newby DE, Flapan AD. Omega 3 fatty acids and cardiovascular disease-fishing for a natural treatment. Br Med J 2003;328:30-35. 2. van Vliet T, Katan MB. Lower ratio of n-3 to n-6 fatty acids in cultured than in wild fish. Am J Clin Nutr 1990;51:1-2. 3. Nordoy A, Dyerberg J. n-3 fatty acids in health and disease. J Intern Med 1989;225 Suppl 1:1-3. 4. Wen ZY, Chen F. Heterotrophic production of eicosapentaenoic acid by microalgae. Biotechnol Adv 2003:21:273-294. 5. Grubb BP. Hypervitaminosis A following long-term use of high- dose fish oil supplements. Chest 1990;97:1260. Competing interests: MDB has received research funding from Scotia Pharmaceuticals and Ross Products Division for work involving fish oil-based preparations |
|||
|
|
|||
|
Jeffrey J. Segall, Retired GP 308 Cricklewood Lane, London NW2 2PX, UK
Send response to journal:
|
The clinical review on the possible protective effect of omega 3 fatty acids against cardiovascular disease refers to the originating work on this topic of Dyerberg et al[1] but does not mention that these investigators also reported that “dairy foods are very scarce in the Eskimo diet”.[2] Related to this restriction is a high prevalence of low lactase activity in adulthood (an inherited characteristic), estimated as 87%.[3] Similarly, of the countries of the Organisation for Economic Cooperation and Development, Japan has the lowest mortality from ischaemic heart disease (IHD), the highest per capita supply of fat from fish, the lowest per capita supply of milk, and the highest prevalence of low lactase activity in adults, estimated as 78%.[3] IHD prevalence and mortality are also relatively low in China, where milk provides only 8 calories per capita daily, and the estimated prevalence of low lactase activity in adults is 94%,[3] but the per capita supply of fat from fish is low - less than half that in the UK.[4] During the Second World War, Norway experienced a decline in mortality from ‘arteriosclerosis’, a term which included IHD. A study in Oslo showed that the consumption of “milk of all sorts” was the lowest and that of fish was the highest ever found in Norway.[5] The MRC seeks more non-pharmaceutical clinical trials. It should compare a high intake of omega 3 fatty acids with a milk-free diet in secondary prevention following myocardial infarction. References 1. Dyerberg J, Bang HO, Hjorne N. Fatty acid composition of the plasma lipids in Greenland Eskimos. Am J Clin Nutr 1975; 28:958-66. 2. Bang HO, Dyerberg J, Hjorne N. The composition of food consumed by Greenland Eskimos. Acta Med Scand 1976;200:69-73. 3. Segall JJ. Dietary lactose as a possible risk factor for ischaemic heart disease: review of epidemiology. Int J Cardiol 1994;46:197 -207. 4. Food and Agriculture Organization of the United Nations. Food Balance Sheets, 1984-86 Average. Rome: FAO,1991. 5. Strom A. Examination into the diet of Norwegian families during the war-years, 1942-45. Acta Med Scand 1948;138(suppl 214):1-47. Competing interests: None declared |
|||
|
|
|||
|
olga n garrard, consultant in child and adolescent psychiatry canada house, barnsole road, gillingham me7 4jl
Send response to journal:
|
i found the article by Din et al very informative, but am unclear why they chose to ignore the plant derived omega 3 fatty acids beyond the initial difinitions. In figure 3, they suggest that the omega 3 fatty acids from fish oils are metabolites of alpha linolenic acid (the plant derived source of omega 3 fatty acids). However, no comment was made on whether alpha linolenic acid is as effective as oily fish in the beneficial effects described. Is this because no tials exist or trials show less effect? Din et al comment on concerns about depleting fish stocks and environmental contamination of certain fish. Would suggesting a trial of alpha linolenic acid supplements or a diet rich in the plant sources of this oil as well as their proposed trial of fish oil supplements be an option for future research? Competing interests: None declared |
|||
|
|
|||
|
Gilbert De Bruycker, retired 9000
Send response to journal:
|
Omega 3 fatty acids and cardiovascular disease—fishing for a natural treatment by Jehangir N Din, David E Newby and Andrew D Flapan. http://www.bmj.com/cgi/content/full/328/7430/30? ijkey=66b98811d643dc0623e73f95dbc45848d784dca0&keytype2 =tf_ipsecsha Dear Sir, This article states that omega - 3 fatty acids (provided as capsules) reduce triglyceride concentrations in a dose dependent manner, with intakes of about 4 g per day. Do you mean by this the "fill weight" of the capsules or only the weight of the omega - 3 fatty acids? And what about the ratio between eicosapentanoic acid and docosahexanoic acid within the omega 3 itself? For a Mor EPA capsule for example, the ratio between EPA an DHA is 7 to 1, but for other products the ratio is 1,5 to 1. One softgel "Mor EPA" of 1000 mg contains 75% Omega-3, of which 580 mg EPA and 83 DHA 83 mg. But in case of BIOLEINE, 1000 mg contains 54% Omega-3, of which 270 mg EPA and 170 mg DHA. Which product would you suggest? And how many capsules a day?! Sincerely, Gilbert De Bruycker Competing interests: None declared |
|||
|
|
|||
|
Todd L. Miller, Distributor for a nutrional Co. 17328 Cleeco Place, Poway, CA 92064, Todd Miller
Send response to journal:
|
Dear Gilbert: I would like to make some suggestions for you so you can better understand Omega 3 supplements. I work for a nutrional co. and have read 3 books on Omega 3 fatty acids, not to mention have taken them personally for the past 5 years. When it is mentioned that you should consume an intake of 4 grams per day, that refers to the amount of Omega 3 only. It does not mean the total fill amount as you questioned. It is not the total amount of fat in grams that is significant but the amount of Omega 3's. The higher percentage of Omega 3's the better. All you have to do is add the total amt. of EPA and DHA and take that total amt. and divide it into the total amt of fat grams. So if you have 450mg of EPA and 250mg of DHA and a total of 1.5 mg of fat, you would come up with the following formula (just an example). 450+250=700mg of total Omega 3's 1.5grams=1500mg 700/1500=46.6% concentration. As far as ratio's go, the standard amount is 2:1 EPA/DHA but some people, like myself do better with a ratio as high as 6:1 EPA/DHA. Some people receive a side effect of decreased mood with too much DHA. I believe that EPA is more beneficial to mood and Cardiovascular disease prevention among the many other benefits. I think you should try to find a product with at least 70% potency and with the highest ratio of EPA to DHA ratio. Your body hangs on to DHA much more then EPA. EPA is much more rapidly turned over and needed to be replaced in the diet or through supplementation daily. The only differences would be pregnant women, nursing Mothers and babies who need more DHA. One product I can suggest is called OmegaBrite and you can receive all the info at www.OmegaBrite.com and it is a pharmaceutical grade product, however if that is too pricey, there is an excellent product that most Wal-Marts carry called Omega HMJ (Heart, Mind, Joints). It comes in a blueish silver box with 45 caps. for $5.94 which should cover a month's worth if you consume 1000mg a day or 1 gram a day of omega 3's. I hope this helps. Competing interests: None declared |
|||