Increase Omega-3 Polyunsaturated Fatty Acids

and Prevent Cardiovascular Disease

Wednesday, February 10, 2010 by: Helmut Beierbeck, citizen journalist

Cardiovascular disease is a leading cause of death in the developed world. It is largely a lifestyle disease,
and simple changes in diet and exercise can considerably lower the risk. One such simple change is an
increase in the consumption of n-3 (omega-3) polyunsaturated fatty acids (PUFAs) (1). The authors of a
2009 article estimated that between 72,000 and 96,000 premature deaths could be prevented annually
just in the U.S. alone by optimizing n-3 fatty acid levels (2).

The importance of n-3 PUFAs in health and disease is readily acknowledged by mainstream health
organizations. For example, the Nutrition Committee of the American Heart Association (AHA) has this
to say about omega-3 fatty acids and cardiovascular disease (3):

"Omega-3 fatty acids have been shown in epidemiological and clinical trials to reduce the incidence of
cardiovascular disease. Large-scale epidemiological studies suggest that individuals at risk for coronary
heart disease benefit from the consumption of plant- and marine-derived omega-3 fatty acids, although
the ideal intakes presently are unclear. Evidence from prospective secondary prevention studies suggests
that EPA + DHA supplementation ranging from 0.5 to 1.8 g/day (either as fatty fish or supplements)
significantly reduces subsequent cardiac and all-cause mortality. For alpha-linolenic acid, total intakes of
1.5 to 3 g/day seem to be beneficial."

One way in which n-3 fatty acids affect cardiovascular disease is by competing with n-6 fatty acids in the
formation of a class of hormone-like substances collectively referred to as eicosanoids. These
eicosanoids - prostaglandins, thromboxanes, and leukotrienes - mediate the body's response to injury
such as free radical damage. Eicosanoids derived from the n-6 PUFA arachidonic acid (AA) initiate a
much more virulent reaction than those synthesized from the n-3 PUFA eicosapentaenoic acid (EPA). It is
the role of n-3 eicosanoids to prevent this healing response from getting out of hand and causing further
tissue damage.

This is clearly seen by looking at the EPA/AA content of cell membrane phospholipids, the immediate
eicosanoid precursors. The lower the phospholipid-bound EPA/AA ratio in plasma cell membranes, i.e.
the higher the AA content, the higher the death rate from coronary heart disease (4). Of course, we can
make neither n-3 nor n-6 fatty acids; the most important dietary sources are the n-3 PUFA alpha-
linolenic acid and the n-6 PUFA linoleic acid plus EPA and docosahexaenoic acid (DHA) from marine
sources. Our dietary choices therefore determine the eicosanoid healing response and the risk of
developing cardiovascular disease.

Only small amounts of n-3 and n-6 PUFAs are needed for eicosanoid synthesis. Unfortunately, many of
us carry large stores of n-6 fatty acids, and correspondingly larger amounts of n-3 fatty acids are
required to balance the n-6 PUFA load. The large excess of n-6 PUFAs is mainly due to the excessive
consumption of vegetable oils. Canola oil has the least unfavourable n-3/n-6 ratio at ~1 : 2. That ratio for
soy oil is ~1 : 7; sunflower at ~1 : 20 and corn oil at ~1 : 80 are even worse. Peanut and safflower oils
contain n-6 PUFAs but no n-3 PUFAs at all (5).

The best way to balance n-3 and n-6 eicosanoids is to both minimize the consumption of vegetable oil
and increase the intake of n-3 fatty acids, preferably through fish consumption or EPA/DHA supplements
rather than relying on EPA synthesis from alpha-linolenic acid. It is an inexpensive and effective way to
reduce the risk of cardiovascular disease.

Reaction:
The point of my article is that an n-3/n-6 PUFA imbalance is associated with cardiovascular disease, that
n-6 PUFAs predominate in the Western diet (mainly because of the excessive use of seed oils), and that
correspondingly large amounts of n-3 fatty acids are required just to match the n-6 PUFA load. Taking
preformed EPA is more effective for this purpose than making EPA from alpha-linolenic acid; first, alpha-
linolenic acid must compete with much larger linoleic acid amounts for the necessary enzymes, and
secondly EPA synthesis from alpha-linolenic acid isn't very efficient. I don't doubt that people like the
Hunza manage very well without fish oil supplements; they don't cook with seed oils or eat meat from
grain-fed cattle. These people get their essential fatty acids in the right proportions from the food they
eat; for them supplementation and life style diseases like cardiovascular disease are non-issues. In our
part of the world, on the other hand, the n-3/n-6 PUFA balance first needs to be reestablished. For this
purpose EPA is more effective than alpha-linolenic acid, at least until the large n-6 PUFA excess is
eliminated.