Addressing omega-3 deficiency: lessons learned from biomarker-based research

In a world increasingly plagued with disease, we need successful public health interventions.  In 1992, the British Nutrition Foundation Task Force on Unsaturated Fatty Acids suggested a desirable population intake for EPA and DHA of 0.5% of energy, which equates to about 8g/week (1.14g/day) for women and 10g/week (1.42g/day) for men, equivalent to 2-3 medium servings of oil-rich fish per week.  Despite this, current UK omega-3 recommendations are set at a mere 450mg EPA and DHA daily (2 portions fish weekly, of which one should be oily).  Even with this relatively low target, it is clear that the majority of the UK population are falling considerably short, with estimates suggesting an actual average intake of around 200mg/day.  Given that the omega-3 content of farmed fish has reduced by almost 50% in the last few years, the level of intake of these important long-chain fatty acids is likely  considerably lower than 200mg/day, leading to suboptimal omega-3 levels (i.e. an omega-3 index <4%).  This is disturbing from a health perspective given than it is estimated that an average 77kg individual would need a daily dose of 16mg/kg omega-3 (equivalent to 1.25g)  to raise their omega-3 index from 4% to 8%.

Despite knowing how good omega-3s are for us and how important supplementing is for our health, the latest research shows that we are still falling well short of the intake needed to achieve cellular levels associated with health protection and promotion. A recent article, published in Progress in Lipid Research, looked at data from 54 countries and 298 studies, and found that the majority of the world still has suboptimal levels of omega-3 (as defined by an omega-3 index of ≤4%), which the authors directly attribute to a significantly increased risk of chronic disease across the globe.

Part of the problem with public health, and its failures in effecting behavioural change, is that it does not, indeed it cannot, address the individual’s needs. This is also true of blanket dose recommendations for nutrient interventions. By applying a ‘one size fits all’ approach, public health interventions may certainly save several billions of pounds, and prevent hundreds of thousands of premature deaths, but on a one-to-one basis, are people really seeing a difference? Are those of us not in the highest risk categories seeing the fruits of our labours or considering our money well spent? People want noticeable, at least perceived, improvements in health and wellbeing, ideally without considerable upfront mental, physical or financial investment. Sadly, the public health messages, being necessarily far too generic, fail to address our dramatic bio-individuality and need for different support and tailored interventions, which then leads to dilution of perceived benefits and very poor compliance.

Linking biomarkers with therapeutic interventions

The omega-3 index, together with the AA to EPA ratio, has been a focus of Igennus research, recommendations and formulations for many years, given that a low omega-3 index and a high AA to EPA ratio is linked with increased risk and severity of a multitude of inflammatory-based conditions. Whilst combining the two biomarkers provides a comprehensive understanding of our cellular, physical and functional health and allows us to determine whether an individual’s cellular fluidity or inflammatory regulation could be a key contributor to their conditions, it is only recently (and yes, we are very excited!) that studies are using these biomarkers to increase the rate of therapeutic success with omega-3 interventions, in addition to better understanding the contributing biological mechanisms. By targeting omega-3 interventions according to the individual’s omega-3 index and AA to EPA ratio, these studies directly benefit each participant, and not just those ‘lucky enough’ to respond to the usual generic dose.

An example of the potential for using these biomarkers to increase intervention success comes from a recent meta-analysis published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry. The aim of the study was to clarify the link between low omega-3 status and ADHD symptom severity as well as, specifically, the relationship with RBC omega-3 & 6 levels, including the AA to EPA ratio. Confirming previous findings – including those of Parletta and colleagues  whose paper was published only months earlier – they showed that, when  compared to controls, individuals with autism spectrum disorders (ADS), and specifically ADHD, have a low omega-3 index and elevated omega-6:3 and AA:EPA ratios, all of which correlated with symptom severity.

Their analysis draws particular attention to the importance of both absolute levels of the long-chain omega-3s and 6s in the blood and the specific ratios between these important fats, as a mechanistic factor and therapeutic target. They also stress that failing to achieve an optimal omega-3 status and AA to EPA ratio is a likely reason for the lack of consistency in study results to date.

Prior to the publication of this meta-analysis, Sorgi and colleagues were one of the very few groups to directly look at the link between ADHD and the omega-3 index and AA to EPA ratio. Their study, published in 2007, and likely publicly disregarded due to low participant numbers and a non-randomised methodology,  actually measured baseline omega-3 index, omega-6:3 and AA:EPA and used omega-3 doses high enough to raise all three biomarker levels to optimal within the study period. Participants started the study with an average omega-3 index of 2.79% and an AA:EPA ratio of over 20 (optimal being >8% and between 1.5 and 3 respectively). By the end of the 8-week intervention, all of the children had achieved an omega-3 index of >8% and saw significant reductions in their AA:EPA ratio, which significantly correlated with symptom severity improvement.

Bigornia and colleagues have recently shown a similar link between symptom severity and omega-3 index in patients with depression.

A further meta-analysis published in June of this year confirmed the link between EPA and DHA intake and circulating levels, and protection against all-cause mortality. For each 0.3g increase in EPA and DHA intake, the relative risk of death was reduced by 6%, whilst just a 1% increase in the proportion of EPA and DHA within the red blood cells resulted in a huge 20% reduction in all-cause mortality. Whilst this study again looks at risk, it clearly shows that as intake increases, greater clinical results are achieved. Just a 1% increase in circulating omega-3 levels brings people closer to achieving ‘optimal’ biomarker status and has a significant impact on mortality by providing a greater level of protection.

On reflection, it seems that if we had followed the advice offered 24 years ago by  the British Nutrition Foundation Task Force on Unsaturated Fatty Acids (suggesting we should be consuming 8-10g EPA and DHA weekly), the level of omega-3 deficit and associated conditions would not be as significant as it is today.

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Dr Nina Bailey

About Dr Nina Bailey

Nina is a leading expert in marine fatty acids and their role in health and disease. Nina holds a master’s degree in Clinical Nutrition and received her doctorate from Cambridge University. Nina’s main area of interest is the role of essential fatty acids in inflammatory disorders. She is a published scientist and regularly features in national health publications and has featured as a nutrition expert on several leading and regional radio stations including SKY.FM, various BBC stations and London’s Biggest Conversation. Nina regularly holds training workshops and webinars both with the public and health practitioners.