Camexpo talk summary
The use of omega-3 is common in clinical practice, yet inter-individual differences in treatment outcomes can be a challenging barrier to successful intervention. The impact of dose, bioavailability and subsequent cellular enrichment can affect clinical outcomes and Dr Bailey explains why personalised nutrition intervention is key to a successful practice.
Take home messages from recent clinical trials
A vast body of science highlights the role of omega-3 fatty acids – especially EPA and DHA – in many areas of health. The benefits for cardiovascular health are the most widely reported but studies are expanding into new areas as scientists discover more about the mechanisms of these important nutrients. Contradictory trial results questioning the benefits of omega-3 fatty acids highlight the importance of using omega-3 biomarkers – not just for research studies, but in the context of clinical nutrition too. Researchers do not always understand how subtle differences in formulation and dosage can produce significantly different omega-3 red blood cell levels (the omega-3 index) depending on an individual’s baseline levels. This fundamental oversight translates to major flaws in study design and consequently misleading outcomes in terms of the therapeutic potential of omega-3 fatty acids. Patients are the casualty of such poor approaches to research, and subsequently damning media reporting. The clear message that is coming through from a number of key researchers in omega-3 nutrition science is that studies need to adapt to take on a more personalised approach to intervention.
Implications for practitioners: steps to optimise outcomes
1. Consider dose and bioavailability
The debate around factors such as dose and bioavailability is far from new. When delivered in their natural form (bound to triglycerides or phospholipids), omega-3 EPA and DHA are generally good in terms of bioavailability and uptake but, when taken in ‘conventional’ doses, fail to raise omega-3 levels to the same extent as the concentrated forms (re-esterified triglyceride rTG or ethyl-ester EE) used in large scale intervention studies. For a supplement to offer therapeutic potential, it must be able to raise the omega-3 index, with dose and bioavailability being significant influencers. Standard fish oils used at a manufacturer’s recommended dose will not have the same effect on omega-3 status as concentrated oils in re-esterified triglyceride or ethyl-ester form.
2. Consider baseline levels
The benefits of omega-3 intake are significantly determined by an individual’s baseline levels, and people with low baseline omega-3 levels are more likely to respond to omega-3 supplementation than those who are not especially omega-3 ‘deficient’. Thus, since studies do not usually recruit participants according to baseline levels, outcomes are likely to be very varied. As a wide intra-individual variation in omega-3 baseline levels exists within the population, the potential benefits arising
from group studies can be masked. For practitioners, similar issues arise; significantly positive outcomes are more likely to be seen in clients with low baseline omega-3 levels, while clients with good omega-3 levels may need lower doses, or a different route of treatment altogether. A ‘one size fits all’ approach to supplementation essentially flattens the treatment response – whether in a study or in a clinic context. What this tells us is that omega-3 intervention is highly specific – and until studies take into account individual needs for omega-3 fatty acids, we must question the outcomes. The best way for practitioners to address this in the clinical context is via fatty acid testing of clients’ baseline levels – an essential process that is often lacking in large scale studies!
Consider personal intervention: fatty acid biomarker testing
Blood fatty acid testing measures key omega-3 biomarkers – such as the omega-3 index and the AA to EPA ratio. These biomarkers are becoming increasingly valuable for assessing an individual’s risk of disease (low omega-3 index/high AA to EPA ratio) at baseline and change in risk (high omega-3 index/low AA to EPA ratio) after supplementation. The omega-3 index is a validated biomarker of omega-3 status, with dose response studies revealing that large amounts of omega-3 may be required to achieve an omega-3 index of ≥8% (the amount of EPA & DHA expressed as a percentage of total fatty acids within red blood cells and considered to be an ‘optimal’ target level), especially where the baseline levels are suboptimal at ≤4%.
3. Consider body weight when dosing
Body weight is one of the key variables that influence how we respond to omega-3. From a practitioner perspective, identifying a client’s individual requirements by first identifying baseline levels and treating with a personalised (mg/kg) dose aimed at raising the omega-3 index to a predetermined (≥8%) level will increase therapeutic potential of a fatty acid regime.
4. Consider EPA vs DHA
Most chronic disease states are inflammatory driven, with clinical application to reduce inflammation a target for many interventions. Increasing numbers of studies are identifying the unique properties of EPA and DHA on inflammatory regulation, with a subsequent rise in those studies utilising pure EPA. Using the AA to EPA ratio as a biomarker of inflammatory potential allows practitioners to manage inflammation-related conditions. It is recognised that preloading with pure EPA reduces inflammatory status more effectively than EPA and DHA ‘blends’. The reason for this is that a decrease in cell membrane AA (inflammatory omega-6) content and an increase in EPA derived from pure EPA supplementation alters the balance of eicosanoid and cytokine production from a generally pro-inflammatory profile to a less inflammatory and even inflammation-resolving profile. Once a healthy AA to EPA ratio has been achieved, introducing DHA (at an EPA to DHA ratio of 3:1) continues to regulate inflammatory processes whilst supporting structural integrity by maintaining a healthy omega-3 index. Igennus Pharmepa® RESTORE and MAINTAIN supplements have been formulated to support this optimal approach to omega-3 intervention; these super-concentrated omega-3 wild fish oil supplements provide rTG omega-3 – the most effective form of omega-3 at raising cellular levels, fast.
Optimising omega-3 intervention
Successful intervention with omega-3 fatty acids (both in large scale studies and individual clinical intervention) can be enhanced by dosing according to baseline omega-3 red blood cell levels. Dosing according to individual patients’ needs will raise the omega-3 index to >10% and bring the AA to EPA ratio and omega-6 to omega-3 index into healthy ranges within 6 months –significantly improving health outcomes. Click for more information on Pharmepa® RESTORE & MAINTAIN or our Opti-O-3™ blood spot fatty acid biomarker test, or call 01223 421434.