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Craig Cooper

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The Debate Over Men And Omega-3

Posted: 03/12/11 11:57 AM ET

Debate over the health benefits and risks of flaxseed and omega-3 fatty acids, in particular alpha-linolenic acid (ALA- a form of omega-3 fatty acids), is ongoing and often contentious. People tend to become very defensive about their food choices, especially when they are making those choices because they are trying to prevent and/or treat a serious health problem, such as prostate cancer.

One controversy related to omega-3 fatty acids is whether ALA and flaxseed, which is a rich source of ALA, are beneficial or harmful to prostate health. According to medical oncologist and prostate cancer researcher Snuffy Myers, M.D., flaxseed and ALA, contrary to popular marketing, are not helpful for overall health nor for prostate health. Myers also states there is little to no evidence in the medical literature to support the use of flaxseed or flaxseed oil, that these products are hyped by marketers, and that people should turn to fish and fish oil as the best sources of omega-3 essential fatty acids. (1)

Omega-3 Essential Fatty Acids

Omega-3 essential fatty acids are so-named because the body needs them for overall health. However, because the body cannot manufacture them they must be acquired through diet and/or supplementation. This fact is also true for omega-6 essential fatty acids. One significant difference between these two types of essential fatty acids -- and there are several differences -- is that omega-6s are plentiful and even excessive in the Standard American Diet (yes, our "SAD" diet) while omega-3s tend to be deficient.

The three dietary omega-3s are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). In addition to flaxseed and flaxseed oil, ALA is found in soybeans and soybean oil, pumpkin seeds and pumpkin seed oil, walnuts and walnut oil, and purslane. EPA and DHA are found in cold-water fish such as halibut, herring, mackerel, salmon, sardines, and tuna. These fish do not themselves produce EPA and DHA, but instead acquire it from the krill and algae they eat.

EPA and DHA are the omega-3s necessary for health. This does not mean ALA has no role in your well-being. However, ALA is much less active than EPA and DHA and is mostly limited to cardiovascular benefits, and even in this capacity it is less effective than the other two omega-3s. In fact, before ALA can be utilized by the body, it must be converted into EPA, which is then transformed into DHA. Because the conversion rate of ALA to EPA and DHA in men is very low -- less than 4 percent of ALA is changed to EPA and less than 0.1 percent becomes DHA -- it is clearly better to get omega-3s from sources that provide EPA and DHA rather than ALA. Young women experience a significantly higher conversion rate -- 21 percent of ALA becomes EPA, and 5 to 9 percent of EPA is converted into DHA -- because the conversion is supported by estrogen activity. (1)

Flaxseed and Flaxseed Oil

Flaxseed is often touted as providing protection and relief from a number of ailments, although the validity of these claims has been questioned by some researchers. One group that examined the claims was from Memorial Sloan-Kettering Cancer Center.

Experts at Sloan-Kettering reviewed the available literature on flaxseed in human studies from nine databases, 20 additional journals, and various bibliographies. The reviewers found 13 categories in which flaxseed had been studied, including prostate cancer, constipation, attention-deficit hyperactivity disorder, high cholesterol, atherosclerosis, breast cancer, cyclic breast pain, menopausal symptoms, diabetes, high blood pressure, lupus nephritis and HIV/AIDS. The reviewers concluded that nearly all the studies were of poor quality, and that "although flaxseed and flaxseed oil have several promising future uses, the available literature does not support recommendation for any condition at this time." (Basch 2007)

When it comes to health impact, which one is worse, flaxseed or flaxseed oil? Although advocates of flaxseed and flaxseed oil might say the oil is the better deal because it delivers much greater amounts of ALA than does flaxseed, high levels of ALA also appear to increase the risk of advanced prostate cancer (see "Alpha-Linolenic Acid and Prostate Cancer" below).

In defense of flaxseed (but not the oil), Dr. Myers notes there is "good evidence" that flaxseed can quickly reduce the severity of high blood pressure, and that it is also beneficial in reducing elevated blood sugar levels in people with diabetes. This quality is attributed to flaxseed's high soluble fiber content. (1)

Alpha-Linolenic Acid and Prostate Cancer

Research has uncovered evidence that ALA from foods such as flaxseed, egg yolks, and canola oil may increase the growth and spread of prostate cancer. In a Harvard School of Public Health study that included more than 40,000 men followed for 10 years, the investigators found that ALA consumption increased the risk of advanced prostate cancer while omega-3s from fish reduced the risk. (1)

In a study published in the American Journal of Clinical Nutrition, researchers explored the association between the risk of prostate cancer and intake of the omega-3 fatty acids alpha-linolenic acid, EPA, and DHA; and the omega-6 fatty acids linoleic acid and arachidonic acid. A total of 47,866 men aged 40 to 75 who had no history of cancer in 1986 were followed for 14 years.

During the follow-up period, 2,965 new cases of total prostate cancer were identified, and 448 of these were advanced. An analysis of the men's intake of omega-3 and omega-6 fatty acids showed that intake of ALA was not related to a risk of total prostate cancer. ALA, however, was associated with an increased risk of advanced prostate cancer, with ALA from non-animal sources (e.g., flaxseed, flaxseed oil, canola oil) presenting a greater risk than from meat and dairy sources.

Intake of EPA and DHA, however, was associated with a lower risk of prostate cancer, both total and advanced, while consumption of the omega-6 fatty acids were unrelated to prostate cancer risk. The authors concluded that men who had increased intake of alpha-linolenic acid may have an increased risk of advanced prostate cancer. (Leitzmann 2004)

On the other hand, not all the available research has found ALA-rich flaxseed to be detrimental to prostate health. A team of scientists from The University of Texas M.D. Anderson Cancer Center conducted a randomized controlled trial to examine the effects of a low-fat and/or flaxseed-supplemented diets on the prostate and other biomarkers for prostate cancer. A total of 161 men with prostate cancer who were scheduled for prostatectomy were assigned to one of four diet groups: usual diet, flaxseed-supplemented diet, low-fat diet, or flaxseed and low-fat diet. The men followed the diets for an average of 30 days.

At the start of the study and before surgery, all the men had their blood drawn and tested for prostate-specific antigen (PSA), testosterone, C-reactive protein, cholesterol levels, and other biomarkers. After the surgeries, the men's tumors were examined, and men who had consumed either of the flaxseed-supplemented diets had significantly lower cancer proliferation rates than men who had followed a normal or low-fat diet. No differences were seen in any of the biomarkers except for cholesterol, which was significantly lower in the low-fat diet groups.

The study's authors concluded that flaxseed is safe and may provide some protection against prostate cancer. (Demark-Wahnefried 2008)

Fish and Prostate Cancer

For prevention and lowering your risk of prostate cancer, a large study from Harvard School of Public Health provides some answers. For 12 years, researchers followed 47,882 men who had participated in the Health Professionals Follow-up Study. The men's dietary intake was assessed every four years. During the follow-up period, 2,482 cases of prostate cancer were identified, of which 617 were determined to be advanced prostate cancer, including 278 metastatic cancers.

The investigators determined that men who ate fish more than three times per week had a reduced risk of prostate cancer, and the strongest association was for metastatic cancer. Each 500 mg of omega-3 fatty acids the men got from eating fish was associated with a 24 percent decreased risk of metastatic cancer. (Augustsson 2003) (View the amounts of omega-3s found in fish and seafood.)

Numerous other studies
have also shown a significant reduction in prostate cancer risk associated with omega-3 fatty acids.

What About Krill Oil?

Krill oil is an oil extracted from shrimp-like crustaceans called krill. Like fish oil, krill oil is a rich source of EPA and DHA. At a molecular level, krill oil has a phosphate molecule attached, which makes the EPA and DHA in krill oil phospholipids. This is important because phospholipids significantly increase the absorption (bioavailability) of the EPA and DHA, allowing the omega-3s to be more readily available throughout the body. Fish oil is in a triglyceride form, which is less bioavailable.

Krill oil may be of higher quality than fish oil, and one reason is that krill are at the lower end of the food chain and so are much more unlikely to accumulate dioxin, PCBs, mercury, and other toxins than are fish. Krill oil is also generally produced from krill harvested from cold Antarctic waters, which tend to be less contaminated than waters from which fish are harvested for fish oil. However, there are fish oil supplements made from fish caught in unpolluted waters as well.

Unlike fish oil, krill oil contains higher levels of a potent antioxidant called astaxanthin, which in addition to its ability to fight free radicals and oxidative stress, also helps make krill oil less perishable than fish oil. One major problem with fish oil is that it oxidizes, which means every time you open the bottle to take a dose, the fish oil loses a bit more of its potency. Oxidation also leads to the formation of harmful free radicals. Fish oil capsules mostly eliminate this problem.

One major concern about krill oil is that krill, along with plankton, make up the largest biomass on the planet. As such they are a critical and basic source of food for marine animals. While krill oil makers and others who harvest krill for food insist krill are an easily renewable food source, not everyone agrees, especially given the declining state of ocean health -- even the Antarctic from which much of the krill is harvested.

How Much Omega-3 Do You Need?

How much omega-3 do you need? A number of studies have indicated that EPA and DHA may be helpful in a number of health conditions, including arthritis, asthma, cancer, cardiovascular disease, dementia, depression, diabetes, high blood pressure, and schizophrenia. Therefore, in 2008, the Technical Committee on Dietary Lipids of the International Life Sciences Institute North America announced recommended daily intakes of both EPA and DHA. (1)

The Committee recommended that adults consume 250 to 500 mg of EPA and DHA daily, and it noted that people could not achieve this goal by taking ALA. Since flaxseed is a rich source of ALA, it is not recommended as a way for individuals to reach their daily omega-3 intake. Instead, people need to eat cold-water fish, take fish oil supplements, or supplements of DHA extracted from algae.

Dr. Myers recommends a much higher intake of fish oil supplements for men who want to prevent prostate cancer. Although there are no formal recommendations for fish oil doses regarding prostate cancer prevention and fish oil/omega-3s have not been proven to prevent prostate cancer, Myers suggests, for maximum benefit, 4,000 to 6,000 mg daily, or eating five servings of cold-water fish per week.

These recommendations concerning intake of EPA and DHA are especially critical for men, because those who depend on ALA and flaxseed for their omega-3s risk an omega-3 deficiency since their conversion rate of ALA to EPA and DHA is so poor. In addition, there are other risks for men who depend on ALA for their omega-3s, and so at this point there seems to be no reason to get ALA from flaxseed, flaxseed oil, or other similar products.

See also

Omega 3 and Prostate Cancer

Best Sources of Omega 3

References:

(1) Myers S. Flaxseed: Panacea or Poison? A Health Manifesto.

 

Follow Craig Cooper on Twitter: www.twitter.com/prostatenet

Debate over the health benefits and risks of flaxseed and omega-3 fatty acids, in particular alpha-linolenic acid (ALA- a form of omega-3 fatty acids), is ongoing and often contentious. People tend to...
Debate over the health benefits and risks of flaxseed and omega-3 fatty acids, in particular alpha-linolenic acid (ALA- a form of omega-3 fatty acids), is ongoing and often contentious. People tend to...
 
 
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07:16 PM on 03/28/2011
This later study shows no effects of ALA on prostate cancer
"dietary intake of total ALA and ALA from specific food sources was not associated with risk of total prostate cancer or prostate tumors that were defined by stage and grade."

http://www.ncbi.nlm.nih.gov/pubmed/16783606?dopt=Citation
OBJECTIVE: We prospectively evaluated total ALA and ALA from specific food sources including animal, fish, and plant sources in relation to prostate cancer risk.

DESIGN: A cohort of 29,592 male participants (age 55-74 years) in the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was followed for an average of 5.1 years.

RESULTS:. We found no association between total ALA intake and overall prostate cancer (multivariate RR comparing extreme quintiles=0.94; 95% CI=0.81-1.09; P for trend=0.76). In addition, no relations were observed between ALA intake from any specific food source and the risks of total, organ-confined, or advanced prostate cancer. ALA intake also showed no association with low grade (Gleason sumor=7; n=677 cases) tumors (P for trend=0.26).

CONCLUSIONS: In this prospective study of predominantly Caucasian men who were screened annually for newly incident prostate cancer, dietary intake of total ALA and ALA from specific food sources was not associated with risk of total prostate cancer or prostate tumors that were defined by stage and grade.
10:29 AM on 03/16/2011
Eating fish is so important, even if it's only a couple of times per week.

If Inuit’s could live on a diet exclusively of fish for thousands of years without suffering any form of malnutrition, or AMD, it seems pretty obvious that fish provide every form of vitamin and nutrient that our bodies require. However, the Inuit’s eat all of the fish, not just the meaty part, including the liver, head and eyes. In fact the liver contains as much vitamin D as our bodies require.

So why does not common sense prevail. If we all eat fish, including the liver and other less appetizing parts, we would not suffer from many of the conditions that seem so prevalent today.

If you want to read about other obvious ideas that have been ignored for so long, go visit, www.blindedbyscience.co.uk
11:53 AM on 03/15/2011
The controversy around flax (ALA) stems from people under stress being less able to convert the ALA through the six enzymatic conversion steps necessary to produce EPA and the four remaining steps to produce DHA. While EPA is well known for suppressing inflammatory conditions and DHA has been known to aid cognitive disorders, new studies are showing that EPA may be as effective, if not more so, in helping with schizophrenia.

You can't mix caffeine intake with an inflammatory condition or cognitive disorder and expect to gain any resolution. All those latte addicts, who also take meds or on their way to doing so, are just shooting themselves in the foot. The methylxanthines in caffeine, chocolate, and other sources only elevate stress hormones, which then decrease intestinal absorption of the very nutrients needed to support the enzymatic conversions as stated in the first paragraph.

These are typically: Magnesium, Zinc, Vitamin C, B3, and B6

I don't know why it is rarely mentioned, but stress is the first thing we want to look at when dealing with an inflammatory or cognitive disorders. It all starts in the gut. And as long as people keep whining about how will they ever manage to get moving in the morning without their beloved Starbucks latte, they need snap out of their delirium and nurture their digestive system first, if they want some of that energy to naturally return to them when they wake in the morning.
10:51 AM on 03/15/2011
I wish they would include Evening Primrose Oil in there studies.
09:02 AM on 03/15/2011
I strongly believe that a deficiency in essential fatty acids may affect any part of the body which can be identfied by a variety of signs. Nutritional supplements can be used by people with such deficiencies.

www.vegepa.com
01:09 PM on 03/15/2011
No need to just 'believe.' Plenty of science out there that shows the vast majority of us are deficient in omega-3s, and the health consequences for our entire body are dire ... and expensive.
08:57 AM on 03/15/2011
In principle, all the living cells of our bodies have the chemical machinery to manufacture omega-3 and omega -6 fatty acids that we need.\\unfortunately ,our ability to do this is impaired by factors in our modern life.
04:11 PM on 03/14/2011
can anyone list a number of "coldwater fish" species?
01:20 PM on 03/15/2011
Wild Alaskan salmon, Arctic char, black cod, halibut, albacore tuna, sardines, mackerel, anchovies, oysters, rainbow trout, mussels, menhaden, herring (These last two are mostly used to make fish oil).
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02:32 AM on 03/14/2011
Taking high doses of omega 3's alone can actually be dangerous to some. If interested, please google it, no time to post links here, sorry. Dean Ornish amongst others has commented on the research.
06:10 AM on 03/20/2011
Yes, you are right, especially when you're dealing with supplements. Not really an issue when consuming food because it's not concentrated in a capsule.If you are on blood thinners,the omega-3 supplements can further thin the blood, or if you're on blood pressure meds, these may cause the pressure to lower too much. Check with your MD to make sure there aren't any other interactions with medications. High doses of omega-3's (more than 2-4 g) should be medically supervised. Last thing is that excessive amounts of omega-3 supplements can depress your immune system since omega-3's are also anti-inflammatory.
12:40 AM on 03/14/2011
With all due respect to the author, I think he has this the wrong way around.

The bulk of his evidence for his "conclusion" is based on studies that were not designed to answer the question but to see if there is a possible "association". The most powerful kind of study is one designed to answer a cause an effect, and he does cite one study that takes this form: The University of Texas study. This study was unable to show any cause and effect.

The type of analyses are akin to the type of conclusion that an "association" between fat consumption and obesity means that eating fat makes you obese. OK, let's tell everyone to eat less fat when it's really the calories that count. We can all see how much weight we all lost during the "no fat" policy!

One other point: you have to look very closely at how the study and researchers are paid. There is a lot of money in fish oil!

Good health to all!
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HUFFPOST SUPER USER
goodmarina
Most People use Religion to justify their bias!
12:39 AM on 03/14/2011
Thanks for all the great posts & discussion on this article.   I am sincerely learning from yall!!

Have a great night :D
09:54 PM on 03/13/2011
As a physician, I am appalled that "supplements" are totally unregulated by the FDA. People make a fortune selling the latest "fad" with no studies to prove benefit or exclude harm. An observational study that people who eat more fish have less cancer or less heart disease does NOT mean that taking a pill with one component of fish will have the same benefit. This is an area where REGULATION is important to save consumers from being hurt physically and financially.
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HUFFPOST COMMUNITY MODERATOR
peegan
Silence like a cancer grows...S/G.
12:09 AM on 03/14/2011
Eat a balanced diet of whole food, minimal processing, minimal additives. Exercise. If I could just figure out how to turn those two statements into the latest fad diet and make a million. But it just isn't that complicated.
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HUFFPOST SUPER USER
eds123
My micro-bio is less filling and tastes great!
12:45 AM on 03/14/2011
All diets can be summed up into "Eat less, exercise more".
12:51 AM on 03/14/2011
The problem with this line of reasoning is that regulation tends to be driven by quantitative abstractions which are intended to approximate a qualitative norm. For example, the assayed mass of certain carboxylic acids is taken as the objective basis for regulating EFA supplements.

These regulations by nature of their practical implementation impose a degree of analytical simplification on a more sophisticated reality which, in turn, is not yet thoroughly understood by nutritional science. 

The public policy dilemma concerns the appropriate means of disseminating objective information in a domain for which there remain substantial unknowns. Do we restrict access to information whose practical implications are somewhat unclear, or if we do present this information, how might we communicate a recommend context in which it should be interpreted?

In other words, do we report that a certain food contains 1.5g of omega-3 fatty acids, with an asterisk noting that this information might be of limited use for a number of reasons? Or maybe the whole Nutritional Facts label should be footnoted with an advisory that there is no universal scientific consensus on how to relate any of this data to the practice of good nutrition -- consult with your physician?

This is ridiculous. If consumers don't form their own understanding of how to apply regulated nutritional assays to their dietary goals, either through self-study and/or through professional consultation, and if they don't realize that they should be skeptical by default of health claims made by food marketers, then there is essentially nothing that the government can do to help these people.
09:44 PM on 03/13/2011
Says the Dr being paid by the Fishing Industry ... eat well and think healthy folks and stop falling for the latest thing.
01:09 PM on 03/15/2011
..... Are you really denying all this just because you somehow have not heard of the benefits of fatty acids for the ENTIRETY OF YOUR LIFE? I remember hearing about it in FIFTH GRADE BIOLOGY.
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boilinabag
Nam et ipsa scientia potestas est.
08:26 PM on 03/13/2011
one week eggs are bad, the next eggs are great. these studys are never 100% correct. eat right, excersize, avoid the freeway, and if we dont blow it all up real good, then you might see Alzheimer's,

o boy.
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HUFFPOST SUPER USER
bleedingheart9
one small step for man...
08:08 PM on 03/13/2011
Hemp Protein was left out of the discussion, or did I miss something.

4 tablespoons of Hemp Protein Powder provides 600 milligrams of Omega 3 fatty acids, with 1.8 mgs of non saturated Omega 6 to boot.

Don't forget your mother, Nature.
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boilinabag
Nam et ipsa scientia potestas est.
08:28 PM on 03/13/2011
hemp oils are always left out, because its good for you. i can run a diesel on hemp oil cheap if i could grow it legal. and use the hemp fibers for a dozen other useful things.
12:13 AM on 03/14/2011
Correct, although I prefer the shelled (i.e. removed from the shells) hemp seeds to the protein powder because they're less processed and more flexible.

The important thing about the EFAs in hemp seed or hemp oil is that they are present in a 3:1 ratio of omega-6:omega-3, which is considered to be the ideal ratio. The large majority of Americans consume a ratio greater than 10:1, and some American diets reach an alarming 50:1.
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HUFFPOST SUPER USER
Cyrus Trance
America is not a theocracy.
08:19 PM on 03/14/2011
Hemp does not contain EPA, it contains ALA and GLA.

ALA and GLA are not good.
07:40 PM on 03/13/2011
Jeez, this is bad news for me as an older male vegetarian. I guess I need to find some of that algea concentrate, 'cuz I'm sure as hell not gonna start drinking krill-juice.
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sixchair
Always left, usually right
10:14 PM on 03/13/2011
it comes in capsules. go to walgreens.
12:11 PM on 03/15/2011
Or go online to find krill oil. However, you might want to do a little research about what to look for on the label so that you know you're getting the real stuff. Like most things that are being sold, there are good and bad actors who are selling them. You can find some good review on krill oil labels at WellWise, a non-profit website about nutrients.
Also, soon there will be algal omega-3s in greater abundance on the market, which in time will ease some of the pressure on marine life.