The Omega-3 Effect

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Foreword

The book you are holding has been written by a doctor who shares with you his joy in good health and his love for his family and patients. Dr. Bill Sears wrote this book to "reach the most readers with the best science in the simplest way." During the past year, I saw him tirelessly work to develop stories and lessons that would help people understand how they might prevent and reverse habits that cause untold damage to their health and the health of their families.

As an experienced author, Dr. Bill knows to "keep it simple, make it fun" for his readers. As an experienced physician who has seen the tragic results of bad health habits and guidance, he knows that he must "keep it scientific, make it factual," he must avoid telling entertaining but misleading fantasies. You will enjoy seeing how he succeeds in giving science-made-simple explanations.

Although we have vast biomedical knowledge about disease, more than 80 percent of U.S. health care dollars are spent on issues caused by preventable lifestyle behaviors. Something is missing. The Omega-3 Effect makes us aware of what we need to understand and do to prevent this problem.

I happened to be a professor of biochemistry in 1964 when an article first reported that our bodies convert vitaminlike omega-3 and omega-6 fats into a complex set of powerful hormones. The next several decades were years of exciting discoveries, as hundreds of scientists uncovered even more important news about omega-3 and omega-6 hormones, including that they act on selective receptors located on nearly every cell and tissue of the body. As a result, these hormones affect nearly every physiological and pathological aspect of our lives. They play a role in many conditions, including atherosclerosis, thrombosis, arrhythmia, heart attacks, immune-inflammatory disorders, asthma, arthritis, psychiatric disorders, depression, suicide, oppositional behavior, unproductive workplace behaviors, cancer proliferation, and length of stay in hospitals.

The scope of the omegas' effects on our health is amazing. Although it has become common biomedical knowledge that omega-3 and omega-6 hormones are powerful enough to help prevent and treat many health problems, the incidence and prevalence of preventable diseases has not diminished. Enter Dr. Bill, who, like a patient Zen scholar, searched for simple metaphors that would shock the mind into awareness and lead readers to experience an enlightened or awakened state. He creates fresh views of how omega-3 nutrients help your heart, build smarter brains and better moods, help childhood learning and behavior, make pregnancies healthier and baby brains brighter, help balance inflammation, aid weight loss, keep you young, help you heal, and more. He helps you understand how the interaction between omega-3 and omega-6 fats is a key to good health. The Omega-3 Effect will make you aware of, and alive to, what you can do for your family and friends.

Bill Lands, PhD

Author of Fish, Omega-3 and Human Health

Fellow AAAS, ASN, SFRBM

Meet the Experts

A big helping of thanks to my board of advisers, who collectively have authored more than fifteen hundred scientific articles on health issues:

Tom Brenna, PhD. President of the International Society for the Study of Fatty Acids and Lipids (ISSFAL) in 2012; professor of human nutrition and chemical biology, Cornell University. His research mostly deals with studies on fatty acids and brain health.

Jørn Dyerberg, MD. One of the world's leading authorities on the health benefits of omega-3 fish oils. In the early 1970s he led a research team that studied the association between fish oil and heart disease in the Inuit population of Greenland.

William Harris, PhD. Omega-3 index coinventor; American Heart Association author; research professor, Sanford School of Medicine, University of South Dakota; senior scientist, Health Diagnostics Laboratory, Richmond, Virginia; president, Omega-Quant LLC.

Bruce Holub, PhD. Professor emeritus, Department of Human Health and Nutritional Sciences, University of Guelph, Ontario, Canada. Scientific director, DHA/EPA Omega-3 Institute, www.dhaomega3.org.

Penny Kris-Etherton, PhD. Distinguished professor of nutrition, Department of Nutritional Sciences, Pennsylvania State University. Her research includes over twenty years of clinical studies evaluating the role of diet on risk factors for cardiovascular disease.

Bill Lands, PhD. Author of Fish, Omega-3 and Human Health, second edition (AOCS Books, 2005). His website www.FastLearner.org discusses the omega balance scores of many foods. Professor Lands is credited with discovering the benefits of balancing the effects of excess omega-6 fatty acids with dietary omega-3 fatty acids, and he is widely regarded as one of the pioneering omega-3 researchers.

While I have for the most part followed the advice of these experts, occasionally even scientists differ in their interpretations of research studies, so some of my conclusions may not reflect the views of all my advisers.

THE
OMEGA-3
EFFECT

Introduction

Fishing for the Omega-3 Effect

This book is about my twenty years of learning and living with the omega-3 effect. I hope that after reading it you will experience your own health benefits of omega-3s. I will take you on a journey through various cultures in the world and share with you stories that will change your life, as they have changed mine and the lives of many of my patients. In my medical practice, I have become more passionate about the health-promoting properties of omega-3 EPA/DHA than about any other nutrient. Having personally experienced the lifesaving qualities of this gift from the sea during my own health crisis and witnessed the omega-3 effect in my own patients, I feel compelled to share my "catch" with you. My wish for you is that after reading this book you will live a happier, healthier, and longer life.

Part I begins with the fish stories that gave rise to the idea for this book. I also take you fishing with some of the most trusted omega-3 scientists. Then, after you understand why I'm so passionate about omega-3s, you will get a science-made-simple explanation of the main omega fats you should know about, so that strange words like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) become familiar.

In Part II, I take you into my medical office for a series of visits addressing all your head-to-toe concerns. Imagine yourselves as patients coming to my office.

Part III features Dr. Bill's simple two-word prescription for nutritional health: "Go fish!" It includes a green-yellow-red traffic light list on how to select safe seafood. You will also learn how much seafood and fish oil supplements to take for the ailments you have.

After asking many patients in my medical practice what style of writing would best hold their attention, I selected the KISMIF principle: keep it simple, make it fun. I also wanted another KISMIF: keep it scientific, make it factual, to please the show-me-the-science readers. Any claim about a miracle nutrient releases the inner skeptic in them. They want authors to back up their statements with scientific references. So, in the notes section, I summarize some studies and cite many scientific references.

My China Story. Among my colleagues I'm known as the science-made-simple doctor. During my four speaking trips to China between 2009 and 2011, the chairperson of the Chinese Nutrition Society decided, "Put the American last on the program. He's funny and everyone will stay." My presentation opened, "Let me introduce my partner in medical practice, Dr. O. Mega III." Laughter was followed by a sip of green tea, which I took as a gesture of "like." Dr. O. Mega III was born one day in my office as I was explaining omega-3s to a patient, who then called me "the fish doctor." I imagined Dr. O. Mega III as a head-to-toe specialist, my partner in medical practice: a neurologist, ophthalmologist, pulmonologist, cardiologist, gastroenterologist, rheumatologist, dermatologist, and whatever other -ologist a patient would need.

My Roundtable Story. On April 27, 2011, after enjoying the traditional Sears salmon-at-sunset dinner the evening before, six of the top omega-3 researchers in the world gathered around our dining room table, including Dr. Jørn Dyerberg, the father of omega-3 research. In this first Omega-3 Effect Scientific Roundtable I was privileged to be surrounded by scientists who collectively had published more than fifteen hundred scientific articles. I had asked this panel of experts to help me critique the first draft of this book. My objective was to select the best science from the best scientists and translate it in a simple and entertaining way.

I opened the meeting by presenting the purpose of this book: "To reach the most readers with the best science in the simplest way." Lively discussions, constructive disagreements, and aha moments culminated in 106 pages of typed notes from the recorded session.

These experts scrutinized each page of the book to be sure the science was explained simply but accurately. Naturally, they allowed me a bit of poetic license when I challenged them to explain a complicated biochemical principle in simple and entertaining terms, such as, "Tom, imagine you're explaining this magical molecule to your mother." Occasionally, they couldn't get out of their white-coat laboratory lingo, and we laughed, saying, "See, that's why we need this book!" As we got deeper into the science in certain chapters, I realized that although there are thousands of published articles about the health benefits of omega-3 fats, there is solid science and soft science. These professionals knew the difference.

At the end of this memorable day I reminded my colleagues that one of the reasons their advice for this book was so brilliant and perceptive is that I had loaded them up with an omega-3 meal the evening before.

   PART I   

WHAT YOU NEED TO KNOW
ABOUT OMEGA-3S:
SCIENCE MADE SIMPLE

After recounting four fish stories that prompted my interest in omega-3s, I take you inside the biochemistry of omega-3 fats to help you appreciate how this marvelous molecule is made and why it behaves so beautifully in your body and brain. I also clear up the standard consumer confusion about fats, explain why and how to give yourself an oil change, and point out that the key to good health is not necessarily a low-fat diet but rather a right-fat diet.

1

Four Fish Stories

The following stories tell about my search for a lifesaving nutrient and how discovering it enriched my health.

OUT OF THE MOUTHS OF BABES

My passion for omega-3 research began with the birth of our eighth child. The story begins in 1991 with the pregnant teenage daughter of a close friend. Like many pregnant teens, she was struggling with the realization that she did not have the maturity to raise her child. Yet, giving her child up for adoption was an even more upsetting alternative—choosing strange parents from a stack of résumés, perhaps never seeing her child again, and always wondering if she'd made the right decision.

Sensing her struggle, my wife, Martha, and I offered to raise her child in open adoption, where she could choose to be involved on her own terms. She was overjoyed, as were her parents, and she thrived throughout the rest of her pregnancy.

The Tale of Two Milks. Then came another decision that helped plant the seed for this book. Each of our previous seven children had been exclusively breast-fed. Although we wanted the same for the new baby—call her Lauren—we knew that Martha would only be able to produce half of what Lauren needed. Would Lauren be the first formula-fed Sears baby? No big deal, right? Wrong!

Around that time studies had started to show what breast-feeding mothers had suspected all along: children who are breast-fed grow up to be smarter and healthier.¹ We felt that just because Lauren was adopted, she shouldn't be deprived. We began searching for the formula closest to mother's milk.

After looking into the nutritional content of all the infant formulas, I discovered that every formula, especially those made in the United States, was missing vital brain-building omega-3 fats. The brain is 60 percent fat, and one of the top omega-3 fats in the brain is DHA. Hmm! Growing brains need special fats, yet infant formulas contained none. What's wrong with this cerebral picture? In the end, the only choice was to find a way to give Lauren breast milk. We concluded that the best alternative to her mother's milk was another mother's milk.

Two Mothers Making Milk. A few minutes after Lauren was born, she was nursing from her birth mom, who was producing colostrum, the perfect immune-boosting starter milk for a newborn. Meanwhile, Martha was hooked up to pumps trying to produce breast milk of her own. You should have seen the look on the obstetrical nurse's face when she came into the room and saw this dual-mom milk-making scene, probably the first and the last such scene of her career.

Milk Moms to the Rescue. The challenge was how to get enough breast milk for Lauren. During office visits mothers of infants would often comment on how much milk they were making. They were happy to give me the excess; at the end of each day I would leave the office with bottles of this liquid gold. Two years and thirty-five milk moms later, Lauren had made a smart nutritional start.

Improving the Formulas. What I learned from the failed formula search for our adopted baby made me angry. For more than ten years the known nutritional information about brain fats in human milk had been ignored by most formula makers, the Food and Drug Administration (FDA), and even my own profession. That had to change. I was motivated to "milk" the scientific literature for all the available facts. The more I read and studied about DHA in the brain, the more appalled I felt that millions of babies in much of the world went to bed each night without the most important brain-building fat. My crusade to get omega-3 smart fats into infant formulas began.

When I made my case to one of the largest formula sellers in the United States, I presented a slide show of what I thought was compelling proof for why omega-3 DHA, the smartest fat in the brain, must be added to infant formulas. To my amazement and disappointment, the head number cruncher said, "It would not be profitable for us to add DHA to our formula at this time because it would cost the consumer thirty-five cents more a can." Shocked, I pleaded, "I don't know a parent in the world who would not pay thirty-five cents more a day for their baby to grow a better brain!" I lost my case.

One of the joys of being a pediatrician is what I call the helper's high, the feeling that someone's life will be better because of something you said or did. Vowing to get formula companies to upgrade their offerings, I teamed up with doctors and scientists who taught me about brain-building fats, and continued crusading.

Finally, in 2001, the FDA and the infant formula companies could no longer ignore the science, and today nearly all companies add omega-3 fats to their infant formulas.

CANCER CAUSED ME TO CARE

Growing up Roman Catholic, I ate fish once a week. I thought I had to if I wanted to go to heaven. Yet what I ate were fish sticks and breaded fish sandwiches. Real seafood was not at the top of my list until April 1997, when I was diagnosed with colon cancer. Following major surgery, chemotherapy, and radiation therapy, I studied the data on survivors of major illnesses and life-changing events. Survivors had one thing in common: they made a project out of their problem. So that's what I did. Because my problem was in my gut, I began to search for the healthiest foods. Why not make a project out of healthy aging at the same time I was searching for the perfect health food? I found that the food that was ranked as the best health food also got top marks for healthy aging—seafood. In fact, the same fats that were crucial for baby brains were also important for senior brains and bodies. From head to toe—brain, eyes, heart, gut, muscles, joints, and skin—seafood was the best food to help prevent all the ailments I didn't want to get.

One of the earliest studies I discovered showed that cultures that eat more seafood have less cancer, especially colon cancer. In fact, these cultures have a lower incidence of just about every ailment of aging, like cardiovascular disease and many of the -itis illnesses, such as arthritis, bronchitis, and dermatitis. There was even emerging research suggesting these neuroprotective fats might delay Alzheimer's disease, or what I call cognitivitis. In my life before cancer I was a hearty carnivore, habitually devouring grilled steaks. "Burn a big one" was my eating-out meat order. In my postcancer life I became a healthier kind of foodie, a seafood lover.²

INUITS DON'T GET HEART DISEASE

In order to learn more about omega-3 fats, I followed the advice I gave young medical students: "Surround yourself with wise mentors and have the wisdom and humility to learn from them."

In June 2006 I had the opportunity to spend a week fishing in Norway with a Danish doctor, Jørn Dyerberg, who is deservedly known as the father of omega-3s. After hearing of his thirty-plus years of research, I came home not only motivated to eat more fish with my family but also to share this research with my readers and patients.

As a medical resident in 1970, Dr. Dyerberg was intrigued by this paradox: Inuits ate a high-fat, high-cholesterol diet but enjoyed a low incidence of cardiovascular disease. That didn't fit with the conventional wisdom of the time, "Fat is bad for the heart." So Dr. Dyerberg traveled to Greenland to study the Inuits in the hope of finding a clue to this medical puzzle. While traveling through the Inuit villages he observed that the natives had frequent nosebleeds. Many people have nosebleeds in the winter. Must be the dry air in those igloos, he reasoned. Not so fast!

"Their nuisance nosebleeds seemed to take longer to stop than I remember occurring back home," he told me. When Dr. Dyerberg took blood samples from the Inuits, the tests revealed their bleeding times (the time it takes for blood to clot) were longer than the average bleeding times of Europeans. Could a high omega-fat diet cause thinner blood, he wondered? Many people on high-fat Western diets were dying of diseases related to blood that clotted too fast—at that time called the thick blood syndrome.³

Dr. Dyerberg continued to try to piece together the puzzle of longer bleeding times and lower incidence of heart disease. Could it be that when blood is slower to clot, arteries don't get plugged? Intrigued, he collected more blood samples from the Inuits and then, back at home, compared them with similar blood samples from the Danes. Here's what he found:

Dr. Dyerberg realized that compared to the Danes, the Inuits ate more omega-3s (found in fish oils) and less of their cousins, the omega-6s (found in factory-processed foods).⁴ Could there be a cause-and-effect relation here? Thirty years and over twenty thousand scientific articles later, the medical community had proved that one simple oil change could lower the rate of heart disease throughout the world.

Coincidentally, Dr. Dyerberg studied with Professor John Vane, who won the Nobel Prize for figuring out that aspirin worked by blocking the production of biochemicals that inflame the tissues. It's interesting that Dr. Dyerberg had a theory, later proven, that fish oil could have a similar therapeutic effect by a similar mechanism.

Dr. Dyerberg believed, and subsequent research confirmed, that the high doses of EPA in the Inuit diet lowered the risk of coronary artery thrombosis by shifting the tendency for blood's clotting too fast to clotting just right. When Inuits started eating like Americans, their blood began overclotting, and their rates of dying from cardiovascular disease became similar to the American rates. It's alarming that the relation between higher dietary proportions of omega-3s and lower incidence of heart disease was known in 1970, but as of 2012 the United States still does not have an official government Recommended Daily Intake (RDI) for omega-3s.

A year after our 2006 fishing trip and twice again in 2011, I had the pleasure of hosting Dr. Dyerberg at our home for the traditional Sears salmon-at-sunset dinner, where we caught up on the latest in omega-3 research and more fish stories. At one of our dinners I asked him to tell me more about his challenges in getting his discovery accepted by his medical colleagues.

When he studied blood platelets—those blood cells that bunch up and stick together—the Inuits' platelets contained a much higher proportion of omega-3s compared to the Danes', and their bleeding times were nearly twice as long. Dr. Dyerberg believed that the high proportion of omega-3 EPA fat in the Inuit diet shifted the blood to a slower-to-clot state and that the difference could help explain why the Inuits suffered fewer heart attacks.

Dr. Dyerberg went on to publish more than three hundred scientific articles on the health benefits of omega-3 fats. But these good fats had a public relations problem. The information about the good they do for bodies and brains lay hidden in journals that were not found in supermarkets. Finally, in the late 1990s, the popularity of omega-3 fats soared as top doctors began prescribing them as "medicine." All those -ologists started to use omega-3 EPA/DHA fats and saw that they were good. The cardiologists saw how much they helped hearts stay healthy. Ophthalmologists saw that they were good for the eyes. Neurologists saw how they built smarter brains. Gastroenterologists saw they were good for the gut. Rheumatologists found that they helped alleviate arthritis, and dermatologists discovered that omega-3 EPA/DHA improved the skin. The list of medical problems alleviated by eating more omega-3 EPA/DHA is even longer.

MY MEDICINE MEAL

Much of this book was written under the influence of the omega-3 effect during my four lecture tours of Japan, the country with one of the highest per capita rates of seafood consumption and healthiest longevity. In Kyoto, Japan, in 2001 I was invited to speak about family health issues. Before the talk our host announced, "We will take you and Mrs. Sears out for a medicine meal." While I seldom eat a big lunch before giving a talk, it would have been rude to refuse. At the restaurant we were served a traditional meal, consisting of fifteen strange-looking small dishes, which our interpreter translated as "seafood and edible sea plants." Our host announced, "It's a Japanese tradition to feed visiting professors this medicine meal before their lecture. We find they give a better talk."

About an hour after my omega-3 overload, I felt the first effect—satisfied but not uncomfortably full. My lecture was in a hall adjacent to a famous Buddhist temple. After being escorted to the stage by the resident monk, I was amazed by the words that came out of my mouth. I experienced a level of alertness and eloquence that took me by surprise. Afterward Martha said, "That was your best talk yet." Those good gut feelings, together with a high cerebral alertness and mental peace, lasted several more hours. On three subsequent visits to Japan, I experienced similar omega-3 effects after prelecture medicine meals.