Understanding Disparities: How Difference in Health is Reinforced through Dominant Discourse1/22/2015 Historically in the United States, disparities in health across populations have been well documented. Research has shown that certain groups suffer disproportionately from auto-immune and other infectious diseases, such as diabetes, asthma, cancer and cardiovascular disease. The causes of these disparities are wide-ranging and involve a number of variables, including: accessibility of health care, environmental threats (i.e. air pollution), increased risk of disease from occupational exposure as well as underlying genetic, ethnic and familial factors (NIH, 2014). While it would be unfair to try and tackle a topic this big in a single blog post, I do want to shine some light on the subject because I feel that it can present opportunities to engage in dialogue. On a personal level, I am extremely passionate about the issue of health disparities and plan on studying it moving forward. In this post, I take a critical look at health disparities in the US, identifying issues of access, infrastructure, and cultural barriers. What are Health Disparities? According to Braveman et al. (2004), health disparities are defined as, “a difference in which disadvantaged social groups such as the poor, racial/ethnic minorities, women and other groups who have persistently experienced social disadvantage or discrimination systematically experience worse health or greater health risks than more advantaged social groups.” Although disparities in health have existed for centuries in this country, they have received increased attention as a legitimate crisis over the past couple of decades. In terms of percentages, while these problems affect people of all walks of life, they are particularly prevalent among racial and ethnic minorities. Indeed, compelling evidence indicates that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations (OMHD, 2007). Evidence of disparities in the U.S. are most pronounced among the African-American and Hispanic communities, respectively, with growing numbers within the American Indian community. Studies have shown that these groups are more likely to live in poverty, have lower levels of education, work in jobs with higher rates of occupational hazards and have a lower median income than Whites and Asians (Mead et al., 2008). These groups are also more susceptible to chronic health conditions. To begin, these groups are overrepresented among the numbers of uninsured, with Hispanics, for example, representing 13% of the population, but 25% of those without health insurance (U.S. Census, 2013). As noted by Betancourt et al. (2008), “Lack of insurance takes a significant toll on these [minority] populations, with health effects including less access to preventive care than among people with insurance, high rates of emergency department use and avoidable hospitalizations, later-stage diagnosis of cancer, and the inability to obtain prescription medications” (p. 294). Coinciding with this, the difference in disease and illness between minority populations and Whites continues to grow. For example, a 2010 study in the Journal of the American Medical Association found that adult obesity rates for African-Americans are higher than those for Whites in nearly every state in the nation, with 37% of men and 50% of women, respectively, suffering from obesity (Flegal et al., 2010). In the same study, evidence found that Hispanic women contract cervical cancer at twice the rate of White women. As it relates to diabetes, hypertension and heart disease, African-Americans were shown to possess the highest rates of all populations, with 15% of Blacks nationwide affected by diabetes compared with 8% for Whites (Mainous et al., 2004). And the problem is only getting worse, as disparities in health and quality of care are not getting smaller. So how do we go about finding solutions? The problem is obviously extremely complex and hinges upon a number of important factors. To start, we have to take a critical look at some of the root causes. How Disparities are Reinforced through Dominant Discourse More so now than ever, the issue of health disparities in the United States remains a hot button topic among government policymakers and the mainstream public alike – and with good reason. In 2009, health disparities cost the U.S. economy $82.2 billion in direct health care spending and lost productivity (NUL, 2012). African Americans bore the majority of that cost with $54.9 billion, followed by Hispanics with $22 billion (NUL, 2012). Coinciding with this, the minority population is only expected to grow, with estimates of more than 40% of the U.S. population by 2035 and 47% by 2050. Thus addressing their health needs has become an increasingly visible public policy goal (Brach & Fraserirector, 2000). More importantly, as the gap between the haves and have-nots continues to widen each year, so does the hierarchy in health across populations. In an attempt to alleviate the problem, government involvement and spending on health-related research has increased. In 2012, the US spent $119 billion on health research, which equaled more than double the totals from the previous decade (Chakma et al., 2014). The health crisis has become so significant that political leaders often hinge entire campaigns on their policies towards health (i.e. Obamacare). Nevertheless, this increased attention among policymakers has resulted in little to no consensus on what can be done and should be done to reduce these disparities, as the issue continues to be a pressing concern for society as a whole. Even more troubling is the fact that the leading health indicators have demonstrated little improvement in disparities over the past decade. In charting government progress, a recent study by the US Department of Health and Human Services found “less than adequate progress toward eliminating health disparities for the majority of objectives among segments of the U.S. population, defined by race/ethnicity, sex, education, income, geographic location, and disability status” (p. 2). Similarly, recent analyses of progress on Healthy People 2020 objectives found that “significant racial and ethnic health disparities continue to permeate the major dimensions of health care, the health care workforce, population health, and data collection and research” (HHS,2011). And while the increase in governmental spending and awareness is acknowledgeable, there remain many underlying frameworks which allow an existing status quo to persist. Examples of this are wide-ranging and include everything from exclusionary issues to concerns with zoning and access. Infrastructural Concerns: Federal Food Subsidy Programs In terms of nutritional disparities, one area where inequities become reinforced is through some of our federal food subsidy programs. A pertinent example of this is the availability of organic and local foods for low income families. For instance, the federal supplemental nutrition program for Women, Infants and Children (WIC) is a program which provides subsidies for low-income families to purchase nutritious food. The USDA (2014) describes the program as “providing supplemental foods designed to safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.” The federal program, which is overrepresented by racial and ethnic minorities (the African-American and Hispanic demographic combined participation in the program is 58%) establishes minimum nutritional guidelines for states to follow, and individual states then determine specifically what is excluded (Doherty, 2006). The acceptable foods include items such as: juice, cereal, eggs, cheese, milk, peanut butter, beans, infant formula, tuna, and carrots. The problem with many of these state-run programs is that they completely exclude organic foods from being purchased. In fact, there are currently 31 states that explicitly say no to all organic foods, with 13 states (including California) that exclude certain foods (such as eggs and milk). Similarly, the current WIC framework enforces many of the same restrictions as it pertains to farmer’s markets, as only about 58% of states currently participate in the WIC Farmer’s Market Nutrition Program (FMNP), and only 21 states currently authorize farmers to accept WIC cash value vouchers (USDA, 2014). Although it is not only the WIC program that has implemented these restrictions, as the current federal EBT and food stamp program also have very limited participation in farmer’s markets, mainly due to cost considerations and lack of technical infrastructure (Doherty, 2006). This is not say that these programs are not effective or do not provide great benefit to those that need it, but without the option of being able to purchase organic or locally grown food, lower income families are forced to comply to a list of products laden with pesticides, unknown growth hormones, added sugars, artificial sweeteners, and GMO-ingredients, further contributing to the proliferation of health disparities nationally. In addition, on a broader scale, the food processing methods by which these products are made are unsustainable for future generations. Accessibility Concerns: Food Insecurity Another pressing concern in the incidence of health disparities nationally is the issue of food insecurity and availability. According to Andersen (1990), food insecurity refers to the “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” Also referred to as “food deserts” by academics, policy makers and community groups alike, many lower income and underserved communities in the U.S. (particularly populated urban areas) do not have access to an affordable and healthy diet (Cummins & Macintyre, 2006). The primary concern with food deserts is that members of these communities (which are predominately comprised of racial/ethnic minorities) do not have access to supermarkets, grocery stores, or other retailers that offer foods needed for a healthy diet (i.e., fresh fruit, veggies, whole grains, dairy. etc.), or do not have adequate transportation to get there. Instead, residents of these areas become reliant on small grocery stores or convenience stores which offer more limited varieties and carry fewer fruits and veggies (USDA, 2009). More importantly, the foods that are carried by these smaller retailers often have higher sugar and sodium content, not to mention highly processed and genetically modified. The end result is that these communities suffer from an inadequate diet, thus reinforcing the prevalence of disparities, particularly among minority groups. Indeed, interest in the relationship of food access to diet and health is rooted in an extensive body of literature that shows disparities in many health outcomes across race, ethnicity, and socioeconomic status (Institute of Medicine, 2003; National Research Council, 2004; USDA, 2009). Along these lines, research has shown that limited access to nutritious food and relatively easier access to less nutritious food may be linked to poor diets and, ultimately, to obesity and diet-related diseases. For example, a study by Larson et al. (2009) found that better access to a supermarket is associated with reduced risk of obesity and better access to convenience stores is associated with increased risk of obesity. Similarly, a study by Currie et al. (2009) found a connection between school-level obesity rates among 9th graders in California and relative distance between the school and fast food and full-service restaurants. In examining the larger implications of food deserts, while perhaps the largest contributor is disparity in socio-economic status, a closer analysis uncovers bigger concerns of power and privilege. More specifically in terms of zoning and regulation, dominant health discourses allow inequalities to persist by maintaining control of the geographical spaces of food system infrastructures. As these spaces are strategically placed, and tend to cater to a specific consumer base, dominant frameworks become reflected not only by the people who frequent them, but also along the lines of the cultural codings that are performed within these spaces. Exclusionary Concerns: Disparities in Healthcare Collectively, as we continue to gain understanding into the root causes of health disparities, we recognize just how complex of an issue it is. The problem is indeed multi-factorial, and solutions must be adopted both at the federal and local levels. However, one area where I think we drop the ball as a society is dismissing disparities in health as simply a socio-economic problem. Particularly as it relates to health care, while it is commonly believed that health disparities occur simply because of a lack of health insurance and access to health care, disparities in quality of care for those with access to the healthcare system are equally troubling. In fact, there is a growing amount of research that shows evidence of racial/ethnic disparities in quality of care for those with access to health care. A recent Institute of Medicine report titled Unequal Treatment: Confronting Racial/Ethnic Disparities in Health Care found over 175 studies illustrating racial and ethnic health disparities in the diagnosis and treatment of various conditions, even when analyses were controlled for socioeconomic status, insurance status, site of care, stage of disease, comorbidity, and age, among other causes (IOM, 2002; Betancourt et al., 2003). This issue has required researchers to seek out other potential factors, and one area of inquiry that has gained a good amount of attention recently is the role that the patient-practitioner relationship plays in reinforcing health disparities. Particularly as it relates to intercultural health, as the U.S. continues to grow in terms of diversity, there continue to be an increase in patients with a wide range of perspectives regarding health, often influenced by their social or cultural backgrounds (Betancourt et al., 2005). According to a number of studies, one particular area in the context of healthcare; patient-practitioner communication; has been hypothesized as a mechanism for racial/ethnic health disparities. There is a good amount of research on this topic alone. In fact, a large majority of research in the health communication field is dedicated specifically to the study of “cultural competency” within healthcare contexts. As it relates to the connection between culture and health, numerous studies have shown that disparities can manifest themselves in many different ways. One instance where this plays out is in the power dynamics that exist between healthcare provider and patient. For example, in many health care settings, clinicians may intentionally or unintentionally reflect and reinforce dominant societal messages regarding value, self-reliance, competence, and deservingness (Roter, 2000). In addition, as noted by van Ryn & Fu (2003), providers may unknowingly communicate lower expectations for patients in disadvantaged social positions (i.e. race/ethnicity, income, education, class, etc.) than for their more advantaged counterparts. This is problematic because not only can it influence patients’ expectations for the future, but also the extent to which they expect to gain the resources and help that they need. Similarly along these lines, there is the issue of language barriers. For instance, patients with certain ethnic backgrounds may present their symptoms differently from the way they are presented in medical textbooks (Betancourt et al., 2005). In many instances, these patients may have limited English proficiency, different pathways for seeking care, and unfamiliar beliefs that influence whether or not they adhere to provider recommendations (Berger, 1998). Consequently, as issues of access continue to persist, this remains a major problem in our national healthcare system. According to a study by Bailey (2009), health care providers nationally cite language difficulties and inadequate funding of language services to be major barriers to access to health care for limited English proficiency individuals and a serious threat to the quality of care they receive. As it relates to overall quality of care, research has shown that patient-practitioner communication is linked to patient satisfaction and adherence to medical instructions and health outcomes (Stewart et al., 1999). Accordingly, if socio-cultural differences are not addressed, poorer health outcomes will continue to persist. Discussion The overall purpose of this post was to inspire dialogue as it relates to understanding disparities. I understand how important delving into a topic like this is and do not go into it lightly. While the issue is extremely complex and there are many sides to which people’s opinions may fall, I think that it is always important to get topics like these on the table. For me personally, I have found that writing on issues such as these to be very eye-opening, in that it has allowed me to be made aware of my space as it relates to privilege, access etc. By striving for this sense of self-awareness, it has allowed me to better understand the implications of my voice, actions and ideas. In terms of the issue itself, where do we start? I think to begin we have to cultivate this sense of awareness not only as it relates to ourselves, but also how it relates to our understanding of dominant health frameworks. While on the surface, many of these issues appear benign and unassuming; it is important to remember that it is these very nuances that underpin the existence and propagation of disparities. On a broader level, collectively we have to continue to push for systemic change, as the elimination of health disparities would benefit all members of society, not only from an ethical and moral standpoint, but economically as well. In a 2009 report from the Urban Institute, research found that by simply addressing racial and ethnic health disparities, overall national health care costs could be reduced by nearly $24 billion per year, including $15.6 billion in the Medicare program alone (Waidmann, 2009). Definitely some food for thought! References: Anderson, S.A. (1990). Core indicators of nutritional state for difficult-to-sample populations. Journal of Nutrition, 12, 1559-1600 Bailey, K. (2009) Americans at risk: One in three uninsured. Washington: Families USA Berger, J.T. (1998). Culture and ethnicity in clinical care. Archives of Internal Medicine. 158(19), 2085–90. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong 2nd, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports, 118(4), 293. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Park, E. R. (2005). Cultural competence and health care disparities: key perspectives and trends. Health affairs, 24(2), 499-505. Brach, C., & Fraserirector, I. (2000). Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review, 57(4), 181-217. Braveman, P. (2006). Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health, 27, 167-194. Centers for Disease Control and Prevention (2007). Disease burden and risk factors. Retrieved from http://www.cdc.gov/omhd/amh/dbrf.htm Cummins, S., & Macintyre, S. (2006). Food environments and obesity—neighborhood or nation? International journal of epidemiology, 35(1), 100-104. Currie, J., S. DellaVigna, E. Moretti, and V. Pathania (2009). The effect of fast food restaurants on obesity. National Bureau of Economic Research. Retrieved at http://www.nber.org/papers/w14721 Doherty, K. E. (2006). Mediating the Critiques of the Alternative Agrifood Movement: Growing Power in Milwaukee (Doctoral dissertation, The University of Wisconsin-Milwaukee). Flegal, K. M., Carroll, M. D., & Ogden, C. L. (2010). Fact sheet: benefits for Latinos of new affordable care act rules on expanding prevention coverage. Journal of the American Medical Association, 303(3), 235-41. Larson, N.I., M.T. Story, and M.C. Nelson (2009). “Neighborhood environments: Disparities in access to healthy foods in the U.S.” American Journal of Preventive Medicine, 36(1): 74-81.e10. Mainous, A. G., King, D. E., Garr, D. R., & Pearson, W. S. (2004). Race, rural residence, and control of diabetes and hypertension. Annals of Family Medicine, 2(6), 563–568. National Institutes of Health (2014). Minority Health. Retrieved from http://www.niaid.nih.gov/topics/minorityhealth/pages National Urban League (2012). State of urban health. Retrieved from http://iamempowered.com/article/2012/12/02/state-urban-health Ploeg, M. V., Breneman, V., Farrigan, T., Hamrick, K., Hopkins, D., Kaufman, P., ... & Tuckermanty, E. (2009). Access to affordable and nutritious food: measuring and understanding food deserts and their consequences. Report to Congress. In Access to affordable and nutritious food: measuring and understanding food deserts and their consequences. Report to Congress. USDA Economic Research Service. Stewart, A. L., Nápoles‐Springer, A., & Pérez‐Stable, E. J. (1999). Interpersonal processes of care in diverse populations. Milbank Quarterly, 77(3), 305-339. Thomas, S. B., Fine, M. J., & Ibrahim, S. A. (2004). Health disparities: the importance of culture and health communication. American Journal of Public Health, 94(12), 2050. United States Census Bureau. (2013). Retrieved from http://www.census.gov/hhes/www/hlthins/ United States Department of Health and Human Services (2011). HHS Action Plan to Reduce Racial and Ethnic Health Disparities. Retrieved from http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf Van Ryn, M., & Fu, S. S. (2003). Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health?. American journal of public health, 93(2), 248-255. WIC Farmers' Market Nutrition Program (FMNP). (2014). Retrieved fromhttp://www.fns.usda.gov/fmnp
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In today’s post, I take an in-depth look at the topic of omega-3 fatty acids to gain a better understanding of their purpose and their role in human health. With the recent rise in the amount of cardiovascular and auto-immune diseases in this country, we have reached an exigency in terms of our overall well-being. Statistics show that over 50 million Americans suffer from some type of autoimmune disease, with annual health care costs exceeding $100 billion (AARDA, 2014). And while experts point to a number of potential causes, there is a good amount of research that specifically connects these increases with a rise in the omega-6/3 ratios of our modern diet. Coinciding with this, the popularity of omega-3 supplements and discourse has seen a rapid increase both within mainstream culture and health-savvy circles. In fact, a 2009 Nielsen report found that sales of omega-3 products showed a 42% growth from previous years (Nielsen, 2010). Nowadays, it has become damn near impossible to go to the grocery store or vitamin store without seeing some sort of fish oil or flaxseed promotion. Especially during this time in the new year, as people try their best to turn over a new leaf in terms of losing weight and eating healthy, will flock to the store to buy their daily multi’s and fish oil. But while we have been programmed to buy these products, I think many of us are still in the dark as far as understanding their true usefulness. So my goal in writing this post is to create awareness and bring a bigger picture perspective as it relates to our dietary choices. Let’s get it crackin… What are Omega-3 Fatty Acids? Simply speaking, omega-3s are a type of fat that are found in foods. From a chemical standpoint, omega-3 fats are defined as polyunsaturated fatty acids (PUFAs) because they have more than one unsaturated carbon bond in the molecule, also known as a double bond (poly=multiple). There are 2 main types of PUFAs: omega-3s and omega-6s. These fats are considered “essential fatty acids” (EFA’s) because as mammals we cannot produce them and must get them from diet and supplements (Simopoulos, 1991). While omega-6s are inherently bad for us, omega-3s have been shown to elicit many health benefits. In human physiology, there are 2 different types of omega-3 fatty acids: ALA (alpha-linoleic acid), and EPA (eicosapentaenoic acid)/ DHA (docosahexaenoic acid). ALA is comprised of short chain fatty acids, and found predominately in plant sources, including: the green leaves of plants, grass, flaxseed, and a number of plant-based oils (i.e. canola, soy). EPA/DHA are comprised of long chain fatty acids, and are found in the fatty layers of cold-water fish and shellfish, marine algae, meat, eggs and various dairy products (Whole 9, 2014). While both types are essential to human health, ALA omega-3 fatty acids have been shown to have less potent anti-inflammatory benefits than EPA and DHA. In addition, research has also found that while the human body can convert ALA to EPA and DHA, the conversion is extremely limited, with less than 5% of ALA getting converted to EPA, and less than 0.5% of ALA converted to DHA, making EPA and DHA a superior source of omega-3 (Kresser, 2011). The way the conversion works in the human body is ALA from plants is converted by animals or fish to EPA and DHA. The ALA itself is not actually anti-inflammatory, as fish (and to a much lesser degree, land animals) do the metabolic work to convert the plant-based ALA into concentrated EPA and DHA (Whole 9, 2014). This is why it is so important to get our omega-3s from sources like fish and seafood, and explains why most vegans have low omega-3 intakes and blood levels. Why are Omega-3s Important in Our Diets? In recent times, health discourse pertaining to omega-3s has gained a good amount of mainstream attention. The combination of nutrition experts’ collective “thumbs up” regarding the purported heart and cardiovascular benefits, along with a rise in our society’s interest in health have all of us running to the nearest Costco or Vitamin Shoppe to pick up our monthly supply of fish oil. Indeed, recent trends have marked an increase in the amount of omega-3 supplement products (fish oil, krill oil, flaxseed, etc.) in the marketplace. However, this influx raises the larger question of why is there a sudden need for more omega-3 supplementation in our diet? What has changed that we cannot get enough omega-3 from food alone? To get a better understanding, we have to look back and consult our past. If we trace our history back 200 years ago to before the industrial revolution, our diet was much different. Back then there were no processed foods and things were eaten in their natural state. On top of that, the foods that we consumed were also eating what they were designed to eat. Farmers did not have to delineate grass-fed beef, pastured eggs and wild caught fish from conventional farming methods because that’s all that was around; and as a result foods had a larger abundance of omega-3 fatty acids. Unfortunately, as time has gone on we have not followed the same dietary blueprint. Due to things like poor meat quality, over-consumption of fast foods, processed foods and vegetable oils, most of our modern diets are lacking in these essential fatty acids (and overly rich in pro-inflammatory omega-6 fatty acids) (Whole 9, 2014). As noted by Eaton & Konner (2004), today’s industrialized societies are characterized by 1) an increase in energy intake and decrease in energy expenditure; 2) an increase in saturated fat, omega-6 fatty acids and trans fatty acids, and a decrease in omega-3 fatty acid intake; 3) a decrease in complex carbohydrates and fiber; 4) an increase in cereal grains and a decrease in fruits and vegetables; and 5) a decrease in protein, antioxidants and calcium intake. In terms of omega-3 consumption, anthropological research has found that our hunter gatherer ancestors consumed omega-6 and omega-3 fats in a ratio of roughly 1:1 (Kresser, 2011). It also indicates that both ancient and modern-hunter gatherers were free of the modern inflammatory diseases such as cancer, diabetes and heart disease which are the leading causes of death today (Simopoulos, 2008). In today’s Western diets, omega-6/3 ratios are way out of whack, skyrocketing up to 25:1 in some cases. According to Kresser (2011), this change is due predominately to both the advent of the modern vegetable oil industry and the increased use of cereal grains as feed for domestic livestock (which in turn altered the fatty acid profile of meat that we consumed). The reason why these ratios are problematic is that they increase the amount of systemic inflammation in the body. In humans, omega-6 is pro-inflammatory, while omega-3 is neutral. Diets that are rich in omega-6s will promote chronic inflammation (which can lead to heart disease, cancers, arthritis, etc.), while diets rich in omega-3 will reduce inflammation. Essentially omega-3s have the same effect on the body as OTC and prescription NSAIDs (non-steroidal anti-inflammatory) (i.e. aspirin, ibuprofen), although they occur naturally without any of the side effects. Indeed, research has made the connection between a decreased omega-6/3 ratio and a decrease in chronic diseases. Among others, a study by Smith et al. (2006) found that decreasing omega-6/3 ratios by replacing corn oil with olive oil lead to a 70% decrease in total mortality. Health Benefits of Omega-3s Along with functioning as a natural anti-inflammatory, there is good evidence that points to a number of other health benefits of omega-3 fatty acids. For example, the American Heart Association found evidence from randomized control trials that omega-3 fatty acids have beneficial effects on cardiovascular disease (Kris-Etherton et al., 2002). In addition, omega-3s, particularly EPA and DHA, have shown to lower the levels of bad cholesterol (LDL) and increase good cholesterol (HDL). Similar research suggests that EPA and DHA from supplements of food sources can reduce triglyceride levels (NIH, 2014). In addition to heart health benefits, omega-3 supplementation has recently been popularized as a weight loss aid. Researchers in South Australia found that taking a daily dose of omega-3 enriched fish oil combined with regular exercise provides significantly greater benefits in the fight against obesity than exercise or fish oil alone (UNISA, 2009).The study found that omega-3 fats in fish oil have the ability to switch on enzymes specifically involved in oxidizing or burning of fat, but they need to be fueled by exercise to increase the metabolic rate in order to lower body fat. Omega-3s also have the potential to help with anxiety and depression. A study by Calabrese et al (1999) found that fish oil could aid in mood stabilization and the treatment of bipolar disorders. Comparably, a study by Nemetz et al. (2002) noted significantly lower levels of omega-3s in the red blood cell membranes of patients with depression. In this same vein, research conducted on prisoners found that those who had been convicted of violent crimes had lower levels of omega-3 fatty acids than ordinary, healthy subjects, and researchers attributed this to omega-3's ability to foster the growth of neurons in the brain's frontal cortex, the bit of gray matter that controls impulsive behavior (Mihm, 2006). Furthermore, studies have shown that regular consumption of EPA and DHA omega-3s can boost your immune system to help fight off common diseases like colds, coughs and the flu. A 2013 study in the Journal of Leukocyte Biology found that DHA-rich fish oil enhances white blood cell activity in mice (FASEB, 2013). Other potential benefits to omega-3s are wide-ranging, and include: high blood pressure, diabetes, arthritis, osteoporosis, schizophrenia, ADHD, acne, asthma as well as some cancers. Dietary Sources of Omega-3 Fatty Acids In view of the amount of pro-inflammatory omega-6s that have infiltrated our modern diet, luckily there are a number of dietary sources where we can get quality omega-3s, particularly EPA and DHA. Along with supplements, there are a number of foods that provide great sources. For the majority of people that keep their diet in check, getting omega-3s in the diet is not actually that big of a challenge. I think the bigger concern for most of us is limiting the amount of omega-6s we consume and keeping that ratio as close to 1:1 as possible. In terms of a daily recommended allowance, there is no standard recommendation for how many omega-3s we need, however suggestions range from 500 to 1,000 milligrams (mg) daily (WebMD, 2014). Some good sources of foods containing omega-3s include: grass-fed beef, wild rice, walnuts, flaxseed, wild-caught fish and seafood and pasture raised eggs. To give a context, you can find more than 500 mg in a can of tuna or a few ounces of salmon. Also check food labels because some fortified foods offer 100 mg or more (but be careful because many packaged foods are highly processed, resulting in the omega-3 content being neutralized). As far as supplements, there are a number of products currently on the market, including: fish oil, krill oil, calamari oil, flaxseed oil and kiwifruit seed oil. Just remember, as mentioned earlier, omega-3s obtained from meat and dairy sources are superior to plant sources. Particularly as it relates to EPA and DHA, it’s best to look for omega-3 sources that are meat (or seafood) based. Ambiguity in Omega-3 Food Labeling Claims/ FDA Ruling As the popularity of omega-3 products continues to grow, they are becoming more sought after in the marketplace. As consumers continue to make a conscious effort to include omega-3s in their diet, they are actively seeking and willing to spend more on these products. However, as demand increases, so does competition among food companies to get our discretionary dollars. In an attempt to entice us to buy their products, food companies come up with clever ways to market the purported health benefits of their foods. Particularly in terms of labeling, claims of omega-3 content and benefits in products can be highly ambiguous and misleading. In fact, many of the foods making claims have little or no omega-3s, and reading labels can become dicey when trying to figure out how much or which omega-3 fat the foods contain. For proof of this, look no further than your local grocery store, where nowadays everything from bread to mayonnaise to eggs make claims of quality omega-3 content. Because of this, institutions such as the Center for Science in the Public Interest (CSPI) demand consumers to adopt a critical eye and be wary of these claims. They point to a number of examples in which the labels were misleading:
In addition, there is the issue of fortified foods. To begin, the majority of fortified foods, such as bread and cereal are infused with ALA, which as mentioned earlier does not offer the same heart health benefits as EPA and DHA. Also, because they are packaged, they are highly processed and contain high amounts of omega-6 to begin with, so any fortified omega-3 is negligible. It has gotten to the point where you almost need a nutrition degree to go shopping! But luckily for us, the FDA has stepped in enforced guidelines in terms of omega-3 content regulation. Their “final rule” prohibits certain nutrient content claims for foods that contain omega-3 fatty acids ALA, EPA and DHA. According to the FDA (2014), the final rule prohibits statements on the labels of food products, including dietary supplements, that claim the products are “high in” DHA or EPA, and synonyms such as “rich in” and “excellent source of.” The final rule similarly prohibits some such claims for ALA. Under the Federal Food, Drug & Cosmetic Act, nutrient content claims such as “high in” are allowed only for nutrients for which a reference level to which the claim refers has been set. While the FDA does not have currently established nutrient levels that can serve as the basis for nutrient content claims for DHA, EPA, or ALA, they allow authoritative statements published by certain types of scientific bodies, such as the Institute of Medicine of the National Academies (IOM). This “final rule” for foods and supplements takes effect January 1, 2016, and food companies will be given up to a year to update all applicable labels. Discussion Wow, I know that was a lot! How do you think I felt writing it all? All joking aside, I think this topic is extremely relevant today and important to talk about. Especially now, with the rise in nutrition-related diseases and illnesses, there is a lot to uncover as a consumer. What’s scarier is if you look at the way the modern food industry is set up, unless you are making an extremely diligent effort to keep your omega 6/3 ratios in check, it’s almost impossible to do so. On top of that, the conflicts of interest that persist between our health and big business have us set up to fail. With everything ranging from corporate giant’s emphasis on cheaper farming methods to the multi-billion dollar pharmaceutical industry, our ratios are more out of whack than ever before. So what can we do? I think collectively we have to be more aggressive in terms of researching our own health. We have to assume the worst when it comes to what we are being told by big pharma and the government, and find out things for ourselves. I think a good start would be to eat foods in their natural state. The closer to nature our food is grown and prepared, the less inflammatory it will be on our system. In terms of supplementation, there really is no magic number when it comes to omega-3s because everyone’s body and diet is different. However, based on my personal research and experiences, I always say it’s never a bad idea to supplement with fish oil. A good rule of thumb is to take up to 3000mg per day until you have established balanced ratios in your body. But what is important to note here is when we talk about mg, we are not looking for absolute totals, we are looking for the total sum of EPA/DHA. So for example, if you buy a fish oil supp with 400mg of EPA and 300mg of DHA, the net total will be 700mg, not what it says on the bottle. I hope this post fostered some new insights and takeaways! Feel free to leave a comment or hit me up on Facebook. Let’s start the dialogue! References: AARDA Autoimmune Statistics. (2014). Retrieved January 5, 2015, from http://www.aarda.org/autoimmune-information/autoimmune-statistics/ Calabrese, J. R., Rapport, D. J., & Shelton, M. D. (1999). Fish oils and bipolar disorder: a promising but untested treatment. Archives of General Psychiatry, 56(5), 413-414. Eaton, S. B., Konner, M. (1985). Paleolithic nutrition. A consideration of its nature and current implications. New. Engl. J. Med. 312:283–289. Federation of American Societies for Experimental Biology. (2013). Nothing fishy about it: Fish oil can boost the immune system. ScienceDaily. Retrieved January 4, 2015 from www.sciencedaily.com/releases/2013/04/130401111545.htm Kresser, C. (2011). How too much omega-6 and not enough omega-3 is making us sick. Retrieved January 5, 2015, from http://chriskresser.com/how-too-much-omega-6-and-not-enough-omega-3-is-making-us-sick Kresser, C. (2011). 9 steps to perfect pealth - #1: Don't eat toxins. Retrieved January 5, 2015, from http://chriskresser.com/9-steps-to-perfect-health-1-dont-eat-toxins Kris-Etherton, P. M., Harris, W. S., & Appel, L. J. (2002). Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. circulation, 106(21), 2747-2757. Mihm, S. (2006). Does Eating Salmon Lower The Murder Rate? Retrieved January 5, 2015, from http://www.nytimes.com/2006/04/16/magazine/16wwln_idealab.html?ei=5090&en=42040a1da92a9fe6&ex=1302840000&adxnnl=1&partner=rssuserland&emc=rss&adxnnlx=1382129345-qIx5bQSppT3SUr3hfPZJw&_r=0 National Institutes of Health. (2014). Fish oil: MedlinePlus supplements. Retrieved January 5, 2015, from http://www.nlm.nih.gov/medlineplus/druginfo/natural Nemets, B., Stahl, Z., & Belmaker, R. H. (2002). Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. American Journal of Psychiatry, 159(3), 477-479. Newswire. (2010). U.S. healthy eating trends part 1: Commitment trumps the economic pinch. Retrieved January 5, 2015, from http://www.nielsen.com/us/en/insights/news/2010/healthy-eating-trends-pt-1-commitment-trumps-the-economic-pinch.html Omega-3 Fatty Acids: Fish Oil Benefits for Heart Health. (2014). Retrieved January 5, 2015, from http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/supplement-guide-omega-3-fatty-acids Omega-3 Madness: Fish Oil or Snake Oil ~ Newsroom ~ News from CSPI ~ Center for Science in the Public Interest. (2007). Retrieved January 5, 2015, from http://cspinet.org/new/200710011.html Simopoulos, A. P. (1991). Omega-3 fatty acids in health and disease and in growth and development. The American journal of clinical nutrition, 54(3), 438-463. Simopoulos, A. P. (2008). The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Experimental Biology and Medicine, 233(6), 674-688. Smith, S. C., Allen, J., Blair, S. N., Bonow, R. O., Brass, L. M., Fonarow, G. C., ... & Taubert, K. A. (2006). AHA/ACC Guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Endorsed by the National Heart, Lung, and Blood Institute. Journal of the American College of Cardiology, 47(10), 2130-2139. University of South Australia (2009). Anti-obesity research exercises the good oil. Retrieved January 5, 2015, from http://w3.unisa.edu.au/researcher/issue/2005march/obesity.asp U.S. Food and Drug Administration. (2014). FDA finalizes rule prohibiting certain nutrient content claims for dha, epa and ala fatty acids. Retrieved from: http://www.fda.gov/Food/NewsEvents/ConstituentUpdates/ucm394855.htm Whole9 - Let us change your life. (2014). Retrieved January 5, 2015, from http://whole9life.com/faq/ |
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