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Aspirin or Pycnogenol for Heart Health?

I recently received a question asking, “is it better to take a baby aspirin or pycnogenol, a natural bark extract, to prevent blood clots (platelet aggregation) and improve heart health?”

My Answer:

Take aspirin if your doctor concurs. “The degree of measured anti-inflammatory potential of pycnogenol on COX enzymes (targets of Aspirin) are still lower than Aspirin itself.” (COX enzymes makes prostaglandins, creating inflammation. Aspirin prevents the prostaglandins from ever being synthesized).

What Aspirin Does

Aspirin interferes with your blood’s clotting action. When you bleed, your blood’s clotting cells, called platelets, build up at the site of your wound. Aspirin therapy reduces the clumping action of platelets in the vessels that supply blood to the heart and possibly prevents a heart attack. Aspirin “thins” the blood and helps prevent blood clots from forming. So it helps prevent heart attack and stroke. Aspirin also helps reduce inflammation. It has been suggested that inflammation may play a major role in cardiovascular disease.

For individuals who have already had a heart attack or stroke, or have other evidence of coronary artery disease, such as angina or a history of a coronary bypass operation or coronary angioplasty, the FDA states that there is more benefit than risk of taking aspirin. They feel that the available evidence does not supports the use of aspirin for preventing a heart attack or strok and that there are risks of bleed in the brain and stomach. 

https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm390574.htm

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm390539.htm

To see the guidelines about taking aspirin, go to this Mayo Clinic article: http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/ART-20046797

You should not start aspirin therapy without discussing it with your doctor. The benefits and risks of aspirin therapy vary for each person.

Sources:

https://examine.com/supplements/pycnogenol/

http://www.webmd.com/vitamins-supplements/ingredientmono-1019-PYCNOGENOL.aspx?activeIngredientId=1019&activeIngredientName=PYCNOGENOL&source=0

http://www.docsopinion.com/2013/05/03/inflammation-and-heart-disease/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317089/

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Glucosamine Supplements: Which form is best?

Glucosamine is sometimes recommended for someone who has joint pain or arthritis. It appears to offer benefits for both pain relief and slowing down arthritis but check the label. You will need glucosamine SULPHATE. Glucosamine HYDROCHLORIDE has been shown to be less effective. Also, make sure your dosage is enough. For any benefit, you must take at least 1,500mg daily.

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Guide to Choosing the Best Supplement Omega-3 Supplement

Health Benefits of Omega-3 Fatty Acids

Omega-3 fatty acids are associated with many health benefits. New studies are identifying potential benefits for a wide range of conditions including cancer, hypertension, cardiovascular disease, high triglycerides, anxiety and depression, bipolar disorder, eczema, asthma, osteoporosis, cognitive function and Alzheimer’s, diabetes and metabolic syndrome, inflammatory bowel disease, and autoimmune diseases such as lupus and rheumatoid arthritis.

The reason omega-3s can provide all these benefits? In large enough amounts omega-3’s reduce the inflammatory process that leads to many chronic conditions such as obesity, diabetes, cardiovascular disease and aging.

Because of these health benefits, there is general agreement amongst health professionals, that individuals should consume more omega-3. We need omega-3 fatty acids for many normal body functions, such as controlling blood clotting and constructing cell membranes in the brain, and since our bodies cannot make omega-3 fats, we must get them through food and/or supplementation.

Before taking omega-3 supplements check with your doctor if you have diabetes, are at risk of bleeding or on aspirin, chemotherapy drugs or blood pressure medicine. Also, don’t take the supplements if you have an implanted defibrillator. Omega-3 supplements may contain shellfish. So do not take if you have an allergy to clams, scallops, shrimp, lobster, crayfish, crab, oyster, mussels, others. And, before having any laboratory test, tell your doctor and the lab staff that you are taking omega-3 supplements.

Types of Omega-3 Fatty Acids

Not all omega-3s are the same. The three main forms are eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA).

The most beneficial forms of omega-3s are DHA and EPA. DHA and EPA come from animal sources: salmon, mackerel, herring, lake trout, sardines and albacore tuna. DHA and EPA are more potent and beneficial to health than ALA. Though beneficial, ALA omega-3 fatty acids have less potent health benefits than EPA and DHA. ALA omega-3s comes from plant sources. The richest sources of ALA are seeds (chia seeds, flaxseeds, flaxseed oil, hempseeds, hempseed oil) and walnuts. Other good sources are soy, phytoplankton and algae, black currant seeds, soybean oil, and canola oil and to a lesser degree, leafy green vegetables.

DHA and EPA are the forms most easily used by the body. The body can convert plant source ALA to EPA and DHA but the process is extremely slow and inefficient. Omega-3s from ALA-rich plant sources can be converted in limited amount (anywhere from 1%- 10%) by the body into primarily EPA and DHA. And if the diet is too high in omega-6 fatty acids (as in the typical American diet) this conversion is even less (about 50% less) because they compete with omega 3’s for certain enzymes as they are metabolized.

If you are healthy, the standard advice is to eat fatty fish twice a week. A serving is 3.5 ounces cooked, or about ¾ cup of flaked fish, says the American Heart Association. But if you don’t eat this much fish, you might want to consider taking an omega-3 supplement, especially if you have heart disease or high triglycerides.

Fish from wild, deep-water ocean fish supplies more omega-3 fatty acid than fish raised in fish farms. If you are concerned about the mercury levels, smaller fish contain less mercury than larger fish.

If you have heart disease, the American Heart Association recommends 1 gram (1,000 milligrams) a day of EPA and DHA from fatty fish and/or fish oil supplements. For people with elevated triglycerides, it is advised to get 2 to 4 grams of EPA and DHA a day from supplements.

How Do You Select the Best Omega-3?

When purchasing an omega-3 supplement it is important to note the amount of EPA and DHA, not necessarily “Omega 3” or “Fish oil”. If the ingredient label simply says “fish oil concentrate” or “omega-3 fatty acids”, that isn’t good enough. Look for the total amount of EPA and DHA on the label. These levels should be clearly stated on the label. If the label says, for example, “1000 mg of omega-3” then you have little idea how much DHA and EPA this contains since other fats will make up some of this 1000 mg. “1000 mg of fish oil” does not necessarily mean 1000 mg of Omega 3 fatty acids or 1000 mg EPA and DHA. Remember, it’s most important to know how much EPA and DHA.

Choose a supplement that has relatively high amounts of EPA and DHA per capsule to negate the need to take several pills. Some capsules are more concentrated than others. As an example, the label may say 1,000 milligrams of “fish oil concentrate per capsule”, but the small print may show only 300 milligrams of EPA and DHA per capsule. That would mean you need to take three capsules to get about 1000 mg gram day. It would be better to find a product that provides 1000 mg of EPA and DHA in only two capsules.

Don’t purchase a supplement with an “omega oil blend” (e.g., 3-6-9). You won’t be getting enough of the omega-3s DHA and EPA because the product also contains omega-6 and omega-9s. Here is a sample label: “Each serving may also provide the following naturally occurring amounts of polyunsaturated fats and monounsaturated fats: Omega-3 oils: Alpha Linoleic Acid (ALA) 900 mg Omega-6 oils: Linoleic Acid and Gamma Linoleic Acid (GLA) 530 mg Omega-9 oils: Oleic Acid 350 mg.” Note that in this product the omega-3 is in the form of ALA which is hard for the body to convert to DHA and EPA.

Get the best ratio:  Mayo Clinic Professor of Medicine Dr. Stephen Kopecky recommends a 3:2 ratio of either EPA to DHA or vice-versa. According to the research, DHA outperforms EPA in reducing total triglyceride counts and increasing HDL (good) cholesterol. Alternatively, EPA has a more beneficial effect on lowering overall LDL (bad) cholesterol.

If you are purchasing a liquid fish oil supplement, look for added antioxidants on the label. The addition of antioxidants such as vitamin E is very important as they can help prevent the oil from being oxidized and damaged by free radicals once the bottle is opened. Specifically, look for alpha-tocopherol because it prevents oxidation better than tocopherol acetate. Oxidation appears not a problem for capsules.

Purity is very important, especially for pregnant and lactating women. Choose a supplement that indicates that contaminants such as mercury and PCBs have been tested for and removed.

Like all over-the-counter dietary supplements, omega-3 capsules are unregulated, so you don’t really know what you are getting.

To help you in selecting the best omega-3 supplement, I have some sample labels from actual products and have commented on each one.

Supplement Facts

1 capsule

Water (including DHA/EPA) 300 mg

Maria’s comments: This doesn’t say exactly how much DHA or how much EPA.

Supplement Facts

1 capsule

Fish Oil Concentrate 2400 mg

Omega 3 Fatty Acids DHA and Other Omega 720 mg

Maria’s comments: This doesn’t say how much of the total omega-3 are contributed by DHA or EPA. And we don’t know how much is from the “other Omega-3”.

Supplement Facts

1 soft gel

Omega 3 Fish Oil 1000 mg

EPA 180 mg

DHA 120 mg

Maria’s comments: There is only 180 mg EPA and 120 mg DHA= 300 mg total per softgel. You would have to take 3 softgels to almost reach the 1000 mg recommendation.

Supplement Facts
Serving size 2 capsulesTotal Omega 3s 1280 mgEPA 650 mgDHA 450 mg

Other Omega 3s 180 mg

Oleic Acid (Omega 9) 56 mg

Maria’s comments: This clearly states how much EPA and DHA is in 2 softgels. 650 mg + 450 = 1100 mg. And in a 3:2 ratio that is considered optimal.

Supplement FactsServing size 1 capsuleFish Oil concentrate 2400 mgOmega 3 60 mg

Omega 3  240 mg

Maria’s comments: Look at this sneaky label. 2400 mg fish oil concentrate, 360 mg and 240 mg of omega-3. But from EPA, DHA or ALA?

Supplement Facts

1 capsule

Omega 3 Fatty Acids 600 mg

EPA 300 mg

DHA 200 mg

Other Omega 3 100 mg

Maria’s comments: Per softgel there is 300 mg EPA and 200 mg DHA= 500 mg. And in a 3:2 ratio. You could take 2 softgels and get the recommended 1000 mg.

 

For more information on Omega-3 fatty acids, health benefits and research studies:

Linus Pauling Institute at Oregon State http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa/ National

Center for Complementary and Alternative Medicine (NCCAM) http://nccam.nih.gov/health/omega3/introduction.htm

The Office of Dietary Supplements National Institutes of Health http://ods.od.nih.gov/factsheets/Omega3FattyAcidsandHealth-HealthProfessional/

References

Doughman SD, Krupanidhi S, Sanjeevi CB. Omega-3 fatty acids for nutrition and medicine: Considering microalgae oil as a vegetarian source of EPA and DHA. Curr Diabetes Rev. 2007;3(3):198-203.

Kusbak R, Drapeau C, van Cott E, Winter H. Blue-green algaaphanizomenon flos-aquae as a source of dietary polyunsaturated fatty acids and a hypocholesterolemic agent. Presented at: Annual Meeting of the American Chemical Society; March 21-25, 1999; Anaheim, Calif.

Das UN. Essential fatty acids: Biochemistry, physiology, and pathology. Biotechnol J. 2006;1(4):420-439.

Davis BC, Kris-Etherton PM. Achieving optimal essential fatty acid status in vegetarians: Current knowledge and practical implications. Am J Clin Nutr. 2003;78 (3 Suppl):640S-646S.

Gerster H. Can adults adequately convert alpha-linolenic acid (18:3 n-3) to eicosapentaenoic acid (20:5 n-3) and docosahexaenoic acid (22:6 n-3)? Int J Vit Nutr Res. 1998;68(3):159-173.

Das UN. Essential fatty acids: Biochemistry, physiology, and pathology. Biotechnol J. 2006;1(4):420-439.

Burdge GC, Wootton SA. Conversion of alpha-linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. Br J Nutr. 2002;88(4):411-420.

Burdge GC, Jones AE, Wootton SA. Eicosapentaenoic and docosapentaenoic acids are the principal products of alpha-linolenic acid metabolism in young men. Br J Nutr. 2002;88(4):355-363.

Indu M, Ghafoorunissa. n-3 fatty acids in Indian diets—comparison of the effects of precursor (alpha-linolenic acid) vs product (long-chain n-3 polyunsaturated fatty acids). Nutr Res. 1992;12:569-582.

Masters C. Omega-3 fatty acids and the peroxisome. Mol Cell Biochem. 1996;165(2):83-93.

Harnack K, Andersen G, Somoza V. Quantitation of alpha-linolenic acid elongation to eicosapentaenoic and docosahexaenoic acid as affected by the ratio of n6/n3 fatty acids. Nutr Metab (Lond). 2009;6:8.

Doughman SD, Krupanidhi S, Sanjeevi CB. Omega-3 fatty acids for nutrition and medicine: Considering microalgae oil as a vegetarian source of EPA and DHA. Curr Diabetes Rev. 2007;3(3):198-203.

Kusbak R, Drapeau C, van Cott E, Winter H. Blue-green algaaphanizomenon flos-aquae as a source of dietary polyunsaturated fatty acids and a hypocholesterolemic agent. Presented at: Annual Meeting of the American Chemical Society; March 21-25, 1999; Anaheim, Calif.

U.S. Department of Agriculture Agricultural Research Service. USDA national nutrient database for standard reference, release 21.2008. Available at: http://www.nal.usda.gov/fnic/foodcomp/search. Accessed November 2009.

Sanders T, Lewis F. Review of nutritional attributes of good oil (cold pressed hemp seed oil). King’s College London Nutritional Sciences Division. 2008. Available at: http://www.goodwebsite.co.uk/kingsreport.pdf.

Leaf A. Prevention of sudden cardiac death by n-3 polyunsaturated fatty acids. J Cardiovasc Med. (Hagerstown). 2007; 8 Suppl 1:S27-29.

Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet. 1999; 354:447-55.

Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007; 369:1090-98.

Mozaffarian D, Ascherio A, Hu FB, et al. Interplay between different polyunsaturated fatty acids and risk of coronary heart disease in men. Circulation. 2005; 111:157-64.

Leitzmann MF, Stampfer MJ, Michaud DS, et al. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer. Am J Clin Nutr. 2004; 80:204-16.

Koralek DO, Peters U, Andriole G, et al. A prospective study of dietary alpha-linolenic acid and the risk of prostate cancer (United States). Cancer Causes Control. 2006; 17:783-91.

Eilander A, Hundscheid DC, Osendarp SJ, Transler C, Zock PL. Effects of n-3 long chain polyunsaturated fatty acid supplementation on visual and cognitive development throughout childhood: a review of human studies. Prostaglandins Leukot Essent Fatty Acids. 2007; 76:189-203.

Oken E, Kleinman KP, Berland WE, Simon SR, Rich-Edwards JW, Gillman MW. Decline in fish consumption among pregnant women after a national mercury advisory. Obstet Gynecol. 2003; 102:346-51.

 

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