The Mediterranean Zone (10 page)

The solution to removing most of this contamination in fish oils was developed about fifteen years ago with the implementation of sophisticated new refining techniques that not only removed the majority of toxins, but also concentrated the omega-3 fatty acids. Unfortunately, most fish oil products available for the consumer don’t use this sophisticated technology, so it remains “caveat emptor”—buyer beware—when it comes to omega-3 fatty acid supplements in the supermarket or local health food store. Given that precaution, what things should you look for in a fish oil supplement?

The first factors are color, smell, and taste. There are many wine connoisseurs (most seem to be located in California), but very few fish oil connoisseurs (I happen to be one). The best way to test a good wine is exactly the best way to test for good fish oil. Just as a wine should be clear to the eye, the same is true of refined fish oil. If the fish oil capsule is cloudy, you can be assured that the oil inside is probably contaminated with toxins such as PCBs.

So why are PCBs so bad for you? PCBs were used as an insulating fluid
for electric transformers in the twentieth century. At the time they were considered inert chemicals. However, in 1979 PCB production was banned in the United States and eventually stopped worldwide in 2001 because of their toxicity. Unfortunately, by that time millions of pounds of PCBs had been dumped into lakes, rivers, and oceans. Since PCBs are virtually indestructible (that is why they were such a good insulator for electronic transformers), they accumulate through the marine food chain, eventually ending up concentrated in fish. When you eat the fish at the top of the food chain, you are also getting a lot of PCBs. The only way to measure PCBs is with incredibly expensive analytical equipment. So unless you have a half-million-dollar machine in your kitchen, then how do you know?

There is one simple test of fish oil purity that doesn’t require a lot of sophisticated equipment. Simply break open four or five fish oil capsules and empty the contents into a shot glass. Put the shot glass in the freezer. Then come back five hours later with a toothpick. If you can’t put the toothpick through the fish oil (meaning it is frozen solid), this is a good indication that your fish oil is probably the “sewer of the sea.” If you can put a toothpick through it, it might be OK. I say
might be
, because it can still contain high levels of PCBs.

This is why you should never trust anyone in the fish oil industry to tell you the truth. When I wrote my book
The OmegaRx Zone
, which started the fish oil revolution more than a decade ago, I warned of this problem. Since then, many more people consume fish oils believing they are pure. So here are the four dirty secrets of fish oil marketing you should be aware of:

The industrial chemicals (such as PCBs) that have been dumped into the rivers and oceans for the past two generations ensure that every fish in the world today is contaminated. Stating that any fish or fish oil is totally free from PCBs is simply a lie. Drug companies selling prescription fish oil products often make the statement that their fish oil is completely free of PCBs. Good marketing, but bad science. While prescription fish oil products are lower in PCBs than what you buy in a supermarket or health food store, they definitely are not free of these toxins.

Recently the state of California began to require warning labels on any food product (and that includes fish oils) that contains more than 90 nanograms of PCBs in a recommended daily dose. A nanogram (ng) is like a single drop of water in a large swimming pool. Because of the levels of PCBs in many popular consumer brands of fish oils, recommending more than a single capsule per day would force a manufacturer to have a warning label on its bottle stating it may be dangerous to your health. In fact, eight fish oil manufacturers were sued by environmentalists in 2010 because they were not disclosing the true value of PCBs in their products. They were reporting less than 4 percent of the 209 total PCB isomers in order to claim that their products met the new standards in California. The fish oil manufacturers lost the lawsuit, and now all fish oil products have to report the true levels of PCBs.

When
Consumer Reports
, a leading consumer magazine in the United States, investigated a number of fish oils in its January 2012 issue, its researchers found several national American brands were so high in PCBs that one or two capsules would have exceeded the maximum intake of total PCB levels set by the state of California. Before taking your next fish oil capsule, go to the website of the manufacturer and search for the technical data on the levels of all 209 isomers of PCBs in that particular lot of the company’s product. If the product isn’t there, then assume that the maximum amount of fish oil you should be consuming is about one gram (that’s usually one capsule). Unfortunately, one fish oil capsule a day will not get you very close to my recommendations of 2.5 grams of EPA and DHA daily, but at least you are protecting yourself from PCBs accumulating in your fat cells and in your brain.

Natural fish oil needs only to be heated to release the stored fats from the fish. Unfortunately, the maximum levels of omega-3 fatty acids in these natural fish oils is never greater than 30 percent of the total fatty acids. Natural fish oil, however, can then be refined to make much more concentrated omega-3 fatty acid products. The more refined the fish oil, the higher the levels of omega-3 fatty acids and the lower the levels of PCBs it will contain than in natural fish oils (especially cod liver oil). This is one case where refined is better than “natural.”

Furthermore, other “fish oils” (such as krill oil) are not really fish oil. Krill are small shrimp that are dissolved in gasoline (hexane) and then treated with nail polish remover (acetone) to get the final product. This is also how you purify soy lecithin, an emulsifier used in many, many pre-packaged foods, from reduced-fat margarine to cooking sprays. (This is another little secret of the health food industry.) A substantial amount of the fatty acids in krill oil are actually free fatty acids, which are very prone to oxidation. So in addition to having low levels of omega-3 fatty acids compared to fish oil concentrates and high levels of easily oxidized free fatty acids, krill oil still contains PCBs.

To get rid of PCBs from any fish oil or krill oil, you first have to make ethyl esters from the extracted crude fish oil. This requires ethanol, which, unlike hexane or acetone, is not particularly harmful to you (since ethanol is the alcohol in wine). From these ethyl esters you can then distill out the vast majority of the remaining PCBs, making it safe to consume (see Dirty Secret #1). The vast majority of human clinical studies with omega-3 fatty acids have been done with omega-3 fatty acid concentrates consisting of purified ethyl esters low in PCBs.

However, you can process ethyl esters further to make a reconstituted “natural” triglyceride. Unfortunately, the postioning of the omega-3 fatty acids is now a totally different configuration than the true natural fish oil in the wild. As a result, these “natural” triglycerides are not natural at all.

The freshness of any edible oil is determined by its rancidity. This is measured by its total oxidation (Totox) value. The World Health Organization (WHO) has set the upper Totox value at 26 milliequivalents per kilogram (mEq/kg). Any Totox number higher than 26 indicates the product is rancid. Many poorly refined fish oils have significant odor problems because of the presence of oxidation products consisting of aldehydes and ketones. As a result, marketers often add flavors to them and market them as “fresh.” In reality, these flavors do nothing more than mask the smell of fish oil that still often exceeds Totox limits, making it unsuitable for human consumption as judged by World Health Organization standards. Because the omega-3 fatty acids are extremely prone to oxidation (even after they are
put into a capsule or bottle), the only way to ensure that a fish oil product is not rancid is to test its Totox levels after it is has been bottled or encapsulated. A good quality fish oil company will post both the PCB and Totox levels of every batch of fish oil they sell on their website.

The typical American diet is so low in omega-3 fatty acids and so rich in omega-6 fatty acids that you’d need a lot of purified fish oil to make a difference. Since omega-6 fatty acids are the cheapest form of calories known, they now represent the single largest item in the American diet. To get a better balance of omega-6 to omega-3 fatty acids, the average American is going to have to eat a lot of fish (such as the Japanese) or take a lot of purified omega-3 fatty acids as a supplement to have any significant reduction in cellular inflammation. This is why so many clinical studies with fish have conflicting results. They often give the subjects in the study too little omega-3 fatty acids to make a significant change in the balance of omega-3 to omega-6 fatty acids and thus the levels of cellular inflammation. If you give a placebo dose of omega-3 fatty acids, then you can expect placebo results.

The only way you can determine if you are eating enough fish or fish oil (both are highly unlikely) or consuming too many omega-6 fatty acids from vegetable oils (highly likely) is a blood test. In particular, you are looking for the level of the omega-6 fatty acid arachidonic acid (AA), the primary indicator of the level of pro-inflammatory responses in the body, relative to the level of the omega-3 fatty acid eicosapentaenoic acid (EPA), the primary indicator of the level of anti-inflammatory resolution responses in the body. You need a balance of both fatty acids to maintain a healthy inflammatory response. That balance can be found in your AA/EPA ratio in the blood. The lower the AA/EPA ratio is, the less cellular inflammation you have in your body. This is why I use this blood test as one of the key clinical markers of being in the Zone.

Ideally, you want to be taking in enough purified omega-3 fatty acids so that the AA/EPA ratio in the blood is between 1.5 and 3. (See the chart in
Chapter 3
.) The lower the AA/EPA ratio you have, the less cellular inflammation your body is exposed to. For comparison, the AA/EPA ratio is 1.5
in the Japanese, who are the longest-lived individuals in the world with the least amount of age-related disability (in other words, they age better). For Americans, the average AA/EPA ratio is about 20. For years, the Mediterranean population was somewhat between these two ranges. However, a recent study in Italy indicated that the older population still has a relatively low AA/EPA ratio (about 10), but the younger population now has an AA/EPA ratio similar to Americans (about 20). Our twin epidemics of obesity and diabetes are direct consequences of the growing imbalance of AA and EPA in our bodies, which has led to increased cellular inflammation. As you can see from the changes in the AA/EPA ratio in the Italian population (especially the younger generation), our cellular inflammation problem is spreading to the Mediterranean region. This may explain why, in one generation, Italian children have gone from being the leanest in Europe to among the fattest.

How much purified, omega-3-rich fish oil you have to take to control cellular inflammation depends on how closely you are following the Mediterranean Zone. The more you control diet-induced inflammation by following the Mediterranean Zone, then the less purified omega-3 fatty acids you will need to reduce cellular inflammation. On the other hand, the more white carbohydrates (bread, pasta, rice, and potatoes) you eat and the more omega-6 fatty acids (coming from vegetable oils) you consume, the more purified omega-3 fatty acids you will also need to consume to restore the necessary AA/EPA ratio into a range consistent for a healthy, balanced inflammatory response in your body.

My book
The OmegaRx Zone
was subtitled
The Miracle of High-Dose Fish Oil
. Let me give you three examples of the power of high levels of supplemental omega-3 fatty acids to support that subtitle.

EXAMPLE #1:
Probably the most serious injury to the brain is severe brain trauma resulting in deep coma. The likelihood of emerging from that coma is usually slim to none. My first experience with such a patient occurred in 2006 after the Sago Mine (West Virginia) disaster, in which thirteen miners were trapped in a cave-in surrounded by high levels of carbon monoxide for forty-one hours. When the miners were finally rescued, only one, Randall McCloy, was still alive, but just barely. He was rushed to the nearest national brain trauma center, which was under the direction of Julian Bailes, one of the top neurosurgeons in the country. When Randall
was examined at the trauma center, he had heart failure, kidney failure, liver failure, and brain failure. The brain failure came from being exposed to more than forty hours of high carbon monoxide levels that had destroyed much of the white matter in his brain. That night I got a call from Julian saying that since he had read my book
The OmegaRx Zone
, he thought that fish oil might help keep Randall McCloy from dying. I told him we should start with about 15 grams of EPA and DHA per day and his response was, “Oh my God, he will bleed to death.” I assured Julian that Randall would not bleed to death because I would use continued testing to make sure that his AA/EPA ratio never fell below 1.5, which is the average in the Japanese population, and they certainly don’t bleed to death. That night I air-shipped several bottles of highly purified liquid omega-3 fatty acids to Julian. He still had to fight the other members of the medical team on the use of that level of omega-3 fatty acids, but he convinced them that this was Randall’s only hope.

Every day Randall was fed 15 grams of purified omega-3 fatty acids through his feeding tube. Of course, we were constantly measuring his AA/EPA ratio during that time, and it never went below 3. After two months on high-dose fish oil, he came out of his coma. The same dose was continued with oral feeding, using a tablespoon as a low-tech delivery system. Four months after the mine disaster, he was discharged to go home. His heart was normal, his kidney function was normal, his liver was normal, and he gave a speech to the media that would rival that of any politician. The press announced it a miracle, but in reality it was the aggressive use of high-dose omega-3 fatty acids to reduce the inflammation in his heart, liver, kidneys, and, of course, brain.