The Missing Wellness Factors: EPA and Dha: The Most Important Nutrients Since Vitamins?

By Jorn Dyerberg and Richard Passwater

Wellness is more than the absence of disease. It's a vital combination of vibrancy, vitality, abundant energy, and extraordinary health. Here, the authors reveal two essential wellness factors which are often missing in people's diets - omega-3 fatty acids EPA and DHA.

• Language: English
• Publisher: Turner Publishing Company
• Release date: May 15, 2012
• ISBN: 9781591203452

Jorn Dyerberg

One of the world's leading authorities on the health benefits of omega-3 fatty acids EPA and DHA. A professor at the University of Copenhagen and author of more than 350 scientific articles.

Book preview

Preface

Dr. J rn Dyerberg's quest to find out why the high-fat diets of Eskimos resulted in less heart disease than the diets of their more Westernized brethren led to a serendipitous discovery that can help to protect many of us from heart disease. But, more importantly, Dr. Dyerberg's discovery has led to a new class of nutrients essential to all human health—more than just heart health!

Thanks to the research initiated by Dr. Dyerberg and his colleagues, we now know that the nutrients EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are required by the body for their unique vital functions. However, these omega-3 essential fatty acids are inadequate in modern diets and, furthermore, are continuing to disappear at an accelerated pace. Other nutrients, even of the same omega-3 family of fats, cannot perform the unique vital functions of EPA and DHA. These fatty acids are similar in many ways, but, as we will explain later, each has separate and independent functions. We must depend on our diets to provide adequate amounts of both EPA and DHA. Not just one or the other, but both.

While Western medicine was focusing on cholesterol and fats as the major cause of heart disease in the 1960s, the Eskimos were providing Dr. Dyerberg with a more important cause—and prevention—of heart disease and many other diseases and disorders.

In this book, we will travel with Dr. Dyerberg to Greenland as he and his colleagues unlock the clues to this health mystery that is proving to be the most important health discovery since vitamins. We will then look at the scientific research and many clinical studies that show the importance of this new class of nutrients to heart and artery health, to brain function and the prevention of dementias including Alzheimer's disease, and to the easing of arthritis and diabetes' symptoms, and to keeping every cell in our bodies young.

1

Unlocking the Eskimos' Nutritional Treasure

The yapping of the huskies was simmering down, but the biting Arctic wind still made conversation difficult. Dr. J rn Dyerberg had many questions as the scientific expedition's eight dogsleds hauled by eighty-eight huskies glided over the sea ice ( Figure 1.1 ). But he had to keep his thoughts to himself, as the only companion on his sled was the driver, Jonas, who only spoke Inuit. In fact, away from the towns, there were no noises other than the wind and whatever sounds you might be making. The quiet was striking.

Figure 1.1. A view from the dogsled of Dr. J rn Dyerberg on one of his expeditions to remote Greenland Inuit villages. The view never changes except for the lead dog.

Dr. Dyerberg and Dr. Hans Olaf H.O. Bang were leading a Danish research team in April 1972 to the settlement Igdlorssuit (now called Illorsuit) on Unknown Island, some eighty miles out from the coastline of northern Greenland in Baffin's Bay. At the settlement, approximately ninety Eskimos (Inuits) lived as hunters and fishers, in ways they had done for generations.

Let's pick up the story in Dr. Dyerberg's own words when they had been underway for ten hours, and both the dogs, dragging the heavy load of personal and scientific gear, and the passengers, unaccustomed to this type of traveling, were getting tired.

SCIENTIFIC ENDEAVOR AND PERSONAL ADVENTURE

I was wondering: Would this trip give us the final clue or are we on a wild goose chase? During our previous expedition in August–September 1970, we had uncovered some interesting clues, but we need a final piece of the puzzle to solve the mystery of why Eskimos don't have heart disease. We had found, in spite of their high fat diet, that the Eskimos had favorable cholesterol and blood lipid (fat) levels. Traveling and living far above the Arctic Circle wasn't what I had in mind when I joined Dr. Bang's research group, but it certainly gives room for experiences! Will our efforts be well received by the Eskimos? Will months of preparations that had brought us this far give an answer to our question? Now we are at least ready to test whether the answer will be found in the traditional Eskimo diet, which consists mainly of seal and fatty fish. It was a race against time as the world was changing, including the world of the Eskimo.

I thought to myself: We'll just have to start by collecting all the facts that we can. I hope my new blood analysis technique will help us. The daylong trip over the frozen sea under a sun that doesn't set has at least been an experience not many are given. As the team's technician said during a tea pause, If not for the amount of clothes I am wearing, I would have pinched my arm to see if I was dreaming. Tea pauses were popular because they were warm, and tea could be made from melted ice so we didn't have to carry heavy water (Figure 1.2).

Figure 1.2. Melting snow to make tea while the dogs rest. Dr. Dyerberg is on the right.

Flashback

This adventure really began in 1968 when an editorial in the Danish Medical Society's weekly journal pointed out the unusual pattern of heart disease among the population of Inuits or Eskimos who were Danish citizens living in the part of Denmark named Greenland. The major part of the world's Inuits were at that time Danish citizens. It was the editor's opinion that Danish medical doctors had an obligation to research the medical peculiarities that existed—before it was too late, meaning before Westernization of the Inuit society took over—when comparing the populations in the two parts of the Danish kingdom: Denmark and Greenland.

I was at that time resident physician at Dr. Bang's laboratory at the city hospital of Aalborg. Dr. Bang had been conducting intensive research in lipid-related risk factors for coronary heart disease. He had found, as had other lipid researchers, that a high blood level of cholesterol was a major risk factor for that, and the culprit was a high intake of fat in our diets. Dr. Bang had visited Greenland in the 1950s when a measles epidemic struck the then-virgin population, causing severe illnesses. He suggested that we should respond to the journal's call to action and revisit Greenland to perform plasma lipid analyses on Eskimos living in their original way.

The surprising information in the editorial was namely that the Eskimos, in spite of a high fat content in their traditional diet, did not have a high coronary heart disease incidence—quite the contrary, a very low incidence! Could that be due to the composition of the marine fats they lived on? Upon reading this editorial, Dr. Bang said to me, I guess no one else is going to be collecting samples from Inuits who hunt and fish any time soon, so let's take samples and publish the results so at least people will know what the blood parameters were in the 1970s. I agreed that the world was changing fast and the window of opportunity was short. So we dropped everything else we were doing and devoted ourselves to obtaining these samples while there was still time.

Obviously, these were solid scientific reasons to examine the Eskimos' blood lipids to see if these, in spite of high fat consumption, were as favorable as the low coronary heart disease incidence indicated!

Important factors in coronary heart disease development are in the blood proteins that transport fats and cholesterol. Fats and cholesterol are not soluble in blood, which is largely water, and must be transported in proteins called lipoproteins. Lipoproteins are friendly to both water and fats. They carry the fats inside their structures whose outsides are compatible with water and blood. At that time I had nearly finished my doctoral thesis based on a new method for measuring the various lipoproteins in blood. I had developed an agarose-based electrophoresis method that would enable us to determine not only the blood lipids in Eskimos, but also the blood lipoproteins—if only we could get up there and sample their blood. We had to do the analyses on the spot, as lipoproteins in the blood are unstable and could not be shipped to Denmark for analysis.

A lot of clerical work had to be done before undertaking the expedition. It included applications to the ministry of Greenland, the health authorities, and other government officials and not least to apply for money for such an expedition—monies to buy and ship equipment, both personal and analytical, for a month-long stay for three people in the wilderness. We finally managed to collect $5,000 for our expedition to collect blood from Eskimo hunters and fishermen and their families.

On Our Way

We were now on our way to Igdlorssuit, but we were basing our operations out of a small town on the coast of Baffin's Bay called Umanak because it had both electricity and a hospital. Incidentally, as it turns out, umanak means heart in Inuit. Perhaps you may recognize igloo in the name Igdlorssuit, which translates to the big houses.

The trip was cumbersome. We had to fly from Copenhagen to the American air base in Sondrestrom, Greenland. From there, a helicopter took us to the city of Egedesminde. We then boarded a cargo boat that also carried a few passengers and delivered us some days later farther up the Greenland west coast.

We were well received at the small twenty-bed hospital in Umanak and were kindly invited to join the doctor on his trips to the small settlements in the Uummannaq district, where about 100 people lived at each one. The families depended on the hunter-fisherman's ability to provide the family with food. As I've mentioned, their traditional diet was based on seal and fatty fish, and now and then a small whale. Western food items were sparse, mostly sugar and biscuits.

By necessity, the Eskimo diet is different from diets of those living in warmer climates. The snow- and ice-covered Arctic with its long periods of darkness is not conducive to growing plants, so isolated villages depend mostly on fishing and whatever else they can find hunting for food. The classical food pyramid for U.S. citizens has fats, oils, and sweets in the smallest section with the recommendation to use them sparingly. Figure 1.3 depicts how the Eskimo food pyramid might look to an outsider. Needless to say, it's quite different than the U.S. food pyramid!

I lived on Eskimo provisions on many occasions and grew quickly fond of raw seal liver with a helping of fresh seal blubber and a meal of dried seal meat. The food we ate was identical to the Eskimo protein- and fatrich diet, with very little carbohydrate. We also ate the seal intestines, after turning them inside out and washing them by dragging them after the boat. The sled dogs also liked these meals, and I had to be on guard to defend my meals from them. I carried fairly large sticks or stones for this purpose. Towns here usually had a ratio of ten dogs for every person, but the dogs are not pets.

Figure 1.3. How the Eskimo food pyramid might seem to outsiders.

On reflection today, my experience in Greenland was very pleasant. It was more than the thrill of the science; it was the enjoyment of the people and the land as well. In our five Greenland expeditions, the scientific results of which made a turning point in human nutrition by discovering the role of omega-3 fatty acids' essentiality in heart health and their unique physiological effects, we in heart health enjoyed the experience of going out there in the wilderness!

Being a young doctor in my thirties, science was of course my priority on the tours, but I shall not underestimate the value of having had the opportunity to experience what many are not given. On some expeditions we chose to go in April or in August to take advantage of the long Arctic days. However, the almost endless daylight was not conducive to sleeping, and thus we had the opportunity to explore and play. We were able to go sailing, kayaking, and dogsledding for days. We ate raw seal and whale, and slept on floors in schools and churches in sleeping bags and in houses in remote places. I even shot birds and caught fish myself (I never shot a seal but have been on hunting tours with Eskimo hunters who did). Certainly the science was and is of a very high value for me, but the personal experiences I had during those scientific endeavors I shall never forget.

Collecting Blood Samples

Now, back to our scientific detective work: We managed at our first expedition in 1970 to collect blood from 130 Eskimos, males and females. The blood lipid and lipoprotein analyses that we did at the laboratory in Umanak showed uniformly a low content of the triglyceride-containing very low-density lipoprotein (VLDL). VLDL contains the highest amount of triglycerides, the main form that fats are carried in the blood and a known risk factor for heart disease. This was the first indication of what we know today, namely, the strong triglyceride-lowering effect of the omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). However, we would later find that EPA and DHA have even more important effects to reduce the risk of heart disease.

After returning to Denmark we finished analyzing the blood samples and in April 1971 published the article Plasma Lipid and Lipoprotein Pattern in Greenlandic West-Coast Eskimos in the reputed medical journal the Lancet (Bang, 1971). Even though the word omega-3 was never mentioned in this seminal article, the editor notes, These early observations were crucial in formulating a hypothesis to account for the low incidence in coronary heart disease in a population consuming a high-fat, high-cholesterol diet. The study has since been classified as a nutrition classic.

Nonetheless, we had to conclude that even though the Eskimos had favorable blood fat levels, they were not low enough to explain why these remote-living Eskimos had only about one-tenth the incidence of heart disease compared with Danes and Americans. Thus we had to search for additional explanations. What could they be?

Testing for Clues

The first thing we did was to get an old gas chromatograph working again that Dr. Bang had in his lab. For readers not familiar with gas chromatography, it was an early analytical instrument that was used to separate and quantify individual compounds of a mixture. Since we weren't looking for anything special, our goal was to determine whatever we could about the Eskimo blood fat profiles with our 130 samples and then compare the fatty acid composition with that of typical Danes. The research was hard work, but we felt it was our duty to analyze and learn as much as we could before the Eskimos' diet and traditional way of life were altered.

As I said, we were just testing for everything we knew about, but we did notice a couple of extra peaks in the chromatogram analysis of the blood samples from the Eskimos—peaks that we had never noticed before. We didn't know what these mystery compounds indicated, but it was reasonable to believe that they were fatty acids. We didn't know if one or both of them were related to the mystery. So I sought help in the interpretation of our results from Dr. Ralph Holman at the Hormel Institute in Minnesota, who was the leading fatty acid analyst of the time.

Judging from the position of the peaks, Dr. Holman postulated that we had found omega-3 fatty acids in the blood, quite possibly EPA and DHA. I still remember repeating these two strange names—eicosapentaenoic acid and docosahexaenoic acid—just to learn them. At that time no notice was given to these fatty acids in either human medicine or nutrition. (We'll describe these missing wellness factors in more detail in Chapter 3.)

Eventually, after years of research and several more expeditions, we detailed our findings Fatty Acid Composition of Plasma Lipids in Greenland Eskimos in the American Journal of Clinical Nutrition (Dyerberg, 1975). We concluded that "If dietary differences are the main reasons for the differences in coronary heart disease incidence in Eskimos, the results from this study point toward qualitative differences in respect of fatty acid composition of the food." But I'm getting ahead of myself.

Back to Greenland

It would take years in the interim to discover where EPA and DHA came from, if they were related to heart disease, and if so, how. We consequently were to find these two fatty acids in the Eskimo food! The focus of our next two expeditions to Greenland in 1972 and 1976 was to collect and analyze the Eskimo food and to see if we could find the explanation in the food for their favorable blood lipid levels—despite their high fat diet. No one had done that before.

We did that in both summer- and wintertimes (1972 and 1976, respectively) with a special focus on EPA. By that time, we had found a very high content of EPA (and DHA) in Eskimo blood. We were still working with the analysis to be published in 1975, but we had seen these fatty acids in many samples in 1972. I wrote—very foresighted as it turned out to be—in 1972 in the first food-collecting expedition diary: This fatty acid (EPA) can only come from the food, as our bodies cannot make it. Even if any connection between a component that unique and lowering of coronary disease risk at present is purely speculative and completely unfounded, it opens up for very wide nutritional perspectives and justifies fully a detailed analysis of the original Eskimo food.

What we did at these two expeditions to Igdlorssuit was to sample the food the Eskimos were living on, by asking the volunteers to use the double-portion food-collection technique. We supplied them with plastic bags and asked them to put exactly the same sort and amount of food in the plastic bag as they ate at every meal during the day. We then the next morning bought the bag after many friendly price negotiations. What is the price of a fresh seal eye, considered a special delicacy? I have had it, and it tastes good, but it is a bit difficult to chew. Every one of our volunteers cooperated perfectly; even the hunters, on hunting trips for days, brought back their plastic sacks with raw meat and seal liver.

We used a generator to give us electricity to run a meat grinder and a blender. We then weighed a sample of a day's homogenized provision and froze it. We did not have a freezer, but used an ice and salt mix in an isolated box we had built. Such a salt-ice mix can have a temperature of zero Fahrenheit, and there was plenty of ice to sample! The rest of the minced provisions were given to the huskies, of which approximately 900 ran freely around on the island, when they were not working as sled dogs. Greenland huskies are not pets, and even if you feed them, you should never try to caress them. They are tough, and never come into the houses. A heavy stick is a good thing to have in your hand when close to them.

The results from both expeditions were strikingly similar to the fatty acid analysis of the 130 blood samples published in the American Journal of Clinical Nutrition. At that time we had found the key to unlocking the Eskimos' nutritional treasure—our special fatty acids EPA and DHA that had unexpected and hitherto unknown biological effects. This brought us to the end of our first three expeditions. As we would discover over the next two expeditions and in subsequent years, each has separate functions, and they are not merely two of the same. Table 1.1 chronicles our expeditions to Greenland and the principal purpose of each expedition. We could now shift our focus from what these mystery compounds were to discovering just what each has to do with human health.

Onward.

TABLE 1.1. RESEARCH SUMMARY OF SCIENTIFIC EXPEDITIONS TO GREENLAND

2

"Eicosa What?

Docosa What?"

At this point in our story, we have established that a difference between the blood of Greenland Eskimos and their Danish co-citizens in Denmark is that the Eskimos' blood contained eicosapentaenoic acid and docosahexaenoic acid in high amounts. You may be thinking, Eicosa what? Dicosa what? If the terms eicosapentaenoic and docosahexaenoic (pronounced eye-co-sa-pen-tah-i-no-ic and do-co-sa-hex-a-e-no-ic ) sound Greek to you, be assured that they do at first to many scientists. Don't be put off by their long names; you don't have to pronounce them or use them. Most people, including scientists, merely call them by their acronyms: EPA and DHA.

Even though these compounds are called acids, they are not harsh chemicals normally associated with the word acid. In fact, these acids are weaker than common acids found in foods such as fruit acids or acetic acid in vinegar. They are fatty acids, which don't react or attack normal body compounds, but only react with the help of enzymes with certain compounds like glycerol to form fat compounds.

Fats perform many vital roles in our bodies. In fact, some readers may be surprised to learn that fats are essential to our health (especially to heart and brain health!) and protect us against many diseases. It is often written that there are good fats and bad fats. However, there are really no bad natural fats, only bad quantities of fat intake. (Man-made trans fats, which are produced by a manufacturing process called hydrogenation, are one exception; more on these fats later.) Even the often-maligned saturated fats associated with animal fats have their roles in maintaining proper membrane functions and transporting fat-soluble vitamins. But this too is a concept for later discussion.

BASIC FATTY ACID ANATOMY

Fatty acids are the basic units or building blocks of fats. All life is based on the biochemistry of compounds containing the element carbon. Carbon is the second-most plentiful element by weight (behind oxygen) in the body, typically at 18 percent, and the third most plentiful element in terms of the number of atoms (9.5 percent). We will gradually work our way to explaining why EPA and DHA are called omega-3, long-chain polyunsaturated fatty acids (or omega-3 LC-PUFAs, a term we'll be using frequently, so keep it in mind), but for right now you don't have to be concerned with this concept. The only thing that is really important to know about EPA and DHA now is that their chemical structures are unique and they have two important functions because of these unique structures.

We require both of these specific nutrients for optimal health because of their unique vital functions. Even though EPA and DHA are related structurally and usually occur together, they are distinct compounds having unique functions. EPA cannot replace DHA, nor can DHA replace EPA; even though the body can convert small quantities of each into the other, that amount is not adequate for good health. Unfortunately, EPA and DHA levels in modern diets are inadequate and are disappearing rapidly. Other nutrients, even fatty acids of the same omega-3 family other than EPA and DHA, cannot perform the vital functions of EPA and DHA. As we will discuss later, this is because of their chemical structures as very long, very unsaturated molecules. The vital functions of EPA and DHA will be described in the following chapter, but for now let's interrupt Dr. Dyerberg's recounting of his exciting scientific detective story to discuss the basic biochemistry of fatty acids, and specifically the importance of EPA and DHA's chemical structures.

One note: Our mission in writing this book is to help you live better longer, not to teach biochemistry to readers less interested in why and more