Becky Wright, Aker BioMarine Antarctic03.03.14
At an American Heart Association meeting in the early 2000s, Dr. Clemens Von Schacky and Dr. William Harris met to discuss a new Harvard paper showing a relationship between blood omega-3 levels and sudden cardiac death. The result of this meeting would impact the omega-3 world forever.
“As we discussed this new paper, it dawned on us that measuring omega-3 levels goes beyond just knowing how much fish you ate; it’s actually a ‘risk factor’ for coronary heart disease,” said Dr. Harris. “And having a certain level correlates with either reducing or increasing your risk for heart attack.”
In the years that followed this meeting, Drs. Von Schacky and Harris both established omega-3 testing companies—Dr. Harris in the U.S. and Dr. Von Schacky in Germany. The initial goal was simple: to develop a blood test doctors could use to measure patients’ omega-3 levels. The result was the HS Omega-3 Index Blood Test; and the timing was perfect, as the omega-3 market was growing considerably and so was consumer awareness.
A Numbers Game
Today, sales of omega-3 supplements exceed $1 billion and consumer awareness of omega-3s is at or above 90% in many countries. These numbers reflect a solid, established market, but also a maturing one. So as this market continues to develop and growth slows, how can companies bring new consumers into the omega-3 category? The Omega-3 Index could be the solution. Research—of all kinds—will also be crucial.
For example, late last year the Council for Responsible Nutrition (CRN) commissioned market research firm Frost & Sullivan to conduct a cost/benefit analysis of a variety of nutritional ingredients, including omega-3 fatty acids. The report, “Smart Prevention—Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements,” examined four different chronic diseases and the potential for healthcare cost savings when U.S. adults 55 and older, diagnosed with these chronic diseases, used one of eight different dietary supplement regimens.
The analysis demonstrated that supplementation at preventive intake levels in high-risk populations could reduce the number of disease-associated medical events, representing the potential for hundreds of millions of dollars in savings—and billions in some cases.
For omega-3 fatty acids in particular, the study showed that the potential avoided hospital utilization costs related to coronary heart disease through the full use of omega-3 supplements at preventive intake levels could be as much as $2.06 billion on average per year, with a cumulative savings of $16.46 billion from now through 2020.
Form = Function
Omega-3 fatty acids are among the most researched nutrients in the world (GOED, 2012). The problem with omega-3s, like most nutrient categories, is that they offer benefits that cannot always be felt. But they can be measured, which is where the Omega-3 Index comes in.
The Omega-3 Index is defined as the percentage of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in red blood cell (RBC) fatty acids (see Figure 1). While most omega-3s will raise the Omega-3 Index, how quickly and efficiently that happens depends on the source.
Calculating the Omega-3 Index
According to recent research, certain fatty acid sources preferentially raise the Omega-3 Index. In fact, two clinical studies featuring Superba krill phospholipid omega-3s increased total plasma EPA and DHA more than fish oil (on a per mg omega-3 fed basis) after both 4-week and 7-week supplementation periods (Nutrition Research, 2009; Lipids, 2011). Research also shows that higher levels of EPA and DHA in blood are linked to decreased risk of sudden cardiac death as well as other harmful cardiac events (NEJM, 2002). In fact, both in the steady-state and after omega-3 supplementation, the Omega-3 Index has been found to correlate directly with EPA and DHA levels in human cardiac tissue (Circulation, 2004; AM J Clin Nutr, 2007 & 2010).
In contrast to plasma fatty acid measurements, which respond to short-term omega-3 fatty acid intake, the Omega-3 Index is believed to mirror overall tissue EPA and DHA levels, and therefore a person’s health status. This is similar to hemoglobin A1c serving as a better marker of average glucose levels than plasma glucose. An Omega-3 Index of 8% or above is considered optimal (Current Cardiology Reports, 2010).
Since increases in EPA and DHA levels can reduce risk for sudden cardiac death, researchers have looked into whether 2 grams per day of krill oil could increase omega-3 RBC levels after 8 weeks of supplementation in healthy volunteers (unpublished data).
In this study, researchers compared the delivery form of omega-3 fatty acids—phospholipids (in krill) vs. triglycerides (in fish), on a per gram omega-3 fed basis—and found that phospholipid-bound omega-3s were better at raising the Omega-3 Index compared to triglyceride-bound omega-3s. More specifically, krill oil increased the Omega-3 Index by about 70% compared to fish oil at the end of study after dose adjustment between the two treatment groups (see Figure 2).
After Dose Adjustment, Krill Oil Increased the Omega-3 Index by 70% vs. Fish Oil
These results go hand in hand with a recent publication (Nutrition Research, February 2014), which investigated the effect of 12 weeks daily Superba krill intake in volunteers with “borderline high” or “high” blood triglyceride levels. A total of 300 volunteers were divided into five groups and supplemented with krill oil at either 0.5, 1, 2 or 4 grams per day or placebo (olive oil). The subjects included in the study had blood triglyceride values between 150 and 499 mg/dL. Blood lipids were measured at baseline, 6 weeks and 12 weeks of treatment.
Relative to subjects in the placebo group, those administered krill oil had a statistically significant 10% reduction in serum triglycerides. Moreover, LDL cholesterol levels were not increased in the krill oil groups relative to the placebo group, an important finding considering an increase in LDL cholesterol has been observed in some fish oil trials.
“It is remarkable that krill oil, providing on average less than 400 mg per day of EPA and DHA, produced a significant 10% reduction in serum triglyceride levels,” said Dr. Harris.
Equally important, study participants significantly increased their Omega-3 Index levels. This was especially evident in the krill oil group taking 4 grams per day, where the levels went from 3.7% to 6.3% (see Figure 3).
Krill Oil Supplementation Raised the Omega-3 Index as High as 70%
“It is interesting to point out that with the highest dose of krill oil, the Omega-3 Index increased by 70%,” said Dr. Von Schacky.
“Even with the lowest dose of 500 mg krill oil, there was a significant increase. Thus, this might have an impact on the risk of sudden cardiac death, which has been demonstrated in several studies during the latest decade.”
Know Your Number
Adam Ismail, executive director of the Global Organization for EPA & DHA Omega-3s (GOED), Salt Lake City, UT, believes the Omega-3 Index will continue to influence the market positively going forward. “We’ve heard and seen anecdotally that when people know what their Omega-3 Index is and they have a shortfall, they become extremely compliant. Simply just knowing your number will have an impact,” he said.
For now, Dr. Harris noted that at just one clinical lab in the U.S., close to 3,000 HS Omega-3 Index Tests are ordered every day. Although he believes it may take another several years before the Omega-3 Index becomes a standard measure of cardiovascular health, the future looks very bright.
About the author: Becky Wright is the communications and marketing manager for Aker BioMarine Antarctic, Issaquah, WA. She can be reached at 206-855-6736, ext. 210 or becky.wright@akerbiomarine.com.
“As we discussed this new paper, it dawned on us that measuring omega-3 levels goes beyond just knowing how much fish you ate; it’s actually a ‘risk factor’ for coronary heart disease,” said Dr. Harris. “And having a certain level correlates with either reducing or increasing your risk for heart attack.”
In the years that followed this meeting, Drs. Von Schacky and Harris both established omega-3 testing companies—Dr. Harris in the U.S. and Dr. Von Schacky in Germany. The initial goal was simple: to develop a blood test doctors could use to measure patients’ omega-3 levels. The result was the HS Omega-3 Index Blood Test; and the timing was perfect, as the omega-3 market was growing considerably and so was consumer awareness.
A Numbers Game
Today, sales of omega-3 supplements exceed $1 billion and consumer awareness of omega-3s is at or above 90% in many countries. These numbers reflect a solid, established market, but also a maturing one. So as this market continues to develop and growth slows, how can companies bring new consumers into the omega-3 category? The Omega-3 Index could be the solution. Research—of all kinds—will also be crucial.
For example, late last year the Council for Responsible Nutrition (CRN) commissioned market research firm Frost & Sullivan to conduct a cost/benefit analysis of a variety of nutritional ingredients, including omega-3 fatty acids. The report, “Smart Prevention—Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements,” examined four different chronic diseases and the potential for healthcare cost savings when U.S. adults 55 and older, diagnosed with these chronic diseases, used one of eight different dietary supplement regimens.
The analysis demonstrated that supplementation at preventive intake levels in high-risk populations could reduce the number of disease-associated medical events, representing the potential for hundreds of millions of dollars in savings—and billions in some cases.
For omega-3 fatty acids in particular, the study showed that the potential avoided hospital utilization costs related to coronary heart disease through the full use of omega-3 supplements at preventive intake levels could be as much as $2.06 billion on average per year, with a cumulative savings of $16.46 billion from now through 2020.
Form = Function
Omega-3 fatty acids are among the most researched nutrients in the world (GOED, 2012). The problem with omega-3s, like most nutrient categories, is that they offer benefits that cannot always be felt. But they can be measured, which is where the Omega-3 Index comes in.
The Omega-3 Index is defined as the percentage of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in red blood cell (RBC) fatty acids (see Figure 1). While most omega-3s will raise the Omega-3 Index, how quickly and efficiently that happens depends on the source.
Calculating the Omega-3 Index
According to recent research, certain fatty acid sources preferentially raise the Omega-3 Index. In fact, two clinical studies featuring Superba krill phospholipid omega-3s increased total plasma EPA and DHA more than fish oil (on a per mg omega-3 fed basis) after both 4-week and 7-week supplementation periods (Nutrition Research, 2009; Lipids, 2011). Research also shows that higher levels of EPA and DHA in blood are linked to decreased risk of sudden cardiac death as well as other harmful cardiac events (NEJM, 2002). In fact, both in the steady-state and after omega-3 supplementation, the Omega-3 Index has been found to correlate directly with EPA and DHA levels in human cardiac tissue (Circulation, 2004; AM J Clin Nutr, 2007 & 2010).
In contrast to plasma fatty acid measurements, which respond to short-term omega-3 fatty acid intake, the Omega-3 Index is believed to mirror overall tissue EPA and DHA levels, and therefore a person’s health status. This is similar to hemoglobin A1c serving as a better marker of average glucose levels than plasma glucose. An Omega-3 Index of 8% or above is considered optimal (Current Cardiology Reports, 2010).
Since increases in EPA and DHA levels can reduce risk for sudden cardiac death, researchers have looked into whether 2 grams per day of krill oil could increase omega-3 RBC levels after 8 weeks of supplementation in healthy volunteers (unpublished data).
In this study, researchers compared the delivery form of omega-3 fatty acids—phospholipids (in krill) vs. triglycerides (in fish), on a per gram omega-3 fed basis—and found that phospholipid-bound omega-3s were better at raising the Omega-3 Index compared to triglyceride-bound omega-3s. More specifically, krill oil increased the Omega-3 Index by about 70% compared to fish oil at the end of study after dose adjustment between the two treatment groups (see Figure 2).
After Dose Adjustment, Krill Oil Increased the Omega-3 Index by 70% vs. Fish Oil
These results go hand in hand with a recent publication (Nutrition Research, February 2014), which investigated the effect of 12 weeks daily Superba krill intake in volunteers with “borderline high” or “high” blood triglyceride levels. A total of 300 volunteers were divided into five groups and supplemented with krill oil at either 0.5, 1, 2 or 4 grams per day or placebo (olive oil). The subjects included in the study had blood triglyceride values between 150 and 499 mg/dL. Blood lipids were measured at baseline, 6 weeks and 12 weeks of treatment.
Relative to subjects in the placebo group, those administered krill oil had a statistically significant 10% reduction in serum triglycerides. Moreover, LDL cholesterol levels were not increased in the krill oil groups relative to the placebo group, an important finding considering an increase in LDL cholesterol has been observed in some fish oil trials.
“It is remarkable that krill oil, providing on average less than 400 mg per day of EPA and DHA, produced a significant 10% reduction in serum triglyceride levels,” said Dr. Harris.
Equally important, study participants significantly increased their Omega-3 Index levels. This was especially evident in the krill oil group taking 4 grams per day, where the levels went from 3.7% to 6.3% (see Figure 3).
Krill Oil Supplementation Raised the Omega-3 Index as High as 70%
“It is interesting to point out that with the highest dose of krill oil, the Omega-3 Index increased by 70%,” said Dr. Von Schacky.
“Even with the lowest dose of 500 mg krill oil, there was a significant increase. Thus, this might have an impact on the risk of sudden cardiac death, which has been demonstrated in several studies during the latest decade.”
Know Your Number
Adam Ismail, executive director of the Global Organization for EPA & DHA Omega-3s (GOED), Salt Lake City, UT, believes the Omega-3 Index will continue to influence the market positively going forward. “We’ve heard and seen anecdotally that when people know what their Omega-3 Index is and they have a shortfall, they become extremely compliant. Simply just knowing your number will have an impact,” he said.
For now, Dr. Harris noted that at just one clinical lab in the U.S., close to 3,000 HS Omega-3 Index Tests are ordered every day. Although he believes it may take another several years before the Omega-3 Index becomes a standard measure of cardiovascular health, the future looks very bright.
About the author: Becky Wright is the communications and marketing manager for Aker BioMarine Antarctic, Issaquah, WA. She can be reached at 206-855-6736, ext. 210 or becky.wright@akerbiomarine.com.
