Omega-3s Touted as a Cure-all

The rabbis used to come from Chile, but they didn't work out, so now they're flown in from Argentina. Two at a time, brought to the small Peruvian fishing village for the fall anchovy season.

This article was originally published in Maclean's Magazine on January 29, 2007

The rabbis used to come from Chile, but they didn't work out, so now they're flown in from Argentina. Two at a time, brought to the small Peruvian fishing village for the fall anchovy season.This article was originally published in Maclean's Magazine on January 29, 2007

Omega-3s Touted as a Cure-all

The rabbis used to come from Chile, but they didn't work out, so now they're flown in from Argentina. Two at a time, brought to the small Peruvian fishing village for the fall anchovy season. Their first stop is the barge, about a kilometre offshore, where the boats tie up and have their catches sucked from the holds. By the time all the FISH are transported to shore - through an undersea pipe - the learned gentlemen are at their assigned post inside the processing plant. Taking shifts, they stand on a catwalk alongside the conveyor belt, keeping an eye out for non-kosher species - octopus, shellfish etc. - that have been caught up in the nets. It's the last chance to set things right. Within seconds, the anchovies are in a giant concrete holding bin, being preheated to 85ºC, and ground with an auger. A hydraulic screw press smushes the bits and pieces, forcing out every last drop of water, and the viscous fluid the rabbis are there to watch over. Fish oil - for decades a waste product, fit only to give pets a glossy coat - is now suddenly the hottest thing in human health.

Ocean Nutrition Canada, the world's largest processor of the slick substance, has only been in business for 10 years. The technology that allows the Dartmouth, N.S.-based company to convert the foul-tasting and smelling anchovy juice into a flavourless, odourless powder, was developed in 2002, and ruled safe for use as a food additive two years later. But it's already in yogourt, bread, tortillas and cookies. This month, it will show up on supermarket shelves inside specially packaged Tropicana orange juice. The process to add the "MEG-3" brand powder to potato chips has already been patented. The day when it will be a "healthy" feature of fast-food meals isn't far off - a couple of major chains are mulling things over. Ensuring that the oil has the stamp of kosher purity just makes economic sense. No major manufacturer wants to deal with an additive that isn't acceptable to everyone. So, other rabbis regularly inspect and oversee the cleaning of Ocean Nutrition's refinery in Mulgrave, N.S., and its plants in Dartmouth and Wisconsin. There's also a halal production run, for the observant Muslim market.

The health trend that has turned fish-plant garbage into grocery-store gold is the explosion of interest in omega-3s. Oily fish - like SALMON, TUNA, HERRING, SARDINES and anchovies - are among the best sources of the suddenly fashionable fatty acids. Scientists have known about the crucial role that omega-3s play in brain and retina development since the 1930s. (The popular notion of fish as "brain food" dates back a couple of millennia.) But it's the seemingly unending series of research papers touting their health benefits that have consumers clamouring for more of it in their diets. Omega-3s have recently been identified as promising treatments for arthritis, colon and breast cancer, heart disease, macular degeneration, depression, behavioural problems and Alzheimer's disease. And that's just a partial list. The studies just keep on coming. Watching the TV news, or reading the papers, it can often seem like omega-3s are the cure for everything. And if that's what you're inclined to think, a lot of companies are out there just waiting to sell them to you.

Dr. Joseph Hibbeln believes he knows how to make the world an infinitely happier and safer place. For the past 15 years, the psychiatrist and physician, who has the public health rank of commander as a researcher with the U.S. National Institutes of Health (NIH), has been studying the link between omega-3s and a wide variety of illnesses and mental disorders. Hibbeln is convinced that modern societies, particularly those in the West, are suffering from the pernicious effects of a widespread omega-3 deficiency. Since diets started rapidly shifting in the early 1960s, incorporating more fast food, ready-made meals, and junky snacks, the intake of soya, corn and sunflower oils - all rich in a different type of fatty acid, omega-6 - has soared. (In 1909, per capita American consumption of soybean oil was less than 10 g a year. Today, it's 11.3 kg, and nearly 20 per cent of all calories.) Consequently, the ratio of omega-3 and omega-6 in our bodies and the chemical balance of our brains has changed. A shortage of omega-3 may inhibit the transfer of things like hormones, neurotransmitters and nutrients across neural cell walls, and affect levels of serotonin, a key mood determining chemical. The result, says Hibbeln, is more violence, murder, suicide, depression and illness.

Starting in 1998, with a paper published in The Lancet, the NIH researcher and his colleagues began comparing diets and health outcomes around the world. Countries with the highest levels of fish consumption - Japan, Taiwan and Korea - had the lowest levels of depression. Men in Hungary, Bulgaria and Austria, among the world's smallest consumers of seafood, had the highest rates of suicide. Crunching World Health Organization data from 38 different countries, they charted the growth of omega-6 consumption against rising homicide rates - the more we eat, the more we kill, was their conclusion.

Last June, in a paper published in the American Journal of Clinical Nutrition, Hibbeln and his co-authors went a step further, looking at world diets and estimating the overall percentage of 13 different types of illnesses and deaths attributable to omega-3 "deficiencies." Those findings were even more extraordinary. They attributed 20.8 per cent of all male mortality, and 31.5 per cent of female deaths, to a shortage of the fatty acids. The paper links 28.4 per cent of homicides, and 27 per cent of cardiovascular deaths to diet, as well as 65.5 per cent of postpartum depression, 98.5 per cent of major depression, and 99.9 per cent of bipolar disorders.

So much for the more traditional villains - poverty, drugs and alcohol, the disintegration of the family, even Hollywood - normally held responsible for our poor health and social ills. Of course, it's impossible to actually prove that the change in our diet is the sole explanation for our worsening behaviour, and ultimately, deaths. But Hibbeln believes it is the primary one; the pattern across different countries and through the decades is just too consistent, he argues. "Increasing omega-3 fatty acids reduces violence and aggression." Like scurvy or rickets, which all but disappeared when people started eating more vitamin C and D, a simple change in diet - more seafood or omega-3 supplements - could banish a whole host of ills, he says.

Proselytizers, steeped in the growing gospel of omega-3, are not hard to find. But heretics are scarcer than hen's teeth. Still, among the more than 8,000 published studies on the effects of the fatty acids, there is a tiny, but significant, body of dissenting opinion. In the last year, two meta-analyses - gold-standard reviews that assess and weight the various contributions to scientific literature - have dampened some of the enthusiasm. The first, published in The Journal of the American Medical Association last January, found that omega-3s do not appear to actually reduce the risk of cancer. Animal studies that suggested the fatty acid inhibited tumour growth were poorly designed, the reviewers said. And after poring over 40 years' worth of human data, involving some 700,000 people, the researchers declared it a draw. While studies suggested there were "significant associations" between omega-3s and breast, skin, lung, prostate and colorectal cancer, the findings cut both ways - some said the fatty acids reduced the risk, others found they increased it.

Last March, the British Medical Journal published a comprehensive review of the data on omega-3 and the prevention of heart disease - long considered a scientific slam dunk - strokes and cancer. Dr. Lee Hooper from the University of East Anglia and her team looked at 89 research projects - 48 randomized controlled trials, and 41 cohort studies - and concluded that there is no clear evidence that the fats offer any protection from the various ailments. In fact, in direct contradiction of the prevailing wisdom, they concluded that men with angina may be at higher risk of heart attacks and death if they consumed an omega-3-rich diet. Hooper says the response to her findings has been "angry." But scientists have a responsibility not to get caught up in the hype, she says. "Omega-3s may be useful in many conditions, but in actuality may not be useful, or even harmful in some others." A large part of the problem with the existing research is who the scientists have been studying. "The people who are taking omega-3 are richer, they have better health care, they were eating better," says Hooper. "They were more likely to take physical activity, they were less likely to smoke, they had better social support. Everything was in their favour, really."

Health Canada has generally been agnostic on the issue of omega-3s. It labels the fatty acids an "essential" part of a balanced diet, but continues to sound a note of caution about over-consumption. Excessive intake of eicosapentanenoic acid (EPA) and docosahexaenoic acid (DHA), the long-chain omega-3s found in oily fish, which act as natural anti-inflammatories, has been linked to increased risk of hemorrhagic stroke and clotting problems, as well as suppressed immune functions, says the federal body.

Kevin Fritsche, an associate professor of nutritional immunology at the University of Missouri, is another cautious dissenter. He found that mice on a high fish-oil diet were more susceptible to infection by listeria bacteria, a common source of food poisoning. His findings may not have wide application - the mice had no prior exposure to the bacteria, humans encounter it relatively frequently and build up a natural resistance. But it could well mean something to people with compromised immune systems: AIDS or chemotherapy patients, transplant recipients, newborns or the very old. The trouble is that, even though listeria kills 500 people in the United States every year, no one seems that interested in following up Fritsche's research. "I think there are plenty of good reasons to increase our omega-3 intake," says the Missouri prof. "But I've struggled to get funding to look into this stuff. No one wants to be the one with the bad news, I guess."

The pint-sized Einsteins are everywhere in the commercial - playing the piano, kicking around a soccer ball, even sitting on the toilet. Child actors with white fright wigs and bushy moustaches, carefully selected for their heart-tugging cuteness and ability to convey a simple message: this product will make your kids smarter. The actual packaging for Danino, an omega-3-fortified children's yogourt made by Danone, is slightly more restrained - a nerdy, glasses-wearing cartoon dinosaur surrounded by school books, with small print bumph about DHA, an active ingredient in omega-3, supporting the "normal development of the brain, eyes and nerves." But a TV spot is no place for subtlety. Hence the ad's tag line: "Treat your little genius to some." (The commercial is trading on a series of small, but intensely publicized fish-oil trials with U.K. schoolchildren that purported to show improvements in their behaviour, powers of concentration and cognitive abilities. Critics - who note that none of the trials were conducted with "normal" mainstream children - suggest the evidence is sketchy at best.)

The yogourt maker is not alone is shilling health benefits - real or potential. "Great Taste" or "New and Improved" no longer cuts it on the grocery-store shelves; the favoured way to grab consumer attention now is a direct appeal to our better instincts. The trade calls them "superfoods," fat-free, high fibre, low in cholesterol, good for the heart, organically grown, but mostly rich in promise. And omega-3s have become the hottest part of that "functional food" market. Sales are growing 300 per cent per year, according to AC Nielsen. In the past year alone, food manufacturers have introduced dozens of new omega-rich products, ranging from breakfast cereals to chocolate bars.

Like so many other things, it's a boomer-driven trend, says Robert Orr, president and CEO of Ocean Nutrition Canada. Staring down their 60s, the Me Generation now wants foods that will help them live a longer and more healthy life - and all the better if they're granola-style "natural" remedies. "There are more people in North American who regularly attend alternative health care practitioners - acupuncturists, massage therapists, etc. - than go to their GPs," notes Orr.

Ocean Nutrition (a privately held company, whose major shareholder is Clearwater Fine Foods Inc.) is one of the companies riding that wave. In 2006, 15 different types of products containing its MEG-3 fish-oil concentrate made it to worldwide grocery shelves, including frozen pizzas, yogourt drinks and tortillas. On this day, Orr is offering visitors samples of President's Choice Oh Mega J, an orange juice. (There's no hint of sea life in the taste, just - as the old slogan goes - sunshine.) But all those products are just the thin edge of a very large wedge, if industry predictions are to be believed.

Frost & Sullivan, an international consulting firm, pegged the value of the global omega-3 retail market (for both supplements and enriched foods) at more than US$700 million in 2005. Soon its worth will be counted in billions. The firm estimates that demand for omega additives will almost double in the U.S. by 2011, with food manufacturers buying $524 million worth of fatty acids each year. Orr is even more bullish. Most of the fish oil Ocean Nutrition produces now is sold as supplements, but he believes he can make MEG-3 the core of its business over the next half decade, with sales in the $200-million to $300-million range - a 10- to 20-fold jump.

A PowerPoint presentation for his potential clients pitches some seductive woo. Why sell regular old food when, with the magic of fish oil, you could transform your product into a "Nutrition Delivery Vehicle"? "Wellness, not from the medicine cabinet, but the refrigerator." But consumers are the real target these days. Ocean Nutrition has ambitions of becoming a market Goliath, with a product that people ask for by name. Think Kleenex and tissues. The company spent eight expensive months coming up with a brand and logo that it hopes will become synonymous with healthy fatty acids - MEG-3, and a happy, little, blue cartoon fish. "Meg" as she is known, has a wide smile and a heart-shaped tail. Initially, she looked more like a serious minnow, but focus groups steered the company towards the jolly-guppy end of the spectrum. "They said that she made them smile," says Lori Covert, Ocean Nutrition's vice-president of marketing. "And when you come up with a brand that can make people smile, you know you've got a winner." Soon Meg will have her own website with interactive games for the kids, and television commercials where she riffs à la Charlie the Tuna. Covert is envisioning a young, twentysomething female voice for her creation, but with a wholesome vibe, more Hilary Duff than Britney Spears. Boomers may drive trends, but every marketer knows that kids sustain them. Grocery-store moms particularly like "functional foods," especially for their children. And it isn't hard to upsell them on omega-3s - a familiar additive to most since 80 per cent of all the infant formula sold in North America is already fortified with the fatty acid.

One of Ocean Nutrition's biggest challenges has been getting consumers past the yuck-factor of having liquefied sardines and anchovies in their yogourt or orange juice. In the end, they've decided to accentuate the health benefits and tackle the flavour-fears head on. "All the goodness of fish, without the taste," is the oft-repeated MEG-3 mantra.

What makes seafood taste, and smell, like seafood has been an Everest-scale headache for the fledgling omega-3 industry. Simply put, when fish oil is exposed to air it begins to oxidize, its molecules breaking down. Add it, in its natural form, to a carton of OJ and by the time you break the seal, it will smell like a hot summer's day at the wharf. Ocean Nutrition, which employs 40 research scientists, spent millions looking for a permanent stink solution. In 2002, its R&D chief Colin Barrow and his team came up with a patented micro-encapsulation technique where microscopic oil droplets are coated with a thin gelatin shell. Dozens of the particles are then carefully agglomerated into a larger bundle, protected by an even thicker gelatin shell. The end result is a powder as fine as flour, with the fishy flavour locked away, and a shelf life of months, not hours.

Building a better mousetrap is no guarantee of success in the deeply conservative food business, however. Manufacturers have seen the danger of too much tinkering with a trusted brand (New Coke) and were understandably leery of adding seafood to their ingredients list, whatever the purported benefits of omega-3. As a result, Ocean Nutrition has had to go to some extraordinary lengths to convince big name customers to sign on. Inside its shiny Dartmouth labs, along with the olfactory testing units (machines with nose portals so that formulas can be screened for even the faintest whiff of the deep), there's a large test kitchen equipped with stoves, microwaves and five bread makers. Much of the company's R&D budget these days goes into figuring out how to add MEG-3 into pre-existing products - perfecting the amounts, timing and temperature adjustments for mass quantity recipes. Matteson and Co, a California food research company, is on retainer to help deal with the stickier problems. It's proof in the pudding sales. When Ocean Nutrition went courting Muller, the U.K.'s biggest yogourt manufacturer, for example, Robert Orr arrived with samples of yogourt, enriched with his fish oil powder, in hand for the first meeting.

The strategy appears to be working. Ocean Nutrition is building a big new plant next to its Dartmouth offices, which will allow it to double its manufacturing capacity. It's still slow going - it takes 24 to 36 months to get a product onto store shelves. But Barrow and his team are already busy working on the next great challenge - adding the powder to clear beverages like pop or sports drinks. It's a leap from micro- to nano-encapsulation - for the blending to work, the particles of fish oil will need to be 1,000 times smaller than the current technology permits.

And while fish oil may be among the best sources of fatty acids, it's hardly the only one. The substance is found in many green plants, nuts and grains, as well as algae, and if you feed animals omega-3 rich diets, their bodies build up deposits of the fatty acid. Consequently, competition for this particular healthy food niche is now coming from all quarters. Omega-3 enriched eggs have been on store shelves for a decade, and now account for close to 10 per cent of the Canadian market. There's an omega-3 milk, and a Manitoba hog processor recently unveiled its own brand of omega-3-rich pork. Steven Leeson, the University of Guelph professor of animal nutrition who developed the eggs, has been working on omega-3 poultry. It's been a painstaking process to find the right mix - too much of the fatty acid and people start tasting fish. "There's a very delicate balance between adding enough to give you meaningful enrichment and not adding so much that the consumer will complain about it," says Leeson. "North Americans are used to bland-tasting meat and eggs. And the difficulty with the food business is that if even one person in 100 doesn't like the flavour, that's a major problem."

Fish oil's major competition these days comes from the flax and canola industry. The oily plants are rich in alpha linolenic acid (ALA), a short-chain omega-3 that the human body can convert (although not overly efficiently) into EPA and DHA, the more complex fatty acids associated with most of the supposed health benefits. Fish oil is naturally rich in those two acids, hence the argument that its a better dietary source of omega-3s. But that kind of distinction is lost on the average consumer. And the flax and canola growers have been marketing their product just as aggressively as the fish-oil processors. In the baking business, for example, a "quiet war" - as one industry publication dubbed it - has been raging between the plant and fish people. (Bakeries, still recovering from the Atkins diet craze, are desperate to make bread healthy again.) Ask Robert Orr about it and he spits nails. "It's ridiculous. They're trying to promote their health benefits largely on borrowed science."

At particular issue is the way that Health Canada treats the different sources of omega-3. There's a government-recommended daily intake of ALA - 160 mg for adult males, 110 mg for females - but none for EPA and DHA. And while products containing up to 300 mg of ALA can label themselves "a source of omega-3 fatty acids," fish-oil producers have been trying unsuccessfully for three years to get the same designation. Their list of complaints of discrimination goes on. In the U.S., the maximum allowable amount of EPA and DHA is 300 mg per serving; in Canada it's 100 mg. "If we had the kind of lobby and marketing budgets that the flax and canola people have, the problem would have been solved a long time ago," says Orr.

Health Canada says its caution about EPA and DHA is well-founded, pointing to the evidence of risks along with the health benefits. The government says it's up to the Institute of Medicine of the U.S. National Academies, which recommends daily intakes for all of North America, to pronounce on how much of the fishy omega-3 should be in our diet. (The U.S. Food and Drug Administration, which polices food additives, says that dietary dosages of up to three grams per day of omega-3 fatty acids from marine sources are "Generally Recognized as Safe.") Japan recently set its recommended EPA/DHA guideline at 260 mg a day.

Either way, no one in the federal government seems to be trying to stem the tide of omega-3 products now washing over grocery-store shelves. And Ocean Nutrition has its own, more direct, lobbying plans in the pipeline. The company is reaching out to family doctors to educate them about the benefits of omega-3, and hopes to set up accredited study courses with the provincial colleges of physicians. Right now, there are 30 different clinical trials underway for everything from cardiovascular disease to schizophrenia, using company supplied fish oil. At the rate things are going, by the time anyone in Ottawa gets around to taking a hard look at the claims of "miracle" cures, it will be in our donuts and coffee.

There is a certain irony in the fact that the citizens of the richest, most advanced, and plentiful society the world has ever known, return to their vast homes at night and consume frozen pizzas. The choice of foods available at the local supermarket is staggering - fresh vegetables and exotic fruits even in the dead of winter - and still we choose to eat crap. If everyone followed the expert advice and ate a balanced diet there would be no need for any enhanced, enriched or fortified foods. But somehow, the idea of a magic bullet is much more appealing.

The U.S. Centers for Disease Control and Prevention estimate that nearly 40 per cent of Americans take supplements regularly - shelling out as much as US $1.7 billion a year. Billions more are spent on the growing functional foods category. And most of the people who care enough about their health to buy multivitamins or high-fibre cereals don't actually need them. Still, the thinking goes, if it's good for you, what's the harm?

Robert Orr and the people who work for him are true believers. The CEO takes three large capsules of 60 per cent concentrated fish oil every day, and regularly eats the "superfoods" produced by his customers. Barrow, his chief of research, stirs heaping teaspoons of MEG-3 powder into his morning yogourt - four grams a day. It's a health-conscious corporate culture. Orr admits that there has been some internal debate about the propriety of adding omega-3s to junk food, but the reality is that most North Americans aren't going to start eating the recommended amounts of oily fish - no matter how good it might be for them. "Consumers say they want more nutrition, but what they really want is to eat the same food, at the same price, with the same taste," says Orr. "You have to meet people where their needs are."

But the question of whether the general public should be ramping up their omega-3 intake is still a matter of scientific debate. Dr. David Jenkins, who holds a Canada Research Chair in nutrition and metabolism at the University of Toronto's Faculty of Medicine, remains skeptical. "Initially we thought they were going to be the answer, but now we're not so sure," he says. The growing body of contradictory research on the effects of omega-3s has Jenkins worried about potential dangers, especially to those with undiagnosed heart ailments. "I don't think we're in a position to be giving advice. We're in a position to be doing a lot more research." Jenkins, a vegetarian since he was 13, gets his omega-3s from plant sources, and believes everyone else should too. The fervent proponents of fish oil have confused passion for science, he says.

Dr. Joseph Hibbeln of the NIH speaks just as convincingly of the endless benefits of fish oil. "I feel like I've been honoured with many eureka moments over the past 15 years," he says. "Every time I ask a question, I turn the page over and there's the answer." Omega-3s. Hibbeln has been overseeing clinical trials with violent criminals in the Washington, D.C., area, feeding them fish oil. Initial results suggest their levels of anger and irritability have fallen by a third. This past month, the doctor staged an "intervention" on an unnamed U.S. Indian reservation. A change in diet will help heal their broken community, he says. And the wider world needs to hear the same message. "We have information that can significantly reduce the distress of large numbers of people and potentially reduce the risk of homicide, suicide and violence," says Hibbeln. "It's a mission."

It would be nice to have a cure for everything. And better still to be the one selling it.

Maclean's January 29, 2007