The Life Ahead Program, diet, exercise, weight, fitness, health

Abstract: A new global analysis of all relevant population research found shows that certain omega-3 polyunsaturated fats called EPA and DHA found in fish and fish oils and another named Alpha Linolenic Acid found in a variety of foods can reduce the risk of death from cardiovascular diseases about in half. This target will require intakes of about 400 mg/day of EPA+DHA or 2400 mg/day of Linolenic acid respectively, or combinations of these nutrients in lesser amounts individually. Life Ahead provides the tools needed to identify how much of each of these key nutrient fats are included in a diet, and how needed amounts of them can be obtained by specific diet modifications or from available dietary supplements. A typical US person of age 50 will be able to achieve a gain of about 1.5 to 2 years of future Well-Days by conveniently improving usual intake of omega-3 acids over future years. Those with very low present intakes have an opportunity to gain 3 or more years from this diet modification. The benefits of omega-3 fats from 54 research comparisons included appended are consistent and conclusive.

Background: We have been barraged for decades by advice to eat less fat. "The cry has been "Keep your fat down to 30% of calories" This is wrong. The Eskimos that ate by he largest amount of population total fat experienced little if any heart disease. The "bad" fats are the saturated fat and transfats that usually comprises about 13% and 1% respectively of our food calories. Monounsaturated fats that account for another 13% of calories are modestly beneficial, and polyunsaturated fats that usually account for 8-9 % of our calories can be very beneficial. Thus the majority of fats are actually good for us And by far the most healthful of known fats are polyunsaturated ones called the omega-3's. The Eskimos ate large amounts of omega'3's. This more than overcame the negatives of their saturated fat. Fats with 9 calories per gram do contribute to weight gain. But recent research reviewed in Life Ahead now shows that a gram of carbohydrate contributes nearly as much to weight as does a gram of fat.

There has been much publicity about omega-3 fats, more than a thousands research studies about it are posted on the NIH Medline site and books have been written about it. Yet health-interested individuals have had no way to to learn how much of these fats are in their usual diets, how their intake of the omega-3's compares with the amounts needed for best health, or how they can obtain most acceptably the most healthful amounts of Omega-3's.

Advice on how to obtain proper amounts of omega-3's has been widely inconsistent. In fact some often cited advice may be seriously inaccurate. A problem is that there are two major kinds of omega-3 fats - one called here as EPA+DHA, and another called linolenic acid. These have a six-fold differing benefit per gram of amount taken, and may operate in somewhat different ways. The first is included mainly in fish, and the second is included variously in many different foods. There is no simple way for us to estimate our dietary intake of these omega-3's. Life Ahead may provide a first useful solution to this problem.

The Omega-3's and their Unique Benefits: The first above omega-3 fat group includes eicosapentaenoic acid, designated 20:5n-3 and called EPA; and docosahexaenoic acid designated. 22:6n-3 and called DHA. The second or alpha linolenic acid, is designated 18n-3 linolenic acid. The EPA and DHA that are the most potently beneficial of these fats are found almost entirely in fish or fish oils. Our dietary intake of omega-3's must be valued based on a total of linolenic acid plus the EPA and DHA. But we can't use the usual method of just adding amounts of each because linolenic provides only about one sixth of the benefits per gram of intake as does EPA and DHA.

Omega-3's provide benefits from a different than usual mechanism. First, they may not reduce the risk of heart disease per se very much. But when this event does happen, either at a first or subsequent attack, they substantially reduce the risk of all-important sudden death from the event. This is because they reduce the risk of heart arrhythmias or wildly fluctuating heart rates during an attack that can become deadly. The reduction of atherosclerosis or blood clotting that is accomplished by most other health actions does not provide this specific benefit. Only omega-3 fatty acids and cardiofitness appear to reduce substantially the risk of sudden heart death during an attack. For this reason the omega-3 fats can substantially reduce the risk of death from a new attack for those that recovered from a prior attack. And they thus provide a benefit that is different from and adds to the benefit of most other actions that reduce the risk of an early death from a cardiovascular disease. A three fold higher amount of omega-3 linolenic was a key difference in the famous Mediterranean diet that produced a 70% lower risk of heart disease death for individuals that had the same cholesterol level. More on this follows.

Second, the health benefits of EPA and DHA are obtained coincident with or soon after their use. Reductions in risk from use of antioxidants via atherosclerosis from most vitamins act by slowing the progress of diseases, and a new use of such agents in diet requires 7-10 years of use duration for useful benefit. Third, research confirms directly that dietary supplements can provide benefits similar to those obtainable from foods.

The paragraphs that follow first pertain to EPA and DHA that usually are considered together. Analysis of the benefits of alpha linolenic acid and the way in which Life Ahead values overall Omega-3 benefits will be described next. Ideas on how to obtain adequate intake of omega-3's are then suggested.

The Research on Omega-3 or n-3 Fatty Acids: The section appended to this report entitled "The Research on Health Benefits of Omega-3's---" discusses the key available research on these factors detailed in Tables A, B, and C. Included in this review is a tabulation of actual research results now published on the benefits of eating fish. No similar comprehensive listing, review and analysis of the actual results of the overall population research on Omega-3's was found elsewhere.

A data base of 54 comparisons of the risk of different amounts of fish and EPA+DHA was established from the research shown in Table A. This quite extensive data base was subjected to detailed analyses. The amounts of EPA+DHA included in each study were provided differently in various studies, but were converted to a more consistent grams and milligrams taken per day. This provides a more potentially accurate and comprehensive analysis than that obtainable from the usual comments on results from individual studies that is provided in conventional published medical reviews.

Another valuable finding from this analysis was that the EPA+DHA content of fish provides most of its health benefit. This was derived from the benefit vs. dose formulas from all research on fish and its assumed average content of EPA+DHA and from the benefit of EPA+DHA per se from observation and clinical studies. Other nutrient values of fish including its low saturated fat and antioxidants as selenium and vitamin A explain some additional heart risk benefit for fish that is now computed in Life Ahead. A value of about 0.4 gram or 400 milligrams of EPA+DHA per day reduces risk of a cardiovascular death about in half. A close look at the research shows that very small amounts of fish eaten as only one or two times a month still can reduce heart attack risk somewhat.

Forty two comparisons of risk from 12 research studies measured the effect of eating fish on CVD risk. Despite a failure of one study to find an effect, the resulting correlation was overwhelmingly significant with a correlation coefficient of 0.90. The coefficient 't' value of 12 noted in the appended formula is six times the value of 2 needed for 95% significance. Yet despite this impressive relationship the risk associated with different kinds of fish varies considerably. This is because the as shown in this accompanying table amount of EPA and DHA in different kinds of fish vary.

The so-called fatty fish of salmon, mackeral and herring can have up to 10 times the amount of these key nutrients as will more frequently eaten tuna, shrimp or cod. Study A57 confirms directly the substantially different changes in risk from eating fatty vs. lean fish. And there can be significant variations in the EPA+DHA content of samples of the same kind of fish. For example halibut from the Atlantic and Pacific oceans averaged 0.46%, but halibut from colder Greenland waters was 1.17% EPA+DHA.

The important observation here is that assuming that EPA+DHA is the main health benefit of fish consumption, one portion of salmon should convey the same benefit as 7 portions of cod, catfish or flounder. This is confirmed in study A57, and is further confirmed by the similar effects of EPA+DHA in supplements with that in fish. Another very important observation is that fried fish may be of no or negative benefit. This derives first from the fact that most fried fish is of the flounder or cod type that has low EPA+DHA. Further, fried fish includes more saturated fats and transfats that are known to be harmful. A direct confirmation that fried fish probably will not produce health benefits comes from study A61. Fried fish at 3+ times per week including fish sandwiches produced elevated risk ratios of 1.37, 1.64 and 1.93 for all CHD death, arrhythmic death, and non-fatal death. This compares with beneficial risks of 0.47, 0.32 and 0.67 for "Other" or not fried fish on the same population.

Recent medical advice suggests "That we should eat fish, preferably fatty fish, twice each week" Although useful, this advice now is inadequate. The substantial portion of fish eaten fried and in sandwiches could be of negative rather than positive value. And how many people know which kinds of fish are fatty? Eating most types of fish just twice per week provides far from a sufficient amount of needed omega-3's. There is no guidance in this recommendation on the value of different kinds of fish or of fish supplements. There also is no advice here that Omega-3's may be provided alternatively by linolenic acid that is present in many other foods and in supplements.

The Life Ahead Valuation of Cardiovascular Risks for Fish and EPA+DHA. Life Ahead now values the health benefits of fish supplements and three different classes of fish as fried, not fried and lean, and salmon and fatty. Fried fish are accorded no benefits for included EPA+DHA, and are valued on their other nutrient content. The minority that eats mackerel or herring can select the option for salmon. The table following provides presently estimated risk ratios for CV disease death for varying amounts of these classes: Risks as for all others in Life Ahead are taken vs. that for the US average population. This assumes an average population consumption of 12.8 grams per day of fish of average 0.5 % content by weight or about 65 daily milligrams of DHA+EPA . A limiting benefit for any amount of this nutrient is set as a risk factor of 0.5 based an available research and some conservatism.

Risk ratio of Cardiovascular death vs. that of average US population
Portions Taken	Lean Broiled Fish	Salmon as Fatty Fish	360 mg EPA+DHA as Supplement
None	1.22	1.22	1.22
1/month	1.09	1.18	1.07
2/month	1.04	0.88	1.02
1/week	0.97	0.76	0.95
2/week	0.88	0.64	0.85
3/week	0.82	0.61*	0.76
7/week	0.66	0.61*	0.61
EPA+DHA assumed at 0.50 of the 1.22 risk or 0.61

This will require about 0.4 gram or 400 milligrams of EPA+DHA per day. This in turn will require two 3 ounce portions of salmon each week or a daily consumption of either a usual fish oil supplement or three ounces of a usual lean type fish. But as will be shown later, the needed intake of omega fats also can be achieved via intake of fish oil supplements or from linolenic acid. These values are for a hypothetical average person. Small women would need less, and large men would need correspondingly more of these nutrients for these estimated health benefits.

The research results for the effect of fish on risk of coronary heart disease death are unusually consistent. The extensive research now published shows an average risk of 0.55 times or a reduction in risk of 45% for about 0.3 gm/day or 300 milligrams/day of DHA+EPA. Most studies obtained results quite close to this average. This should leave little question on the health value of eating adequate amounts of fish - the only food that includes useful amounts of these fatty acids.

These are quite substantial benefits for an individual food, and are far larger than those obtainable from other "Good" foods such as fruits or vegetables. For example, 1

portion per week of salmon may contribute the cardiovascular risk benefits obtainable

from 4 portions per day of fruits or vegetables. Eating salmon only 1 to 2 times per

month appears to contribute usefully to reducing risk Computed as a single added

factor, 2 portions of salmon per day over rest of life may contribute 3 more years of average population Well-Days for a person of age 50. Although this contribution would be less when accomplished as a part of some other health improvements, every health-interested person should achieve a near target intake of omega-3 fatty acids. This is because these nutrients provide unique short and long term reductions in risk of major disease that may not be achievable from any other diet or health modification.

The formulas used in Life Ahead for valuation of fish are provided following the tables of the actual research data found. A limiting risk factor for any amount of fish is set at 0.50 because research does not yet confirm any any advantage for higher amounts than about 0.3 -0.4 gram/day of DHA+EPA.

About Mercury and PCB's in Fish: There has been much publicity about the possibly harmful effect of mercury that can be included as a contaminant in fish, and especially in fresh water fish and some farmed salmon. This has discouraged some people from eating any fish. This publicity has been unwarranted and misleading.

First, risks on mercury and PCB's as for other environmental factors are usually identified as deaths per million years of exposure. These risks are in different world and dimension as those identifying risk of health habits. Those warning about these "hazards" have not been forthcoming on specific levels of risk. One analyst of this quotes: "If 100,000 people were to eat eight ounces of salmon every week for 70 years we predict that one person will get cancer from PCB's" In contrast, thousands of persons will die from heart attacks because they did not eat this salmon.

Second, the fish eaten in studies A30 through A39 conducted in various parts of the world did measure its effects on death. These populations ate fish that probably included the usual amounts of mercury and PCB's other contaminants still showed very substantial health benefits both to CV and all cause death. Study A38 investigated the potential harm of a rather high amount of mercury. Taken by itself, highest blood contents of mercury may increase risk of heart disease death. But the fish involved that included the most mercury still were healthful. This suggests that fish should be far more beneficial than any harm due to this factor. A FDA advisory said the women pregnant or with young children should not eat more than 7 ounces per week of "High mercury fish" of 0.7-1 part per million. No harm was indicated for adult consumption of usual fish that has 0.05 to 0.2 parts per million of mercury. Fish now purchased commercially in stores, restaurants, etc usually is regulated for mercury content.

Similarly, much publicity has been given the possibility that sport and other fish from fresh waters and farmed salmon can contain some harmful PCB's. Again, this risk is based on a few deaths per million of population. A review of the literature on this found no quantified evidence that harm of this could be of significance vs. the very powerful benefits of small amounts of salmon that can reduce risk of death from the major CV diseases in half. The risks of a CVD disease death for the average male US population of age 50 just to ages 60 and 70 is about 4.5% and 17% respectively. Reducing this risk in half would save 2,250 and 8,500 lives per 100,000 men. In contrast, risks of death from PCB's and most other environmental chemicals are commonly reported as a handful deaths per 100,000 individuals for lifetime exposures. It will require only two three ounce portions of salmon per week to achieve this benefit, and more salmon than this may not produce much further benefit. Thus for those concerned, there appears to little reason to eat more salmon than this for the purpose of health.. And fish oil supplements appear to have no mercury, PCB's or other known problem agents. Thus those concerned and those that do not like fish have this equally healthful alternative. And the publicity about mercury and PCB's has stimulated the fish industry to take serious steps to remove these problems that are in progress..

Alpha Linolenic Acid: The second important omega-3 fat as noted above is Alpha Linolenic Acid. This fat is not included in useful amounts in most fish, but derives usually in small individual amounts from a wide variety of foods. It is found in appreciable amounts only from flaxseed (23% by weight), butternuts(9%), walnuts(3-7%), and soybeans(2-3%). It is further included in amounts of a few tenths of a percent in each of a diverse variety of foods. It also is included in good amounts in canola or rapeseed oil, but because of recent controversy about its other possible harmful health effects the option of using canola oil is not valued in Life Ahead.

Observation studies A13, A15, A16, A19, A20 and clinical studies A34, A39, and B1 in Tables A and B include the major available research on coronary (CHD) or cardiovascular risk. These confirm in aggregate a highly significant effect of linolenic acid on risk of fatal heart disease. Results from large study A13 for women and from large A15 on both men and women were dose related and confirmed that largest amounts of dietary linolenic reduced risk of CHD about in half. This was confirmed further in A20 and by risks related to amounts in blood in A19, A34 and A39. Study A19 that involved strong confounding with other fats found no effect when unadjusted, but a substantial benefit after adjustment. Study A19 involved both a very high error margin and a small difference in amounts of linolenic. Recognizing this, the A19 result was statistically consistent with results of the majority.

The formula derived that is used in Life Ahead for linolenic acid is appended following the tables. A problem in the analysis is that the methods for measuring dietary linolenic acid probably were not consistent in the different studies. Amounts of linolenic reported on average and for groups were lower in A15 than in A13 and A20. But the relationship of relative amounts to cardiovascular risk were still quite consistent. Many foods include small amounts of linolenic acid and derivation of a total amount in a diet is complex. But the overall average result from this research was a risk factor of 0.60 or a 40% reduction in risk for an increase consumption of linolenic acid from 0.6 to 2.5 grams per day. But note that a 6 times higher amount of linolenic acid for the upper limit was needed to reach the benefit obtained from only 0.3 gram/day of DHA+EPA. Thus it takes about 6 times the amount of linolenic acid to produce the benefit obtainable from a given amount of DHA+EPA. The formulas now used in Life Ahead for linolenic acid also are appended to the tables of research results found.

No useful research was found for combinations of EPA+DHA and linolenic acid. But these two omega-3 factors probably are at least partly and more probably mostly alternates for reducing the same basic risk. Thus they should be viewed in combination. A useful measure of total omega-3 fats is equivalent grams per day of DHA+EPA plus an accompanying 1/6th of the grams per day of linolenic acid. A limiting risk factor of 0.50 is set for use of any combination of these two nutrients.

The healthful targets for Life Ahead Version #3 are set at 0.4 gram or 400 equivalent mg/day of DHA+EPA with Linolenic added to DHA+EPA at 1/6th of its included grams per day . This value target is further adjusted for user sex and weight. This adjustment for linolenic acid is a revision of the method used in Life Ahead Version #2.

It will be best for us achieve the target amount of omega-3's from consumption of both fish and linolenic equivalents from either foods or supplements. These are quite different chemical entities and there is no assurance that they produce benefits from identical mechanisms. Today's research shows only that each group does produce benefit. We have no adequate research for their use in combinations. Life Ahead now uses EPA+DHA equivalents to value the potential of a combination of the two omega-3 nutrient groups, with the total of mg of DHA+EPA plus one sixth equivalent via mg of Linolenic. Users can use goals of 500 added mg of EPA+DHA, 1000 added or 3 grams of linolenic.

Using Life Ahead: It will not be convenient for many individuals to estimate their own consumption of omega-3's from EPA+DHA and linolenic from various diets. Although as mentioned some guides about this will follow, this problem is solved with use of the Life Ahead computer model. The model calculates amounts of each of these nutrients from any diet entered, adjusts these amounts for sex and body size, and compares amounts taken with needed targets. Thus any person can easily view their actual amounts of these key nutrients eaten and compare this with amounts needed to best protect health and life.

A diet containing target amounts of omega-3's taken over life should add about 1.5 to 2 years of Well-Days to the healthy longevity of an average US 50 year old man or woman. Larger benefits are potential for those whose regular diets are now quite low in omega-3 fats. The Life Ahead diet analysis will show the potential gains in Well-Days for omega-3 dietary modifications from any present diet and combination of other factors.

Estimating Amounts of EPA+DHA Equivalents: A first guideline is that a 3 oz portion of salmon will include about 1350 mg of EPA+DHA. For a 500 mg/day or 3500 mg/week target just two portions per week of salmon will supply most of our omega-3 fat need. But most fish includes only a fifth of the EPA+DHA of salmon, and thus even a daily portion of most other fish will fall short of our need. Fortunately the research suggests that fish oil supplements will provide the computed EPA+DHA benefit. A typical fish oil supplement includes about 360 DHA+EPA equivalents. Thus 5-6 such weekly supplements will supply the omega-3 need. Or 1 portion of salmon plus three of these supplements will suffice.

But it should be better to obtain at least part of our omega-3 need from linolenic acid. The table following shows the values of linolenic acid in grams and in equivalent milligrams of EPA+DHA equivalents for these included foods. Note that these values refer to amounts per portion of food as identified by in the Life Ahead food library, and are not the usual values per gram of weight. These values all are taken from US Dept of Agriculture data on food composition. A value equivalent of 1 gram of linolenic acid is taken as that of about 0.166 grams of EPA+DHA. .

Food	Linolenic per portion, gms / mg DHA+EPA	Food	Linolenic per portion, gms / mg DHA+EPA	Food	Linolenic per portion, gms / mg DHA+EPA	Food	Linolenic per portion, gms / mg DHA+EPA
flaxseed oil, tblsp	7.25 / 1200	potato salad,1/2 cup	0.30 / 50	milk, 3.5%, 8 oz	0.20 / 33	soybeans, 1/2 cup	0.14 / 23
walnuts, 1 oz	2.6 / 430	mayonnaise, 1 tblsp	0.29 / 48	cheeseburger,1 med	0.20 / 33	navy beans, 1/2 cup	0.14 / 23
walnut oil, 1 tblsp	1.4 / 230	pie, 1 slice	0.25 / 42	frankfurter, 1	0.17 / 28	melon, 1/2	0.125 / 68
bean soup, 1 cup	0.50 / 88	margarine,1 tblsp	0.20 / 33	ice cream, 1/2 cup	0.15 / 25	quinoa, 1/2 cup	0.11 / 20
tuna salad, 3oz	0.50 / 83	Italian dressing, 1 tblsp	0.20 / 33	chicken dark, 3oz	0.15 / 25	olive oil, 1 tblsp	0.11 / 20
blue cheese, 1 tblsp	0.50 / 83	lamb, 3oz	0.20 / 33	cheese omelet, 5 oz	0.15 / 25	cheese, 1 oz	0.10 / 17

A richest source of linolenic acid is flaxseed or linseed oil. The seeds per se can be useful if ground adequately, but no good basis for computing effective omega-3 amounts of these was found. Some doctors and groups have advocated the use of incredibly large amounts of flaxseed oil as a way for obtaining our full need for omega-3's. This probably involves a vast overkill in the use of a dietary nutrient, and may not be a best approach. Just one tablespoon of flaxseed oil that includes 7.25 grams or 7,250 mg produces 1200 EPA+DHA equivalents. Thus the equivalent of just three tablespoons per week will supply the week's full computed need for omega-3's. The Mediterranean diet group obtained much of their large benefit by consuming 1.79 grams of total linolenic acid per day or 1.1 grams more than did the control diet group. Yet some guru's and diet supplement marketers have advocated use of multiple tablespoons of flaxseed oil per day. Sadly, we have no direct population research confirming either the benefit or dose need for flaxseed oil. No data was found on the harm of it in such large amounts, but this does not confirm that such large amounts are really safe. Large amounts of usually beneficial nutrients are not always better. Beta carotene and Vitamin A are beneficial to amounts of 15,000 and 5,000 IU per day, but harmful in larger amounts. And each added tablespoon of flaxseed oil contributes another 120 fat calories to body weight. A more sensible use of flaxseed oil would be a maximum of perhaps three tablespoons of the oil per week, and this can be reduced if fish also is eaten.

A concern was raised from two large studies of men that suggested large amounts of Alpha Linolenic Acid increased the risk of prostate cancer. A problem with this is that the foods highest in ALA tend to be meats and junk foods and other foods high in saturated fats that are known to produce cancer. The evidence on this is not now sufficient for inclusion of a factor on this in Life Ahead. But this does provide a further warning about taking any more flaxseed oil than is shown to be useful. And men and especially those with a risk of prostate cancer might prefer the alternative of meeting targets for omega-3's from DHA and EPA

Walnuts and walnut oil is a next highest content source. Just an ounce of walnuts eaten each day can supply the needed omega-3 benefit. But a variety of other foods such as bean soup, tuna salad and blue cheese can include useful amounts of linolenic acid. There is no simple way for individuals to know which foods include this nutrient and which foods do not include it in useful amounts. The amount of linolenic in these above 'other' foods varies from 0.2 grams to 1.17 grams in the 11 Life Ahead demo diets provided in the program. Thus as noted above, without a computer program such as Life Ahead there is no practical way for an individual - and this includes the health professional - to know how much omega-3 is included in a diet.

There also is no relationship between omega-3 content and the usual "Good" and "Bad" health valuations of food health based only on total or saturated fat. Life Ahead's multivariable valuation of health benefits shows here and elsewhere that conventional health value ideas of a food that are based only on saturated fat and cholesterol and further for just one cause of death as heart disease can be completely wrong. In contrast, Life Ahead values the combined effect of up to 23 nutrients in a dietary food on up to 15 different causes of major disease and premature death.

Life Ahead users will obtain a valuation in the diet analysis display of how much overall omega-3's are included in any diet entered, and how much more of this nutrient is needed for best health. The program will also show on option the omega's from any entered food either in the diet or in the health library. The user then can try alternate additions of omega-3 containing foods with guidance of the above tables (and these values are provided in the program) to learn how this deficiency can be acceptably corrected.

Supplements of EPA+DHA: Research on the benefits of fish oil supplements as in studies A32, A36 and A37 showed benefits similar to those from amounts of EPA+DHA in fish. Thus those that find fish distasteful have the option of using fish supplements which have a benign taste. A popular fish oil supplement of 1.2 grams includes 216 mg of EPA and 144 mg of DHA, or a total of 360 mg or 0.36 gram of the needed nutrients. But other supplements may include differing amounts of EPA and DHA. Thus Life Ahead provides for entering the actual average amount of EPA+DHA taken per day in milligrams from a supplement. The program values omega-3 factors from fish as the sum of the average amount of EPA+DHA eaten in fish intake plus that eaten in supplements per day. And omega-3 benefits also are obtainable from the added intake of alpha linolenic acid that can be taken via supplements of flax oil.

Omega-3's and Cancer: It has long been proposed that omega-3 fats will reduce the risk of cancer. Dr. Johanna Budwig proposed this in 1951. And a Dr. Dan Roehm has written extensively about this. This writer did attempt a brief search on this, but did not find sufficient and consistent research in this review to include a properly quantified cancer benefit for omega-3's in Life Ahead. Age. A large meta analysis of 38 different studies (Maclean, CH, JAMA 2006; 295:403) found similarly inconsistent results for omega-3 fats on 11 different types of cancer. This subject is due for further future study to learn more about why such different results were obtained.. Any benefit of these nutrients for reducing risk of cancer could add significantly to the herein well confirmed benefits of ometa-3's on cardiovascular diseases

Fish, EPA+DHA and Stroke: Studies C1 and C10-12 in Table 1 show risks of stroke for both fish intake and omega-3 fatty acid intake. On average, highest amounts of omega-3 fats reduced risk of stroke by about 25%. Although this is a somewhat lower reduction in risk than that obtained for coronary disease death, it seems likely the benefits of fish intake are roughly similar for the two different cardiovascular diseases.

Other Polyunsaturated Fats: Although the omega-3 fats are the most beneficial of the polyunsaturated fats, the full range of polyunsaturated fats appears to be somewhat more beneficial than that estimated from their effect on serum cholesterol. But research found is not adequate to support an effect of polyunsaturated fats in addition to that found for its usually included amounts of omega-3's.

Omega-3 Fats and Cancer: There are a number of studies showing a protective effect of Omega-3 fats on Cancer. This factor has not yet been studied for inclusion in Life Ahead. But the benefits of the Omega-e's on Cardiovascular disease is so substantial that any benefits for them from cancer will endorse their use even more strongly.

Effect of Polyunsaturated Fats on Death from All Causes: The research in Table C following shows a consistent benefit of the included polyunsaturated fats and particularly fish and EPA+DHA on the risks of death from all causes. This provides a positive confirmation of about a 25% potential risk of death and a confirmed probable increase in life expectancy from the appropriate inclusion of these key factors in our diet.

Identifying an adequacy of omega-3 intake in a diet is a complex problem that up to this time has not been usefully solved. The Life Ahead program does identify conveniently the amounts of both linolenic acid and other omega-3 fats from fish oils in nearly any diet, compares these amounts with desirable goals, and shows both an change in risk of heart disease and a likely loss in Well-Days of life from an any diet deficiency in omega-3 fats vs. healthful targets used regularly over the long term. And the program provides a variety of acceptable dietary options that individuals can select from to remedy this deficiency. Download and install the computer program from Download Life Ahead, enter your habits and factors, and try entering a usual daily or weekly diet, and compute your outlook as detailed by the program. From the result display, access 'Actions for More Well-Days' and then 'Diet Analysis' to bring up the listing of diet nutrients for healthful targets. This will display your intake of total omega-3 fatty acids vs. targets from both fish and linolenic acids. Life Ahead may now be be the only available computer program that can develop this valuation from most user diets. You can learn how the program displays these factors without entering your own health factors simply by running the Demo program for either men or women on one or more optional diets.

THE RESEARCH on HEALTH BENEFITS of OMEGA-s FATTY ACIDS

The Research on Omega-3 Fats, EPA+DHA. A search of the the vast Medline data base on research disclosed no other serious published quantitative analysis of the benefits of omega-3 fatty acids such as that described above. Conventional health factor reviews usually discuss results of each individual research study, and these results taken individually nearly always are inconsistent and confusing. This is usually because individual studies can have very large margins of errors that usually are overlooked in this type of review. Life Ahead reanalyzed the actual data provided in each and all studies found objectively and more quantitatively. The Tables 1 to 3 appended here summarize actual risk values and their error margins for all useful population type research studies found. Research on EPA and DHA that considered the benefits of the sum of these two nutrients is shown for observation studies A10-A14 and A17-20 and for clinical studies A31-2 and A36-9 are shown in Table A following. 16 of the 18 different comparisons confirmed reduced risk of CHD or CVD death for the Omega-3's. These reductions in risk often were substantial. It has been suggested that the failure of multivariable comparison A10 could have been due to the fact that most men were fish consumers and omega's were estimated from fish consumption. The comparison of those eating vs. those not eating fish in this study was consistent with the result of the majority. Study A35 compared results of EPA+DHA taken in impractically large amounts with similar large amounts of corn oil that in such amounts also could have been beneficial. Thus this was not a true direct valuation of the benefit of EPA+DHA.

Study A19 that was based on amounts of EPA and DHA in blood showed a substantial reduction in risk for higher values. Study A18 found a five fold reduction in risk of sudden coronary death associated with different amounts of EPA+DHA in blood. Clinical study A39 also found a 2/3rds reduction in risk of sudden death (but not for coronary disease per se) for differing amounts of EPA+DHA in blood. The meta analysis of 11 clinical studies found an average reduction in risk of 30% for fatal CHD and for sudden death for various differences in amounts of EPA+DHA. And this meta analysis found similar results for EPA+DHA taken in supplements vs. that taken in fish. Overall, it seems well-confirmed that EPA+DHA taken in the amounts of only a half to one gram per day usually will reduce risk of heart disease death about in half.

Some additional studies and risk ratios are referenced in a very extensive summary report on Omega-3 fatty acids research listed in the NIH Office of Dietary Supplements, http://odp.od.nih.gov/ods. Some studies therein not included below are not quantitatively useful, or have excessive error margins.

TABLE A

EFFECT of POLYUNSATURATED FATS on CORONARY HEART DISEASE

Study

Sex

Scope

Risk Ratio

Error Margin

Basis

Diff in Amount

Cause

Notes

TOTAL POLY UNSATURATED FATS

Ascherio, A, BMJ 1996, 313:84

Hlth Professionals Study, N=734

1.04

0.80

0.82-1.33

0.63-1.03

5ths

3.5-7.1%

0.4-0.7%

All CHD

Linoleic Acid

Linolenic Acid

(key poly-fats)

Hu, FB N Engl J Med,

1997, 337:1491

Nurses Study

N= 658

0.83

0.62

0.67-1.02

0.46-0.85

5ths

2.9-6.4%

for + 5% of Calories

All CHD

Multivariable adjust

Multivar + transfat

n-3 UNSATURATED FATTY ACIDS

OBSERVATION STUDIES

Dolecek,TA World Rev nutr diet 1991, 22:205

MRFIT Study of12,900 at high risk for coronary disease, 10 yrs

0.66

0.59

0.41-1.05

P=0.004

5ths linolenic

EPA+DHA

0.87-2.8 g/d

0-0.66 g/d

CVD death

Ascherio A,,Br Med J 1996,313:84

734 CHD for 43,750 Health Professionals

0.41

P < 0.01

5ths of Linolenic Acid

0.8-1.5 gms.day

All CHD

Age adjusted rr=1.05 (1.03 on fatal CHD but heavily confounded. Value 0.41 uncertain

A10

Ascherio,A, N Engl J Med 1995,332:977

Hlth Professional Study, 1543 events of 45,000

1.14

0.86-1.51

5ths

DHA+EPA

0.07-0.98 g/day

All CHD

Multivariable adjust. Unadjusted was similar

A11

Siscovick,TE, 1995 JAMA 274:1363

M&W

334 cases and controls. Univ of Washington

0.5

O.4-0.8

equiv 1 fatty fish/wk

1.5 g, EPA +DHA/wk via fish

CHD cardiac arrest

rr-0.3 (0.2-0.6) for quartiles of polyunsats in blood

A12

Albert, MA JAMA 1998; 279:23

133 Sudden coronary deaths of 20,500, Physicians Health Study

1.0

0.58

0.34

0.60

0.43

Base

0.28-1.21

0.15-0.75

0.29-1.27

0.20-0.93

5ths of

DHA+EPA

0.3 gm/mo

0.3-2.7 g/mo

2.7-4.9 g/mo

4.0-7.4 g/m

>7.4 g/mo

Sudden cardiac death

computed from fish consumption

A13

Hu, FB, Am J of Clin Nutr 1999, 69:890

232 events fatal MI, 597 of non-fatal MI on 76,000 Nurses, 10 yrs

1.00

0.99

0.90

0.67

0.55

0.85

Base

0.66-1.48

0.59-1.39

0.42-1.09

0.32-0.94

0.61-1.19

Alpha Linolenic Acid

0.71 gm/d

0.86

0.98

1.12

1.7

Fatal MI

Non-fatal MI

From foods as oil & vinegar, mayonnaise, margerines,

A14

Rissanen, T, Circulation, 2000, 102:2677

194 Events of 1871 men, coronary free

0.56

0.35-0.99

5fths of DHA+EPA

2.1-3.9% of fatty acids

All CHD

Men with avg hair amt of mercury. risk = 0.33 for men with low mercury

A15

Djousse, L, Am J Clin Nutr 2001, 74:612

M&W

362 events of 2024 men and 123 events of 2382 women. All CHD free, but 1/2 selected were at higher risk

0.60

0.54

0.53

1.0

0.66

0.70

0.49

0.66

Base

0.43-0.83

0.38-0.74

0.38-0.77

0.38-0.74

Base

0.36-1.19

0.39-1.28

0.27-0.89

0.40-1.10

Alpha Linolenic Acid

0.53

0.67

0.78

0.90

1.14

0.46

0.58

0.65

0.76

0.96

All CHD

Men

Women

A16

Oomen, CM, Am J Clin Nutr 2001, 74:457

98 CHD events of 667 elderly, Zutphen Elderly Study, 10 yrs

0.97

0.58-1.63

Alpha Linolenic

acid

0.4-0.65 est % of energy

All CHD

Diff in amt tested is very small and error margin high. Heavy

interaction With TransFats

A17

Hu, FB, JAMA 2002, 287:1815

1513 CHD events (484 deaths) of 85,000 Nurses

1.0

0.93

0.78

0.68

0.67

0.61

0.77

Base

0.78-1.09

0.65-0.93

0.56-0.82

0.55-0.81

0.46-0.82

0.58-1.02

5thsof DHA + EPA from fish

Fish Consumption and EPA+DHA in the US
Fish Type	Consumption, grams/day/ capita	% of total Consumption	% of EPA + DHA
Tuna	2.63	20.4	0.26
Shrimp	1.63	12.7	0.35
Cod	1.12	8.8	0.19
Salmon	1.02	8.0	1.45
Flounder	0.46	3.6	0.20
Catfish	0.34	2.7	0.18
Haddock	0.25	1.9	0.24
Herring	0.09	0.07	1.5
Mackerel	0.09	0.07	2.0
All Fish	12.83	100	0.50 est