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April 19, 2011 at 6:01 pm Leave a comment

Understanding the ABC’s of DHA
By: Jasmine Jafferali, MPH

Parents engaged in home baking in the early 1900’s routinely gave their kids a daily dose of Cod Liver Oil.  This daily spoonful was important for health and wellbeing because it contained vast amounts of vitamin D and DHA.  Today, we suffer from information overload when it comes to fats.  Whether it is good fats, bad fats, trans fats, polyunsaturated fats, unsaturated fats, the information about the different kinds of fats is confusing.  Researchers continue to publish studies highlighting the importance of Omega 3 fatty acids.  But how important is it?  Let’s take a closer look so we can better understand the sources of DHA and why it is so important for fetal, infant, and toddler development

Omega 3 fatty acids
There are two types of fatty acids – omega 6 fatty acids and omega 3 fatty acids.  They are both ‘essential’ fatty acids, which means your body does not make them – you need to ingest them.  Both types are important for good health. However, most Americans consume much more omega 6 fatty acids than omega 3’s, placing our bodies in an omega 3 deficit.  This becomes vitally important for the childbearing woman, since Omega 3’s have proven benefits for mom and baby.

The three main forms are eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA).  In terms of the childbearing/infant population, we are most concerned with DHA and EPA intake.  The body converts ALA to DHA, but this process is not very effective or consistent.   So, when talking about the benefits of omega 3 for pregnancy and lactation, is it important to understand that not all Omega 3’s are created equal. When thinking about food choices, or supplements, it is wise to think about maximizing your DHA and EPA intake, and not just your overall omega 3 consumption.

DHA has been proven to be particularly important for fetal/newborn development and has been shown to improve brain function and eye development.  In fact, DHA and EPA make up about 70 percent of a newborn baby’s brain, retina and nervous system.  The discovery of DHA in breastmilk as one of its many key components has lead to the addition of DHA in most commercial infant formulas.  The only way the developing fetus can get this important Omega 3’s is from the mother’s diet; however, it is nearly impossible to get enough through diet alone, since a main dietary source of DHA is fish or algae. (Fish obtain the DHA from eating algae). Furthermore, the FDA recommendation for fish consumption during pregnancy is no more than 2 servings a week due to the concern of mercury levels in fish.  Mercury consumption via fish is also concerning for infants and young children.

Antepartum and Postpartum
By the time a pregnant woman reaches 30-weeks gestation, the baby’s brain development is at its peak.  Therefore the third trimester is the most crucial time for a baby’s brain growth.  Although there is no  official RDA for omega 3’s or DHA, experts feels that expecting mothers need  a minimum of 300mg of DHA and EPA per day to maximize fetal development.  Other scientists recommend a daily dose of 900 mgs of fish oil, which is equivalent of one serving or three ounces of fresh water salmon per day. Besides being important for fetal brain/eye development, DHA has other advantages for the expectant mom:

  • reduced internal inflammation which decreases the chances of developing of preeclampsia,
  • reduced chance of c-section by fostering proper fetal weight gain,
  • Prevention of early delivery, by increasing in the average gestational period of about  six days (Obstetrics & Gynecology, 2003), which can be crucial for a mother that has a history of premature births.

During the postpartum period, getting the right amount of Omega 3 fatty acids can foster recovery from labor and delivery and hasten postpartum weight loss (The Academy of Sciences of the Czech Republic in Prague, and Pronova BioPharma of Norway…)  Some studies suggest that DHA reduces postpartum depression.  Research has found low levels of DHA in mother’s milk and in the red blood cells of women suffering from postpartum depression. (Journal of Affective Disorders, 2002). Some scientists believe increasing levels of maternal DHA may reduce the risk of postpartum depression (Medscape, 2002), however a recent study published in the Journal of the American Medical Association, October 2010 are questioning the benefits.

Newborns & DHA consumption
Experts around the world recommended 300mg DHA intake for nursing moms.  However, a recent study published in 2009, found 900mg may be necessary to cover the needs of both mom and baby.  This is crucial as the newborn baby’s brain triples its size during the first year of life.  ( Hibbeln JR, Davis JM. Considerations regarding neuropsychiatric nutritional requirements for intakes of omega-3 highly unsaturated fatty acids. Prostaglandins Leukot Essential Fatty Acids 2009; 81:179-186.)   Even though DHA is found naturally in breastmilk, the content of the breastmilk DHA varies based on the mom’s DHA consumption. So, it is important for lactating moms to supplement their diet with DHA.  A 2005 study published in the July issue of American Journal of Clinical Nutrition showed that infants of mothers who supplemented with DHA during the first four months of breastfeeding had better psychomotor skills at 2 1⁄2 years of age.  Another study published in Child Development, 2004 found that babies whose mothers had high blood levels of DHA at delivery had advanced attention spans into their second year of life. During the first six months of life these infants were two months ahead in cognitive skills than babies whose mothers had lower DHA levels.

Parents who are feeding formula to their baby should choose a formula with DHA added.  The Society for Research in Child Development in 2009 found a boost in cognitive development when babies were fed formula fortified with DHA.  By the time these babies reached 9 months of age, the babies given DHA scored higher on a problem solving test.  You can find more at …Supplementing Babies’ Formula with DHA Boosts Cognitive Development, Study Finds, Science Daily retrieved from December 21, 2009

Other health benefits for infants & toddlers

Recently infants and children suffering from food and environmental allergies have increased.  A 2009 study found fish oil can improve digestive health, possibly by promoting immune cell membrane fluidity and healthy cytokine balance. This study investigated supplementing pregnant women from 25 weeks gestation through 3-4 months of breastfeeding with fish oil containing 1.6 grams of EPA and 1.1 grams of DHA. The results indicate that mothers given fish oil maintained healthy IgE production (allergies) and provided support for infant skin sensitivity (eczema) and immune health.

As the baby’s first birthday approaches, there typically is a decline in the amount of DHA that is consumed.  This happens naturally as babies are weaned from breastmilk/formula to solid foods.  The average toddler receives about 19mg of DHA per day, whereas the recommended daily amount should be 150mg per day..  Parents should be sure to supplement with DHA or foods that are high in DHA to the toddler’s diet.

Where are the Omega 3’s hiding
One of the best sources of DHA/EPA is cold water fish, yet regular fish consumption is not recommended for expectant/lactating moms or infants/children due to heavy metal contamination.  Furthermore, it is best for this group to avoid the known ‘high-mercury’ level fish such as shark, tilefish, swordfish, and mackerel. This EPA brochure on fish and mercury (http://water.epa.gov/scitech/swguidance/fishshellfish/outreach/upload/2004_05_24_fish_MethylmercuryBrochure.pdf) can be printed and provided to patients.

Other natural sources of Omega 3’s are listed below:
Best Natural Sources

  • Breastmilk
  • Organic or Grass-fed calf liver (eat sparingly during pregnancy to prevent excess vitamin A levels)
  • oily, cold-water fish such as salmon, herring, sardines, and anchovies (one 3.5 ounce serving of salmon has 600 mg of DHA)
  • Algae or algae oil
  • Egg yolks (Egg yolks have 25-50 mg of DHA; omega 3 fortified eggs may have more DHA, but they are generally higher in ALA than DHA – check the package. If the amount of ‘fortified’ DHA is not listed on the label, it falls below federal standards for reporting and is insignificant)

Other natural sources:

The below sources are high in Omega 3’s but contain ALA, instead of DHA.  The body will convert ALA to DHA, but this process is ineffective and variable.  Yet, these can be good choices when used in conjunction with other DHA sources.

  • Ground flax seeds or unfiltered flax oil (40% omega 3)
  • Chia Seeds (64% omega 3)
  • Hemp oil or seeds (22% omega 3)

Omega 3 supplements
Some prenatal vitamins now have DHA, so check your prenatal vitamin bottle to see if your vitamin has DHA added.  Too much omega 3’s can have adverse effects. Below are things to look for when purchasing supplements:

  • Look for the USP quality seal.  This means the product has gone through voluntary independent testing to validate the purity and quality of the product.
  • Purchase only pharmaceutical grade fish oils.  Typically oils processed in the Scandinavia use the highest quality fish.
  • Fish oil should come from cod-liver NOT tuna.  Fish that eat other fish, such as tuna tend to be higher in mercury.  Beware that many baby foods and juices are fortified with tuna and soy oils.
  • There are also vegan, algae-based DHA supplements available.  This is also an ideal vegetarian source for those who do not consume any meat products.  Many people report that the algae based DHA supplements also have less of the ‘fishy aftertaste” than fish oil. Algae supplements are available as tablet or as oils (oils should be purchased in dark, glass bottles and stored in the refrigerator to prevent them from going rancid).

Additionally, keep in mind that it is the amount of DHA/EPA in the supplement that is important, not the overall amount of omega 3.  So read the labels carefully to determine how much of the supplement is required to receive your daily DHA dose.  Supplement brands vary in their amount of DHA content.  You may have to take 2 tablets of one brand to get enough DHA and 8 tables of another brand to receive the same DHA amount. Additionally be mindful of the DHA dosing in omega 3 bars and chews.  They are designed to taste good, so you will often need 10-12 chews a days to receive adequate DHA.  Cleveland Clinic has a nice chart that compares various supplements at http://my.clevelandclinic.org/heart/women/nutritioncorner_omega.aspx.

Another source of omega 3 is unfiltered flax oil or Hemp oil.  Although flax and hemp oils are primarily ALA instead of DHA, they are generally more palatable to kids than fish oils.  And one teaspoon of flax oil daily is enough for kids under the age of three.  (This is great way to help combat constipation too! Even adults benefit from 1 tablespoon per day.)  Both flax and hemp oil is relatively tasteless in fruit smoothies, so this can be a good way to increase consumption as well.   Some experts feel that pregnant women should not consume flaxseed because it can have an effect on hormone regulation. Additionally, a recent study also noted a 12% increase in preterm birth form flaxseed oil ingested during the last 2 trimesters of pregnancy (http://www.nouvelles.umontreal.ca/archives/2007-2008/content/view/1939/249/index.html therefore no more than two tablespoons should be ingested per day. Pregnant women should always check with their doctor before supplementing with flaxseed, omega 3, or other supplements.  Depending on each person’s personal situation, there can be possible concerns with vitamin overdosing, bleeding from excessive omega 3 supplementation, and other issues from co-morbidities, such as diabetes or high triglycerides. http://www.marchofdimes.com/pregnancy/nutrition_omega3.html & http://www.mayoclinic.com/health/flaxseed/NS_patient-flaxseed/DSECTION=safety).
A note on safety and recent environmental events

Many published studies have stated the benefits of fish oils.  Unfortunately, the fishing industry is experiencing a decrease in large predatory fish populations.  The BP Oil Spill and nuclear radiation leak following Japan’s tsunami has caused concern about the safety of the consumption of fish.  The FDA claims fish oils are safe for consumption, but we don’t know the long term risks.  Algae-based DHA is a more sustainable option, and it is free of the environmental pollutants that accumulate in the fatty tissue of fish, like mercury, PCBs, and dioxin. Most experts agree that the benefits of DHA outweigh the risk of not consuming it.


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