The FDA’s New EPA/DHA Health Claim

Jessica Levings wrote . . . . . . . . .

Fish and seafood packaging may now boast qualified health claims stating that omega-3s can help reduce risk of hypertension and coronary heart disease and lower blood pressure.

In June, the FDA approved the use of certain qualified health claims on foods and dietary supplements containing the omega-3 fatty acids EPA and DHA relating to their ability to reduce the risk of hypertension and coronary heart disease, as well as lower blood pressure. The decision was in response to a 2014 petition submitted by the Global Organization for EPA and DHA Omega-3 (GOED).

According to Harry Rice, PhD, GOED’s vice president of regulatory and scientific affairs, who spearheaded the health claim petition on behalf of the organization and its members, “The new qualified health claims provide what many, including GOED, consider to be long overdue acknowledgement from the FDA about the blood pressure–lowering benefits associated with EPA/DHA, the primary long-chain omega-3 fatty acids found in fatty fish. Linking EPA/DHA intake to blood pressure reduction provides consumers a benefit to which they can relate.”

Before the announcement of the new qualified health claims, since 2004 the FDA has allowed the following qualified health claim on certain foods and supplements: “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”

Following are the new qualified health claims the FDA announced, which manufacturers may voluntarily use on labels of seafood and other qualifying foods and supplements:

1. Consuming EPA and DHA combined may help lower blood pressure in the general population and reduce the risk of hypertension. However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.

2. Consuming EPA and DHA combined may reduce blood pressure and reduce the risk of hypertension, a risk factor for CHD (coronary heart disease). However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.

3a. Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by lowering blood pressure. However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.

3b. Consuming EPA and DHA combined may reduce the risk of CHD (coronary heart disease) by reducing the risk of hypertension. However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.

4. Research shows that consuming EPA and DHA combined may be beneficial for moderating blood pressure, a risk factor for CHD (coronary heart disease). However, FDA has concluded that the evidence is inconsistent and inconclusive. One serving of [name of the food or dietary supplement] provides [ ] gram(s) of EPA and DHA.

Dietary supplements and conventional foods bearing any of the above claims must contain at least 0.8 g EPA and DHA (combined total) per serving and meet certain other nutrient content criteria. Importantly, the requirement of 0.8 g per serving isn’t a recommended intake level but rather a level of intake the FDA observed to lower blood pressure in limited studies.

Under general health claim requirements, individual foods can’t bear a health claim if they exceed 13 g total fat, 4 g saturated fat, 60 mg cholesterol, and 480 mg sodium per reference amount customarily consumed (RACC), per labeled serving size, and per 50 g if the RACC is 30 g or less or two tablespoons or less. Furthermore, to bear a health claim, individual foods also must contain, before any nutrient addition, at least 10% DV for vitamin A, vitamin C, iron, calcium, protein (5 g), or dietary fiber per RACC.

Evidence Base for the EPA/DHA Health Claim

The FDA determined that the overall evidence relating to EPA/DHA intake and blood pressure didn’t meet the “significant scientific agreement” standard required for an authorized health claim, but it did meet the “credible evidence” standard for a qualified health claim.

To assess whether a beneficial link exists between consuming EPA and DHA together and lowering blood pressure, the FDA evaluated 104 intervention studies analyzing the effect of EPA and DHA from conventional foods, dietary supplements, and prescription drugs on blood pressure in both normotensive and hypertensive people. Only 36 of the 104 studies showed a statistically significant benefit, with durations ranging from four weeks to one year, and combined doses of EPA and DHA ranging from 390 mg per day to 15 g per day.

Based on its findings, the FDA concluded there’s “some credible evidence suggesting a relationship between the combined intake of EPA and DHA from conventional foods, dietary supplements, and prescription drugs and blood pressure reduction. However, this evidence is highly inconsistent.”

Sources of EPA and DHA, Average Intake

EPA and DHA are added to certain supplements and are naturally found or fortified in some conventional foods, including fatty fish (eg, salmon, mackerel, sardines), fish oils, seaweed, and algal oils. Studies have found that food contributes a small amount of DHA and EPA to total daily omega-3 intakes; the National Institutes of Health estimates the amounts at 40 mg in children and teenagers and about 90 mg in adults.

Dietary supplements containing omega-3s also contribute to total omega-3 intake, with fish oil as one of the most commonly used sources. According to 2012 data, 7.8% of US adults and 1.1% of US children reported taking supplements containing fish oil, omega-3s, and/or DHA or EPA. According to 2003–2008 National Health and Nutrition Examination Survey (NHANES) data, supplements add about 10 mg to average DHA intakes, and 20 mg to average EPA intakes in adults. Data from the FDA and NHANES indicate that the current average intake of EPA and DHA in the United States is only about 77 mg per day from all sources for people aged 4 and older.

Currently, there’s no recommended intake level in the United States for EPA or DHA. However, to help improve heart health, the 2015–2020 Dietary Guidelines for Americans (DGA) recommend individuals in the general population to consume about 8 oz per week of a variety of seafood, providing about 250 mg per day of EPA and DHA. Importantly, the DGA note that this recommendation is for the total package of nutrients seafood provides, including its EPA and DHA content.

Use of the EPA/DHA Health Claim on Fish

For items sold at seafood counters in supermarkets, nutrition labeling of fresh fish and packaged single-ingredient fish is voluntary unless nutrient content or a health claim is made. Fish and packaged seafood may bear the claim if they meet all the required criteria for its use.

The FDA defines fish as “fresh or saltwater finfish, crustaceans, other forms of aquatic animal life (including, but not limited to, alligator, frog, aquatic turtle, jellyfish, sea cucumber, and sea urchin, and the roe of such animals) other than birds or mammals, and all mollusks, where such animal life is intended for human consumption.” With regard for labeling these products with the EPA/DHA qualified health claims, the FDA considers “products that are essentially all fish” to be those without any added ingredients and with an “insignificant amount” of added fat or carbohydrate. Examples of products considered all fish include raw, boiled, and broiled fish.

Source: Today’s Dietitian

How Diets Full of Ultra-processed Foods Are Causing a Malnutrition Crisis Among Poor Children

Kylie Knott wrote . . . . . . . . .

Cheap, filling and tasty. There are many reasons why the humble instant noodle is a go-to comfort food for millions of people worldwide.

Packing shelves of supermarkets and convenience stores, the plastic-wrapped meals that take just minutes to prepare are also stocked in some office vending machines – a quick way to satisfy desk slaves too busy to leave the building.

But a new report says diets that rely on cheap and quick ultra-processed foods such as instant noodles are leading to a malnutrition crisis among the world’s underprivileged children.

The State of the World’s Children, an annual report whose 2019 edition was released this month by the United Nations Children’s Emergency Fund (Unicef), paints a depressing picture for millions of children, warning that poor diets are now the main risk factor for disease.

The report, the most comprehensive assessment of 21st-century child malnutrition, says that at least one in three of the world’s almost 700 million children under the age of five is undernourished or overweight, while half suffer from hidden hunger – a deficiency caused by eating food that is cheap and filling but lacking essential vitamins and micronutrients.

The report also found that 149 million children are stunted, or too short for their age, while 50 million children are wasting, an extreme form of undernutrition when a child is too thin for their height.

It also found that many poor city-dwelling children live in either “food deserts”, with no healthy food options, or in “food swamps”, with an abundance of high-calorie, low-nutrient processed foods. Meanwhile, almost 45 per cent of children worldwide aged between six months and two years are not fed any fruit or vegetables, and almost 60 per cent do not eat any eggs, dairy, fish or meat. The shift in diets, the report says, is due to the rural population moving to cities in search of jobs.

“Sadly, as this report shows, too many children and young people are not getting the diets they need, which is undermining their capacity to grow, develop and learn to their full potential,” says Unicef’s executive director Henrietta Fore.

“Despite technological, cultural and social advances of the last few decades, we have lost sight of this most basic fact: if children eat poorly, they live poorly.”

Diets that rely on ultra-processed foods such as instant noodles have become the meal of choice for working populations looking for cheap and easy food options, the report states.

“Instant noodles are what I call empty-calorie foods,” says Michelle Lau, principal dietitian and founder of Nutrilicious, a Hong Kong-based nutrition consultancy and communications company. “They have a long shelf life but provide little or no nutritional benefit.” She adds that they are also refined carbohydrates so they take longer to digest, meaning children don’t feel hungry after eating them.

With children’s bellies full, parents and carers are happy. But many are unaware of the food’s poor nutritional value.

High in saturated fat, instant noodles are loaded with calories, salt, artificial food colours, flavourings and preservatives, says Lau. Their high sodium content, a known risk factor for obesity and high blood pressure, is another downside, she adds.

“The effect is even greater if people are overweight or obese. A diet heavy on cheap and convenient food like instant noodles that fill stomachs but lack key nutrients such as protein, fibre and iron is not recommended for children. In fact, they are not recommended for anyone.”

In somewhat of an ironic twist, the Unicef report points out that while nations such as the Philippines, Indonesia and Malaysia are becoming economically wealthier, people’s diets have become poorer, especially children whose parents’ hectic lifestyle leaves them with less time to prepare healthy meals.

For these three nations, it found about 40 per cent of children aged five and below were malnourished – much more than the one-in-three global average.

Malaysia bears a significant double burden of malnutrition: while 20.7 per cent of children under five suffer from stunting and 11.5 per cent from wasting, 12.7 per cent of children (five to 19 year olds) are obese. This reality is more complex in poor urban areas, where malnutrition rates tend to be higher than the national average.

Lau says underweight children or unhealthily thin children are usually undernourished. But she says this can also apply to overweight children – and she is keen to dispel some cultural misconceptions.

“Many Asian parents have the mindset that if their children are overweight, then they must be nourished, which is false.”

“Millions of children subsist on an unhealthy diet because they do not have a better choice,” says Fore, adding that the way we understand and respond to malnutrition needs to change. “It’s not just about getting children enough to eat. It’s about getting them the right food to eat. That is our common challenge today.”

The Unicef report says one way children and families can make healthier food choices is to encourage companies to switch to front-of-package nutrition labelling, where it’s visible, accurate and easy to understand. Lau agrees.

“It’s vital consumers check nutritional labels when purchasing items such as instant noodles,” she says. “Check the amount of total fat, saturated fat and sodium, and then choose the variety with the lower sodium and fat options.

“Nutrition labels of instant noodles are expressed as ‘per package’, so consuming the whole pack of noodles, the nutrition intake will equate to value shown on the nutrition label.”

The World Health Organisation and the Food and Agriculture Organisation of the United Nations recommend that total fat and saturated fat intake should be no more than 30 per cent and 10 per cent of the daily energy intake, respectively.

Based on a 2,000-calorie daily diet, the upper limit of the daily intake of total fat and saturated fat is about 60 grams and 20 grams, respectively.

But despite the unhealthy nature of instant noodles, demand is strong, with the shift in working populations’ eating habits creating the perfect opportunity for the market to flourish. Last year the global instant noodle market hit US$42.2 billion and it is projected to soar to US$57.5 billion by 2024, according to

Manufacturers are slurping up the news, offering consumers more choice – such as vegetarian options – and expanding flavours, colours, textures and seasoning to satisfy different palates worldwide.

It is a global food item, after all. Consider statistics from the World Instant Noodles Association.

In 2018, a massive 103.6 billion servings of instant noodles were consumed globally. That is about 280 million servings eaten daily, with Asia driving demand, accounting for almost 80 per cent of total consumption.

China and Hong Kong, with a combined 40.25 billion servings in 2018, leads the noodle-eating pack, while Indonesia (12.54 billion) is the second-biggest consumer. Filling out the top 10 are India, Japan, Vietnam, the United States, the Philippines, South Korea (the country with the highest per capita consumption), Thailand and Brazil.

In China, instant noodles were even interpreted as an economic indicator after sales slipped to 38.5 billion servings in 2016, before rising to 40 billion last year, feeding speculation that the sharp recovery was because of concerns over the economy.

For those consumers keen to break their instant noodle habit, Lau says there are healthier alternatives such as buckwheat noodles – also called soba noodles and Japanese pasta – that have less calories and carbohydrates than others.

“I recommend 100 per cent buckwheat noodles because they are gluten free, so are ideal for children with a gluten allergy.”

She says rice vermicelli is also a good alternative, adding that it’s a great source of carbohydrates, has no cholesterol and contains very little fat. “And most don’t have added preservatives, bleaching agents or artificial colours.”

As well as the health cost, instant noodles come with a high environmental one – and not just from non-biodegradable plastic and foam-cup packaging.

“Instant noodles are highly processed and often processed in palm oil for fast cooking,” says Lau.

Palm oil is an edible vegetable oil derived from the fruit of palm oil trees, but it has a “bad boy” reputation.

According to the wildlife NGO the WWF, 85 per cent of the global supply of palm oil comes from Indonesia and Malaysia, but irresponsible production has been blamed for rapid deforestation in these areas, a leading cause for loss of orangutans and their habitat. Tigers, elephants and rhinos are also affected, according to the WWF, as tropical rainforests are cleared to plant new palm plantations.

Source : SCMP

Scientists Identify New Markers in Bood and Urine to Know What We Eat and Drink

Researchers at McMaster have identified several chemical signatures, detectable in blood and urine, that can accurately measure dietary intake, potentially offering a new tool for physicians, dietitians and researchers to assess eating habits, measure the value of fad diets and develop health policies.

The research, published in the journal Nutrients, addresses a major challenge in assessing diets: studies in nutrition largely rely on participants to record their own food intake, which is subject to human error, forgetfulness or omission.

“This has been a major issue in nutritional research and may be one of the main reasons for the lack of real progress in nutritional sciences and chronic disease prevention,” says Philip Britz-McKibbin, a professor in the Department of Chemistry and Chemical Biology at McMaster University and lead author of the study, which was a collaboration with Dr. Sonia Anand and colleagues from the Departments of Medicine, and Health Research, Evidence, and Impact.

Scientists set out to determine if they could identify chemical signatures, or metabolites, that reflect changes in dietary intake, measure those markers and then compare the data with the foods study participants were provided and then reported they had eaten. The specimens analyzed were from healthy individuals who participated in the Diet and Gene Intervention Study (DIGEST).

Over a two-week period, researchers studied two contrasting diets: the Prudent diet, rich in fruits, vegetables, lean meats, and whole grains, and a contemporary Western diet, rich in trans fats, processed foods, red meat and sweetened beverages.

Researchers were able to validate a panel of metabolites in urine and plasma that correlated with the participants’ consumption of fruits, vegetables, protein and/or fiber.

“We were able to detect short-term changes in dietary patterns which could be measured objectively,” says Britz-McKibbin. “And it didn’t take long for these significant changes to become apparent.”

Britz-McKibbin cautions that food chemistry is highly complex. Our diets are composed of thousands of different kinds of chemicals, he says, and researchers don’t know what role they all may play in overall health.

In future, he hopes to broaden this work by examining a larger cohort of participants over a longer period of time. His team is also exploring several ways to assess maternal nutrition during crucial stages of fetal development and its impact on obesity and metabolic syndrome risk in children.

Source: McMaster University

Personalized Nutrition

Ben Warren wrote . . . . . . . . .

I think fad diets will be around for a while yet, and they do help people change their eating habits (when it comes to rethinking your diet, the hardest thing to do is actually make the change). Yet the real future of ‘what to eat’ lies in ‘personalised nutrition’ – eating the right diet for you. We are all different, we are genetically varied and our immune systems and autonomic nervous systems respond differently to the foods we eat. We also now know that we all have varying needs for vitamins and minerals, which depend on both our genetics and our environment. We truly need to individualise our nutritional intake for optimal expression of our genes.

To personalise your diet, you need to know what your body might be lacking in or need more of, and there are a number of tests you can take:

The HbA1c test is traditionally used to monitor type 2 diabetes; it’s a measure of how much glycation has occurred to your hemoglobin from sugar (or how much damage has been done to your red blood cells from sugar). Higher levels of HbA1c are associated with eating too many simple carbohydrates for your genetics.

If you are feeling a bit flat, get your vitamin D levels tested, as low vitamin D is associated with seasonal affective disorder (SAD), a type of depression related to low exposure to sunlight. We really want to be above 80nmol for health, yet one study found 84 per cent of New Zealanders were below this threshold. If you are low, make extra effort to get more safe sun exposure and eat more foods containing vitamin D, such as sardines.

If you are tired, you may want to undertake a full iron studies test, as well as B9 and B12 tests, as without adequate levels you can’t make high-quality red blood cells. Adequate and high-quality red blood cells are responsible for carrying oxygen around your body, which is essential to your energy levels on a daily basis. If yours are low, increase your consumption of red meat and leafy greens.

Moving into more advanced testing, you can test to see how your body’s immune system is responding to the foods you are eating. Gluten (a protein found in wheat, rye and barley) is probably the most common problem. At the extreme end of gluten sensitivity is someone who is celiac – basically, a celiac has a severe immune reaction to gluten, resulting in a lot of collateral damage to the intestines and associated inflammation. Others have less severe reactions, which are regarded as sensitivities to certain foods.

Gluten is not the only problem; any food can drive an immune response, leading to increased immune activity and associated inflammation, giving rise to gut issue symptoms and immune dysfunction. I like people to do a blood test to measure the amount of immune molecules the body is making in response to 96 different foods, so people can then eliminate these foods to help improve how they feel.

The next level of testing comes in the form of genetic testing. With genetic testing we can see future risk and even tell you what foods you should or should not be eating. For example, if you have the DQ 2 or 8 gene it puts you at a much higher risk of being celiac (94 per cent of celiacs have this gene). If you have low copies of the AMY1 gene it puts you at an eight-fold increased risk for being obese from eating carbohydrates, indicating that high-quality natural fats and proteins will be a better choice for you.

There has been much work on a nutrient recycling system and the genetic aspect of it, called methylation. Genetic faults in this system are heavily associated with mental health issues, fatigue and a build-up of a toxic byproduct that is associated with heart disease.

The future of nutrition therefore lies in integrating your genetic susceptibilities and mitigating your weak genetic links with personalised nutrition to optimise the expression of your genes, not only for minimisation of future health risks but to achieve the best possible version of ‘you’.

Source: Good Magazine

What Is Potassium?

According to the 2015-2020 Dietary Guidelines for Americans, potassium is an underconsumed nutrient, and because there are health concerns associated with low intakes of potassium, it is considered a nutrient of public health concern. Food manufacturers will be required to include potassium content on the new Nutrition Facts label.

Potassium is a mineral that, among other things, helps muscles contract, helps regulate fluid and mineral balance in and out of body cells, and helps maintain normal blood pressure by limiting the effect of sodium. Potassium also may reduce the risk of recurrent kidney stones and bone loss as we age.

Guidelines issued by the National Academies of Sciences, Engineering and Medicine were recently updated and recommend males 19 and older consume 3,400 milligrams (mg) of potassium per day and females of that same age group consume 2,600 mg daily. Obtaining potassium from foods is preferred, so be sure to discuss dietary supplements with a health care provider before taking any.

Potassium is found in a wide range of foods, such as leafy greens, tomatoes, cucumbers, zucchini, eggplant, pumpkins, potatoes, carrots and beans. It’s also found in dairy products, meat, poultry, fish and nuts.

To meet your daily potassium goal, consider adding some of these foods to your menu on a regular basis:

  • 1 medium baked potato with skin: 930 milligrams
  • 1 cup cooked spinach: 840 milligrams
  • ½ cup raisins: 618 milligrams
  • 1 cup cooked broccoli: 460 milligrams
  • 1 cup cubed cantaloupe: 430 milligrams
  • 1 cup chopped tomatoes: 430 milligrams
  • 1 medium banana: 420 milligrams
  • 1 cup raw carrot slices: 390 milligrams
  • 1 cup low-fat milk: 350 to 380 milligrams
  • ½ cup cooked lentils: 365 milligrams
  • 1 cup cooked quinoa: 320 milligrams

Including a variety of foods can help you meet your potassium needs for the day, as well as get other important vitamins and minerals that promote health.

Source: Academy of Nutrition and Dietetics

Read also at National Institute of Health:

Potassium – Fact Sheet for Health Professionals . . . . .