Prenatal DHA Formulation

DHA Formulation Ideas and Discussion

DHA (Docosahexaenoic Acid 22:6-n3) – 300mg per day

EPA (Eicosapentaenoic Acid 20:5-n3) – 150mg per day

ALA (α-Linolenic Acid 18:3-n3) – 500+mg per day

Pregnant & Nursing Mothers
Healthy Ideas:

  • Work with your doctor first. Go to all required doctor visits during your pregnancy. Follow your doctor’s recommendations first.
  • Supplement with 300mg DHA, 150mg EPA, and 500mg (or more) ALA per day
  • Eat 2 servings of low-mercury fish each week. (Salmon, Oyster, Tilapia, Hake, Sardine, Anchovies, Pollock, Herring, Catfish)
  • Follow the National Institutes of Health general recommendations for nutrition during pregnancy
  • Eat a wide variety of nutrient-dense foods. Fruits, Vegetables, Lean Meats, Fats, etc. Aim for moderation and variety.
  • Do not avoid any specific food groups unless you have a diagnosed medical condition precluding you from eating them.
  • Eat enough calories. Use a calorie calculator to calculate your caloric expenditure. Then add enough extra calories to cover your baby’s development.
  • Eat 2.2 grams of protein per kilogram of lean body mass. (1 gram per pound of bodyweight).
    Helms et al determined “…most but not all bodybuilders will respond best to consuming 2.3-3.1 g/kg of lean body mass per day of protein, 15-30% of calories from fat, and the reminder of calories from carbohydrate.” (1) Most people are not body builders, however in this case we are focusing on synthesizing lean body mass which would likely carry over to prenatal nutrition as well. Usually under higher calorie conditions you can lower protein intake from this level, however pregnant woman are slowly building another human body, so higher protein applies. We also recommend getting 30% of your calories from fat during pregnancy, since you will likely have higher fat needs and lower carbohydrate needs.
  • Avoid foods and drugs that should not be eaten/taken during pregnancy. These include, but are not limited to: Green Tea, Cigarettes, Excess Caffeine, Alcohol, etc…

Men and Women who are Not Pregnant or Nursing
Healthy Ideas:

  • Supplement with 300mg DHA
  • Follow most of the “Healthy Pregnancy Recommendations” above. Omit the parts about doctor visits, calories for your baby’s development, and avoiding green tea. But follow everything else.

Polyunsaturated Fatty Acids

Polyunsaturated Fatty Acids (PUFAs) are essential for human life. We will be looking specifically at Omega-3 and Omega-6 PUFAs. These compounds are used in all parts of the bodies of mammals.

In one study, Lin and Salem supplemented fat-free fed rats with Polyunsaturated Fatty Acids, then sacrificed the rats at various times(2). The rats were dissected and each part of their body was analyzed separately for PUFA content. From this study it can be seen that the Omega-3 and Omega-6 fatty acids were generally present in all parts of the mammalian body. Some specific fatty acids like Docosahexaenoic acid (DHA) accrued in greater quantities in the brain, central nervous system, and retina.

The key aspect here is balance. PUFAs are not a “holy grail” for perfect health. Once we correct any deficiencies, adding more PUFAs will not necessarily result in increased health. They will simply get used for energy or stored as body fat. However, most people eating Western Diets are deficient in certain PUFAs, including EPA, DHA, and ALA. (3)

Polyunsaturated Fatty Acid Chart
Image from Wikipedia: Polyunsaturated Fatty Acids

Polyunsaturated fatty acids start as a “parent fatty acid” which is either Linoleic Acid (LA 18:2-n6) for Omega-6 fatty acids or Alpha-Linolenic Acid (ALA 18:3-n3) for Omega-3 fatty acids. These parent fatty acids can be converted by the body into other fatty acids further down the chain.

However, this conversion process is inefficient and the body is often not able to meet it’s intake needs of these fatty acids further down the chain. (4). Estimates range from <5% to 21% of ALA converting to EPA and <1% to 9% of ALA converting to DHA.(5)

Even more importantly, these conversions often share resources. If the body has to convert one fatty acid into another it may have less resources to convert other fatty acids.

Desaturation and Elongation of Essential Fatty Acids
Image from Linus Pauling Institute: Essential Fatty Acids

As an analogy, imagine a car factory. The input being steel (Alpha Linolenic Acid ALA 18:3-n3). This steel is then assembled into a simple car chassis (Stearidonic Acid SDA 18:4-n3), then wheels are added to make a rolling chassis (Eicosatetraenoic acid ETA 20:4-n3). These steps are repeated until finally you have a drivable working car (Docosahexaenoic acid DHA 22:6-n3).

The factory may not have enough resources to complete many cars in a single day. You may need 300 cars (300mg of DHA) but the factory is only producing 10 cars (10mg DHA). Or the Omega-6 factory next door may be using all the resources to produce city busses (Arachidonic Acid AA 20:4-n6) and you can only produce 5 cars (5mg DHA).

This analogy is an oversimplification but the end result is the same. The body only has so many resources to convert polyunsaturated fatty acids from one form to another.

Fortunately for us, we can get “preformed” fatty acids in our diet. Fish, as one example, are high in preformed EPA and DHA, while being relatively low in ALA and other fatty acids. Flaxseed oil is high in ALA but not a commonly used cooking oil.

Going back to our analogy, rather than trying to force the body to produce 300 cars from raw materials, we can simply give it 300 cars.

Let’s take a look at the specific PUFA’s that are both needed during pregnancy and also deficient in a Western Diet.

Not pregnant? Keep reading. Chances are you are also deficient, and if you care about your nervous system (brain) and cardiovascular (heart) health this information also applies to you.

The 3 Ingredients: DHA, EPA, ALA

DHA

Polyunsaturated Fatty Acid Chart with Docosahexaenoic Acid Highlighted
Image from Wikipedia: Polyunsaturated Fatty Acids. DHA has been highlighted red.

In a rat study by Lin and Salem(2), DHA accrued preferentially in the brain and central nervous system over time. The charts below show this effect:

DHA Accumulation 1
Images from: Whole body distribution of deuterated linoleic and a-linolenic acids and their metabolites in the rat. Red highlights are mine.

One study showed of women in an Icelandic fishing community showed that “Infant size at birth increased with fish consumption, especially for women in the lower quartiles of consumption.”(6) Increased size and weight at birth is a positive marker of infant health. Keep in mind that the key here is balance. The same study noted “Infants of women in the highest quartile of fish oil intake (≥1 tablespoon (11 ml)/day), consuming threefold the recommended dietary allowance of vitamin A and twofold that of vitamin D, were shorter (p = 0.036) and had a smaller head circumference (p = 0.003) than those of women consuming less…smaller birth size was linked to the highest levels of fish oil intake. Constituents of fish and fish oil might affect birth size differently depending on the amount consumed.”

Keep in mind that the women in this Icelandic fishing community ate 47g of fish per day(6). In the United States, fish intake is only about 20g per day.(7)

In one randomized controlled trial by Olsen et al, healthy Danish women were either given a fish oil supplement (fish group) or an olive oil supplement (control group). Pregnancies in the fish group were 4.0 days longer and resulted in a birthweight that was 107g higher.(8)

Bottom Line: Unless you eat a lot of fish already, your dietary intake of DHA is likely sub-optimal. If you are pregnant it is absolutely critical to correct this immediately.

If we analyze the PUFA content of fish we see that the majority of the fatty acids are from EPA and DHA.

Alaska Pollock contains 0.22% by weight EPA & DHA, and 0.29% total Omega-3s (fully 76% of omega-3 fatty acids as EPA & DHA). Wild salmon contains 83% of Omega-3s as EPA & DHA. Farmed Salmon contains 63% of Omega-3s as EPA & DHA.(9)

In addition to birthweight and size, DHA also shows evidence towards greater cognitive development and visual acuity. The US Department of Agriculture studied the subject and concluded “in particular DHA from at least two servings of seafood per week during pregnancy and lactation is associated with increased DHA levels in breast milk and improved infant health outcomes, such as visual acuity and cognitive development. Two servings per week is the equivalent of approximately 8 ounces per week, which should provide an average 250 milligrams per day of DHA and EPA.”(10)

The major problem is that a Western Diet with very low fish intake fish intake is extremely low in DHA.(11)

The National Institutes of Health recommends pregnant and lactating women get “300mg of DHA daily”.(12) Dr. James Greenberg recommends “the dietary goal for omega-3 fatty acids is 650 mg, of which 300 is DHA” while keeping mercury intake very low.(13) These recommendations are both in line with research data.

DHA Daily Supplementation Level: 300mg per day

EPA

Polyunsaturated Fatty Acid Chart with Eicosapentaenoic Acid Acid Highlighted
Image from Wikipedia: Polyunsaturated Fatty Acids. EPA has been highlighted red.

EPA does not accrue to appreciable levels in the brain and central nervous system(2), so it tends to be ignored in prenatal health. Most infant formula and prenatal supplements on the market today attempt to minimize EPA intake as much as possible, often trying to completely eliminate EPA from the formulation.

These same groups will also stand by the recommendation that pregnant women also eat 2 servings of low-mercury fish per week. The reason is that we frequently find a correlation between increasing fish intake and better birth outcomes in Western Diets.(15)

The irony here is that fish contain both EPA and DHA in high concentrations. Compared to DHA, Salmon contains 52% as much EPA, Alaskan Pollock contains 63% as much EPA, Herring contains 76% as much EPA.

Polyunsaturated Fatty Acid Content of Various Fish
Image from: Survey of n-3 and n-6 polyunsaturated fatty acids in fish and fish products. Red highlights are mine. Note the arrows which show total Omega-3 Fatty Acids compared to total EPA+DHA. You can see that the majority (75%-95%) of Omega-3 fatty acids in fish are either EPA or DHA.(9)

There is data that EPA is required in the human body in some degree or another. In one study, omnivores and vegetarians supplemented with only DHA showed a retroconversion of DHA to EPA of 9.4%(16). This indicates that the body needed some level of EPA for normal functioning and was forced to retroconvert that EPA from DHA. Since we know that PUFA conversion pathways compete for resources, this retroconversion could possibly inhibit the ability of the body to convert other fatty acids. In this study, Arachidonic Acid (AA 20:4-n6), Docosapentaenoic Acid (22:5-n6), and Docosapentaenoic Acid (DPA 22:5-n3) all decreased, possibly indicating the body did not have enough resources to convert all these compounds due to the DHA to EPA conversion load.

We do not know if a 9.4% conversion ratio provided optimal levels of EPA in the body. Given the fish ratios of 52-76% EPA it likely did not. It is likely that pregnant women supplemented with only DHA will be deficient in EPA.

Dr James Greenberg sums up the importance of EPA balance in his research report titled “Omega-3 Fatty Acid Supplementation During Pregnancy”:

“EPA, but not DHA, has been positively correlated with mRNA expression of all membrane proteins. Thus, higher maternal EPA concentrations may increase FATP expression (FATP-4 in particular) that, in turn, has been shown to increase cord blood DHA levels…Because only about 4% to 11% of DHA is retroconverted to EPA, pregnant women who just take DHA supplements, without any dietary EPA, may be unable to produce the right balance of eicosanoids and may limit the transport and uptake of DHA into fetal cells.”(13)

We can speculate that a fetus in the womb will require different levels of nutrients than a young infant. That said, we can still look at the DHA and EPA ratios in human breastmilk to get an idea of the approximate values of EPA and DHA transmitted to infants, and thus possibly also required by a developing fetus. Compared to DHA, breastmilk contains on average 66% as much EPA, with the level dropping as low as 44% EPA and going as high as 100% EPA depending on regional diet.(17)

Clearly there is a need for EPA in the human body. If preformed EPA can be provided in a balanced ratio of DHA:EPA, then we can free up conversion pathways for the body to successfully convert other PUFAs.

EPA Daily Supplementation Level: 150mg per day

Alpha-Linolenic Acid (ALA)

Optimal Supplementation Level: 500mg+ per day

Polyunsaturated Fatty Acid Chart with Alpha Linolenic Acid Highlighted
Image from Wikipedia: Polyunsaturated Fatty Acids. ALA has been highlighted red.

Alpha-Linolenic Acid (ALA 18:3-n3) is the parent Omega-3 fatty acid. Research indicates that human beings evolved on a diet of Omega-3 to Omega-6 fatty acids in a ratio of close to 1:1. Western Diets now contain a ratio closer to 15:1 to 16.7:1 Omega-3 to Omega-6 (25). This imbalance is thought to cause excessive inflammation, which is frequently studied as a cause of numerous “diseases of civilization” including cardiovascular disease, autoimmune diseases, even some cancers.

Although researchers argue about the ideal ratio of Omega-3 to Omega-6 fatty acids, the general consensus is to get more fatty acids from Omega-3 sources and less from Omega-6 sources.

ALA becomes a significant factor in not only keeping the Omega-3 to Omega-6 ratio in check, but also providing a stable source of parent Omega-3 fatty acids for conversion to other Omega-3 fatty acids and as a source of ALA for fetal development.

To see the ratio of ALA compared to DHA, EPA, and AA, we can analyze the levels naturally found in human milk.

Average Values of Polyunsaturated Fatty Acids in Mother’s Milk(17)
(Using 14 European Studies)
Omega-3
Alpha-Linolenic Acid (ALA 18:3-n3): 0.9% wt/wt (Range: 0.7%-1.3%)
Eicosapentaenoic Acid (EPA 20:5-n3): 0.2% wt/wt (Range: 0.0%-0.6%)
Docosahexaenoic Acid (DHA 22:6-n3): 0.3% wt/wt (Range: 0.1%-0.6%)

Omega-6
Linoleic acid (LA 18:2-n6): 11.0% wt/wt (Range: 6.9%-16.4%)
Arachidonic acid (AA 20:4-n6): 0.5% wt/wt (Range: 0.2%-1.2%)

These ratios would point to a required amount three times larger than that of DHA. In our case this would be at least 900mg ALA. Since the Western Diet is unusually low in Omega-3 fatty acids, we can err on the high side for ALA intake without worrying about going over a “maximum safe” level.

This sentiment is echoed in the scientific community. The International Society for the Study of Fatty Acids (ISSFA) and Lipids stated that “most studies showed benefit from an increasing intake of ALA” and recommends a dietary intake of ALA at 0.7% of energy. For a 2,000 calorie diet this would yield 1,550mg ALA (26). Various international recommendations range from 1,350mg per day to 2,200mg per day. Given these numbers, our goal would be to exceed 1,800mg per day of ALA intake during pregnancy.

Common dietary sources high in ALA include: flaxseed (or flaxseed oil), canola oil, soybeans (or soybean oil), tofu, and walnuts (or walnut oil). The chart below shows that most oils are relatively low in ALA (ALA represented by the yellow bars).

Oil Content of Various Products
Image from: cspinet.org. Chart data from: USDA Nutrient Database for Standard Reference, the Flax Council of Canada, and the National Sunflower Association.

Despite being a good source of the Omega-3s DHA and EPA, fish are not a good source of ALA. Salmon contains only 5.9% of it’s Omega-3s as ALA and Alaska Pollock contains only 1.8% of it’s Omega-3s as ALA.(9) Given the limitation of 2 servings of oily fish per week for pregnant women (due to mercury intake), fish would not be an effective dietary source of ALA.

7,036 females in the United States were studied for ALA intake from 2003 to 2008. The average ALA intake was 1,300mg per day, with 36% of women getting less than this amount.(27) Using 1,300mg per day as an average dietary intake and our goal as 1,800mg (or more) of total ALA intake, we should supplement with at least 500mg ALA. More than this amount would likely not be harmful, and may even provide additional health benefits.

ALA Daily Supplementation Level: 500mg (or more) per day

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Sources

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