George J Pardos, M.D.

George J Pardos, M.D.

Change of Diet We no longer forage for food Agribusiness Feeds the World We Eat Processed Food Destroys a percentage of nutritional value of food Pasteurization - Heat Introduces chemical preservatives alpha-tocopheryl acetate (Vitamn E) Use of Cheap, Plentiful Oils in Processed Food. Diminished Intake of Nutrients May Play a Role in Increased Prevalence of Certain Inflammatory Diseases

Cannot be stored or made: must be consumed. Diseases resulting from lack of Essential Nutrients: 3 rd Century Goiter Lack of Iodine 18 th 19 th Century- Scurvy Lack of Vitamin C 1970-1980 s Neural Tube Defects Lack of Folic Acid -Vitamin B9 21 st Century Inflammatory Diseases?

Arthritis/Fibromyalgia Adult & Childhood ADD/ADHD Alzheimer s Disease Cardiac Disease Asthma & Allergies Anxiety, Depression & Bipolar Cancer Ocular Surface Disease Macular degeneration

Polyunsaturated Fats Healthy Balance between Omega-3 and Omega-6 1:1 The average North American Diet is 1:10-1:20, Omega 6/ Omega 3 and as high as 1:50 This occurred when healthy unsaturated fats were replaced with trans fatty acids and diets full of processed foods (high in Omega-6)

Omega- 3 Anti-Inflammatory Plants Wild rice 1/1.25 Nuts Wild Fish Pasture-Grass Fed Cattle 3/1 Omega-6 Pro-Inflammatory Vegetable oils Corn Oil Soybean oil Corn Fed Cattle 13/1 Farm Raised Fish Processed Food

Safflower oil all Omega 6 Corn Oil 46:1 Sunflower Oil 40:1 Olive Oil 13:1 Soybean Oil 7:1 Canola Oil 2.5:1

Over-abundance of Omega 6 to Omega -3 leads to: Exuberant inflammatory Response Slowed Resolving Phase of Healing :

Omega-3 family -linolenic acid 18:3-3 Eicosanoids pg = prostaglandin pgi = prostacyclin tx = thromboxane lt = leukotriene = less inflammatory = more inflammatory 6 desaturase Omega-6 family linoleic acid 18:2-6 stearidonic acid -linolenic acid 18:4-3 GLA 18:3-6 elongase eicosatetraenoic acid 20:4-3 5 desaturase pge 1 pgf 1 txa 1 blocks lt 4 dihomo -linolenic acid DGLA 20:3-6 pgd 3 pge 3 pgf 3 eicosapentaenoic acid pgi 3 txa 3 EPA 20:5-3 lta 5 ltb 5 ltc 5 ltd 5 pgd 2 pge 2 pgf 2 pgi 2 txa 2 lta 4 ltb 4 arachidonic acid m ain ltc 4 ltd 4 lte 4 AA 20:4-6 Sprecher's Shunt elongase docosapentaenoic acid DPA 22:5-3 4 desaturase docosatetraenoic acid 22:4-6 docosahexaenoic acid A/J-Ring Neuroprostane docosapentaenoic acid DHA 22:6-3 17S Resolvins 22:5-6 blocks prostanoids

Omega 3 Alpha Linolenic Acid (ALA) Eicosapentaenoic Acid (EPA) Docosahexaenoic Acid (DHA) Omega 6 Linoleic Acid (LA) Gamma- Linolenic Acid (GLA) Arachidonic Acid (ARA)

Displacement Dietary ω-3 decreases tissue concentrations of ω-6, so there is less to form ω-6 eicosanoids. Competitive inhibition DGLA and EPA compete with AA for access to the cyclooxygenase and lipoxygenase enzymes. So the presence of DGLA and EPA in tissues lowers the output of AA's eicosanoids. Counteraction Some DGLA and EPA derived eicosanoids counteract their AA derived counterparts.

Omega-3 family -linolenic acid 18:3-3 Eicosanoids pg = prostaglandin pgi = prostacyclin tx = thromboxane lt = leukotriene = less inflammatory = more inflammatory 6 desaturase Omega-6 family linoleic acid 18:2-6 stearidonic acid -linolenic acid 18:4-3 GLA 18:3-6 elongase eicosatetraenoic acid 20:4-3 5 desaturase pge 1 pgf 1 txa 1 blocks lt 4 dihomo -linolenic acid DGLA 20:3-6 pgd 3 pge 3 pgf 3 eicosapentaenoic acid pgi 3 txa 3 EPA 20:5-3 lta 5 ltb 5 ltc 5 ltd 5 pgd 2 pge 2 pgf 2 pgi 2 txa 2 lta 4 ltb 4 arachidonic acid m ain ltc 4 ltd 4 lte 4 AA 20:4-6 Sprecher's Shunt elongase docosapentaenoic acid DPA 22:5-3 4 desaturase docosatetraenoic acid 22:4-6 docosahexaenoic acid A/J-Ring Neuroprostane docosapentaenoic acid DHA 22:6-3 17S Resolvins 22:5-6 blocks prostanoids

Over-abundance of Omega 6, in theory, allows the inflammatory response to become robust. Over-abundance of Omega 6, in theory, allows the inflammatory response to continue. A possible contributor to the increase in itis diseases

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GLA = Omega-6 = Pro-Inflammatory

2-4 servings/wk of tuna fish reduced the incidence by 18%, compared to <2 servings/wk 5-6 servings/wk of tuna fish reduced the incidence by 66%, compared to <2 servings/wk Tuna Consumption Dry Eyes The greater the Omega-3 intake the lower the risk for dry eye Copyright 2010

Copyright 2010

Omega 3 Alpha Linolenic Acid (ALA) Eicosapentaenoic Acid (EPA) Docosahexaenoic Acid (DHA) Omega 6 Linoleic Acid (LA) Gamma- Linolenic Acid (GLA) Arachidonic Acid (ARA)

Decreased Cardiac Disease Decreased Incidence of Dry Eye Decreased development and progression of AMD But the Omega-3, Alpha Linolinec Acid: Is poorly converted to EPA and DHA May be harmful? Retro-converted to LA

High in EPA High in DHA Not from ALA

Triglyceride Form of Omega- 3- Natural Form Ethyl Ester Form of Omega-3 not Found in Nature!

Copyright 2010

Need to Consume Twice as Much Ethyl Ester Form of Omega -3 to Equal Same Plasma Level Achieved by the Triglyceride Form of Omega -3

Pressed TG Form Natural form found in fish PELAGIC FISH How most Fish Oil Is Sold in USA Native Oil Ethyl Ester Oil Microdistillation With Ethyl Alcohol Concentrated Transesterification and alcohol removal TG Form Natural form found in fish Triglyceride (rtg) Oil Copyright 2012

EPA + DHA (mg/l) 200 180 160 140 120 100 80 60 40 20 0 rtg FO EE rtg=re-esterified triglycerides p =.001 DHA & EPA FO=fish body oil EE=ethyl esters Dyerberg, J., et al (1995) Bioavailability of n-3 Fatty Acid Formulation. Vol, 20 (Prevention and Treatment in Vascular Disease. Pg 217-225)

Trusted Name Label can read Triglyceride but not entirely composed of Triglyceride Form: May also contain cheaper Ethyl Ester form of Omega -3 NSF Certification The NSF Good Manufacturing Practices (GMP) Registration for contract manufacturers and internal manufacturing facilities of dietary supplement companies enables contract manufacturers to become independently registered by NSF as complying with GMP requirements as listed in Section 8 of NSF/ANSI Standard 173-2008. These requirements are consistent with the published GMP regulation for dietary supplements as defined in 21 CFR 111, which was published by the FDA in May 2007.

1 3 grams a day of DHA and EPA RBC Omega- 3 membrane level above 8%

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Comparison of RBC Saturation with Omega-3 Oral Supplements Frank A. Bucci, Jr., MD, Bucci Laser Vision Institute Wilkes Barre, PA Presented at ASCRS March 25, 2011 in advance of publication

Results % RBC Saturation

1. An objective blood test, the HS Omega-3 Index revealed significantly greater total omega-3 fatty acid RBC saturation (bioavailability to target tissues) for PRN-Dry Eye Omega Benefit vs. both Nature Made and TheraTears Nutrition at 1 and 3 months after ingesting equal amounts of omega- 3

Link Between the Dietary Imbalance of ω-3/ω-6 and Chronic Disease Evidence That Restoring Balance is Beneficial in Preventing Disease Select Correct Omega-3 EPA and DHA/ Not ALA Triglyceride 1-3 grams/day Trusted Company

AMD Benefits Dry Eye Benefits Cardiac Benefits Prostate Benefits Other Anti inflammatory Benefits When taken in the Proper Form of Omega -3s

Eat Healthy Read labels Become an Aware Consumer Consider Omega -3 Supplements Correct composition Correct form Trusted Company THANK YOU!