Further research is needed to explore the relation between consuming plant-based diets and risk of cancer because there are many unanswered questions about how diet and cancer are connected. To date, epidemiologic studies have not provided convincing evidence that a vegan diet provides significant protection against cancer. Although plant foods contain many chemopreventive factors, most of the research data comes from cellular biochemical studies.
Cross-sectional and longitudinal population-based studies published within the past 2 decades suggest no differences in bone mineral density BMD , for both trabecular and cortical bone, between omnivores and lactoovovegetarians More recent studies with postmenopausal Asian women showed spine or hip BMD was significantly lower in long-term vegans 41 , Those Asian women, who were vegetarian for religious reasons, had low intakes of protein and calcium.
An inadequate protein and low calcium intake has been shown to be associated with bone loss and fractures at the hip and spine in the elderly 43 , Adequate calcium intake may be a problem for vegans. Although lactoovovegetarians generally consume adequate amounts of calcium, vegans typically fall short of the recommended daily intake for calcium 8 , 45 , Results from the EPIC-Oxford study provide good evidence that the risk of bone fractures for vegetarians was similar to that of omnivores The higher risk of bone fracture seen in vegans appears to be a consequence of a lower mean calcium intake.
Bone health depends on more than just protein and calcium intakes. Research has shown that bone health is also influenced by nutrients such as vitamin D, vitamin K, potassium, and magnesium and by foods such as soy and fruit and vegetables 47 — Vegan diets do well in providing a number of those important substances. The maintenance of acid-base balance is critical for bone health.
A drop in extracellular pH stimulates bone resorption 51 , because bone calcium is used to buffer the pH drop. An acid-forming diet, therefore, increases urinary calcium excretion However, a diet rich in fruit and vegetables that is typical of a vegan diet has a positive effect on the calcium economy and markers of bone metabolism in men and women The high potassium and magnesium content of fruit and vegetables provides an alkaline ash, which inhibits bone resorption Higher intakes of potassium are associated with greater BMD of the femoral neck and lumbar spine of premenopausal women Blood concentrations of undercarboxylated osteocalcin, a sensitive marker of vitamin K status, is considered an indicator of hip fracture 55 and a predictor of BMD Results from 2 large, prospective cohort studies support an association between vitamin K intake and relative risk of hip fracture.
In addition to a high intake of fruit and vegetables, vegans also tend to have a high intake of tofu and other soy products 14 , Soy isoflavones are suggested to have a beneficial effect on bone health in postmenopausal women In a meta-analysis of 10 randomized controlled trials, soy isoflavones showed a significant benefit to spine BMD of menopausal women In another meta-analysis, soy isoflavones significantly inhibited bone resorption and stimulated bone formation compared with placebo In a randomized clinical trial lasting 24 mo involving osteopenic postmenopausal women, increases in BMD of both lumbar spine and femoral neck were substantially greater with the soy isoflavone, genistein, than with placebo As long as the calcium and vitamin D intake of vegans is adequate, their bone health is probably not an issue because their diet contains an ample supply of other protective factors for bone health.
However, more studies are needed to provide more definitive data on the bone health of vegans. To obtain a nutritionally adequate diet, the consumer must first have an appropriate knowledge of what constitutes a nutritionally adequate diet. Second, accessibility is important, ie, the availability of certain foodstuffs and foods fortified with key nutrients that are otherwise lacking in the diet.
This accessibility will vary greatly, depending on the geographic region of the world, because different countries have different fortification laws. The following section deals with nutrients of concern in the vegan diet. The problem of insufficient calcium has already been discussed in the section on bone health.
Diets that do not include fish, eggs, or sea vegetables seaweeds generally lack the long-chain n-3 fatty acids, eicosapentaenoic acid EPA; n-3 and docosahexaenoic acid DHA; n-3 , which are important for cardiovascular health as well as eye and brain functions. Compared with nonvegetarians, vegetarians, and especially vegans, tend to have lower blood concentrations of EPA and DHA The oil from brown algae kelp has also been identified as a good source of EPA.
The new Dietary Reference Intakes recommend intakes of 1. Vegans should be able to easily reach the n-3 fatty acid requirements by including regular supplies of ALA-rich foods in their diet and also DHA-fortified foods and supplements. However, DHA supplements should be taken with caution.
Although they can lower plasma triacylglycerol, they can raise total and LDL cholesterol 66 , 67 , cause excessively prolonged bleeding times, and impair immune responses For a vegan, vitamin D status depends on both sun exposure and the intake of vitamin D-fortified foods. Those living in areas of the world without fortified foods would need to consume a vitamin D supplement.
Those who are dark skinned, elderly, who extensively cover their body with clothing for cultural reasons, and who commonly use sunscreen are at an increased risk of vitamin D deficiency Another matter of concern for vegans is that vitamin D 2 , the form of vitamin D acceptable to vegans, is substantially less bioavailable than the animal-derived vitamin D 3 In Finland, the dietary intake of vitamin D in vegans was insufficient to maintain serum hydroxyvitamin D and parathyroid hormone concentrations within normal ranges in the winter, which appeared to have a negative effect on long-term BMD Throughout the year serum hydroxyvitamin D concentrations were lower and parathyroid hormone higher in vegan women than in omnivores and other vegetarians.
Heme iron absorption is substantially higher than non-heme iron from plant foods. However, hemoglobin concentrations and the risk of iron deficiency anemia are similar for vegans compared with omnivores and other vegetarians Vegans often consume large amounts of vitamin C—rich foods that markedly improve the absorption of the nonheme iron.
Serum ferritin concentrations are lower in some vegans, whereas the mean values tend to be similar to the mean values of other vegetarians but lower than the mean value for omnivores The physiologic significance of low serum ferritin concentrations is uncertain at this time. Compared with lactoovovegetarians and omnivores, vegans typically have lower plasma vitamin B concentrations, higher prevalence of vitamin B deficiency, and higher concentrations of plasma homocysteine Elevated homocysteine has been considered a risk factor for CVD 73 and osteoporotic bone fractures Vitamin B deficiency can produce abnormal neurologic and psychiatric symptoms that include ataxia, psychoses, paresthesia, disorientation, dementia, mood and motor disturbances, and difficulty with concentration In addition, children may experience apathy and failure to thrive, and macrocytic anemia is a common feature at all ages.
Vegetarians are often considered to be at risk for zinc deficiency. Phytates, a common component of grains, seeds, and legumes, binds zinc and thereby decreases its bioavailability. However, a sensitive marker to measure zinc status in humans has not been well established, and the effects of marginal zinc intakes are poorly understood Although vegans have lower zinc intake than omnivores, they do not differ from the nonvegetarians in functional immunocompetence as assessed by natural killer cell cytotoxic activity It appears that there may be facilitators of zinc absorption and compensatory mechanisms to help vegetarians adapt to a lower intake of zinc Fermented soy products, leafy vegetables, and seaweed cannot be considered a reliable source of active vitamin B No unfortified plant food contains any significant amount of active vitamin B The calcium-fortified foods include ready-to-eat cereals, calcium-fortified soy and rice beverages, calcium-fortified orange and apple juices, and other beverages.
The bioavailability of the calcium carbonate in the soy beverages and the calcium citrate malate in apple or orange juice is similar to that of the calcium in milk 78 , Tricalcium phosphate—fortified soy milk was shown to have a slightly lower calcium bioavailability than the calcium in cow milk The supplement would be highly desirable for elderly vegans.
In addition, it is recommended that vegans consume foods that are fortified with the long-chain n-3 fatty acid DHA, such as some soy milks and cereal bars. Those with increased requirements of long-chain n-3 fatty acids, such as pregnant and lactating women, would benefit from using DHA-rich microalgae supplements.
Benefit could also be obtained by vegans consuming fortified ready-to-eat cereals and other zinc-fortified foods. A more comprehensive list of eating guidelines for vegans is available elsewhere The term vegetarian is often used to describe a whole range of diets practiced with varying degrees of restriction, making it a challenge to meaningfully compare and contrast the health benefits of various vegetarian diets. Although preliminary data are valuable, more scientific studies on vegans are needed to get a clearer picture of their health status 7 , Current data show that vegans have a lower risk of heart disease than do omnivores and other vegetarians, but there are too few studies on other risk factors for definitive conclusions.
One small pilot trial has shown that a vegan diet improves glycemic control in individuals with type 2 diabetes 81 , but more studies are needed that look at the effects of a vegan diet on the risk of diabetes, as well as cancer. On the basis of our present knowledge, vegans do not appear likely to have any significant advantages over other vegetarians about chronic disease patterns The vegan studies that do exist often involve only a small number of subjects.
Research is also needed to investigate whether the age at which a vegan diet is adopted has any influence on health outcomes. Vegans are thinner, have lower serum cholesterol and blood pressure, and enjoy a lower risk of CVD.
BMD and the risk of bone fracture may be a concern when there is an inadequate intake of calcium and vitamin D. Where available, calcium- and vitamin D—fortified foods should be regularly consumed. There is a need for more studies on the relation between vegan diets and risk of cancer, diabetes, and osteoporosis. Vitamin B deficiency is a potential problem for vegans, so that the use of vitamin B—fortified foods or supplements are essential.
Vegans generally have an adequate iron intake and do not experience anemia more frequently than others. Typically, vegans can avoid nutritional problems if appropriate food choices are made. Their health status appears to be at least as good as other vegetarians, such as lactoovovegetarians. Other articles in this supplement to the Journal include references 83 — Stahler C. How many adults are vegetarian? Google Scholar.
Jacobsen MF. Six arguments for a greener diet: how a more plant-based diet could save your health and the environment. Vegetarian diets. J Am Diet Assoc ; : — Fox N , Ward K. Health, ethics and environment: a qualitative study of vegetarian motivations. Appetite ; 50 : — 9. Rollin BE. Farm animal welfare: social, bioethical, and research issues. Ames, IA : Wiley-Blackwell , Volpe T. The fast food craze: wreaking havoc on our bodies and our animals. Health effects of vegetarian and vegan diets.
Proc Nutr Soc ; 65 : 35 — EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33, meat-eaters and 31, non meat-eaters in the UK. Public Health Nutr ; 6 : — A very-low fat vegan diet increases intake of protective dietary factors and decreases intake of pathogenic dietary factors.
Vegetarian nutrition: preventive potential and possible risks. Part 1: plant foods. Wien Klin Wochenschr ; : — Fraser G. Risk factors and disease among vegans. In: Fraser G ed. Diet, life expectancy, and chronic disease. Studies of Seventh-day Adventists and other vegetarians. Cardiovascular disease risk factors are lower in African-American vegans compared to lacto-ovo-vegetarians.
J Am Coll Nutr ; 17 : — Vegetarian diet and cholesterol and triglyceride levels. Arq Bras Cardiol ; 88 : 35 — 9. Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Young Swedish vegans have different sources of nutrients than young omnivores.
Public Health Nutr ; 5 : — Am J Clin Nutr ; 79 : — 7. Dietary intake of fruits and vegetables and risk of cardiovascular disease. Curr Atheroscler Rep ; 5 : — 9. Dietary intake and nutritional status of young vegans and omnivores in Sweden. Am J Clin Nutr ; 76 : — 6. Nuts and coronary heart disease: an epidemiological perspective. Br J Nutr ; 96 suppl : S61 — 7. Whole grain intake and cardiovascular disease: a meta-analysis.
Nutr Metab Cardiovasc Dis ; 18 : — Fraser GE. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Liu RH. Potential synergy of phytochemicals in cancer prevention: mechanism of action. J Nutr ; suppl : S — 85S. World Cancer Research Fund.
Food, nutrition, physical activity, and the prevention of cancer: a global perspective Washington, DC : American Institute for Cancer Research , Google Preview. Health benefits of fruits and vegetables are from additive and synergistic combinations of phytochemicals. Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Dietary intake of vitamin D in premenopausal, healthy vegans was insufficient to maintain concentrations of serum hydroxyvitamin D and intact parathyroid hormone within normal ranges during the winter in Finland.
Low serum levels of hydroxyvitamin D predict fatal cancer in patients referred to coronary angiography. Cancer Epidemiol Biomarkers Prev ; 17 : — Holick MF. Sunlight, UV-radiation, vitamin D and skin cancer: how much sunlight do we need? Adv Exp Med Biol ; : 1 — A prospective study of red and processed meat intake in relation to cancer risk.
PLoS Med ; 4 : e Pancreatic cancer, animal protein and dietary fat in a population-based study, San Francisco Bay Area, California. Cancer Causes Control ; 18 : — Legume and isoflavone intake and prostate cancer risk: the Multiethnic Cohort Study. Int J Cancer ; : — The role of early life genistein exposures in modifying breast cancer risk. Br J Cancer ; 98 : — Childhood dairy intake and adult cancer risk: y follow-up of the Boyd Orr cohort. Am J Clin Nutr ; 86 : — 9.
Does high soy milk intake reduce prostate cancer incidence? The Adventist Health Study. Cancer Causes Control ; 9 : — 7. Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition. Milk consumption is a risk factor for prostate cancer in Western countries: evidence from cohort studies. Asia Pac J Clin Nutr ; 16 : — Am J Clin Nutr ; 74 : — New SA. Do vegetarians have a normal bone mass?
Osteoporos Int ; 15 : — Long-term vegetarian diet and bone mineral density in postmenopausal Taiwanese women. Calcif Tissue Int ; 60 : — 9. Bone mineral density in Chinese elderly female vegetarians, vegans, lacto-ovegetarians and omnivores. Eur J Clin Nutr ; 52 : 60 — 4.
Dietary calcium intake, physical activity and risk of vertebral fractures in Chinese. Osteoporos Int ; 6 : — Calcium intake and physical activity in fractured proximal femur in Hong Kong. BMJ ; : — 3. Smith AM. Veganism and osteoporosis: a review of the current literature. Int J Nurs Pract ; 12 : — 6. Eur J Clin Nutr ; 61 : — 6. Lanham-New SA. Importance of calcium, vitamin D and vitamin K for osteoporosis prevention and treatment.
Proc Nutr Soc ; 67 : — Association of hip fracture and intake of calcium, magnesium, vitamin D, and vitamin K. Eur J Epidemiol ; 23 : — Intake of fruit and vegetables: implications for bone health. Proc Nutr Soc ; 62 : — Critical review of health effects of soyabean phyto-oestrogens in post-menopausal women. A deficiency of essential fatty acids—either omega-3s or omega-6s—can cause rough, scaly skin and dermatitis [ 5 ].
Plasma and tissue concentrations of DHA decrease when an omega-3 fatty acid deficiency is present. However, there are no known cut-off concentrations of DHA or EPA below which functional endpoints, such as those for visual or neural function or for immune response, are impaired.
Evidence that higher LC omega-3 levels are associated with a reduced risk of several chronic diseases, including coronary heart disease, suggests that many Americans could benefit from slightly higher intakes. However, classical essential fatty acid deficiency in healthy individuals in the United States is virtually nonexistent [ 5 ]. During periods of dietary-fat restriction or malabsorption accompanied by an energy deficit, the body releases essential fatty acids from adipose-tissue reserves.
For this reason, clinical signs of essential—fatty-acid deficiency are usually only found in patients receiving parenteral nutrition that lacks PUFAs. This was documented in case reports during the s and s [ 5 ], but all current enteral and parenteral feeding solutions contain adequate levels of PUFAs. The potential health benefits of consuming omega-3s are the focus of a great deal of scientific research.
Many observational studies link higher intakes of fish and other seafood with improved health outcomes. However, it is difficult to ascertain whether the benefits are due to the omega-3 content of the seafood which varies among species , other components in the seafood, the substitution of seafood for other less healthful foods, other healthful behaviors, or a combination of these factors.
Data from randomized clinical trials are needed to shed light on these questions. This section focuses on areas of health in which omega-3s might be involved: cardiovascular disease and its risk factors ; infant health and neurodevelopment ; cancer prevention ; Alzheimer's disease, dementia, and cognitive function ; age-related macular degeneration ; dry eye disease ; rheumatoid arthritis ; and other conditions.
This interest was spurred by epidemiological research dating back to the s that found low rates of myocardial infarction and other coronary events among Greenland Inuit and other fish-eating populations, such as those in Japan [ 3 ]. Results from observational studies have been consistent with these findings, with several systematic reviews and meta-analyses showing that higher consumption of fish and higher dietary or plasma levels of omega-3s are associated with a lower risk of heart failure, coronary disease, and fatal coronary heart disease [ 43 , 44 ].
The authors of a systematic review that included six secondary-prevention trials and one primary-prevention trial of omega-3 supplementation published between and concluded that consumption of LC omega-3s from fish and fish oil supplements reduces rates of all-cause mortality, cardiac death, sudden death, and stroke [ 45 ]. They noted that the evidence of benefit is stronger for secondary than for primary prevention.
Results from the Japan EPA Lipid Intervention Study in supported the growing body of evidence that LC omega-3s reduce the risk of heart disease, especially in people with a history of coronary artery disease [ 51 ]. After a mean of 4. The EPA group also experienced a significant reduction in rates of unstable angina and nonfatal coronary events but not in rates of sudden cardiac death or coronary death in comparison with the control group.
In an analysis of the primary prevention subgroup from this study participants with no history of coronary artery disease , EPA supplementation had no significant effects on any outcome. Several subsequent clinical trials, however, had largely null findings [ ]. For example, the Outcome Reduction with an Initial Glargine Intervention ORIGIN trial included 12, patients who had diabetes or a high risk of diabetes and a high risk of cardiovascular events.
In VITAL, the omega-3 supplement did not significantly reduce the rate of major cardiovascular events combined myocardial infarction, stroke, and cardiovascular mortality after a median of 5. Supplement users also had significant reductions in rates of fatal myocardial infarction, total coronary heart disease, and percutaneous coronary intervention a procedure that widens blocked or narrowed coronary arteries.
No significant reductions in stroke or death rates from cardiovascular causes were observed. After a mean follow-up of 7. Possible reasons for conflicting findings : Dose probably plays a major role in the ability of omega-3 supplementation to confer significant benefits [ 59 ]. The daily dose of 1 g used in many studies of omega-3 dietary supplements might affect some CVD pathways [ 59 ] but has had no significant effect on the primary outcomes in several trials [ 54 , 56 , 57 ].
Other factors, including the omega-3 form, study population, background dietary omega-3 intakes, and use of statins and other cardioprotective therapies might also explain the conflicting findings among studies [ 17 , 54 , 55 , ]. Therefore, use of primary composite endpoints that combine multiple outcomes might dilute significant effects on individual components of those endpoints [ 61 ].
LC omega-3 doses ranged from 0. The authors concluded that LC-omega-3 supplementation reduces the risk of myocardial infarction, coronary heart disease death, total coronary heart disease, CVD death, and total CVD, and the effects appear to be dose related. However, the findings showed no significant associations for risk of fatal and nonfatal stroke. A Cochrane review of 86 randomized controlled trials published between and found that 0. However, the supplements did not affect all-cause mortality, cardiovascular events, stroke, or arrhythmia.
The authors of several earlier meta-analyses and systematic reviews, as well as a report from the Agency for Healthcare Research and Quality, concluded that omega-3 supplements do not appear to significantly reduce the risk of most cardiovascular events [ , ]. Many of these analyses [ , ], however, but not all [ 72 , 79 ], did find that omega-3s reduce the risk of cardiac death. All three advisories recommend one to two servings of seafood per week to reduce the risk of congestive heart failure, coronary heart disease, ischemic stroke, and sudden cardiac death, especially when the seafood replaces less healthy foods [ 60 ].
Although this finding pertains to high-dose prescription omega-3s, an earlier analysis of 58 trials also revealed a dose-response relationship between lower-dose dietary and supplemental omega-3 intakes and triglyceride levels [ 82 ]. The — Dietary Guidelines for Americans states that strong evidence from mostly prospective cohort studies but also some randomized controlled trials shows that eating patterns that include seafood are associated with a reduced risk of CVD [ 83 ].
In addition, consuming about 8 ounces per week of a variety of seafood that provides about mg per day EPA and DHA is associated with fewer cardiac deaths in both healthy individuals and those with preexisting CVD. Conclusions about omega-3s and CVD : Overall, research indicates that consuming fish and other types of seafood as part of a balanced diet promotes heart health, especially when the seafood is consumed in place of less healthy foods. Fish oil and other LC omega-3 supplements lower triglyceride levels and might reduce the risk of some cardiovascular endpoints, especially among people with low dietary omega-3 intakes.
Evidence of a protective effect for omega-3 supplementation is stronger for people with existing coronary heart disease than for healthy individuals. This health claim states, "Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.
Infant health and neurodevelopment Numerous studies have examined the effects of maternal seafood and omega-3 intakes on infant birth weight, length of gestation, visual and cognitive development, and other infant health outcomes. High concentrations of DHA are present in the cellular membranes of the brain and retina [ 5 ], and DHA is important for fetal growth and development. The accumulation of DHA in the retina is complete by birth, whereas accumulation in the brain continues throughout the first 2 years after birth.
Evidence from observational research : Observational studies indicate that maternal consumption, during pregnancy and breastfeeding, of at least 8 ounces per week of seafood that contains DHA is associated with better infant health outcomes [ 83 ]. For example, in a prospective cohort study of mother—child pairs in the United States, maternal fish consumption more than twice per week compared to no weekly consumption was associated with improved visual motor skills in their children at age 3 after adjustment for covariates such as maternal age, education, maternal smoking and alcohol use during pregnancy, paternal education, and fetal growth [ 85 ].
In another observational cohort study in the United Kingdom in 11, pregnant women who reported seafood intakes ranging from none to more than g about 12 ounces per week, lower consumption of seafood during pregnancy was associated with an increased risk of suboptimal communication skills in the offspring at ages 6 and 18 months and suboptimal verbal IQ and prosocial behavior at age 7—8 years [ 86 ]. It is not possible to establish causality, however, because all of these studies were observational.
Seafood contains varying levels of methyl mercury [ 31 ]. However, results from numerous studies, including a systematic review of the literature on maternal fish intake and subsequent neurodevelopmental outcomes, show that the health benefits of consuming moderate amounts of seafood during the prenatal period outweigh the risks [ ]. One of these trials examined the effects of fish oil supplementation in 2, pregnant women on the subsequent clinical outcomes and neurodevelopment of their children [ 90 ].
Compared to the placebo group, children of mothers who received fish oil were heavier at birth and less likely to be born very preterm less than 34 weeks' gestation. However, assessments of of the children all 96 preterm children and randomly selected full-term children found no differences between groups in mean cognitive composite scores or mean language composite scores at age 18 months. A follow-up study of the children at age 4 years found no differences between groups in general conceptual ability score or other assessments of cognition, language, and executive functioning [ 91 ].
In a clinical trial in healthy full-term infants, those who received either DHA-enriched fish oil mg DHA and 60 mg EPA or placebo daily from birth to 6 months had similar scores on neurodevelopment assessments at 18 months [ 93 ]. However, infants receiving fish oil had significantly better performance on language assessments, indicating some benefit for early communication development.
The authors of a systematic review and meta-analysis of 11 randomized controlled trials concluded that the evidence neither supports nor refutes the benefits of LC omega-3 supplementation during pregnancy for cognitive or visual development in infants [ 95 ].
Another systematic review and meta-analysis that included two randomized controlled trials in women with a previous preterm birth found no significant differences in rates of recurrent preterm birth between women who took omega-3 supplements during pregnancy and those who did not [ 95 ]. Omega-3 supplementation did, however, increase latency time from randomization to birth by about 2 days and mean birth weight by about g.
This comprehensive report evaluated the findings from 95 randomized controlled trials and 48 prospective longitudinal studies and nested case-control studies. Most studies examined the effects of fish oil supplements or other DHA and EPA combinations in pregnant or breastfeeding women or of infant formula fortified with DHA plus arachidonic acid, an omega The authors concluded that, except for small beneficial effects on infant birth weight and length of gestation, omega-3 supplementation or fortification has no consistent effects on infant health outcomes.
Recommendations from the Dietary Guidelines for Americans : The — Dietary Guidelines for Americans states that women who are pregnant or breastfeeding should consume 8—12 ounces of seafood per week, choosing from varieties that are higher in EPA and DHA and lower in methyl mercury [ 83 ], such as salmon, herring, sardines, and trout. These women should not consume certain types of fish, such as king mackerel, shark, swordfish, and tilefish that are high in methyl mercury, and they should limit the amount of white albacore tuna they consume to 6 ounces a week [ 31 ].
The American Academy of Pediatrics has similar advice for breastfeeding women, recommending intakes of — mg DHA per day by consuming one to two servings of fish per week to guarantee a sufficient amount of DHA in breast milk [ 89 ]. However, the authors of a paper published by the American Academy of Family Physicians and of two Cochrane reviews one on full-term infants and one on preterm infants have concluded that the evidence is insufficient to recommend the use of infant formulas that are supplemented with these fatty acids [ ].
Cancer prevention Researchers have hypothesized that higher intakes of omega-3s from either foods or supplements might reduce the risk of cancer due to their anti-inflammatory effects and potential to inhibit cell growth factors [ 62 ]. Results from observational studies however, have been inconsistent and vary by cancer site and other factors, including gender and genetic risk.
Other studies have found no associations between omega-3s and cancer risk, and some have even found associations in the opposite direction, suggesting that omega-3s might increase the risk of certain cancers such as prostate cancer [ 14 , 15 , ]. The first large-scale clinical trial to examine the effects of omega-3s on the primary prevention of cancer in the general population was the newly published VITAL trial.
The study included 25, men aged 50 and older and women aged 55 and older with no previous cancer, heart attacks, or strokes. Compared with placebo, the omega-3 supplement had no significant effect on cancer incidence, cancer mortality rates, or the development of breast, prostate, or colorectal cancers. Breast cancer : Evidence from several observational studies suggests that higher intakes of LC omega-3s are associated with a lower risk of breast cancer, but clinical trials are needed to confirm this finding.
According to a systematic review of three case-control studies and five prospective studies published in —, evidence is increasing that higher intakes of dietary and supplemental LC omega-3s are associated with a lower risk of breast cancer [ ]. These authors also found a dose-response relationship between higher intakes of combined LC omega-3s and reduced breast cancer risk.
Intakes of ALA and of fish, however, had no association with differences in breast cancer risk. This finding, which could be due to varying levels of omega-3s in different fish species, warrants further investigation. Colorectal cancer : Limited evidence from observational studies suggests that greater consumption of fish and LC omega-3s is associated with a reduced risk of colorectal cancer [ ]. The authors of a meta-analysis of 19 prospective cohort studies found no significant association between fish intake and risk of colorectal cancer overall.
Results from a more recent systematic review and meta-analysis of 22 prospective cohort studies and 19 case-control studies indicate that fish consumption is inversely associated with colorectal cancer risk. In this analysis, 21 of the studies distinguished between colon cancer and rectal cancer.
Results from the Vitamins And Lifestyle cohort study suggest that associations between fish or LC omega-3 intakes and colorectal cancer risk might vary by such factors as gender and genetic risk. The amount of fatty fish consumed ranged from none to 0. Overall, EPA and DHA intakes from either diet or supplements and fatty fish consumption were not associated with colorectal cancer risk, but associations varied by genetic characteristics certain inherited genetic mutations are associated with an increased risk of colorectal cancer.
For individuals in the lowest two tertiles of genetic risk, higher fatty fish consumption and higher total EPA and DHA intakes were inversely associated with colorectal cancer risk. For individuals in the highest tertile of genetic risk, higher total EPA and DHA intakes were positively associated with colorectal cancer risk. Risk also varied by gender. Additional research is needed to clarify possible associations between fish and omega-3 intakes and colorectal cancer risk.
Prostate cancer : Several prospective and case-control studies have investigated associations between either blood levels or intakes of omega-3s and risk of low-grade or high-grade prostate cancer. Results from these studies have been inconsistent. A few case-control and case-cohort studies have found positive associations between blood levels of LC omega-3s and prostate cancer risk particularly high-grade disease that is more advanced and more likely to spread than low-grade cancer , suggesting that omega-3s might increase prostate cancer risk.
In a nested case-control analysis of men aged 55—84 years participating in the Prostate Cancer Prevention Trial, serum phospholipid levels of DHA were positively associated with risk of high-grade, but not low-grade, prostate cancer [ 14 ]. Serum EPA levels, however, were not associated with risk of either grade of the disease. An analysis of data from the European Prospective Investigation into Cancer and Nutrition cohort also found a higher prostate cancer risk in men with higher plasma levels of LC omega-3s [ ].
Among Whites participating in the Multiethnic Cohort Study, higher levels of omega-3s in erythrocyte membranes and higher ratios of omega-3s to omega-6s were both associated with an increased risk of prostate cancer. However, the results showed no associations, even with advanced or high-grade disease, for other ethnic groups or for the population as a whole [ ].
Both fish and omega-3 consumption were associated with a lower risk of fatal prostate cancer in a cohort of , men participating in the NIH-AARP study [ ]. In the Health Professionals Follow-up Study, a prospective cohort of over 47, men aged 40—75 years, those who consumed fish more than three times per week had a lower risk of metastatic prostate cancer than those who consumed fish less than twice per month [ ].
However, men who used fish oil supplements did not have a decreased risk of prostate cancer. A number of systematic reviews and meta-analyses of prospective studies of the effects of fish intakes, omega-3 intakes, and omega-3 blood levels on prostate cancer risk have had inconsistent findings as well. For example, circulating levels of EPA, but not DHA, were positively associated with prostate cancer risk in a meta-analysis of 5, men with prostate cancer and 6, men without prostate cancer from seven studies [ ].
Another meta-analysis of 12 studies that included 4, men with prostate cancer and 5, men without prostate cancer found that high serum levels of these LC omega-3s were positively associated with high-grade disease [ ]. In other analyses, dietary intakes of LC omega-3s had no effect on prostate cancer risk [ ], whereas fish consumption decreased prostate cancer mortality but had no effect on prostate cancer incidence [ ].
A meta-analysis found no significant associations between dietary intakes or blood levels of LC omega-3s and total prostate cancer risk [ ]. The authors noted that most dietary-intake studies included in their meta-analysis found inverse associations, whereas biomarker studies of blood levels of these fatty acids found positive associations.
Overall, the evidence to date shows no consistent relationships between prostate cancer risk or mortality and omega-3 intakes or blood levels. Other cancers : Evidence is limited for a role of omega-3s in the prevention of cancers at other sites. For example, evidence is insufficient to determine whether omega-3s affect the risk of skin cancers, including basal-cell carcinoma, squamous-cell carcinoma, and melanoma [ , ]. Findings from the Australian Ovarian Cancer Study suggest that there is no association between total or individual omega-3 intakes from foods and ovarian cancer risk [ ].
Associations between omega-3 intakes and endometrial cancer have been mixed. Some evidence indicates that dietary intakes of EPA and DHA may provide protection from the development of endometrial cancer [ ]. Other evidence indicates that they decrease risk in normal-weight women but have no effect or even increase risk in overweight or obese women [ , ]. A systematic review and meta-analysis of 9 prospective cohort and 10 case-control studies did not find an association between fish or LC-omega-3 intakes and risk of pancreatic cancer [ ].
Similarly, systematic reviews and meta-analyses have not found significant associations between fish consumption and risk of gastric or esophageal cancers [ , ]. Summary : Overall, data from observational studies show no consistent relationship between omega-3s and overall cancer risk. Although some evidence suggests that higher LC omega-3 intakes reduce the risk of breast and possibly colorectal cancers, a large clinical trial found that LC omega-3 supplements did not reduce the overall risk of cancer or the risk of breast, prostate, or colorectal cancers.
Additional randomized clinical trials in progress will help clarify whether omega-3s affect cancer risk. Because DHA is an essential component of cellular membrane phospholipids in the brain, researchers hypothesize that LC omega-3s might protect cognitive function by helping to maintain neuronal function and cell- membrane integrity within the brain [ ]. This hypothesis is supported by findings from case-control studies indicating that patients with Alzheimer's disease have lower serum levels of DHA than cognitively healthy people [ , ].
Lower serum DHA levels are also associated with more cerebral amyloidosis build-up of protein deposits called amyloids in healthy older adults, whereas higher DHA is correlated with preservation of brain volume [ ]. In a prospective cohort study involving healthy men aged 70—89, fish consumption was associated with less cognitive decline at follow-up 5 years later [ ]. In addition, a dose-response relationship was observed between tertiles of dietary EPA plus DHA intake and subsequent 5-year cognitive decline.
Subsequent follow-up 6 years after baseline, however, found no associations between omega-3 intakes and incidence of dementia or Alzheimer's disease [ ]. The authors suggest that the discrepancy might be explained by the short follow-up period in the first analysis and the small number of patients who developed dementia. A higher omega-3 index was associated with a greater hippocampal volume in the Women's Health Initiative Memory Study [ ] and with a larger brain volume and improved cognitive test scores in the Framingham Offspring cohort [ ].
A dose-response meta- analysis of 21 cohort studies found that increased intakes of fish and dietary DHA were both inversely associated with the risks of dementia and Alzheimer's disease [ ]. Results from clinical trials, however, suggest that LC omega-3 supplementation does not affect cognitive function in older adults who have no cognitive impairment. In a trial in the United Kingdom, cognitively healthy adults aged 70—79 years received either mg DHA and mg EPA or placebo daily for 24 months [ ].
Cognitive function did not differ significantly between the two groups, although cognitive function did not decline in either group. Clinical trial results also suggest that LC omega-3 supplementation does not benefit patients with Alzheimer's disease, although it might help patients with mild cognitive impairment. For example, daily supplementation with 2 g DHA for 18 months did not slow the rate of cognitive decline compared to placebo in participants mean age 76 years with mild to moderate Alzheimer's disease [ ].
In the OmegaAD trial, daily supplementation with 1, mg DHA and mg EPA for 6 months in older adults with mild to moderate Alzheimer's disease also failed to slow down the rate of cognitive decline compared to placebo [ ]. However, a subgroup of patients with very mild impairment experienced a significant reduction in the rate of cognitive decline.
In a small trial in Malaysia, fish oil supplementation 1, mg DHA and mg EPA daily for 12 months improved memory—particularly short-term, working, and verbal memory—and delayed recall compared to placebo in 35 older adults with mild cognitive impairment [ ]. Several systematic reviews and meta-analyses, including a Cochrane review, have assessed the effects of omega-3 supplementation on cognitive function and dementia in healthy older adults and those with Alzheimer's disease or cognitive impairment [ , ].
For people with mild cognitive impairment, omega-3s may improve certain aspects of cognitive function, including attention, processing speed, and immediate recall [ ]. However, these findings need to be confirmed in additional clinical trials. Based on DHA's presence as a structural lipid in retinal cellular membranes and the beneficial effects of EPA-derived eicosanoids on retinal inflammation, neovascularization, and cell survival, researchers have suggested that these LC omega-3s have cytoprotective effects in the retina that may help prevent the development or progression of AMD [ 6 ].
Results were similar in a study in elderly male twins [ ] and an analysis of 38, healthy female health professionals [ ]. The Cochrane review authors concluded that LC omega-3 supplementation for up to 5 years in people with AMD does not reduce the risk of progression to advanced AMD or of moderate to severe vision loss. Older women, in particular, have a higher risk of dry eye disease than other groups, possibly because of hormonal changes that affect the tear-producing glands [ ].
Researchers hypothesize that omega 3s—particularly EPA and DHA—might reduce the risk of dry eye disease and relieve its symptoms because of their anti-inflammatory activity, and many patients take them as adjunctive treatments to artificial tears and other medications.
Some, but not all, observational studies show inverse associations between self-reported dietary consumption of omega-3s and risk of dry eye disease. But in another cross-sectional study of postmenopausal women, total dietary omega-3 intakes were not correlated with the prevalence of dry eye disease [ ]. Results from clinical trials using omega-3 supplementation, primarily EPA and DHA, have had mixed results in reducing the symptoms and signs of dry eye disease.
Furthermore, there is no consensus on the optimal dose, composition, or length of omega-3 treatment for this condition [ ]. The studies that have found beneficial effects from omega-3 supplementation for symptoms and signs of dry eye disease include one showing that daily supplementation with 1, mg omega-3s mg EPA plus mg DHA for 3 months in men and women mean age about 40 years living in northern India reduced symptoms and some signs of dry eye disease compared with placebo [ ].
In another clinical trial of men and women, daily treatment with supplements containing 2, mg omega-3s 1, mg EPA and mg DHA as re-esterified triglycerides for 12 weeks also reduced symptoms of dry eye disease compared with placebo [ ]. In addition, the supplements increased tear break-up time and decreased tear osmolarity which would be likely to reduce ocular surface damage. However, another large, randomized, double-blind clinical trial conducted in the United States found that EPA and DHA from fish oil supplements are no better than placebo at relieving symptoms or signs of dry eye disease [ ].
Among them, participants received daily supplements of 3, mg omega-3s 2, mg EPA plus 1, mg DHA , and received a placebo containing 5, mg olive oil. Participants could continue taking medications for dry eyes, including artificial tears and prescription anti-inflammatory eye drops, as well as omega-3 supplements as long as the total dose of EPA plus DHA was less than 1, mg per day. At the end of the study, symptoms were less severe than at baseline in both groups, but the results showed no significant differences between groups.
Groups also showed no significant differences compared with baseline in signs of dry eye disease, including conjunctive and cornea integrity as well as tear volume and quality. Overall, the evidence to date shows no consistent relationship between omega-3s and dry eye disease. More research is warranted to fully understand whether increased intakes of dietary or supplemental omega-3s help reduce the risk of dry eye disease and whether they are beneficial as an adjunct treatment.
Rheumatoid arthritis Rheumatoid arthritis RA is an autoimmune disease characterized by chronic inflammation of the joints. Its symptoms include pain, swelling, stiffness, and functional impairments. RA is typically treated with nonsteroidal antiinflammatory drugs NSAIDs , corticosteroids, and disease-modifying antirheumatic drugs [ , ].
Due to their antiinflammatory effects, some scientists hypothesize that LC omega-3s reduce some of the symptoms of RA and patients' reliance on NSAIDs and corticosteroids. Several clinical trials, many conducted in the s, have examined the use of LC omega-3 supplementation in patients with RA.
NSAID use decreased in the treatment group at 3 and 6 months, and global arthritic activity assessed by physicians improved relative to placebo at 3 months. However, patient assessments of pain, morning stiffness, and functional capacity did not differ between groups.
Compared to placebo, omega-3 supplementation had no significant effects on clinical symptoms of RA, including pain and morning stiffness. In post-hoc analysis, the researchers found that the supplements reduced the amount of NSAIDs needed, but only in patients weighing more than 55 kg. In a similar study in Denmark, 51 patients received either LC omega-3s 2.
Compared to placebo, morning stiffness, joint tenderness, and visual pain score decreased significantly in the treatment group. However, there were no significant differences between groups in grip strength, daily activity score, or joint swelling.
The amounts of NSAIDs, aspirin, and acetaminophen that patients needed did not change in either group. Reviews and meta-analyses of studies that assessed whether fish oil and LC omega-3s are beneficial for RA have had inconsistent findings [ 9 , ]. Some suggest that they do not significantly affect the clinical symptoms of RA but do reduce the amounts of NSAIDs and corticosteroids that patients need [ , ].
Others indicate that LC omega-3s reduce joint swelling and pain, morning stiffness, and number of painful joints in addition to reducing NSAID use [ 9 , , ]. Some researchers suggest that differences in findings could be due in part to whether patient-determined use of NSAIDs is considered a measure of pain [ 9 ]. Findings to date suggest that LC omega-3s may be helpful as an adjunctive treatment to pharmacotherapy for ameliorating the symptoms of RA [ 9 , ].
However, more research is needed to confirm this finding. The authors did find a small-to-modest beneficial effect on depressive symptoms, but they concluded that this effect was not clinically significant. Inflammatory bowel disease : The authors of a systematic review of 19 randomized controlled trials concluded that the available evidence does not support the use of omega-3 supplements to treat active or inactive inflammatory bowel disease [ ].
Similarly, the authors of a Cochrane review concluded that, based on the evidence from two large, high-quality studies, omega-3 supplements are probably not effective for maintaining remission in people who have Crohn's disease [ ]. ADHD : A systematic review and meta-analysis of 10 studies in children with ADHD or related neurodevelopmental disorders, such as developmental coordination disorder, found no improvements with omega-3 supplementation on measures of emotional lability, oppositional behavior, conduct problems, or aggression [ ].
Childhood allergies : A systematic review and meta-analysis of 10 prospective cohort studies and 5 randomized clinical trials on omega-3 intakes during pregnancy and outcomes of childhood allergic disease eczema, rhino-conjunctivitis, and asthma found inconsistent results [ ].
Although the authors could not draw firm conclusions due to the heterogeneity of the studies and their results, they concluded that the overall findings were "suggestive" of a protective association between higher maternal intakes of LC omega-3s or fish and incidence of allergic disease symptoms in the offspring. However, the authors concluded that there is not enough evidence to recommend routine use of omega-3 supplements by people with cystic fibrosis.
Summary : The potential benefits of omega-3s for these and other conditions require further study. The AMDR for total fat intake, for example, is based on adverse effects from either very low-fat or high-fat diets. It noted that these doses have not been shown to cause bleeding problems or affect immune function, glucose homeostasis, or lipid peroxidation.
Some doses used in clinical trials exceed these levels. Commonly reported side effects of omega-3 supplements are usually mild. These include unpleasant taste, bad breath, heartburn, nausea, gastrointestinal discomfort, diarrhea, headache, and odoriferous sweat [ , ]. Omega-3 dietary supplements, such as fish oil, have the potential to interact with medications. One example is provided below. People taking these and other medications on a regular basis should discuss possible interactions with their healthcare providers.
The authors of a review concluded that omega-3s do not affect the risk of clinically significant bleeding [ ], and the FDA-approved package inserts for omega-3 pharmaceuticals state that studies with omega-3s have not produced "clinically significant bleeding episodes" [ ]. However, these package inserts also state that patients taking these products with anticoagulants should be monitored periodically for changes in INR. The federal government's — Dietary Guidelines for Americans notes that "Because foods provide an array of nutrients and other components that have benefits for health, nutritional needs should be met primarily through foods.
In some cases, fortified foods and dietary supplements are useful when it is not possible otherwise to meet needs for one or more nutrients e. This fact sheet by the Office of Dietary Supplements ODS provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers doctor, registered dietitian, pharmacist, etc. Any mention in this publication of a specific product or service, or recommendation from an organization or professional society, does not represent an endorsement by ODS of that product, service, or expert advice.
Updated: March 26, History of changes to this fact sheet. Find ODS on:. Strengthening Knowledge and Understanding of Dietary Supplements. Health Information Health Information. For Researchers For Researchers. Lipids, sterols, and their metabolites. Modern Nutrition in Health and Disease. Lipids: cellular metabolism. Present Knowledge in Nutrition.
Washington, DC: Wiley-Blackwell; Harris WS. Omega-3 fatty acids. Encyclopedia of Dietary Supplements. London and New York: Informa Healthcare; Lipids: absorption and transport. Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids macronutrients.
The role of omega-3 long-chain polyunsaturated fatty acids in health and disease of the retina. Prog Retin Eye Res ; Advances in our understanding of oxylipins derived from dietary PUFAs. Adv Nutr ; Exp Biol Med ; Fish oil and rheumatoid arthritis: past, present and future.
Proc Nutr Soc ; Effects of omega-3 fatty acids on cardiovascular disease. Agency for Healthcare Research and Quality, UK Food Standards Agency workshop report: the effects of the dietary nn-3 fatty acid ratio on cardiovascular health. Br J Nutr ; J Natl Cancer Inst ;dju Too much linoleic acid promotes inflammation-doesn't it? Prostaglandins Leukot Essent Fatty Acids ; Serum phospholipid fatty acids and prostate cancer risk: results from the prostate cancer prevention trial.
Am J Epidemiol ; J Natl Cancer Inst ; Omega-3 fatty acids in cardiac biopsies from heart transplantation patients: correlation with erythrocytes and response to supplementation. Circulation ; Are n-3 fatty acids still cardioprotective? Comparison between plasma and erythrocyte fatty acid content as biomarkers of fatty acid intake in US women.
Am J Clin Nutr ; Omega-3 fatty acids and cardiovascular disease - update. The Omega-3 Index: a new risk factor for death from coronary heart disease? Prev Med ; The omega-3 index as a risk factor for coronary heart disease. Relation between blood and atrial fatty acids in patients undergoing cardiac bypass surgery.
Use of red blood cell fatty-acid profiles as biomarkers in cardiac disease. Biomark Med ; Nutr Res Rev ; Fatty acid profiles of commercially available finfish fillets in the United States. Lipids ; Impact of sustainable feeds on omega-3 long-chain fatty acid levels in farmed Atlantic salmon, Sci Rep ; Meat Sci ; Food and Drug Administration. Department of Agriculture, Agricultural Research Service.
FoodData Central , National Institutes of Health. Dietary Supplement Label Database. Fish: what pregnant women and parents should know. Product review: fish oil and omega-3 fatty acid supplements review including krill, algae, calamari, green-lipped mussel oil. Bioavailability of marine n-3 fatty acid formulations. Are krill oil supplements a better source of n-3 fatty acids than fish oil supplements? J Acad Nutr Diet ; Novel developments in omega-3 fatty acid-based strategies.
Curr Opin Lipidol ; Incorporation of EPA and DHA into plasma phospholipids in response to different omega-3 fatty acid formulations--a comparative bioavailability study of fish oil vs. Lipids Health Dis ; Comparison of bioavailability of krill oil versus fish oil and health effect. Vasc Health Risk Manag ; Algal-oil capsules and cooked salmon: nutritionally equivalent sources of docosahexaenoic acid.
J Am Diet Assoc ; What we eat in America, Trends in the use of complementary health approaches among adults: United States,
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|Cover letter for radiology||Inin the United Kingdom, there were approximately 55, new cases of breast cancer flaxseed and breast cancer literature review and about 54, womenof which approximately were diagnosed daily with approximately 11, deaths due to this kind of cancer. Flaxseeds are rich in fiber and are suggested for situations of constipation, as they help to improve the intestinal function. North and South Dakota, the two largest producing U. Flaxseed and its lignan and oil components reduce mammary tumor growth at a late stage of carcinogenesis. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial. Inin Portugal approximately 27, people died of cancer, of which 1, were women with breast cancer. A case-control study using the Ontario cancer registry database consisted of a random sample of women diagnosed with breast cancer, with the aim of analyzing the phytoestrogen intake isoflavones and lignans flaxseed and breast cancer literature review their association with breast cancer risk.|
It is ideal for active, grown-up dogs. It ensures efficient digestion owing to its prebiotic and probiotic formula. A rich complex of antioxidants will boost the defense system of your pet, by eliminating harmful elements from the body. The fact that it contains no preservatives, allergens, by-product meals or hormones adds up to its quality. Make a smart move and simply go for Go!
It will become your partner in keeping your best buddy healthy and content. A quick look at the list of ingredients in this superb formula is the strongest evidence of its quality. It is simple but powerful.
Best quality beef, vitamins, minerals, and water join forces to ensure sound nutrition for your canine. This wet food formula supports the healthy eating habits of your furry friend, making sure it gets all the required nutrients. It is low in carb levels, too. Beef liver, broth, vitamins and minerals included in this mixture provide the body strength, strong immunity, and efficient metabolic processes.
If your pup is struggling with excessive pounds, this formula will make an excellent choice in promoting healthy weight. Keep it simple and stick with the best! Strict procedures and the belief that raw nutrition benefits your canine greatly made the basis for the creation of this formula. Although vegetables and fruits make a smaller minority of its ingredients, they still contribute significant minerals and vitamins.
K9 Natural has the natural feeding habits of dogs at its core. It will meet the nutritive requirements of all types of breeds and life stages of pups. To reduce allergies, intolerances or digestive issues, it leaves out absolutely all potential triggers of such issues. K9 Natural will provide your pet with a balanced, healthy diet.
It will fuel your pal with the energy sufficient for a day packed with activity and exercise. The makers of this tasty blend had pets with allergies and special dietary needs in mind when creating it. This is why buffalo tops the list of its ingredients. Known as an excellent source of protein, it promotes healthy nutrition.
A great selection of whole foods makes it incredibly rich in vital nutrients. These include blueberries, kales sprouts, bok choy, and yams. The list of components not allowed in this clean formula is a lengthy one, too. It leaves out hormones, steroids, antibiotics, and pesticides. Similarly, it is free of corn, potatoes, soy, corn, byproducts, additives, flavors, and colors.
Amounts of carbs in this blend are lower, while it features high digestibility. Dogs of all life stages will be infused will all the essential nutrients which will help them thrive. Bring your search for an ideal food formula to an end — Great Life is just around the corner, waiting for you. Lymph nodes, bone marrow, and spleen are the most common points where lymphomas occur in dogs. These malignancies vary in their invasiveness and metastasis, so there are five distinguished stages in their development.
A quarter of the total number of cancer-affected canines is likely to develop this type of formation. Multiple factors may be the cause of lymphomas in dogs. Genetics, environmental influences, and weak immunity are usually listed as the main reasons why your pal can develop this condition.
This is the most frequently encountered type of skin cancer in dogs. It is the cancer of a specific blood cell, responsible for reacting to inflammatory and allergic processes. Affected areas of skin can vary in appearance, depending on the severity of the condition itself. In later stages, it is most likely to spread to spleen, liver and lymph nodes. This type of malignant skin cancer usually develops on the mouth or mucous membranes.
It is typically found on pigmented sections of the skin, in some cases under the hair. This type of cancer is usually rather aggressive and spreads rapidly. It is likely to grow metastasis on the lungs and liver. However, if diagnosed timely, successful treatment is possible. This type of cancer attacks the blood vessels in your canine. It can appear either on the surface of the skin or anywhere inside the body. This malignancy is very difficult to treat and usually has bad predictions. If formed externally, on the skin surface, surgical removal usually yields positive results.
However, a far more worrying form takes place on internal organs such as heart and spleen. The tumor tissue fills with blood and bursts easily, leading to massive bleeding and eventually death. In some cases, a combination of surgical treatment and chemotherapy successfully increased the life expectancy in pups affected by this condition.
Although it can be found in all dog breeds, giant and large canines are more prone to developing this condition. Bone cancer tends to spread to other organs in the body, and in these cases usually has a fatal outcome. Lumps, swellings, lameness or persistent pain are some of the symptoms which should make owners alert and require an examination by a vet.
Usually resulting from hormones or genetics , it is the most common type of cancer among female dogs. In rare cases, males can suffer from it as well. Mammary glands develop one or more masses, movable or attached to the body wall. These can either be benign or malignant. Breast cancer affects unspayed females in the majority of cases and is less common in pups younger than five. Cancer can strike when you least expect it.
For this reason, you should keep an eye on any untypical changes in your pup. Symptoms of this life-threatening disease may not always be obvious at first. If your pup starts both drinking much more water and urinating more than usual, it may possibly indicate the growth of the hypothalamus tumor.
Chemotherapy involves the use of drugs to fight different types of cancer. It sometimes follows a surgical removal of cancerous tissue. In other cases, it is used to destroy blood-borne cancers. Dogs usually do not suffer severe consequences of chemos. Hair loss does not normally occur during the treatment. In some breeds, the hair may become thinner and brittle. Vomiting and loss of appetite can sometimes follow after these treatments. Anemia may also be present in some pups.
However, most symptoms vanish after a couple of days and are dealt with successfully. Their increasing size presents an obstacle for many vital body functions. The aim of applying radiation therapy isto reduce tumors and prevent them from growing rapidly. In this way, some of the symptoms can be alleviated. Radiation therapy usually extends the length of life , improving its quality for some time, too.
If possible, tumors will ideally be removed surgically. Yet, there are many factors which determine whether or not to perform one. These include types of tumors, their stage, and their location in the body. In the early stages of tumor development, an operation can be the most efficient solution. Removing the entire tumor mass along with surrounding tissue can yield positive results. However, sometimes even the best veterinary surgeons are not able to achieve this.
If this happens, you may expect the tumor to appear again. Immunotherapy is in the majority of cases used alongside chemo and radiation therapy. Following the practice of using immunotherapy in humans, this form of cancer treatment can be used successfully in canines, too. It involves the use of antibodies in fighting the cancer cells, preventing tumors from growing.
These antibodies bind to cancer cells, stopping them from multiplying and leading to their death. Metabolism of carbs, fats, and proteins differs significantly in dogs affected by cancer. Many dogs will suffer a noticeable loss of weight , despite adequate and quality nutrition.
This is known as cancer cachexia. One of the major changes occurs when it comes to the utilization of carbohydrates. While cancer cells make use of carbs through the process of anaerobic glycolysis, normal body cells have to struggle to obtain the necessary energy.
This all results in the sustained growth of cancerous cells, and a substantial loss of body energy. If your furry friend suffers from a certain type of cancer, the synthesis of protein in his body will slow down. At the same time, protein degradation will be on the rise, leading to body mass and muscle loss.
Fats will feature the same tendency, too. Even if your pup fully recovers from cancer, these changes in his metabolism are permanent in nature. The overall condition of your cancer-affected canine will at times reflect negatively on his appetite. There is no need to say how significant it is to help your pup regain energy, prevent the loss of body mass and boost the immune system. As a result, it is vital to offer palatable and tasty food , which will not result in a reluctance to eat. A couple of quality food formulas meet this condition and present a wise choice.
The quality of ingredients in a cancer-fighting diet can be a real game changer. Nutrition experts and medical professionals agree that it is a quality animal protein which should be the number one component in the diet for dogs suffering from cancer. Higher contents of fat are also considered as desirable. It is highly recommended to avoid foods containing grains, as well as those in which the first ingredients are rice, corn or wheat. Fighting cancer is already an extremely difficult task.
Owners should have this in mind when choosing the type of diet for their furry companion. This is why they should take some time and work out the best feeding option which will benefit the body the most. Foods packed with fillers, preservatives, artificial colors, and flavors often cause problems even to healthy pups. Artificial ingredients are difficult to process. They are quite likely to give your already weakened pup an even harder time.
Cancer can make your canine unwilling to eat. Foods containing a higher level of moisture are usually more appetizing. Your cancer-fighting pet will probably be more keen on wet dog food formulas. Higher contents of water will keep your puppy adequately hydrated.
Quality foods with higher levels of moisture will make your pup consume a smaller amount of food. However, it will meet all of his nutrition needs. This means that he will take no excessive calories in the form of carbs or fillers.
Using fresh food ingredients to fight cancer in dogs has several advantages. Benefits of a group of fresh fruits and vegetables are numerous, both in prevention and dealing with cancer. Such ingredients are primarily known for their antioxidant features.
Owing to them, the body deals with harmful elements more efficiently, including cancer cells. Nutrition experts frequently emphasize all the positive sides of the anti-cancer diet based on organic ingredients. Their power lies primarily in the fact that they are clean and natural. Certified organic foods are free from any artificial chemicals, preservatives, taste intensifiers and colors.
They are believed to supply the best quality nutrients, significant in such delicate health conditions. Nutritionists recommend a special dietary regime for dogs dealing with cancer. Carbs, sugars and processed proteins will turn against your pet in its attempt to fight cancer.
These will, as it is well known, only boost the development of bad tumor cells. You should by no means offer any kind of sweets, candies, and cookies to your sick furry friend. In addition, all the foods containing artificial preservatives can do serious harm. Some of these additives can even trigger the development of cancers in your canine. Cutting down on carbohydrates will be the first and foremost bit of advice from any veterinary expert.
The reason for this is clear and valid. Instead of providing your pup with the required energy, carbohydrates actually boost the development of cancer tissues. By utilizing glucose efficiently, cancer cells obtain the energy necessary for their rapid growth. Cravo et al [ ] used 5 mg of folic acid a day a supraphysiological dose in a prospective, controlled, cross-over study of 20 patients with colonic adenoma polyps.
They found that the folic acid could reverse DNA hypomethylation in 7 of 12 patients who had only one polyp. Folate may be more important for rapidly dividing tissue, like the colonic mucosa. Therefore, the cancer risk associated with low folate intake is probably higher for colon cancer than for breast cancer. Most of the breast cancer studies only found a protective effect of folate among women who consumed alcohol see Table 4.
So, there may be a true protective effect that is masked in the western populations by so many other risk factors. Two studies showed that the risk of cancer due to family history can be modified by high folate intake, so a prudent anti-cancer diet would be high in dark green leafy vegetables. Vitamin D is produced primarily from the exposure of the skin to sunshine. Even casual exposure of the face, hands, and arms in the summer generates a large amount of vitamin D.
In fact, simulated sunshine, equivalent to standing on a sunny beach until a slight pinkness of the skin was detected, was equivalent to a 20, IU oral dose of vitamin D 2 [ ]. It has been estimated that 1, IU per day is the minimal amount needed to maintain adequate levels of vitamin D in the absence of sunshine [ ], and that up to 4, IU per day can be safely used with additional benefit [ ].
The concentration of the active hormonal form of vitamin D is tightly regulated in the blood by the kidneys. This active hormonal form of vitamin D has the potent anti-cancer properties. It has been discovered that various types of normal and cancerous tissues, including prostate cells [ ], colon tissue [ ], breast, ovarian and cervical tissue [ ], pancreatic tissue [ ] and a lung cancer cell line [ ] all have the ability to convert the major circulating form of vitamin D, 25 OH D, into the active hormonal form, 1,25 OH 2 D.
So, there is a local mechanism in many tissues of the body for converting the form of vitamin D in the body that is elevated by sunshine exposure into a hormone that has anticancer activity. Indeed, 25 OH D has been shown to inhibit growth of colonic epithelial cells [ ], primary prostatic epithelial cells [ ], and pancreatic cells [ ].
So, the laboratory work is confirming what had been seen some time ago in ecological studies of populations and sunshine exposure. The mortality rates for colon, breast, and ovary cancer in the USA show a marked north-south gradient [ ]. In ecological studies of populations and sunlight exposure no individual data sunlight has been found to have a protective effect for prostate cancer [ ], ovarian cancer [ ], and breast cancer [ ]. Recently Grant found that sunlight was also protective for bladder, endometrial, renal cancer, multiple myeloma, and Non-Hodgkins lymphoma in Europe [ ] and bladder, esophageal, kidney, lung, pancreatic, rectal, stomach, and corpus uteri cancer in the USA [ ].
Several prospective studies of vitamin D and cancer have also shown a protective effect of vitamin D see Table 5. Carotenoids have been studied vigorously to see if these colorful compounds can decrease cancer risk. Beta-carotene may be a marker for intake of fruits and vegetables, but it does not have a powerful protective effect in isolated pharmacological doses. However, there is a large body of literature that indicates that dietary carotenoids are cancer preventative See Table 6.
Studies tend to agree that overall intake of carotenoids is more protective than a high intake of a single carotenoid. So, a variety of fruits and vegetables is still a better anti-cancer strategy than just using a single vegetable high in a specific carotenoid. Of the various carotenoids lycopene has been found to be very protective, particularly for prostate cancer. The major dietary source of lycopene is tomatoes, with the lycopene in cooked tomatoes being more bioavailable than that in raw tomatoes.
Several prospective cohort studies have found associations between high intake of lycopene and reduced incidence of prostate cancer, though not all studies have produced consistent results [ , ]. Some studies suffer from a lack of good correlation between lycopene intake assessed by questionnaire and actual serum levels, and other studies measured intakes among a population that consumed very few tomato products.
The studies with positive results will be reviewed here. In addition to the two reports above a nested case control study from the Health Professional Follow-up Study with cases and controls found an inverse relation between plasma lycopene and prostate cancer risk OR 0. So, the results for lycopene have been found for dietary intakes as well as plasma levels.
In addition to these observational studies, two clinical trials have been conducted to supplement lycopene for a short period before radical prostatectomy. Results showed that the lycopene slowed the growth of prostate cancer. Subjects that took the lycopene for 3 weeks had smaller tumors, less involvement of the surgical margins, and less diffuse involvement of the prostate by pre-cancerous high-grade prostatic intraepithelial neoplasia [ ].
In another study before radical prostatectomy surgery 32 men were given a tomato sauce-based pasta dish every day, which supplied 30 mg of lycopene per day. After 3 weeks serum and prostate lycopene levels increaed 2-fold and 2. The apoptotic index was 3-fold higher in the resected prostate tissue, compared to biopsy tissue [ ].
These intervention studies raise the question of what could have been done in this intervention was longer and combined synergistically with other effective intervention methods, such as flax seed, increased selenium and possibly vitamin E, in the context of a diet high in fruits and vegetable? Vitamin C, or ascorbic acid, has been studied in relation to health and is the most common supplement taken in the USA.
Low blood levels of ascorbic acid are detrimental to health for a recent article see Fletcher et al [ ] and vitamin C is correlated with overall good health and cancer prevention [ ]. Use of vitamin C for cancer therapy was popularized by Linus Pauling. At high concentrations ascorbate is preferentially toxic to cancer cells.
There is some evidence that large doses of vitamin C, either in multiple divided oral doses or intravenously, have beneficial effects in cancer therapy [ — ]. Oral doses, even in multiple divided doses, are not as effective as intravenous administration. Vitamin C at a dose of 1. While vitamin C is quite possibly an effective substance, the amounts required for these therapeutic effects are obviously beyond dietary intakes. However, intravenous ascorbate may be a very beneficial adjuvant therapy for cancer with no negative side effects when administered properly.
There are many more substances that will have some benefit for cancer therapy. Most of these substances are found in foods, but their effective doses for therapy are much higher than the normal concentration in the food. Also, green tea contains a flavanol, epigallocatechingallate EGCG , which can inhibit metalloproteinases, among several possible other mechanisms [ ].
And there are claims for various other herbal substances and extracts that might be of benefit, which are beyond the scope of this review. The bacteria that reside in the intestinal tract generally have a symbiotic relationship with their host. Beneficial bacteria produce natural antibiotics to keep pathogenic bugs in check preventing diarrhea and infections and produce some B vitamins in the small intestine where they can be utilized. Beneficial bacteria help with food digestion by providing extra enzymes, such as lactase, in the small intestine.
Beneficial bacteria help strengthen the immune system right in the gut where much of the interaction between the outside world and the body goes on. Beneficial bacteria can help prevent food allergies. They can help prevent cancer at various stages of development. These good bacteria can improve mineral absorption, maximizing food utilization.
However, the balance of beneficial and potentially pathogenic bacteria in the gut is dependent on the diet. Vegetable fiber encourages the growth of beneficial bacteria. A group of Adventist vegetarians was found to have a higher amount of beneficial bacteria and lower amount of potentially pathogenic bacteria compared to non-vegetarians on a conventional American diet [ ]. Differences in bacterial populations were seen between patients who recently had a colon polyp removed, Japanese-Hawaiians, North American Caucasians, native rural Japanese, and rural native Africans.
Lactobacillus species and Eubacterium aerofaciens , both producers of lactic acid, were associated with the populations with the lower risk of colon cancer, while Bacteroides and Bifidobacterium species were associated with higher risk of colon cancer [ ]. There is a solid theoretical basis for why probiotics should help prevent cancer, especially colon cancer, and even reverse cancer. Probiotics produce short chain fatty acids in the colon, which acidify the environment. Lower colon pH is associated with lower incidence of colon cancer.
Probiotic bacteria reduce the level of procarcinogenic enzymes such as beta-glucuronidase, nitroreductase, and azoreductase [ ]. The second trial also showed that the probiotics worked better than the placebo, except for multiple recurring tumors [ ]. Except for the two studies noted above, most of the research of probiotics and cancer has been done in animals.
Studies have looked at markers of tumor growth or at animals with chemically induced tumors. Studies in rats have shown that probiotics can inhibit the formation of aberrant crypt foci, thought to be a pre-cancerous lesion in the colon. Some of the best results were obtained with a probiotic strain consumed with inulin, a type of fructooligosaccharide.
There was a synergistic effect in using both products together. Similar synergy was seen in rats with azoxymethane-induced colon cancer in another study. Rats fed Raftilose, a mixture of inulin and oligofructose, or Raftilose with Lactobacilli rhamnosus LGG and Bifidobacterium lactis Bb12 had a significantly lower number of tumors compared to the control group [ ].
In lab mice bred to be susceptible to colitis and colon cancer, a probiotic supplement, Lactobacillus salivarium ssp. Salivarius UCC, reduced fecal coliform levels, the number of potentially pathogenic Clostridium perfringens , and reduced intestinal inflammation. In this small study two mice died of fulminant colitis and 5 mice developed adenocarcinoma in the control group of 10 mice, while there was no colitis and only 1 mouse with adenocarcinoma in the probiotic test group [ ].
The research on probiotics and disease is still an emerging field. There is a high degree of variation of health benefits between different strains of bacteria. As new methods for selecting and screening probiotics become available, the field will be able to advance more rapidly.
Many people diagnosed with cancer have digestion or intestinal tract disorders as well. Impaired digestion will greatly hinder a nutritional approach to treating cancer. If the nutrients cannot be released from the food and taken up by the body, then the excellent food provided by the Hallelujah Diet will go to waste. Digestive enzyme supplements are used to ensure proper and adequate digestion of food.
Even raw foods, which contain many digestive enzymes to assist in their digestion, will be more thoroughly digested with less of the body's own resources with the use of digestive enzymes. So, the enzymes taken with meals do not have a direct effect upon a tumor, but assist the body in getting all of the nutrition out of the food for healing and restoring the body to normal function.
Recently, an in vitro system was used to test the use of supplemental digestive enzymes. The digestive enzymes improved the digestibility and bioaccessibility of proteins and carbohydrates in the lumen of the small intestine, not only under impaired digestive conditions, but also in healthy human digestion [ ].
There is evidence that indicates the presence of an enteropancreatic circulation of digestive enzymes [ ]. Digestive enzymes appear to be preferentially absorbed into the bloodstream and then reaccumulated by the pancreas for use again. There appears to be a mechanism by which digestive enzymes can reach systemic circulation.
Enzymes, especially proteases, if they reach systemic circulation, can have direct anti-tumor activity. Wald et al [ ] reported on the anti-metastatic effect of enzyme supplements. Mice inoculated with the Lewis lung carcinoma were treated with a proteolytic enzyme supplement, given rectally to avoid digestion. The primary tumor was cut out, so that the metastatic spread of the cancer could be measured.
In the third group, which received the enzyme treatment since the initial inoculation of the Lewis lung carcinoma, no metastatic spread of the tumor was discernible. In a similar experiment, an enzyme mixture of papain, trypsin, and chymotrypsin, as used in the preparation Wobe-Mugos E, was rectally given to mice that were inoculated with melanoma cells.
Survival time was prolonged in the test group 38 days in the enzyme group compared to 24 days in the control mice and 3 of the 10 enzyme-supplemented mice were cured. Again, a strong anti-metastatic effect of the proteolytic enzymes was seen [ ]. Further evidence of the efficacy of oral enzyme supplementation is available from clinical trials in Europe. In the Slovak Republic an oral enzyme supplement was tested in a placebo-controlled trial of multiple myeloma.
For stage III multiple myeloma, control group survival was 47 months, compared to 83 months a 3 year gain for patients who took the oral enzymes for more than 6 months [ ]. Enzyme supplements have also been shown to reduce side effects of cancer therapy.
Enzyme supplementation resulted in fewer side effects for women undergoing radiation therapy for carcinomas of the uterine cervix [ ], for patients undergoing radiation therapy for head and neck cancers [ ], and for colorectal cancer patients undergoing conventional cancer treatments [ ]. In a large multi-site study in Germany women undergoing conventional cancer therapy were put into a control group or a group that received an oral enzyme supplement.
Disease and therapy related symptoms were all reduced, except tumor pain, by the enzyme supplement. Also, survival was longer with less recurrence and less metastases in the enzyme group [ ]. In all of these studies the oral enzyme supplements were well tolerated, with only a small amount of mild to moderate gastrointestinal symptoms. Even though these few studies don't give a lot of evidence of the effectiveness of oral enzyme supplementation, it is clear that there are some circumstances that will be helped by enzyme supplementation, with very little danger of negative side effects.
At the least, enzymes will improve digestion and lessen the digestive burden on the body, leaving more reserves for disease eradication. However, as the research indicates, the effect may be much greater than that, with the potential for direct anti-tumor activity. A diet-based cancer therapy, the Gerson Therapy, was used to treat melanoma cancer. The five-year survival rates from their therapy compared very favorably to conventional therapy reported in the medical literature, especially for more advanced stages of melanoma [ ] see Table 7.
An Italian cohort of 8, women was followed for an average of 9. Their diets were analyzed by patterns — salad vegetables raw vegetables and olive oil , western potatoes, red meat, eggs and butter , canteen pasta and tomato sauce , and prudent cooked vegetables, pulses, and fish.
The overall dietary pattern does make a very significant difference. In US-based studies the "prudent" diet has been shown to be protective for colon cancer, while the "western" diet has been shown to be detrimental. The "salad vegetable" pattern is still more likely to be protective compared to the prudent dietary pattern, but this pattern did not exist in this study population.
About 3, women who were treated for an early stage of breast cancer have been randomized into two groups. No guidelines were given for animal product intake, and initial results seem to confirm, since there were no changes in body weight, total cholesterol, or LDL cholesterol [ ], which would be affected by animal protein intake. Also, plasma carotenoid concentrations increased significantly in the intervention group, but not in the control group.
It will be very interesting to follow the results of this study. What is the result when all of these things are put together? What if all of these factors reviewed here were taken into account and put into practice? This anticancer diet would have:. As reviewed above, reductions of 60 percent in breast cancer rates have already been seen in human diet studies, and a 71 percent reduction in colon cancer for men without the known modifiable risk factors.
These reductions are without taking into account many of the other factors considered in this review, such as markedly increased fruit and vegetable intake, balanced omega 3 and 6 fats, vitamin D, reduced sugar intake, probiotics, and enzymes — factors which all are likely to have an impact on cancer. Certainly cancer prevention would be possible, and cancer reversal in some cases is quite likely. Google Scholar.
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