Unfortunately, while global sales grew, sales waned in the United States, particularly following negative headlines that perpetuated research suggesting marine oils have no effect on cardiovascular health. Reported by WholeFoods in 2014, GOED estimated that in 2013 sales fell to 2011 levels, a downturn that continued into 2014, with 10–12% drops each month compared to that same time the previous year (3).
Fortunately, it looks like marine oils are bouncing back. In a report published by Grand View Research, the omega-3 market is forecasted to show significant growth, with North America being a significant market, “expected to show high gains over the next seven years mainly in the U.S. on account of rising functional foods & beverages consumption coupled with technological advancements by various key players” (4).
The key words here are “technological advancement.” Ultimately, innovation is what will invigorate marine oil sales by giving old customers an improved product and new customers something to believe in. Here is what you need to know about marine oils and marine oil research as new products hit the shelves and consumer interest piques.
Setting the Record Straight When the media reported on research that found omega-3s to be ineffective for cardiovascular health, many news outlets failed to place the results within context. While research is crucial to further science, particularly within the natural products industry, it can be flawed. At best, a statistically significant finding is only one piece of evidence to add to the pile in an effort to determine what is fact.
Instead, impressionable readers were given headlines that essentially read, “Fish Oil is a Lie!” Many experts were quick to highlight the flawed methodology, namely low doses of EPA and DHA unlikely to produce results in at-risk individuals already deficient in these nutrients. Unfortunately, the damage was done.
Now that marine oils appear to be rebounding, retailers need to prepare to effectively answer the questions of customers looking to understand omega-3s and the recent research. Luckily, a review published in Prostaglandins, Leukotrienes and Essential Fatty Acids details the potential errors made by researchers in those studies and the way future researchers can more effectively conduct trials (5).
Dosage can be a major factor skewing trial results. “The low dosages used in most long chain omega-3 intervention studies are below the range recommended for management of hypertriglyceridemia of 2–4 g/d of EPA + DHA,” say the authors (5). Not only that, but there was also a failure to measure subjects’ baseline omega-3 status to exclude those with high baseline levels. Those with a higher omega-3 profile would not have experienced significant changes, the way someone deficient in omega-3s would have, overshadowing the positive results they may have received.
Another factor to consider is the concurrent use of cardiovascular medications by subjects during the course of a trial. In one study, states the review, “approximately 54% of subjects were taking a statin, 69% were taking an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker, 53% were taking a beta-blocker, and 69% were taking aspirin” (5). Validating this concern, the authors cite a meta-analysis of randomized controlled trials that found a trend toward cardiovascular event reduction from omega-3 supplementation in trials where the subjects are not actively taking lipid-lowering medications (5).
By weighing these factors, future researchers can achieve results that are more accurate.
Sustainability Overfishing is a valid concern for consumers of marine oils and something responsible manufacturers take very seriously. “It starts with transparency,” says Trisha Sugarek MacDonald, B.S., M.S., senior director of research and development and natural education for Sugarland, TX-based Bluebonnet Nutrition Corporation. “It’s about being completely honest with our customers and straightforward and accountable in our actions.” Here’s what you need to know to verify the sustainability of your marine oil inventory.
Fish oil. Like most products these days, third-party certification is the easiest way to determine if a product is responsibly sourced. Conscientious manufacturers maintain strict standards for their crude fish oil suppliers that include compliance with third-party certifications such as Friend of the Sea: Sustainable Seafood Products Certification (FOS), IFFO RS and the Marine Stewardship Council (MSC).
This all starts at the fisheries. Bluebonnet Nutrition Corporation, for example, utilizes the Epax brand of concentrated omega-3 fatty acids for its fish oil products, which predominantly sources its oils from Peruvian anchovies. “The sustainability of the Peruvian anchovy fisheries and marine ecosystem has been ranked best in the world, and in addition, the Government of Peru has made great advances in recent years to assess stock biomass, set appropriate fishing regulations and monitor fish harvests to ensure compliance,” says Sugarek MacDonald.
In addition to all industrial landings being subject to 24-hour, seven days per week monitoring by independent inspectors, fishing is only permitted outside of spawning season and halted when high levels of juveniles are present in the catch. Peruvian authorities also limit by-catch (non-targeted species) to 5% and nets have a minimum mesh size of 0.5 inches with weaves specifically designed for targeting anchovy schools.
Austral Group S.A.A., Epax’s main supplier, was the first South American fishing company to achieve FOS certification for both fishing methods and sustainability requirements. By association, Epax also bears FOS certification as it sources all its concentrates from FOS-certified suppliers. Currently, 80% of the Peruvian fish oil production is FOS certified after Epax worked with the anchovy industry there to support certification.
In terms of processing the raw material, IFFO RS compliance guarantees that factories source their whole fish from fisheries meeting standards of the United Nations Food and Agriculture Organizations Code of Conduct for Responsible Fisheries 1995. This means that any fish by-product is intended for human consumption and facilities responsibly manufacture raw material, segregating compliant and non-compliant material for safety and traceability.
In addition to anchovies, fish oil can also come from sardines and Arctic cod. Green Bay, WI-based EuroPharma, Inc.’s product (Vectomega) utilizes Atlantic salmon, though it is not a fish oil product. “What happens is this: Immediately following the catch, cold water and enzymes are used to produce Vectomega from the heads of the fish, while the body is used for food,” says Cheryl Myers, chief of education and scientific affairs for the firm. This process ensures that there is no waste.
Krill oil. Euphausia superba, small crustaceans found in the Antarctic, are in greater abundance. “The current estimates place the Antarctic krill biomass in the Southern Ocean at around 379 million tons, making it larger than the world’s human population,” says Melody Harwood, director, scientific and regulatory affairs at Neptune Wellness Solutions, Laval, QC, Canada.
While this is certainly a great deal of krill, it is an important source of food for other Antarctic wildlife such as whales, seals and penguins, demanding sustainability in order to preserve other animals. The Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR) regulates krill fisheries as well as other marine fisheries, setting the krill catch limit to 5.6 million tons, which is about 1.48% of the total biomass. However, this limit has never been reached, says Harwood. Only 0.3% of the total quota is harvested on average, amounting to 620,000 tons.
Additionally, less than 5% of this krill is harvested for human consumption, with the rest intended as feed for fish farms, says Eyal Afergan, PhD., vice president of global sales, BioActive Ingredients Nutrition Division, Enzymotec USA, Inc., Morristown, NJ.
Stability Besides sustainability, knowing the supply chain and holding manufacturers to a high standard is crucial for quality control. This ensures that omega-3 supplements are free of pollutants and toxins such as mercury present in some fish populations, as well as freshness. All this makes for not only a safer product, but also a more effective product. “More scrupulous suppliers sell fish oil that is refined and purified, which increases its nutritional value,” says Steve Holtby, president and CEO of Soft Gel Technologies, Inc., Commerce, CA. “The purification process removes other fats that exist in fish, including saturated fat. Natural filtering methods, molecular distillation and careful manufacturing processes help ensure purity—levels of heavy metals, polychlorinated biphenyls (PCBs) and dioxins and other toxic elements.”
Oxidation. With regard to freshness, the main concern is oxidation, something EPA and DHA are highly susceptible to if not properly treated. “Some fish oil products are made with oil from by-products of the fishing industry while others are made from fish harvested specifically for supplement production,” says Holtby. “There is concern that during the by-product process, the oil is not immediately protected from oxidation as it is in the direct process.”One of the real challenges facing the omega-3 industry is getting consumers to take their omega-3 supplements on a daily basis. — Andrew Aussie, The Coromega Company
Heavily oxidated products can be rancid by the time they reach consumers, creating a bad taste that turns them off to fish oil, reducing its effectiveness and, some fear, causing more harm than good by exposing the body to more free radicals. Oxidation can occur from over-exposure to oxygen, light and heat, though the process naturally occurs over time (6).
To determine how oxidation in omega-3 fish oil supplements affects consumer behavior and health, GOED developed a white paper in partnership with the Council for Responsible Nutrition (CRN). Overall, their findings were positive. While a survey found that 11.5% of U.S. consumers cite fishy burps as a barrier for trying fish oil and 18% stopped taking it for that same reason, there is no evidence that “normal usage of omega-3 oils results in adverse health effects due to oxidation” (6).
This was determined after an assessment of EPA and DHA oils commissioned by GOED. Two randomized, double-blind, placebo-controlled trials studying the impact of highly oxidized fish oil and regular fish oil did not find them to induce oxidative stress or influence markers of oxidative stress related to vascular inflammation (6).
Oxidation is most commonly measured by peroxide value (PV), which is the first compound created when polyunsaturated fatty acids oxidize. In their white paper, GOED analyzed oxidation levels in commercial omega-3 supplements tested by them, listed in scientific studies and tested by third parties and found that relatively few tests resulted in high PV. To be specific, out of a total of 2,187 individual tests, only 82 (3.7%) exceeded the limit of 5 meq/mg PV set by GOED and CRN in their voluntary monograph (6).
This voluntary monograph, established in 2002, is set much more stringently than other regulatory authorities. By contrast, the British Pharmacopoeia, European Pharmacopoeia and Australian regulatory authorities set their PV limit at 10 meq/mg. The fact that a majority of commercial products are below this threshold and even meet that of the voluntary monograph is a sign that concerns about oxidation may be exaggerated.
However, the main thing hindering the progress of marine oils is the fishy burps and aftertaste many people find unpleasant. Manufacturers work hard to reign in the fishy taste through their purification processes and defending against oxidation with antioxidants, mimicking the natural processes in the human body (6). They are also developing new processes to improve taste and therefore win over customers new and old.
“One of the real challenges facing the omega-3 industry is getting consumers to take their omega-3 supplements on a daily basis,” says Andrew Aussie, chief operating officer of The Coromega Company, Carlsbad, CA. One way to keep supplementation consistent and consumers coming back is taste. Coromega hopes to solve this problem with its emulsified omega-3 oils that have the consistency of yogurt and are flavored.
“By emulsifying fish oils with citrus and other fruit and other fruit flavorings, people enjoy taking the supplement and tend to stick to their daily regimen better, which also results in better long term health benefits than those that cease their intake simply because they don’t like the taste,” says Aussie.
Biodroga, a division of Neptune Wellness Solutions is taking a similar approach. “We have been working with an external partner in the U.S. to develop flavorful fish oil emulsions via a unique and patented process that provides stability and protection from oxidation of fatty acids for consumption of omega-3s by the spoonful,” says Harwood.
The firm has also successfully developed powdered solutions for fish and krill oils. It “allows for the deodorization, stabilization and incorporation of sensitive liposoluble nutritional ingredients into water-soluble and shelf-stable powders that can be mixed directly in your favorite beverage, yogurt or smoothie,” says Harwood.
By increasing the amount of applications people can incorporate fish oil, compliance becomes easier, less of a chore and more pleasant. Additionally, says Sugarek MacDonald, “Liquid and soft chew formulas are becoming increasingly popular in the marketplace today because they offer better flavor, greater ease of administration and increased compliance.” Krill oil formulators also benefit from removing fishiness from their supplement formulas. Afergan describes a proprietary technology called Multi-Stage Oil Extraction (MSO) that gives their krill “superior organoleptic properties,” which come from “the absence of a molecule called Trimethyl Amine (TMA) which is responsible for the characteristic ‘fishy’ odor.”
Aker BioMarine Antarctic US’s brand new Flexitech technology also has the ability to remove TMA from its krill. ”Flexitech features a unique process that does not involve any form of high temperature treatment such as molecular distillation,” explains Becky Wright, marketing director, Aker BioMarine Antarctic US, Issaquah, WA. “It relies solely on low temperatures and efficient fractionation methods that remove unwanted salts and other polar constituents. Additionally, it does not involve the use of solvents besides ethanol and water.”Offering EPA and DHA in higher concentrations in a form that offers superior absorption helps individuals and health care professionals reduce omega-3 deficiencies more quickly. —Tone Larsen, Nordic Naturals
Potency Besides tackling taste, new technology in fish oil is especially keen on providing higher doses in fewer pills, with greater bioavailability. Manufacturers have different methods of achieving these goals, creating a variety of delivery systems. While one brand will always claim to be better than another, as a retailer you want a variety of efficacious products with delivery formats that meet the spectrum of needs your customers have.
“Oils have a lyophilic (oil loving) nature and must be absorbed by the lymphatic system of the body for optimal absorption and thus, bioavailability,” says Sugarek MacDonald. “Because of their nature, oils need to be taken with a fatty matrix—this can be done with a soft gel, a soft chew (oil based) or an oil liquid product.”
Emulsions like the ones mentioned by Aussie and Harwood, adhere to this idea. “Emulsion technology blends sources of oil and water with compounds that have similar solubility characteristics,” says Aussie. “This process mimics the body’s normal process of digestion and results in improved absorption of EPA and DHA.”
While these new technologies have a great potential to reach new customers with unique flavors, consistencies and applications, soft gels are a format that thrives “because of the extended shelf-life and they are typically free of flavors, sweeteners and additional allergens (ie. corn),” says Sugarek MacDonald. Harwood echoes this sentiment when she says, “They are still an effective delivery format for marine oils, as they allow for higher doses of omega-3s to be delivered without issues related to stability or taste of the oils.”
Companies have also created and continue to develop products that offer higher potencies. “Offering EPA and DHA in higher concentrations in a form that offers superior absorption helps individuals and health care professionals reduce omega-3 deficiencies more quickly,” says Tone Larson, product development manager at Nordic Naturals, Watsonville, CA. “It also means the industry is able to meet the needs of a broader spectrum of people. We are taking advantage of this advanced technology to tailor products to meet personalized nutritional needs.”
So not only do high-potency products fill a need for those whose health demands higher intake of omega-3s, but they also make it easier for those people to fill it. Before, taking more pills was the solution, but now several companies are offering more concentrated oils in smaller soft gels. Nordic Naturals achieves this, says Larsen, by “removing the short-chain fatty acids...then we take the step of putting the oil back to a 90+% triglyceride form (the same form found naturally in fish) for superior absorption.”
Despite these advances and the higher levels of EPA and DHA provided by fish oils, some believe that in their triglyceride form, the absorption of fish oils could be better. This is why some turn to krill oil, which may produce less EPA and DHA content but by being phospholipid bound, provide greater absorption.
Hank Cheatham, vice president of marketing and sales at Daiwa Health Development Inc., Gardena, CA, explains that triglycerides are the form of fat stored by the body to utilize as energy in the future while phospholipids are integral parts of cells and modules of cell membranes. This could give phospholipid-bound omega-3s an advantage by being more readily incorporated in the body to promote cellular function, says Cheatham, while triglyceride-bound omega-3s will be primarily used for energy consumption.
As fish oil manufacturers continue to advance their products to confront any disadvantages, so too are krill manufacturers. Regarding advances in krill oil, says Harwood, “There have been new developments in the manufacturing of krill oil to concentrate the amount of phospholipids…up to approximately 60% compared to krill oils previously available…with levels of phospholipids in the range of 40–42%.”
Aker’s Flexitech, mentioned earlier, not only removes unwanted salts and impurities, but up-concentrates phospholipids and omega-3s to enhance bioavailability. “Flexitech is the cornerstone of Aker BioMarine future development capabilities,” says Wright. “Today, it is producing cleaner krill oils as well as those that are more concentrated. Tomorrow, it could produce oil grades suitable for other applications such as food and cosmetics.”
Enzymotec’s high-potency krill oil (K Real) provides “the same amount of phospholipids and astaxanthin existing in pure krill oil, with more than double the levels of omega-3 in the same small capsule size,” says Afergan. So while some seek to improve phospholipid content, others choose to up the EPA and DHA, similar to fish oil manufacturers.
Other manufacturers have found alternative ways to create bioavailable omega-3 supplements with minimal processing. Vectomega, previously mentioned for its unique and sustainable sourcing methods, is also minimally processed and naturally bioavailable says Myers. “Attached to a phospholipid, [EPA and DHA] maintain their original positions on the carbon chain—a position called sn-2,” says Myers. “Since these omega-3s remain in their original positions on the carbon chain, they are bioidentical—that is, a perfect fit—to the positioning of omega-3 fatty acids in the human brain.” The processing done on other fish and krill oil products affect their carbon chain positions, says Myers.
While there are differing approaches, high-potency formulas are generally good for consumers and public health because they provide more of the essential nutrients while also creating the potential of improved compliance by reducing pill fatigue. Quality manufacturers creating high-potency products each have their redeeming qualities and consumers appreciate variety and choice. Ultimately, people have their preferences.
For example, last month WholeFoods covered plant-based omega-3s, which some consumers preferred because of the minimal processing involved. However, many consumers may not be concerned about the processing and prefer to place their trust in marine oils. Though, even within the marine oil category, there are minimally processed alternatives as demonstrated by EuroPharma. More important than the krill vs. fish oil vs. plant-omega debate is that consumers realize the importance of omega-3s in their diet. For that reason, it is important for the passionate retailers of natural products, such as the one mentioned in this month’s editorial (page 4), to continue educating their customers. Knowledge creates urgency and urgency creates demand. Manufacturers, for their part, will continue to meet this demand, and more importantly innovate, to drive the category forward and keep people coming back.
Reinforcing Health Benefits Consumption of omega-3s has long been associated with good cardiovascular health, but in the United States cardiovascular disease continues to be the leading cause of death. Omega-3 deficiency may be a contributing factor. Omega-3s have also been known to support brain health and inflammatory response, all important health factors that decline with age and require continuous support and management to maintain.
However, recent negative headlines have overshadowed established medical recommendations and research, confusing consumers. For that reason, it’s important to remain updated on current research that casts a positive light on omega-3s and their health benefits. Here are some recent studies that continue to reinforce the importance of omega-3s on human health.Select Marine Oil Products
Aker BioMarine Antarctic US: Superba Krill.
Bluebonnet Nutrition Corporation: Natural Omega-3 Heart Formula, Natural Omega-3 Joint Formula, Natural Omega-3 Brain Formula.
Coromega Company, The: Omega-3 Squeeze (Orange, Tropical Orange+ Vitamin D, Chocolate Orange and Lemon Lime Flavors), Omega-3 Big Squeeze (Lemon, Mango and Tropical Orange+ Vitamin D flavors), Omega-3 Gummies.
Daiwa Health Development Inc.: Daiwa Krill Oil.
Enzymotec: K•REAL, Pure K•REAL, High Potency K•REAL, Omega PC.
EuroPharma, Inc.: Vectomega.
Neptune Wellness Solutions: NKO Original, NKO Beat, NKO Focus, NKO Flex.
Nordic Naturals: Omega One, Ultimate Omega Mini, Ultimate Omega 2X.
Soft Gel Technologies, Inc.: EZMega3.Pregnancy. This past March, a systematic review and meta-analysis published in the European Journal of Obstetrics & Gynecology and Reproductive Biology found that omega-3 consumption significantly reduced the occurrence of preterm birth (8). The study analyzed nine studies amounting to 5,980 women and concluded that the risk of early pre-term delivery (defined as less than 34 weeks) and pre-term delivery (defined as less than 37 weeks) was reduced by 58% and 17%, respectively. It also found that in the experimental groups the mean gestation period was increased by 1.95 weeks and birth weight by 122.1 g (7).
A longitudinal study published in the American Journal of Epidemiology in February analyzed how consumption of high fat fish (rich source of omega-3s) during pregnancy influenced the neurological development of children (8). The study evaluated 1,892 and 1,589 mother–child pairs at ages 14 months and five years, respectively, in a population-based Spanish birth cohort established during 2004–2008. Using Bayley and McCarthy scales as well as the Childhood Asperger Syndrome Test to assess neurological development, researchers found that “consumption of seafood above the recommended limit of 340 g/week was associated with 10-g/week increments in neuropsychological scores” (8).The offspring of women with the highest quartile of fish consumption had an adjusted increase of 2.29 points in McCarthy general cognitive score with similar results observed for the Childhood Asperger Syndrome Test. “Consumption of large fatty fish during pregnancy presents moderate child neuropsychological benefits, including improvements in cognitive functioning and some protection from autism-spectrum traits,” the authors concluded (8).
In an assessment on maternal fish consumption during pregnancy on the neurodevelopment of offspring, the U.S. Food and Drug Administration (FDA) finds that maximum net benefit for children is a mean of three IQ points (9). Unfortunately, currently in the United States, children are only experiencing a benefit of 0.7 of an IQ point, making an argument for the need of greater omega-3 consumption during pregnancy.
Although these studies assessed fish consumption, not supplementation, they definitely have an effect on omega-3 supplementation because while many health professionals recommend eating fish to achieve daily value of omega-3s EPA and DHA, many people fear eating fish, particularly during pregnancy, because of the potential toxins resulting from pollution. By validating the importance of consuming food rich in omega-3, women will be eager to turn to supplementation to meet their dietary needs in a safe and consistent manner.
Mental health. Another meta-analysis of 13 randomized controlled trials, amounting to 1,233 participants, published in March in Translational Psychology found that omega-3 consumption had a beneficial effect on symptoms of major depressive disorder (MDD) (10). After performing a meta-regression, researchers determined that better responses were found in those taking higher doses of EPA and those taking antidepressants at the same time.
Healthcare costs. An article in Lipid Technology outlines the potential impact on healthcare costs if more Americans consumed omega-3s and how this can be achieved by using our current resources of menhaden oil (11). Heart disease is the leading cause of mortality in the United States with cardiovascular disease (CVD) and coronary heart disease (CHD) killing 596,000 and 375,000 people each year, respectively (11). The amount of total direct and indirect costs for these conditions total over $553 billion annually and by 2030 is projected to reach a trillion dollars (11).
A study by global consulting firm, Frost & Sullivan, determined that if all Americans over the age of 55 with CHD consumed the American Heart Association’s recommendation of 1,000 mg of EPA and DHA, nearly $1.7 billion of all hospital costs could be avoided (12). The study does not account for other potential cost savings such as medications or loss in productivity that can impact livelihood. Using Frost & Sullivan’s model, the author states that this could be achieved by using the U.S. annual menhaden oil supply of 74,700 metric tons. This would be enough to supply the deficient population and still have plenty left over for other purposes such as feed for farmed salmon.
The true impact here is the potential for better human health, though unfortunately, economics are often a more effective motivator. The article is entirely speculative, of course, as compliance by the at-risk population is difficult to guarantee, but the idea that it is possible, that we have the resources and it could help people on multiple levels, is highly significant.
A great deal of current research helps reinforce the importance of omega-3 consumption and makes the argument for further, more specific research on how omega-3s benefit human health. Most importantly, by providing your customers with the available data, they are able to come up with their own conclusions, rather than accept the outcomes of a few publicized, yet flawed studies. WF
References
- “Use of Complementary Health Approaches in the U.S.: Most Used Natural Products,” https://nccih.nih.gov/research/statistics/NHIS/2012/natural-products/omega3, accessed 6/24/2016.
- “Use of Complementary Health Approaches in the U.S.: Trends in Natural Products” https://nccih.nih.gov/research/statistics/NHIS/2012/natural-products/trends, accessed 6/24/2016.
- K. Chiarello-Ebner, “Keys for Reeling in Omega-3s Sales,” WholeFoods Magazine. www.wholefoodsmagazine.com/supplements/features-supplements/keys-reeling-omega-3s-sales, accessed 6/24/2016.
- Grand View Research, “Omega 3 Market Analysis by Application (Supplements & Functional Foods, Pharmaceuticals, Infant Formula, Pet & Animal Feed) And Segment Forecasts To 2022,” www.grandviewresearch.com/industry-analysis/omega-3-market?gclid=CNa3wPu8wc0CFUpahgodXtMINg, accessed 6/23/2016.
- H.B. Rice, et al., “Conducting Omega-3 Clinical Trials With Cardiovascular Outcomes: Proceedings of a Work Shop Held at ISSFAL 2014,” Prostaglandins, Leukotrienes and Essential Fatty Acids. 107: 30-42 (2016).
- Global Organization for EPA and DHA Omega-3s and the Council for Responsible Nutrition “Oxidation in Omega-3 Oils: An Overview,” (2014).
- S. Kar, et al. “Effects of Omega-3 Fatty Acids in Prevention of Early Preterm Delivery: A Systematic Review and Meta-analysis of Randomized Studies,” Eur. J. Obstet. Gynecol. Reprod. Biol. 19, 40-46. (2016).
- J. Julvez, et al., “Maternal Consumption of Seafood in Pregnancy and Child Neuropsychological Development: A Longitudinal Study Based on a Population with High Consumption Levels,” Am. J. Epidemiol. 183 (3), 169–182 (2016).
- U.S. Food and Drug Administration, “A Quantitative Assessment of the Net Effects on Fetal Neurodevelopment From Eating Commercial Fish (As Measured by IQ and also by Early Age Verbal Development in Children),” (2014).
- R.J. Mocking, et al. “Meta-Analysis and Meta-Regression of Omega-3 Polyunsaturated Fatty Acid Supplementation for Major Depressive Disorder,” Transl. Psychiatry 6 (3), e756 (2016).
- D.M. Bibus, “United States Menhaden Oil Could Save Billions in U.S. Health Care Costs and Improve IQ in Children,” Lipid Technol. 28 (2), 33–35 (2016).
- Frost & Sullivan, “Smart Prevention—Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements,”(2014).
