Monthly Archives: December 2011

2011 in Review: Top Posts

Posted by on December 31, 2011 15 comments

It’s been a great year for us, full of fun and learning. In this last post of 2011 I’ll review the year’s most interesting posts. Early next week, I’ll add a few more thoughts about 2011 and preview our plans for 2012.

But first let me give a shout out to Stabby Raccoon’s “Guide to Binge Drinking,” at the new group blog “Highbrow Paleo.” If you plan to drink alcohol on New Year’s Eve, either for pleasure or to raise your HDL, you might want to look up Stabby’s advice.

The Puzzle of High LDL on Paleo

One of the more interesting puzzles we delved into this year was the problem of high LDL on Paleo.

Reader Larry Eshelman had this problem, and gathered a large number of examples of low-carb Paleo dieters with high LDL: Low Carb Paleo, and LDL is Soaring – Help!, Mar 2, 2011. We suggested a possible remedy – repairing deficiencies in micronutrients known to be crucial to vascular function – in Answer Day: What Causes High LDL on Low-Carb Paleo?, Mar 3, 2011.

That remedy worked for Larry, and we’ll do an update on his case soon. But it wasn’t the whole story, and later in the year we looked at another cause of high LDL on Paleo – low thyroid hormone levels – in High LDL on Paleo Revisited: Low Carb & the Thyroid, Sep 1, 2011. Going too low-carb causes a reduction in T3 thyroid hormone levels, which leads to inactivation of LDL receptors and potentially large increases in LDL levels. Gregory Barton shared his case history.

Blood Lipids as Diagnostic Tools

We were also led to think about blood lipids because lipoproteins are immune molecules of considerable importance in fighting infectious diseases. We talked about the immune functions of HDL in HDL and Immunity, Apr 12, 2011, and HDL: Higher is Good, But is Highest Best?, Apr 14, 2011. We talked about the immune functions of LDL, VLDL, and Lp(a) in Blood Lipids and Infectious Disease, Part II, Jul 12, 2011.

With help from blogger O Primitivo, we looked at what serum lipid levels optimize health in Blood Lipids and Infectious Disease, Part I, Jun 21, 2011. It’s higher than most think: TC between about 200 and 240 mg/dl is optimal.

We discussed ways to improve immune function by raising HDL in How to Raise HDL, Apr 20, 2011.

Don Matesz objected that newborns have very low serum cholesterol, so we looked at Low Serum Cholesterol in Newborn Babies, Jul 14, 2011. Breast-fed babies achieve normal serum cholesterol of about 200 mg/dl at age six months, which is also when their immune function normalizes.

Another objection was based on the claim by Paleo pioneers Boyd Eaton and Loren Cordain that hunter-gatherers had low serum cholesterol. That led us to a number of posts: Did Hunter-Gatherers Have Low Serum Cholesterol?, Jun 28, 2011; Serum Cholesterol Among the Eskimos and Inuit, Jul 1, 2011; Serum Cholesterol Among African Hunter-Gatherers, Jul 5, 2011; Serum Cholesterol Among Hunter-Gatherers: Conclusion, Jul 7, 2011. The upshot: healthy hunter-gatherers had normal serum cholesterol, with TC usually over 200 mg/dl. The cases of low serum cholesterol were either in stale samples collected from remote sites in the 1930s to 1950s without use of refrigeration and delays of weeks to months in measurement, or from hunter-gatherers with high rates of infectious disease from parasitic protozoa or worms.

This literature survey led us to the belief that there are really only two common causes for low total serum cholesterol (not counting statin consumption): eating a lipid deficient diet, such as a macrobiotic diet; or having an infection with a eukaryotic pathogen.

This means that anyone eating a high-fat diet who has low serum cholesterol should get checked out for eukaryotic infections, probably protozoa or worms. We’ve encouraged half a dozen people or so to do this.

Brendan is a great example. He first left a comment in May asking for advice:

I have rosacea, puffiness in my cheeks, post-nasal drip, frequent headaches, severe constipation (IBS), hypothyroidism, extremely low cholesterol, and a variety of neuropsychiatric symptoms (depression, anxiety, insomnia, and cognitive and motor problems).

“Extremely low cholesterol” is the tell-tale clue. He reported back in December: he did indeed have whipworm and entamoeba infections, and is now seeking treatment.

I like this story because it is a great example of what we’re trying to achieve on this blog. Diet, nutrition, and infections interact to product one’s health; we want to understand how to troubleshoot any problems. I’m excited that blood lipids are turning out to be good diagnostic markers for certain types of infection that are often overlooked.

The Challenge of Obesity

Our diet was designed to help people become healthy; it was not designed as a weight loss diet. Nevertheless, Shou-Ching and I were well aware of the failure of most weight loss diets to cure obesity – rather they tend to produce temporary weight loss followed by yo-yo weight regain – and we strongly suspected that a diet designed for general health might be the best strategy for long-term weight loss. So entering 2011, we were very curious how our diet would work for people trying to lose weight.

From Atkins to the Dukan Diet, recently embraced by Kate Middleton, popular diet books generally recommend high protein consumption, which seems to be very effective at promoting short-term weight loss. A few posts explored the place of protein in a weight loss diet, and whether there are alternatives to high protein: Protein, Satiety, and Body Composition, Jan 25, 2011; Low-Protein Leanness, Melanesians, and Hara Hachi Bu, Jan 27, 2011.

A few people who transitioned to our diet from very low-carb diets noticed an immediate gain of 3 to 5 pounds. This caused us to look into the issue of water weight: Water Weight: Does It Change When Changing Diets? Does It Matter?, Jan 14, 2011.

We also did a bit to link obesity to our favorite causes of disease – malnutrition, toxins, and infections – in Why We Get Fat: Food Toxins, Jan 20, 2011. Another post along this line was Obesity: Often An Infectious Disease, Sep 20, 2010.

Losing weight is especially hard for post-menopausal women, especially if they can’t exercise. Calorie needs may be as low as 1500 calories per day, making it hard to be well nourished on a calorie-restricted diet. The case of erp, a 76-year-old women with bad knees who needed to lose weight for knee replacement surgery, led us to clarify where the calories should come from when few can be eaten: Perfect Health Diet: Weight Loss Version, Feb 1, 2011.

We were happy that erp did indeed lose weight, dropping from size 16 to size 6. Another impressive case of weight loss was recorded by Jay Wright, who started our diet in March at 250 pounds and reached his goal weight of 170 pounds in October. Jay generously shared his story: Jay Wright’s Weight Loss Journey, Dec 1, 2011.

Stephan Guyenet, one of the finest diet and nutrition bloggers, introduced us to “food reward” and to the role in obesity of the brain modules that manage appetite and energy homeostasis. He had a back-and-forth with Gary Taubes over their differing views. I chimed in on a few occasions, notably in Gary Taubes and Stephan Guyenet: Three Views on Obesity, Aug 11, 2011, and Thoughts on Obesity Inspired by Stephan, Jun 2, 2011.

The Guyenet-Taubes debate gave me an opportunity to present a figure from a classic study by Maria Rupnick and colleagues. Giving or withholding an angiogenesis inhibitor causes ob/ob (obesity prone) mice to cycle between obese and normal weight:

It is hard to see how either a brain-centric view or a carb-and-insulin-centric view can account for this. I see this data as testimony to the complexity of biology.

I’m going to be developing my own theory of obesity in 2012; I previewed this theory in my talk at CrossFit NYC on November 19. One element was the subject of a 2011 post: How Does a Cell Avoid Obesity?, Jan 18, 2011. Leptin resistance and insulin resistance – two of the hallmarks of obesity – are symptoms of the disease of obesity, not its cause.

Therapeutic Ketogenic Diets

Ketogenic diets are potentially highly beneficial to neurological function, and are an under-utilized therapy for neurological conditions.

One reason they’re under-utilized is that clinical ketogenic diets have been poorly designed and malnourishing. We discussed how to make a diet ketogenic while minimizing health risks in Ketogenic Diets, I: Ways to Make a Diet Ketogenic, Feb 24, 2011, and Ketogenic Diets 2: Preventing Muscle and Bone Loss on Ketogenic Diets, Mar 10, 2011.

But the goal is to demonstrate that ketogenic diets can be therapeutic for various conditions. We had several great stories from people trying our version of the ketogenic diet.

Kate was able to relieve migraines and anxiety: A Cure for Migraines?:, Mar 29, 2011.

In a poignant story, we learned about a genetic disorder called NBIA (Neurodegeneration with Brain Iron Accumulation). Children with this disorder develop extremely painful muscle spasms and are usually in agony from around age 6, before dying in their teens. It turns out that a ketogenic diet effectively prevents the spasms and pain. Two parents of NBIA children shared photos of their kids in Ketogenic Diet for NBIA (Neurodegeneration with Brain Iron Accumulation), Feb 22, 2011. From being in constant pain, the boys had gone to “smiling and laughing all the time”:

Hypothyroidism

Thanks to our resident expert on hypothyroidism, Mario Renato Iwakura, we had a number of excellent discussions of how to optimize diet and nutrition for hypothyroidism.

First, Mario defended our support of selenium and iodine supplementation in cases of hypothyroidism, including Hashimoto’s autoimmune hypothyroidism, with a thorough review of the literature: see Iodine and Hashimoto’s Thyroiditis, Part I, May 24, 2011, and Iodine and Hashimoto’s Thyroiditis, Part 2, May 26, 2011. It is crucial to get selenium in the range 200 to 400 mcg per day, and to avoid an iodine deficiency. With optimal selenium, a wide range of iodine intakes are healthy, including quite high iodine intakes.

Later in the year, readers asked us to address claims by Anthony Colpo that low-carb diets would lead to “euthyroid sick syndrome,” a condition of low T3 thyroid hormone. We found support for that idea, but only for “very low-carb” diets, ie those with carbs below 200 calories per day (more in athletes or those with inadequate protein intake). Thyroid problems were also exacerbated when omega-6 fat intake was high. A literature search was unable to find instances of thyroid problems on low omega-6 and adequate carb diets. The main posts: Low Carb High Fat Diets and the Thyroid, Aug 18, 2011; Carbohydrates and the Thyroid, Aug 24, 2011; Mario Replies: Low Carb Diets and the Thyroid, II, Aug 30, 2011.

This was a useful discussion, as it led us back to the problem of high LDL on Paleo due to low T3 thyroid hormone levels caused by very low carb consumption.

The Place of Starches in a Paleo Diet

Given that some carbs should be eaten, what form should they take? There are two main food types of carbohydrate, sugars and starches.

I was surprised by the vehement opposition to starch consumption displayed by many low-carb advocates polled by Jimmy Moore in October. Most low-carb diets support the eating of sugary fruits and vegetables, and I would have thought that opposition to starches would be no greater than opposition to sugars. How wrong I was!

My original reply to the many low-carb gurus polled by Jimmy can be found here: Jimmy Moore’s seminar on “safe starches”: My reply, Oct 12, 2011. A week later I added a discussion of why the glycemic index or starches doesn’t matter when they are eaten the way we advise eating them: How to Minimize Hyperglycemic Toxicity, Oct 20, 2011. Dr Ron Rosedale enthusiastically continued the conversation, and I replied to Ron: Safe Starches Symposium: Dr Ron Rosedale, Nov 1, 2011.

Shortly afterward I spoke at the Wise Traditions conference of the Weston A Price Foundation – a great meeting! – and was asked about the GAPS diet of Dr. Natasha Campbell-McBride. It is an excellent diet which embodies a lot of clinical lore about how to heal gut dysbiosis, but its recommendation to avoid starches, while usually helpful, is not always the best course. There are pathogens capable of exploiting every human ecological niche and diet, including very low-carb or fructose-containing diets, and so there is no one diet that is perfect for every patient. Some cases of gut dysbiosis actually benefit from added starch. There seemed to be a bit of controversy about what I said, and I clarified my off-the-cuff comments here: Around the Web; Revisiting Green Meadows Farm, Dec 3, 2011.

Infectious Diseases

I thought I was going to blog a lot more about infectious diseases in 2011, but didn’t get around to it. Still, I got started in February with a few posts: They’ve Got Us Surrounded, Feb 8, 2011; Jaminet’s Corollary to the Ewald Hypothesis, Feb 11, 2011; and Evidence for Jaminet’s Corollary, Feb 15, 2011.

Circadian Rhythm Therapies

I’ve known for a long time that circadian rhythms were important for health. Disruption of circadian rhythms, for instance, by night shift work, is associated with higher rates of disease.

What I didn’t know, until I began to read Seth Roberts, is that simple dietary and lifestyle tactics can have a big impact on circadian rhythms. Seth Roberts and Circadian Therapy, Mar 22, 2011, looks at Seth’s work; “Intermittent Fasting as a Therapy for Hypothyroidism,” Dec 1, 2010, applies circadian rhythm therapies to hypothyroidism.

Cancer

We made a start toward discussing how to eat if you have cancer in two posts: Toward an Anti-Cancer Diet, Sep 15, 2011, and An Anti-Cancer Diet, Sep 28, 2011. Cancer is another disease in which circadian rhythm therapies seem to be important.

However, there’s much more to be said about cancer. We’ll probably discuss HDAC inhibition and anti-viral dieting in 2012.

Miscellaneous Disorders

Check out the “Diseases” categories in our Categories list for other disorders we’ve blogged about. A few items from 2011: Causes and Cures for Constipation, Apr 4, 2011; An Osteoarthritis Recovery Story, May 17, 2011; Around the Web; and Menstrual Cramp Remedy, Mar 5, 2011.

A Year of Food

In 2011, we decided to write a cookbook, and made an earnest start by posting a recipe once a week. Some of our favorite food posts:

Ox Feet Broth, Miso Soup, and Other Soups, Jan 2, 2011

Homemade Seasoned Seaweed, Jan 9, 2011

About Green Tea, Jan 30, 2011

Dong Po’s Pork, Feb 13, 2011

Pho (Vietnamese Noodle Soup), Feb 27, 2011

Pacific Sweet and Sour Salmon, Apr 10, 2011

Crème Brûlée, May 29, 2011

French Fried Potatoes and Sweet Potatoes, Jul 17, 2011

Chicken Wings, Sep 19, 2011

Sarah Atshan’s Lovely Food, Sep 11, 2011

Bi Bim Bap, Oct 16, 2011

Fermented Mixed Vegetables, Nov 27, 2011

Bengali Fish Curry (Machher Jhal), 2: The Recipe, Dec 27, 2011

Art

Shou-Ching wanted to be an artist but settled for being a scientist. This year she began to share some of her art work. We showed some of her paintings in Thank You From Shou-Ching, April 24, 2011, and her Photo Art appears weekly in our Around the Web posts. A complete compilation can be found on the Photo Art page.

Cute Animals

There were too many cute animals in the Around the Web posts to pick a favorite; but here’s one of my favorite places – Logan Pass, Glacier National Park, Montana:

Conclusion

It was a delightful year for us. We made a lot of new friends. Best of all, our diet seems to have improved the health of hundreds, maybe thousands, of people – often dramatically.

We wish all of our readers a very happy New Year! May all of us enjoy improved health in the year to come.

Congratulations Marc and Kelly!!!

Posted by on December 27, 2011 4 comments

Marc Van Dam and his fiancée Kelly have had a very merry Christmas:

Congratulations Marc and Kelly! May 2012 be your best year ever!

Bengali Fish Curry (Machher Jhal), 2: The Recipe

Posted by on December 27, 2011 19 comments

Dr. Shilpi Bhadra Mehta is a Doctor of Optometry, a Board Member of the Archaeological Institute of America, and leader of the Boston Paleo group, Living Paleo in Boston. I asked her to tell us about Indian cuisine, and she offered a discussion of Bengali Fish Curry. We’re doing it in two parts: first, a discussion of its health benefits; second, a recipe with pictures. — Paul

This recipe for Bengali Fish Curry provides 6-8 servings. It will be good up to 5 days in the fridge after cooking. Keep the skin on the fish if it’s wild!

Ingredients

2 pounds fillet or steak of wild fish with skin-in (preferably a high Omega 3 fish like salmon)

1 Large Onion, diced or sliced

3 Tablespoons Ginger Paste (Don’t use if taking warfarin, blood thinners, or have gallstones)

2 Teaspoons Kalo Jeera/Kalonji/Nigella Seeds (available in South Asian grocery stores)

Macadamia Nut Oil

Turmeric powder

Juice of Half a Lemon or 1 Small Lime

1 Cup chopped fresh Cilantro

1 Teaspoon Sea Salt (more can be added to taste by the individual)

Optional:

2 medium Vine Ripe Tomatoes, chopped

1 Green Chili Pepper

1 Teaspoon Red Chili Powder/Cayenne /(Paprika for less heat)

Preparation:

Sprinkle turmeric and salt lightly over both sides of the fish (but not the side with skin if your fish has it). Squeeze the juice of half a lemon/lime on the fish (but not the side with skin if your fish has it). Let it marinate on the counter for 15 minutes, or longer in the fridge for up to 2 days.

Sautéing the Fish:

1) Heat oil in a pan at medium to medium-high heat (depending on your stove). The oil should be sizzling but not smoking. If oil is too cool or the pan gets dry then the fish might break or stick to the pan. Slide fish pieces carefully into hot oil, in a single layer placing them flat.

2) Sauté fish about 2 min to a light brown on each side and flip only once. Do not fry to a dark brown, or they can become stiff and chewy. Then set the fish pieces on a plate.

Making the Sauce/Curry:

1) Heat the remaining oil in the pan to the same temperature as before. Add more oil if necessary – do not let your pan get dry or the fish will stick! Add the Nigella/Kalonji seeds.

2) When the seeds sizzle, add the onion in and fry for 2 – 3 minutes till they get translucent.

3) Stir in the chili, tomato and the ginger, and continue to cook about another 3-5 minutes till the tomatoes become soft and start to break up.

4) Pour in about 2 cups water, and return fish to pan and place them in a single layer, with the skin surface touching the pan. Add fresh cilantro, cover the pan, turn down heat and let simmer for about 10-15 minutes until fish is cooked, and then turn off heat.

5) Enjoy with rice cooked in butter or ghee (you can top with ghee or butter, too) and a vegetable of choice (in this case it was bok choy) for a Perfect Health meal!

Bengali Fish Curry (Machher Jhal), I: Health Benefits

Posted by on December 26, 2011 16 comments

Dr. Shilpi Bhadra Mehta is a Doctor of Optometry, a Board Member of the Archaeological Institute of America, and leader of the Boston Paleo group, Living Paleo in Boston. I asked her to tell us about Indian cuisine, and she offered a discussion of Bengali Fish Curry. We’ll do it in two parts: first, a discussion of its health benefits; second, a recipe with pictures. — Paul

My husband, Amit, grew up in a vegetarian family and never cared much for fish. But when he went Paleo for health reasons he fell in love with this traditional Bengali recipe, so I make it almost weekly! Bengal is part of India and Bangladesh, it is the home of Bengal tigers, but it is most famous for eating and cooking fish.

When Amit and I first tried Paleo we had some minor setbacks, but our experience improved wonderfully on the Perfect Health Diet version of Paleo so we are grateful for the Jaminets’ wonderful book and website. Amit and I are organizers of the Boston Paleo Meetup Group, and hosted a great potluck and lecture by the Jaminets in October 2011. It’s a pleasure to give back by providing a Perfect Health Diet recipe for you!

Health Benefits of Fish Oil, Ginger, and Turmeric

I’m a practicing optometrist and recommend that all my patients regardless of age or health (except those on blood thinners or a week before surgery) eat about a pound of oily fish per week (about 4-5 servings) like wild salmon, sardines, and sablefish (black cod). For those resistant to eating fish, I recommend fish oils (about 1-3 grams total/day depending on age and health). Fish is great for the whole body – especially the heart, brain, and eye!

There are many health benefits to the omega-3 fatty acids in oily fish. They:

  • Exercise anti-inflammatory effects throughout the body.
  • Help with brain and mental issues such as ADHD, autism spectrum disorders, anxiety, depression (including prenatal and postpartum), mood, cognition, Huntington’s disease, bipolar, schizophrenia, etc.
  • Help prevent and reduce age related macular degeneration (AMD/ARMD – a blinding eye disease) even in those with a strong genetic history.
  • Improve cardiovascular health in aspects such as blood pressure, circulation, triglycerides, VLDL, heart attacks, and stroke.
  • May improve immune function, rheumatoid arthritis, and insulin sensitivity.

The long-chain omega 3s EPA (Eicosapentaenoic acid) and DHA (Docasahexaenoic acid) are especially important. DHA is the most common Omega 3 in the brain and the retina – the neural part of the eye that senses light, and part of the central nervous system (CNS)! About 60% of the polyunsaturated fatty acids (PUFA) in the retina are from DHA, and 40% of the brain’s PUFA is DHA. Low levels of DHA are associated with senility, depression, and suicide risk.

DHA is also important for sperm and erythrocytes (red blood cells). In the often blinding eye disease Retinitis Pigmentosa (RP), RP patients compared to normals had far lower DHA in blood and sperm. The RP patients had fewer and lower quality sperm. Since DHA is found in many tissues, the abnormalities in one tissue may share a similar biochemical cause as in other tissues.

The best and most easily absorbed source of omega-3 fatty acids is wild fish. EPA and DHA are most abundant in oily fish and in the breast milk of women who consume fish. Algae, pastured/grass-fed animals, and pastured dairy and eggs from grass-fed animals are other possible sources.

The body can convert some ALA (alpha linolenic acid) found in plants such as flax and chia into EPA and DHA, but this conversion is often poor – as low as 0.05-15% in healthy humans and worse in older people and those with some medical conditions! ALA has not shown the cardiovascular improvements of fish oil.

Although I typically recommend 1-3 grams of fish oil/per person a day for dry eye and other health issues, I cannot recommend the amounts of flaxseed that would be needed to deliver equivalent amounts of omega-3s. In flaxseed this would require 6-60 grams/per person a day which might cause diarrhea, intestinal blockage, nausea, constipation and other GI side effects.

I cannot recommend flaxseed also for women due to estrogenic effects that could negatively affect hormonal conditions like PCOS, endometriosis, fibroids, or any reproductive cancers. I believe flaxseed should be avoided in women of childbearing age – especially pregnant and breastfeeding women – since in animal studies and some human epidemiological studies it has been associated with preterm birth. In rodent studies flaxseed affected menstrual cycle, lowered birth weight, and altered reproduction in offspring including infertility.

In addition to oily fish, Bengali Fish Curry provides healthy plant foods such as onion, ginger, turmeric, and lemon/lime.

Ginger may help improve mood since it affects serotonin receptors. It helps with nausea from morning sickness, chemotherapy, and seasickness. Ginger also may have some antimicrobial properties. In animal studies it prevents skin cancer, kills ovarian cancer cells, and reduces diabetic complications such as cataracts.

Turmeric has anti-oxidant, anti-inflammatory, antimicrobial, and antitumor properties. A component known as curcumin has been shown to help cancer, osteoarthritis, Alzheimer’s disease, pancreatitis, psoriasis, and some infections.

There are so many benefits to Bengali Fish Curry, and probably more will be discovered in time – that is why I recommend it!

Selected References

Wikipedia also has a good introduction to each.

Ginger

Ernst and Pittler. Efficacy of Ginger for Nausea and Vomiting: A Systemic Review of Randomized Clinical Trials. British Journal of Anaethesia. 2000. 84 (3) 367-371. http://bja.oxfordjournals.org/content/84/3/367.full.pdf+html

Kato et al. Inhibitory Effects of Zingiber officinale Roscoe Derived Components on Aldose Reductase Activity in Vitro and in Vivo. Journal of Agricultural and Food Chemistry. 2006. 54 (18), 6640-6644. http://pubs.acs.org/doi/pdfplus/10.1021/jf061599a

Turmeric/Curcumin

Frautschy et. al. A Potential Role of the Curry Spice Curcumin in Alzheimer’s Disease.” Current Alzheimer Research. 2005. Apr; 2(2): 131-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702408/pdf/nihms3585.pdf

Rajasekaran, Sigrid. Therapeutic Potential of Curcumin in Gastrointestinal Diseases. World Journal Gastrointestinal Pathophysiology. 2011 February 15; 2(1): 1–14. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097964/?tool=pubmed

Omega 3 Fatty Acids/DHA/EPA/Flaxseed

Amminger et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Archives General Psychiatry. 2010 Feb;67(2):146-54. http://www.eiyh.org.uk/silo/files/fatty-acids-for-indicated-prevention.pdf

Tou et al. “Flaxseed and Its Lignan Precursor, Secoisolariciresinol Diglycoside, Affect Pregnancy Outcome and Reproductive Development in Rats.” Journal of Nutrition. 1998 Nov;128(11):1861-8. http://jn.nutrition.org/content/128/11/1861.long

Ho et al. Reducing the genetic risk of age-related macular degeneration with dietary antioxidants, zinc, and ?-3 fatty acids: the Rotterdam study. Archives Ophthalmology. 2011 Jun;129(6):758-66. http://www.ncbi.nlm.nih.gov/pubmed/21670343

Barker et al. Nutritional manipulation of primate retinas, V: effects of lutein, zeaxanthin, and n-3 fatty acids on retinal sensitivity to blue-light-induced damage. Investigative Opthalmology & Visual Science. 2011 Jun 6;52(7):3934-42. Print 2011 Jun. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3175953/pdf/z7g3934.pdf

Wong et al. Prevention of age-related macular degeneration. International Ophthalmology. 2011 Feb;31(1):73-82. Epub 2010 Sep 23. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021198/pdf/10792_2010_Article_9397.pdf

Wang et al. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. American Journal of Clinical Nutrition. 2006 Jul;84(1):5-17.

Brenna et al. alpha-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans. Prostaglandins Leukotrienes Essential Fatty Acids. 2009 Feb-Mar;80(2-3):85-91. http://www.ncbi.nlm.nih.gov/pubmed/19269799

Connor et al. Sperm Abnormalities in Retinitis Pigmentosa. Investigative Ophthalmology & Visual Science. November 1997 vol. 38 no. 122619-2628. http://www.iovs.org/content/38/12/2619.long