lena burri, ph.d krill oil

Lena Burri, Ph.D

KRILL OIL CONCENTRATEThe phospholipid factor that sets krill oil apartThe next generation Omega-3 Phospholipid product from Antarctic krill

2 KRILL OIL CONCENTRATE

To effectively maintain our bodily functions and to keep cells and body in balance,

we need a continuous supply of nutrients. Whereas in diseased conditions, it is also

important to address the fluctuations often seen in nutrient uptake and utilization.

There is excitement and growing evidence surrounding krill oil as an important nutrient

based on its major components:

• Long-chain omega-3 fatty acids (EPA/DHA)

• Phospholipids and specifically its choline via its phosphatidylcholine- “lecithin”

component

Krill oil is unique in that it is a combination of these naturally occurring

nutrients. And when ingested, it delivers EPA/DHA, phospholipids, and

choline to the body, where they work individually and in combination; i) as vital

constituents in the structure and functioning of cells, ii) for assisting in the balancing of

bodily functions, and iii) to address their deficiencies in health conditions related to the

heart, brain, inflammation, immunity, liver, etc.

Omega-3 fatty acids are one of the most recognized and studied compounds with more

than 20.000 scientific papers published. Research has shown that when omega-3 fat-

ty acids from marine sources, such as fish and krill, are ingested, they incorporate into

cells to affect cell structure and function. Unlike fish oil, krill oil not only delivers EPA

and DHA, but also phospholipids into cells, where they also exert their effects on re-

modeling cells’ structures, fluidity, and functions. With this, and their ability to affect

cholesterol metabolism, phospholipids may trigger downstream pathways and mecha-

nisms into meaningful health benefits.

This book identifies some of the research that addresses several of these pathways

and mechanisms important for conditions of e.g. the heart, brain, and liver. It details

Foreword


the above-mentioned aspects of krill oil, its components, and how science and research

points to its beneficial health effects while drawing comparisons to fish oil where

applicable.

The latest product development from Antarctic krill is also introduced. It is a highly

concentrated and purified product developed on the premise that a higher omega-3

phospholipid concentration may deliver better health benefits across various health

conditions than its predecessors. Thus, the next generation omega-3 phospholip-

id product is a krill oil concentrate with more omega-3 fatty acids being efficiently

delivered to tissues via more phospholipids high in choline.

Lena Burri, Ph.DAker BioMarine Antarctic AS

Oslo, Norway


Lena Burri, Ph.D

Lena Burri, Ph.D. has been involved in fundamental re search, has published

peer-reviewed articles in leading journals, and contributed review articles, as

well as book chapters on subjects including omega-3 fatty acids. Lena earned her

Master of Science from the University of Ba sel (Switzerland) and her Ph.D. at the

Ludwig Institute for Cancer Research (Switzerland). Her post-doctoral educa tion

included stays at Melbourne University (Australia), University of British Columbia

(Canada), and University of Bergen (Norway). She now works as R&D Director for Aker

BioMarine Antarctic AS.

ISBN: 978-82-690452-0-8All rights reserved. No part of this book may be reproduced in any form or by any means electronic or mechanical, including photocopying, recording or by any information storage and retrieval system without permission in writing from the copyright holder and the publisher.


Summary

• Krill oil is extracted from Antarctic krill.

• Antarctic krill lives in the Southern Ocean around Antarctica.

• The Convention of the Conservation of Antarctic Marine Living Resources (CCAMLR), an international treaty, regulates krill harvesting in a sustainable way. In Area 48 in the Southern Ocean, which is the only area where krill fisheries can operate, the krill industry is allowed to catch one per cent of the estimated 60 million tons of krill.

• Krill oil is rich in omega-3 phospholipids and therefore a good source o f both omega-3 fatty acids and choline from the phospholipid head group.

• What differentiates krill oil from fish oil is the molecular form, in which the omega-3 fatty acids are bound to, namely phospholipids in krill oil and triglycerides in fish oil.

• The long-chain omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) promote healthy heart, brain and visual function and contribute to reducing and maintaining normal levels of inflammation, blood triglycerides, and blood pressure.

• Choline is vital for many biological functions (e.g. membrane structure, nerve signaling, methylation reactions, lipid transport, etc.) and deficiency can lead to fatty liver, muscle damage, atherosclerosis, etc.

• The typical Western diet contains inadequate amounts of omega-3 fatty acids and choline. This contributes to the approximately 90% of the American population who are deficient in omega-3 fatty acids and choline [1,2]. • Krill oil supplementation can help to increase levels of omega-3 fatty acids and choline in the body, thus reducing the deficiencies of these important nutriments.

• Several clinical studies have shown health benefits for supplementation with krill oil.


Table of Contents

Summary ............................................................................................5Krill background ................................................................................8Krill oil concentrate ..........................................................................11 Latest krill oil studies .....................................................................................15

Sport .................................................................................................................15

Skin ....................................................................................................................18

Phospholipids ....................................................................................22 What is a phospholipid? .................................................................................22

Functions of phospholipids in the body .................................................23

Cell membranes ...........................................................................................23

Lipid transport and cholesterol metabolism...................................24

Uptake of phospholipids ...............................................................................26

Phospholipid sources .....................................................................................26

Phospholipid deficiency ................................................................................27

Phospholipids in health and disease .......................................................27

Liver ..................................................................................................................27

Brain .................................................................................................................30

Choline................................................................................................31 What is choline? ................................................................................................31

Functions of choline in the body ................................................................32

Nerve signaling ............................................................................................32

Cell signaling .................................................................................................32

Methyl donor .................................................................................................32

Water balance ..............................................................................................33

Uptake of choline salt versus phosphatidylcholine ..........................33


Choline deficiency ...........................................................................................34

Choline in health and disease ......................................................................35

Brain .................................................................................................................35

Sport .................................................................................................................36

Omega-3 fatty acids ..........................................................................37 What are omega-3 fatty acids? ..................................................................37

Functions of omega-3 fatty acids .............................................................37

Membranes ....................................................................................................38

Gene transcription and enzyme activity ...........................................38

Eicosanoids ...................................................................................................39

Endocannabinoids ......................................................................................39

Omega-3 deficiency ..........................................................................40Omega-3 fatty acids in health and disease ....................................41 Heart ................................................................................................................41

Brain .................................................................................................................42

Krill oil: Phospholipids, choline, and omega-3 fatty acids all in one ...................................................44 Why krill oil? .......................................................................................................44

Uptake of krill oil in the body ......................................................................45

Krill oil in health and disease .......................................................................46

Omega-3 Index .............................................................................................46

Conclusion ..........................................................................................51Acknowledgements ...........................................................................51References .........................................................................................52


Euphausia superba (E. superba) is the scien-

tific name for ‘Antarctic krill’.

The shrimp-like crustaceans from the Eu-

phausiacea family are commonly referred

to as ‘krill’ and consist of 86 species [3].

Euphausia superba (E. superba), also called

‘Antarctic krill’, is the most dominant krill

species in the pristine oceans surrounding

Antarctica [4]. Even though Antarctic krill

are only about the size of your smallest fin-

ger, they are a keystone species of the Ant-

arctic marine ecosystem. Krill is considered

to be at the bottom of the food chain, since

they feed on phytoplankton and are food for

many marine animals, such as whales, seals,

penguins, squid, and fish. Of all multi-cellular

animal species on Earth, Antarctic krill is the

most abundant species with one of the larg-

est biomasses of around 500 million metric

tons.

Compared with other marine life, Antarctic

krill gathers in the largest groups [5] and

also has the most potent known digestive

enzymes on Earth [6].

These small pinkish-red transparent crea-

tures are one of the world’s largest swarm-

ing animals. They often aggregate in large,

dense swarms stretching for tens of kilome-

ters and measuring 30 meters deep.

They tend to swarm and migrate

vertically as methods of avoiding attacks

from predators. They also swim up to the

sea’s surface to feed and reproduce main-

ly during the night and then swiftly swim

down into deeper waters to avoid predators,

such as birds, penguins, seals, squid, fish or

whales. When larger, swarm-hunting animals

attack, they quickly scatter by swimming

backwards (as fast as 60 cm per second) in

all directions to confuse the predator. An-

other defense from smaller attackers is to

leave their exoskeleton behind as a food dis-

traction.

Some krill swarms may consist only of

young krill or either females or males.

Krill are bioluminescent, meaning

that their bodies can emit light by chemical

reactions involving oxygen molecules. These

reactions take place in photocytes, lumi-

nescent cells assembled into light organs.

Krill use muscle contraction and relaxation

Krill Background


for the regulation of the intensity of the light.

When special closure muscles relax, the light is

emitted, which is suspected to be due to more

oxygenated blood reaching the photocytes.

It is believed that this light emission

is important for recognizing members of the

same species and keeping them together in

a swarm [7]. Though suspected, but unknown,

this feature may also be valuable in defending

against detection from predators or in mating.

Another characteristic of krill are their large

dark brown compound eyes, and like with in-

sects, they consist of many little eyes. This

gives krill the ability to see in many differ-

ent directions at the same time, which helps

them to locate food and detect predators.

However, in comparison to human eyes that

can see in only one direction, the vision quali-

ty of each little eye in krill is lower.

Krill can survive up to 200 days with-

out food by shrinking and using their body’s

bio-material for storing energy in the form of

Krill Background

Antarctic krill is found in the Southern Ocean

Krill swarm


lipids. Some krill species hold their lipid

reserves in wax esters and others pre-

dominantly in triglycerides. However,

members of the Euphausiid family are

the only known species in which phospho-

lipids are used as their energy depot. In

particular, Antarctic E. Superba krill uses

phosphatidylcholine containing omega-3

fatty acids as their lipid reserve [3].

E. superba krill uses its spe-

cialized filtering apparatus in their front

legs to help them feed on the tiniest of

plants (phytoplankton and zooplankton)

mostly in the summer, and algae from

under sheets of ice in the winter, when

otherwise food may be scarce. More-

over, krill can live up to seven years. Fe-

males are sexually mature by two years

of age and males by three [9]. Krill shed

their outgrown exoskeleton known as a

moulting process. They moult in order to

grow, while their new shell is still soft and

in times when they shrink due to lack of

food[10].

Antarctic krill’s biophysical make

up is important for their survival.

They withstand the fridge cold wa-

ters of the Antarctic and expend

large amounts of energy constantly

swimming up and down the depths

and lengths of the Antarctic Ocean.

If Antarctic krill stops swimming,

their higher than water body density

would make them sink [8].

Euphausia superba (Antartic krill)


Krill oil is a pure, natural source of

eicosapentaenoic (EPA) and docosa-

hexaenoic (DHA) omega-3 fatty acids,

phospholipids (with choline), and astax-

anthin. This combination of important

nutrients extracted from Antarctic krill

distinguishes it from fish oil and is the

basis for krill oil’s uniqueness. Its natu-

rally occurring antioxidant astaxanthin

is responsible for the dark red color of

krill oil. In contrast, fish oil contains no

astaxanthin, and their omega-3 fatty ac-

ids are incorporated into triglycerides.

There is increasing evidence

that the differences between the mo-

lecular forms of omega-3 fatty acids

(triglycerides and ethyl-esters in fish

oil, and phospholipids in krill oil) are im-

portant. The phospholipid form (from

krill oil) has been shown to facilitate

the incorporation of omega-3 fatty

acids into tissues in a more effective

and efficient manner compared to tri-

glycerides and ethyl-esters (from fish

oil) [14]. Therefore, it is thought that a

lesser amount of omega-3 fatty acids

can be taken with krill oil compared to

fish oil in order to get the same amount

of omega-3 health benefits. Moreover,

there is evidence which points to phos-

pholipids (and choline) itself having

many health benefits.

Krill Oil Concentrate

Astaxanthin contained in krill is

a highly potent antioxidant and

accounts for krill oil’s red color

[11]. It assists in keeping the ome-

ga-3 fatty acids in krill oil stable.

In cells, it provides protection

against free radical attack and

it has been shown to normalize

oxidative stress in persons such

as those that are smokers or are

overweight. As a result, astaxan-

thin has been linked to health bene-

fits such as anti-inflammatory and

pain-relieving effects, faster re-

covery from exercise, UV light pro-

tection in the skin [12], aging and

age-related diseases, liver, heart,

eye, joint, and prostate health [13].


Phospholipids have two fatty acids

bound to a glycerol backbone, while

triglycerides, or triacylglycerols, are a

combination of three fatty acids with a

glycerol backbone. Fatty acid ethyl es-

ters are derived by a chemical process

to exchange the glycerol backbone of a

triglyceride with ethanol, an alcohol.

Each of krill oil’s major components

(phospholipids, choline, and omega-3

fatty acids) have shown to have effects

in the body’s cells and tissues. This is

thought to be the basis of its health

benefits in many bodily systems and

health conditions.

Fatty acids are important nu-

tritional elements of cells, and in partic-

ular phospholipids and omega-3 fatty

acids are essential in cell membrane

structure and function. They also play

an important role in the formulation of

lipoproteins, while their metabolites

serve as vital molecules within path-

ways of the body. For example, they can

modify molecules involved in inflam-

mation (cytokines), eicosanoids, gene

expression, and plasma triglyceride

synthesis, to name a few. Both omega-3

fatty acids and phospholipid deficien-

cies can be associated with damaged

cell structure and decreased fluidity,

which can result in cell dysfunction.

Cellular dysfunction has been linked to

health conditions of the heart, brain,

liver, joints, etc. Therefore, it is thought

that providing more phospholipids and

omega-3 fatty acids with krill oil con-

centrate will result in better cell func-

tioning and ultimately better health

benefits compared to other krill and

fish oil products.

Indeed, the importance of the

amount of phospholipids in krill oil was

shown in a comparison study of two krill

oils containing either a low (600 mg; LPL)

or a high (1200 mg; HPL) phospholipid

amount with the same omega-3 fatty acid

content of 600 mg [15]. LPL, HPL, or con-

trol oils were given to healthy male and

female volunteers for 4 weeks. At study

end, both plasma and red blood cell fatty

acid compositions were compared for the

different treatment groups. While both

the LPL and HPL groups showed signifi-

cantly increased plasma omega-3 levels

when compared to the control group,

there was no statistical difference be-

tween the LPL and HPL groups. However,

when incorporation into membranes was

compared, then LPL only changed EPA

in red blood cells, whereas HPL changed

both EPA and DHA. And the red blood cell

membrane EPA and DHA incorporation

was significantly higher in the HPL group

when compared to the LPL participants.


FISH OIL

Omega-3 fatty acids EPA/DHA

Choline

Phosphatidylcholine

KRILL OIL

Phospholipids

Composition Krill oil Krill oil concentrate

Total phospholipids ≥40 ≥56

Choline ≥5 ≥7

Total omega-3 fatty acids 24 ≥27

EPADHA

≥12≥5,5

≥15≥7

Table 1: Typical content values (g/100g oil) for krill oil and krill oil concentrate.

Major components of krill oil and fish oil

Astaxanthin

Increasing the amount of phospholipids

in krill oil increases the incorporation of

EPA and DHA into membranes [15].

Since incorporation into red blood cells

relates to long-term and tissue absorp-

tion in general [16], and therefore health

benefits, an increased amount of ome-

ga-3 phospholipids will improve the ef-

fects of krill oil.

Hence, to profit from increased mem-

brane incorporation rates, a new prod-

uct advancement of a highly purified

and concentrated version of krill oil

was developed. It was made possible

by a specialized ion-exchange tech-

nology, Flexitech™, that also reduces

the TMA/TMAO (an osmolyte and pro-

tein sta bilizer) and the salt content of

the oil. This results in a product with a

con centrated amount of omega-3 fatty

acids, phospholipids, and astaxanthin,

which is almost taste- and smell-free

(see Table 1).

TriglyceridesOmega-3fatty

acids EPA/DHA


Sourced from the pristine

waters of the Southern Ocean around

Antarctica and due to its low position in

the food chain, krill oil is virtually free of

toxins and heavy metals. Superba™ krill

oil is certified by the Marine Steward-

ship Council (MSC) as being sustainable

and 100% traceable, from sea to shelf,

with the GPS coordinates to prove it.

Trimethylamine (TMA) has a ‘fishy’

odor and gives the characteristic odor

to seafood. Humans can convert TMA

in the liver to trimethylamine oxide

(TMAO).


Several articles on health benefits of

krill oil supplementation in both ani-

mals and humans have been published

over the years and positively changed

health parameters are presented in

more detail in the section on Krill oil

in health and disease. The very latest

krill oil science has emerged in the new

areas of sports nutrition and skin.

SPORTThe immune system is a complex inter-

play of cells, tissues and organs to sup-

port tissue repair and prevent invasion of

the body by bacteria, parasites, viruses,

and fungi. Omega-3 fatty acids enhance

the immune function by mixing into im-

mune cell membranes, which reduces the

amount of the pro-inflammatory fatty

acid, arachidonic acid. The incorporation

of omega-3 fatty acids instead promotes

the formation of the less potent EPA and

DHA-derived inflammatory mediators.

The immune-enhancing properties of

omega-3 fatty acids might particularly

help in situations where the immune sys-

tem function is reduced. Such a compro-

mised immune system can occur after

heavy training and sports competitions,

where the risk for infection is increased,

especially for upper respiratory tract in-

fections of athletes.

It is true that moderate exercise in

comparison to a sedentary lifestyle

lowers the risk of upper respiratory

tract infections (URTI). However, high

intensive exercise can have immune

system modulating effects that weak-

en the defense mechanisms of a recov-

ering body [6].

The relationship between exercise in-

tensity and risk of URTI was s hown in a

graph by Professor Nieman [17].

Latest Krill Oil studies


The immune system changes after

heavy exercise include a decrease of in-

terleukin 2 (IL-2) and interferon gamma

(IFN-γ), molecules that can regulate the

activity of immune cells. Likewise, nat-

ural killer (NK) cell function was shown

to be decreased after heavy exercise.

NK cells are the first line of defense by

reacting quickly to e.g. intruding bacte-

ria and viruses to keep them under con-

trol until the antigen-specific immune

system starts to act. Their activity can

be decreased by up to 60% for several

hours after extended exercise [17]. This

has led to the view that after intense

training or sport competitions, there is

an open window of 1-9 hours with low-

ered host defense, which increases the

likelihood for an infection.

Omega-3 supplementation has

been shown to increase IL-2 and INF-γ

production, as well as NK cell function

and might therefore help to increase host

protection after exercise.

It has been recommended by

Simopoulos that athletes at a leisure

level should eat up to 2 grams of fish oil

per day in a 2:1 ratio of EPA to DHA [18].

Athletes at a competition level should

probably consume even more omega-3

fatty acids to fully benefit from the im-

mune-modulatory effects. In a study of

106 German winter elite endurance ath-

letes, only one athlete was within the

optimal omega-3 target range that low-

ers the risk for cardiovascular events

and suboptimal brain function (reaction

time and executive function) [19]. These

surprisingly low omega-3 levels, which

were even lower than in heart disease

patients [20], may be explained by the

high need of energy of an athletes’ body

that might use these essential fatty ac-

ids as an energy source.

Omega-3 supplementation might there-

fore be crucial to help athletes to opti-

mize their physical and mental perfor-

mance, also in hindsight that EPA and

DHA have the ability to decrease heart

rate and oxygen consumption during

exercise [21].

The potential of krill oil to strengthen

the immune function after a simulat-

ed cycling time trial has been tested

in both male and female participants

[22]. The study was conducted at the Uni-

versity of Aberdeen, Scotland under the

supervision of Dr Stuart Gray, Senior Lec-

turer in Exercise Physiology.

The Omega-3 index, a mea-

sure of the percentage of EPA and

DHA of total fatty acids in red blood

cells, was measured after 6 weeks of

either 2 grams daily krill oil or placebo

consumption. The results showed that

those participants administered krill oil


Active people need omega-3 fatty acids

had a statistically significant increase

of their Omega-3 index.

After 6 weeks of study prod-

uct supplementation, the volunteers

performed an incremental maximal ex-

ercise test on a cycle ergometer. Par-

ticipants cycled at 70 revolutions per

minute with workload increasing by 30

Watts every minute for males, and 20

Watts every minute for females, until

volitional exhaustion.

Immune function parameters, like cell

signaling molecule production (IL-2, IL-

4, IL-10, IL-17 and IFN-γ) and the ability

to destroy target cells by NK cells were

measured at baseline and in the recov-

ery period after exercise (post-exer-

cise, 1h and 3h).

The results demonstrated

that supplementation of the diet with 2

grams per day of krill oil for 6 weeks can

significantly increase the production of

IL-2 and increase the toxic effect of NK

cells on other cells in the recovery pe-

riod after exercise. The effect was gen-

der-independent.

Study coordinator, Dr Stuart Gray com-

ments: “Our study is in agreement with

our previous work with fish oil, where

we have observed similar results. How-

ever, the krill oil EPA and DHA dose used

was only a quarter from the dose given

in the earlier fish oil study. It remains

to be proven if the different structural

form (omega-3 phospholipids from krill

oil versus omega-3 triglycerides from

fish oil) can explain this difference.”

Moreover, a previous dou-

ble-blind 6-week study on krill oil sup-

plementation to the Polish National

Rowing Team has shown that krill oil can

affect levels of pro- and anti-oxidant bal-

ance markers [23]. Study authors found

that exercise significantly increased

values of oxidative stress parameters

in both groups, but recovery levels were

significantly lower in athletes receiving

1 gram krill oil per day compared to the

control group. Based on these results

they concluded that supplementation

with krill oil in trained rowers dimin-

ished post-exercise oxidative damage


to red blood cells during recovery.

Overall, several sport studies

including omega-3 fatty acids highlight

the importance of an adequate ome-

ga-3 fatty acid intake for athletes.

The ability of krill oil to positively influ-

ence oxidative stress and immune func-

tion shows that regular consumption

of omega-3 phospholipids from krill oil

might be an effective nutritional strate-

gy to help athletes in the post-exercise

recovery phase.

Krill oil supplementation has beneficial

effects on oxidative stress and immune

function and can help to improve a bal-

anced sports nutrition for athletes.

SkinSkin is the organ that not only protects

against microbes, pollution, and phys-

ical assaults, it is further important

for sensory perception and

in maintaining the body’s wa-

ter content and temperature.

It consists of several layers.

The epidermis is towards the

outside, with the top cell layer

called the stratum corneum,

which mainly consists of dead

cells and oils. The body sheds

the dead cells with a rate of up

to 40 000 cells per hour. This

can amount to as much as 3.6 kg of dead

skin cells in a year. Under the epidermis

lies the dermis as an inside layer in-

cluding sweat glands, hair follicles, and

nerve endings needed to feel tempera-

ture, pressure, and pain.

The stratum corneum is im-

portant in preventing water loss to

keep the underlying living cells moistur-

ized. If its barrier function is disturbed,

the skin can become dry and flakey. Hot

water, soaps, medication, low humidity,

and medical conditions can all lead to

dry, irritated skin. For example, eczema

is characterized by dry, red skin patches

that can be very itchy, which might be

due to an overactive immune system,

but the exact causes are unknown. Also

in the case of psoriasis it is unknown

why the immune system is not working

properly, which leads to the formation

of excess skin cells that build up in


scales and red, itchy patches.

Healthy skin permits water loss only

to a limited amount. Damaged skin,

such as in atopic eczema, is character-

ized by increased water loss. Krill oil

was shown to alleviate water loss and

dry skin in a 12-week clinical study in

healthy persons.

Both omega-3 fatty acids and

phospholipids are important for skin

health. Deficiency leads to scaling and

dryness of the skin and enhanced tran-

sepidermal water loss (TEWL) [24,25].

TEWL describes the water loss over the

surface of the skin that happens by pas-

sive diffusion. The outer layer of dead

cells makes the skin flexible and elastic,

when it contains enough water. Howev-

er, when the TEWL is high and hydration

low, it becomes hard and rough. Hence,

skin function is negatively affected,

which can lead to discomfort or even

infection.

In general, the skin holds

about 30% of the body’s water and the

dead cells of the stratum corneum and

the lipids ‘waterproof’ the human body.

Water loss and hydration of the stra-

tum corneum is linked to its lipid con-

tent, the generation of new lipids in the

skin, and ultimately the level of damage

to the skin barrier function. A good bal-

ance between the skin’s water content

and the amount of water passing influ-

ences skin elasticity, smoothness, and

roughness and is crucial in maintaining

healthy skin [26].


The skin has several functions, but one

of the most critical ones is to maintain

the body’s water levels and to limit wa-

ter loss into the surroundings. Water

makes up 75 (infants) to 55% (elder-

ly) of the body’s weight and is vital for

biological processes and life. A way to

measure water loss is to assess trans-

epidermal water loss (TEWL).

In contrast to e.g. saturated

fatty acids and cholesterol, EPA and DHA

cannot be made in the skin and must be

obtained from outside sources. The skin

lacks the enzymes needed to convert

short-chain omega-3 fatty acids into the

longer chain EPA and DHA [27]. Omega-3

fatty acid levels in human skin are rather

low with under 2% of total skin fatty ac-

ids. However, significant increases can

be achieved by supplementation and 3

months of 4 grams daily EPA increased

skin EPA 8 times [28].

Krill oil is an attractive dietary

supplement that might help in the mainte-

nance of skin health and treatment of skin

disorders by both its omega-3 and phos-

pholipid components (see above ).

To explore the effects of krill

oil on skin health, 31 volunteers (mid-

dle-aged men and women with normal

skin) were included in an open label,

two-armed clinical trial (unpublished re-

sults). The subjects were randomized to

take 3 grams daily krill oil for 13 weeks.

All skin measurements were done on the

upper forearm and showed that krill oil

intake resulted in a significant increase

in skin hydration and elasticity, as well

as in a significant reduction in TEWL.

In addition, a significant cor-

relation for the change in hydration

and the changes both for elasticity and

TEWL were found. Meaning that the

volunteers that had a high change in

skin hydration also experienced a high

Changed lipid levels in the skin Modulation of inflamation Increased hydration Decreased water loss Improved elasticity Improved smoothness

KRILL OIL

Changed lipid levels in the skin Increased hydration Decreased water loss

Omega-3 effect

Phospholipid effect


change for both elasticity and TEWL.

By using a digital camera, the amount of

wrinkles (as a measure for roughness)

and width and size of wrinkles (as a mea-

sure for smoothness) were assessed at

the start and end of the trial. For both

parameters, i.e. roughness and smooth-

ness, there was a significant beneficial

change observed after krill oil supple-

mentation.

By increasing the amount of

omega-3 fatty acids in the body, krill

oil has the ability to not only influence

skin hydration and elasticity, but also

the amount and size of wrinkles. The

measure of how much omega-3 accumu-

lates in the body, given as the Omega-3

index, was increased significantly in the

study and correlated with the above

mentioned parameters. These results

indicate that the increases in Omega-3

index by krill oil supplementation di-

rectly relate to the positive changes in

skin parameters observed among study

subjects.

Krill oil improves skin parameters


WHAT IS A PHOSPHOLIPID?A phospholipid molecule consists of two

fatty acids, which are long chains of car-

bon and hydrogen molecules. They are

attached to a glycerol backbone that is

further linked to a phosphate group. The

phosphate group has a head group, such

as choline, resulting in phosphatidylcho-

line (PC).

While choline, phosphate, and glycerol

make up the hydrophilic (water-friend-

ly) side of the molecule, the fatty acid

chains are the hydrophobic (water-fear-

ing) part of the molecule.

The first phospholipid was

identified in 1847 by Theodore Nicolas

Gobley, a French chemist and pharma-

cist who analysed lecithin (a rich source

of PC) in egg yolk.

Phospholipids, as the name indicates,

are made up of the mineral phosphorus

and lipids (fats).

The word lecithin originates from the

Greek lekithos, egg yolk. Lecithin’s

chemical name is phosphatidylcholine,

while commercially it is a phospholipid

mixture. Most lecithin products consist

of phosphatidylcholine, phosphatidyl-

ethanolamine, phosphatidylserine, and

phosphatidylinositol [29].

Phospholipids in the form of lecithin

are used as emulsifiers and stabilizers

in foods, in cosmetics and paints or for

therapeutic reasons, and as nutraceuti-

cal supplement. In 1933, leci thin already

appeared in the Italian medicine dictio-

nary Medicamenta, for condi tions such

as, diabetes, tuberculosis, depression,

PhospholipidsCarbohydrates, nucleic acids, proteins, and lipids are the four main biological compounds that determine life. Whereas, phospholipids are part of the lipid group, which are the very basic units of life.



and recovery from infec tious diseases

[30].

FUNCTIONS OF PHOSPHOLIPIDS IN THE BODYPhosphorus, found in the head group

of phospholipids, contributes to the

normal function of cell membranes, en-

ergy-yielding metabolism, and in bones

and teeth [31]. The phospholipid mol-

ecule has many functions and uses in

the body. For example , as a structural

element in cell membranes, a source of

choline for the neurotransmitter acetyl-

choline, an important factor in energy

production and storage, assisting in blood

clotting, antioxidant protection, and

cholesterol solubility to name just a few.

Moreover, it acts as surface-active wet-

ting agent that lines the outside of liver,

lungs, gastrointestinal tract, and kidney

cells.

CELL MEMBRANESThe structural skin around cells and

their organelles is called a membrane.

A phospholipid membrane is only five

millionths of a millimeter thick [32].

10,000 membranes on top of each other

have the same thickness as a piece of

paper.

Both the inside and the outside of

cells is water. When phospholipids are

exposed to water, they arrange them-

selves into a two-layered sheet (a bi-

layer) with all of their hydrophobic tails

pointing towards the center of the sheet

and the hydrophilic heads towards the

surrounding water.

The amount of phospholipids in the hu-

man body is enormous! The body con-

tains over 100 trillion cells with mem-

branes, consisting of phospholipids,

and proteins. The liver itself consists

of membranes that can fill four soccer

fields.

About 60% of what is made in a cell is

needed for membrane structures, either

for channels and receptors inside the

membrane or proteins attached on the

outside of membranes [33]. Membranes

not only give a defined volume to a cell,

they also allow for internal structures,

such as organelles (e.g. nucleus) and

transport vesicles between organelles.

It is important that our cells

maintain a sufficient amount of phos-

pholipids to ensure optimal cell func-

tion. Otherwise many cell functions can

be compromised, such as their ability to

control the exit of waste and the entry

of nutrients into cells, communication


between cells, membrane-bound en-

zyme functions, binding of molecules

(neurotransmitters, antigens, antibod-

ies, etc.) to receptors, and more.

Two of the many factors which

may affect the amount of phospholipids

in cells are, i) as we age phospholipid

amounts in cells decrease, and ii) cells

in skin, lungs, liver, heart, and blood

vessels can become vulnerable to at-

tack from free radicals and toxins [34].

Therefore, damaged and lost phospho-

lipids must be continuously replaced to

ensure optimal cell function and health.

Phospholipids with their unique po-

sition in cell walls are essential for

cell growth and the generation of new

cells. They promote molecule trans-

port across membranes, binding to

receptors and enzyme activities and

determine the fluidity of membranes.

They are a source of messengers in cell

signaling, choline, omega-3 fatty acids

and contain phosphate for energy pro-

duction. Moreover, they are needed in

fat emulsification in the stomach and

blood clotting.

LIPID TRANSPORT AND CHOLESTEROL METABO-LISMIn addition to the central role of phos-

pholipids in membrane function, they

are, together with apoproteins, part of

the outer layer of transport vehicles,

called lipoproteins, because they are

made of fat (lipid) and proteins. This

combination of solubilizers allows the

transport of cholesterol in the wa-

ter-based bloodstream. Cholesterol is

important for cell membrane function

and as precursor for other compounds.

However, in high amounts, it will accu-

mulate on and in blood vessel walls and

make them narrower and stiffer. The

hardening of arteries via the buildup


of cholesterol and fat plaques is called

atherosclerosis. If these plaques burst,

they can lead to blood clots that can

cause heart attacks and stroke.

By forming monolayers, phos-

pholipids surround all lipoproteins that

are classified according to their density

in chylomicrons, VLDL (very low-den-

sity), LDL (low-density), IDL (interme-

diate-density) and HDL (high-density)

particles. Whereas large lipoproteins

have low density and contain more fat

than protein. In short, cholesterol is

taken up in the small intestine and is

delivered to the liver in packages called

chylomicrons. VLDL and LDL are se-

creted by the liver and are risk factors

for atherosclerosis and heart disease

by providing cholesterol to plaques.

LDL is therefore often called the ‘bad’

cholesterol. In contrast, HDL, the ‘good’

cholesterol, has a protective effect by

removing excess cholesterol from the

arteries and bringing it back to the liver

on the ‘reverse transport pathway’.

Every 1% increase in blood HDL levels

has been associated with a 2-3% reduc-

tion in overall heart disease risk [35].

The levels of cholesterol in blood pri-

marily depends on the amount of cho-

lesterol that is ingested (from diet and

bile) or made by the liver. The absorp-

tion rate of cholesterol in the gut, can

vary substantially [36]. It is influenced

by the amount of phospholipids avail-

able, since phospholipids are needed for

the intestinal uptake of cholesterol, but

high amounts of phospholipids reduce

cholesterol absorption through molec-

ular interactions. Indeed, it was found

that a dose of 15mg lecithin can inhibit

cholesterol absorption by 50% in rat

guts [37]. There is also evidence for re-

duced intestinal cholesterol absorption

in the gut of humans after phospholipid

supplementation [38-40].

Research has shown that dietary phos-

pholipids may help to reduce blood LDL

particles, the ‘bad’ cholesterol and re-

duce the risk of heart disease by affect-

ing intestinal cholesterol uptake.


UPTAKE OF PHOSPHOLIPIDSDietary phospholipids are efficiently

(above 90%) taken up into the cells of the

intestinal wall after they are hydrolyzed

to lysoPC and free fatty acids by lipases

in the small intestine. In the intestinal

cells, they are reassembled and included

into chylomicrons for further transport

via the lymph and blood. Some studies

suggest that a fraction of the dietary

phospholipids is directly taken up into

HDL particles already in the intestine,

which later join the HDL blood pool.

Phospholipids move into cells

and their membranes by selective and

whole particle uptake routes. In liver

cells, about two-thirds of the phospho-

lipid uptake is by selective entry routes.

Thereby, phospholipids are transferred

directly from lipoproteins into the cell

membrane. In addition to selective up-

take pathways, cells can incorporate

entire lipoproteins by endocytosis,

which results in an unspecific incorpo-

ration of everything that was part of

the particle, including phospholipids.

Incoming phospholipids can be metab-

olized to triglycerides and can be used

in storage or energy generation, when

not used in membranes.

PHOSPHOLIPID SOURCESDaily phospholipid intake is usually be-

tween 2-8 grams, which corresponds

to 1-10% of the daily fat consumption

[41]. Phospholipids can be found in high

quantities in egg yolk, soybean, meat,

fish and internal organs, while fruits,

vegetables and grains have a much low-

er phospholipid content [42]. However,

the richest sources usually also have a

high content of fat and cholesterol.

Also krill contains high amounts of

phospholipids and E. superba is known

to use them as energy storage form. In

“Illustration provided and modified courtesy of the National Heart, Lung, and Blood Institute’s The Heart Truth® Program.”


the extracted krill oil concentrate, over

56% of the oil consists of phospholip-

ids.

PHOSPHOLIPID DEFICIENCYNot much is known about the optimal

intake levels of phospholipids, since

phospholipid deficiency symptoms are

unknown, except the ones associated

with choline deficiency that are de-

scribed later on. However, due to refine-

ment of oils and fats, cleaned raw ma-

terials, and changes towards a nutrition

low in fat and cholesterol, modern diets

contain only about one third of phos-

pholipids than what they contained a

century ago [43]. In particular, high-risk

groups for deficiency, such as the elder-

ly, athletes and diseased persons might

therefore benefit from phospholipid

supplementation.

PHOSPHOLIPIDS IN HEALTH AND DISEASEAlthough dietary phospholipids are

present in many foods, purified forms

can help to treat various health con-

cerns, including fatty liver, arthritis,

heart disease, cachexia, hypercholes-

terolemia, cancer, and more [44]. Major

health benefits of phospholipid sup-

plementation are presented in Table

2 that underlie their liver-protective,

anti-inflammatory, immune changing,

anti-obesity, memory enhancing, an-

ti-depressant, and anti-tumor effects

[45]. Their effects on liver health and

physical performance, are outlined in

more detail below.

LIVERThe liver is one of the organs that get

the most membrane damage because

of its blood filtering function. It deals

with incoming food nutrients and ei-

ther stores or prepares them for fur-

ther transport to other organs. It is

also responsible for filtering the blood

from harmful substances such as tox-

ins, alcohol, medication, fatty food,

waste products, viruses, etc. These are all

stressors for the integrity of the hepatic

membrane and fat accumulation or alco-

hol misuse can take its toll on the liver

and eventually lead to fatty liver disease

that can progress into cirrhosis and liver

failure.

While studying 700 obese

children, it was found that 15% (10%

girls, 22% boys) of the children already

had fatty liver disease [56]. Overall, the

prevalence of suspected nonalcoholic

fatty liver disease lies at 50% of obese

males in the U.S. [57]. While 45% of


Table 2: Dietary phospholipid (PL) and choline health benefits.

Health area Benefit Explanation Referenc-es

Heart disease Reduced cardiovascular risks

PL improve parameters related to heart and cardiovascular diseases:• Blood lipid profiles (reduction of total cholesterol, LDL and TG levels and increased HDL levels) • Reduced hypertension • Reduced platelet aggregation and the risk of arteriosclerosis

[46-48]

Immune system

Improvement ofimmunological function

PL-induced improvement in phagocytosis, arachidonic acid concentration and neutrophil killing activity.

[49]

Infant development

Improved braindevelopment of fetus

Choline supplements during pregnancy have been shown to affect brain development of fetus and improve lifelong memory characteristics (animal studies).

[50]

Liver disease Improved hepat-

ic disorders

Reduced alcohol-induced liver damage and hepatic damage caused by toxins and virus infections (hepatitis).

[51]

Physical performance

Improved phys-ical performance by reduction of physical stress

PL stimulates acetylcholine synthesis, which triggers the release of neurotransmitters in the brain, thus improving physical performance.

[52]

Stomach and gastrointesti-nal tract (GI)

Reduction of stomach pain in-duced by gastric acid

PL-induced protection of the GI by reduced gastric mucosal lesions. Typical GI side effects of analgetic drugs (NSAIDS) are reduced, likely due to an increased production of cyto-protective mucosal PGE2.

[53]


type-one diabetics have fatty liver [58],

up to 85% of type-two diabetics are af-

flicted with the disease [59,60].

Liver disorders include fatty liver due

to cellular fat accumulation in people

that are e.g. overweight, have diabetes,

or drink too much alcohol leading to an

enlarged liver. Cirrhosis, the inflamma-

tion and scarring of liver tissue, can be

due to hepatitis infection or excessive

alcohol consumption, which can also

lead to cancer. Autoimmune liver disor-

ders damage liver cells by an abnormal-

ly high amount of immune cells.

Whole phospholipid, in contrast to

choline and omega-3 fatty acid supple-

mentation alone, has been shown to

influence liver fat metabolism by either

affecting cholesterol and bile acid gen-

eration, degradation of fatty acids or

the secretion of lipoproteins from the

liver [61]. As shown in animals, a diet rich

in phospholipids reduces liver fat by

means of inhibiting intestinal fat uptake

and influencing the activity of liver en-

zymes that regulate lipid metabolism.

Moreover, liver damage was found to be

alleviated by phospholipids. Reduced

phospholipid levels in liver membranes,

as for example found after alcohol con-

sumption, can be counteracted by phos-

Stress and depression

Reduction in stress-related mood symptoms

Reduced production of stress hormones linked to strenuous exercise and eased stress-re-lated mood symptoms.

[54]

Ulcerative colitis

Protective and healing effects in inflammatory ulcerative colitis

Supplementation of PC has been shown to protect and restore the intestinal lining of the gastrointestinal wall.

[55]

GI, gastrointestinal tract; HDL, high-density lipoprotein; LDL, low-density lipoprotein; NSAIDS, nonsteroidal anti-inflammatory drug; PC, phosphatidylcholine; PGE2, prostaglandin E2; PL, phospholipids


pholipid supplementation. Accordingly,

a study on chronic alcohol consumption

in baboons that were given either ethanol

or ethanol together with lecithin over 6.5

years reported that PC protects against liv-

er fibrosis and cirrhosis [62]. But also other

liver damages like e.g. from viral infections,

can benefit from phospholipid supplemen-

tation to decrease disease activity [63].

Fat accumulation in the liver will often not

lead to symptoms indicating that some-

thing is wrong. Inasmuch, fatty liver silently

increases heart disease risk 3 times in men,

14 times in women and up to 10 times in

type-one diabetics [64].

The majority of the studies performed

with phospholipids, did not include ome-

ga-3-containing phospholipids, indicating

that phospholipids in general have benefi-

cial effects. However, other studies have

demonstrated that phospholipids contain-

ing omega-3 fatty acids have more potent

effects on liver and blood plasma lipid

levels, compared to phospholipids without

omega-3s [65,66].

In particular, Shirouchi and col-

leagues have concluded in their study on

rats that the combination of omega-3 fatty

acids with phospholipids in comparison to

egg phospholipids alone can alleviate liver

steatosis better through the suppression of

fatty acid synthesis, enhancement of fatty

acid degradation, and increase of serum ad-

iponectin levels [66].

BRAINPhospholipids play a central role in brain

function and around 60% of the brain by

weight consists of phospholipids. Phos-

pholipids are particularly enriched in

dendrites and synapses and it has been

shown in vitro that nerve growth increas-

es the demand for phospholipids. Nerve

growth factor, a small protein controlling

nerve growth and maintenance, also stim-

ulates phospholipid generation [67].

The omega-3 fatty acid DHA can

only to a very little extent be made by the

brain, and must therefore be supplied by

the blood and imported over the blood-

brain barrier. Phospholipids are of utmost

importance in the transport of DHA, since

the recently discovered DHA transporter

(Mfsd2a, major facilitator super family

domain containing 2a) accepts DHA only

if it is bound to phospholipids; to be exact

to lysoPC [68]. Mice that are genetically

engineered to not have this transporter,

have very low DHA amounts in the brain

leading to neuronal cell loss and cognitive

deficits associated with severe anxiety.

In addition, humans identified with muta-

tions in Mfsd2a present defective brain

growth and intellectual disability due to


insufficient DHA-lysoPC uptake into the

brain [69,70].

LysoPC in combination with

DHA from the blood is therefore vital for

normal brain growth and function.

The cells of the small blood vessels com-

ing into the brain are tightly stitched

together by tight junctions forming the

so-called blood-brain barrier to restrict

free passage of molecules. This allows

for the protection of e.g. bacteria infect-

ing the brain. Even DHA needs a special

transporter that will transport DHA only

when it is bound to lysoPC.

But not only bring phospholipids DHA

into the brain, they also provide choline,

an essential nutrient [71], which makes

up about 15% of the PC molecule. Like

DHA, choline is important for brain devel-

opment and nerve signaling and thereby

influences cognition [72]. Hence, a 47%

reduced risk for getting dementia was

found in the elderly that had the highest

PC levels in blood [73].

Choline WHAT IS CHOLINE?Choline is an essential vitamin-like nutrient that is crucial for normal cellular function.

Mfsd2a transports DHA over the blood-brain barrier Ill

ustr

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FUNCTIONS OF CHOLINE IN THE BODYCholine as a component of phospha-

tidylcholine, choline plasmalogen and

sphingomyelin is a major component of

cell membranes.

95% of choline in the body is found in

phospholipid form as phosphatidylcho-

line (PC).

The derivatives of choline are ver-

satile and include functions such as

neurotransmitters (acetylcholine),

cell membrane signaling (phospholip-

ids), lipid transport (lipoproteins), and

methyl-group metabolism (homocys-

teine reduction) [74]. Besides, a fetus

depends on choline for brain and mem-

ory development [75] and to reduce the

risk for neural tube defects [76]. A lot of

the maternal choline goes to the fetus,

which might deplete the mother’s cho-

line reserves.

NERVE SIGNALINGCholine is converted to acetylcholine,

a neurotransmitter, in the nervous sys-

tem. Acetylcholine is of importance in

learning, breathing, memory, sleep, and

muscles metabolism. Whereas in heart

tissue, acetylcholine has an inhibitory

effect and leads to reduced heart rate,

in skeletal muscle it has the opposite

effect.

CELL SIGNALINGCholine is a part of the phospholip-

ids phosphatidylcholine and sphin-

gomyelin. They are the precursors of

diglycerides and ceramides, which are

lipid-signaling molecules in cells. Lipid

messengers can freely cross over mem-

branes and can therefore not be stored

in vesicles. They act locally on recep-

tors and enzymes to induce a specific

cellular response.

METHYL DONORCholine is required for the metabolism

of nucleic acids and amino acids and is

an important source of methyl (-CH3)

groups over the generation of S-ad-

enosylmethionine (SAMe). Up to 50

chemical reactions in mammals depend

on SAMe as a methyl donor [77]. These

methylation reactions are of impor-

tance in lipid biosynthesis, regulation Choline is important in nerve signaling


Betaine

Acetylcholine Neurotransmitter

S-adenosylhomocysteine

Phosphatidyl-ethanolamine

Methionine

Dimethylglycine

Brain HealthLiver Health

Brain Functions Memory

Homocysteine Related to heart

disease

Phosphatidyl-choline

Important componment of cell menbranes

S-adenosylmethionine

Important in control of DNA replication and cell growth

CHOLINE

Heart Health

of metabolic pathways, and detoxifica-

tion. Changes in DNA methylation, that

affects gene expression, have been

linked to cancer.

WATER BALANCECholine is converted to betaine, which

is an osmoregulator, meaning that it can

regulate the volumes and water con-

tent of cells [78]. Cells keep water lev-

els constant by allowing ions to enter,

which makes water to follow and move

into cells. Betaine is an organic water

attractant, in particular in cells with

high osmotic pressure such as kidney or

intestinal cells.

Betaine is further used to convert ho-

mocysteine, a risk factor for heart dis-

ease, to methionine.

UPTAKE OF CHOLINE SALT VERSUS PHOSPHATIDYL-CHOLINE Dietary choline is taken up by choline

transporters in the intestine. Most of the

choline is converted to PC and used in cell

membranes. The liver can recycle choline

and the intestine, lungs, and kidneys will

send choline to the brain and liver in time

of need.

Administration of choline will

significantly increase blood choline con-

Cour

tesy

of w

ww

.cho

linec

ounc

il.co

m


centrations [79,80]. It was found that cho-

line in the form of PC, is 12 times better

in raising human blood choline amounts

compared to choline salt [79,80]. While

choline salt show maximum levels after

30 minutes (86% increase, 4 hours until

normal), PC intake raises choline by 265%

and takes 12 hours until normal again [80].

It was suggested that 60% of the choline

in inorganic salts, such as choline chloride,

choline citrate, and choline bitartrate, is lost

to conversion to TMA by intestinal bacteria

[23]. In comparison, dietary PC leads to

three times less TMA [24].

CHOLINE DEFICIENCYOnly little choline can be made by the

body itself, the major part needs to be

taken up over the diet. Choline is found

in higher amounts in e.g. soybeans, eggs,

liver, beef, and milk. Although most di-

ets are considered to provide sufficient

choline, persons at risk of choline defi-

ciency exist. Specifically, the National

Health and Nutrition Examination Sur-

vey in 2003-2004 has concluded that

90% of the American population has an

inadequate intake of choline [1].

90% of the U.S. population is not con-

suming enough choline to ensure opti-

mal membrane function, neurotrans-

mission, and methyl donor availability.

The adequate intake level for choline

was set at 550 mg/day for men and 425

mg/day for women in sight of prevent-

ing liver damage. Choline deficiency-in-

duced fatty liver can occur, when not

enough choline is present for the for-

Cour

tesy

of w

ww

.cho

linec

ounc

il.co

m


mation of PC molecules that are need-

ed for the formation of VLDL particles.

If the fat becomes stuck in the liver, it

accumulates and will eventually lead

to liver damage. Excessive oxidative

stress that damages lipids and DNA in-

duces cell death and inflammation that

can ultimately culminate in end-stage

liver disease [81]. Choline deficiency is

also the only nutrient deficiency that

can lead to cancer.

Genetic predisposition, gender, and

age influences ones choline needs and

care should be taken to ensure an ade-

quate choline intake, since choline defi-

ciency is linked to an increased risk for

fatty liver, muscle dysfunction, athero-

sclerosis, and neurological disorders

[82].

CHOLINE IN HEALTH AND DISEASEWith its many diverse roles, it is not

surprising that choline deficiency will

cause disease in humans. The function

of many organs such as liver, muscle,

kidney, pancreas, and brain all depend

on an adequate choline intake.

BRAINIt was suggested that supplementation

with choline, as a precursor for acetyl-

choline, improves brain function in per-

sons affected by memory impairments

due to aging or pathological conditions.

Inasmuch, Alzheimer’s and Parkinson’s

disease patients have a reduction of

cholinergic neurons in the grey matter

of their forebrains [83]. Also elderly

persons have reduced forebrain cholin-

ergic neurons and acetylcholine [84]. On

the other hand, choline supplementa-

tion increases the amount of choline in

the blood, with a concomitant increase

of choline-containing compounds in the

brain [85]. However, in an analysis of

all available literature on studies with

lecithin given to individuals with Alzhei-

mer’s disease, Parkinsonian dementia

and subjective memory problems, no

clear benefit for memory performance

could be found for patients with Alz-

heimer’s disease and Parkinsonian de-

mentia [86]. Yet, people with subjective

memory difficulties, gained a very sig-

Choline supplementation might improve brain functions


Choline is important for muscle contractions

nificant benefit in one of the analysed

studies [87]. Thus, while the overall

analysis does not support lecithin for

dementia patients, people with sub-

jective memory complaints may profit

from lecithin supplementation.

SPORTIntense physical activity challenges

cellular functions, which are essential

to maintain for optimal sports perfor-

mance. Excessive radical formation and

trauma to the muscles during high-in-

tensity exercise leads to inflammation.

It has been suggested that supple-

mentation with phospholipids, such as

PC might be beneficial to endurance

athletes, because of the choline head

group [88]. Indeed, decreased blood

choline levels were shown in endurance

athletes such as cyclists and runners

[89]. Supplementation with PC signifi-

cantly increases circulating choline

levels; in fact twelve times better than

choline salts alone [79].

If, during exercise, enough choline is

available in the body, then also sufficient

acetylcholine is produced. Since acetyl-

choline is a signaling molecule important

for muscle contractions, sportive perfor-

mance might therefore be optimized by

PC supplementation.

Acetylcholine is a neurotransmitter im-

portant for muscle contractions made

from choline. The available free choline

influences acetylcholine synthesis rate.

If no choline is supplemented, mara-

thon runners can manifest up to a 40%

decrease in blood choline levels [16,17],

which is similar to the choline reductions

found in cyclists [5,18]. Besides, a study

with lecithin supplementation found fast-

er recovery after a bicycle ergometer tri-

al, when compared to the control group

[26,27]

During intense exercise, free choline is

reduced, which might impact on acetyl-

choline release and therefore sportive

performance.


WHAT ARE OMEGA-3 FATTY ACIDS?The main bioactive omega-3 fatty acids

that have been described extensively

are eicosapentaenoic (EPA or 20:5n-

3) and docosahexaenoic acid (DHA or

22:6n-3). EPA consists of 20 carbons

and 5 double bonds and can be convert-

ed enzymatically into DHA. DHA is the

longest fatty acid chain, with 22 carbons

and 6 double bonds. They are called

omega-3 fatty acids, because they have

their first double bond at three carbon

atoms from the methyl end. In compar-

ison, an omega-6 fatty acid has its first

double bond at 6 carbon atoms from

the methyl end.

FUNCTIONS OF OMEGA-3 FATTY ACIDSAside from being a source of nutritional

energy, the functions of omega-3 fatty

acids have a molecular basis. Inasmuch,

the omega-3 fatty acids have the ability

to change membrane fatty acid com-

position and function, regulate gene

transcription, and alter metabolic and

Omega-3 Fatty AcidsOmega-3 fatty acids played an essential role in human evolution and develop-ment. A turning point for the evolution of human intelligence was the diet change from red meat of animals mainly consumed by the Neanderthals to the inclusion of coastal seafood and inland freshwater sources [90]. This might have initiated the growth of the brain about two million years ago.


signal transduction pathways. This in-

volves a wide array of mechanisms that

overlap and interplay in complicated

metabolic networks that maintain the

body’s equilibrium.

MEMBRANESMost importantly, omega-3 fatty ac-

ids, as well as the overabundant ome-

ga-6 fatty acids, are crucial as building

blocks of membrane structures and a

cell’s development, integrity and func-

tion. The flexible structure of omega-3

fatty acids determines the fluidity of

membranes. Membrane fluidity is im-

portant for the correct functioning of

membrane proteins such as receptors,

ion channels, transporters, and en-

zymes. A change in fluidity due to al-

tered membrane fatty acid composition

will change activities and movements

of these proteins. It will also affect how

extracellular signals are transmitted

from receptors to intracellular signal-

ing networks, which is important in e.g.

neurons, cardiac cells and hormone-se-

creting cells. Additionally, membrane

permeability increases with the number

of double bonds present in fatty acid

chains of membrane phospholipids.

The amount of omega-3 fatty acids that

constitute membrane phospholipids

can be influenced by diet.

GENE TRANSCRIPTION AND ENZYME ACTIVITYWhen omega-3 fatty acids reach cells,

they can activate transcription factors

that stimulate the expression of certain

genes [91-94]. This means that omega-3

fatty acids indirectly influence the pro-

duction of functional gene products

(often proteins) in our cells. The ome-

ga-3 fatty acids thereby influence

which proteins are made in a cell and,

ultimately, how the cellular metabolic

functions are impacted. It is still un-

clear to which extent EPA and DHA bind

specifically to different transcription

factors, but there are at least some in-

dications that there are preferences as

to which fatty acid can regulate which

gene expression [91]. However, not only

can fatty acids change the expression

of genes, they can also modulate en-

zyme activities by directly binding to

them [95,96].

Omega-3 fatty acids influence gene expression


EICOSANOIDSThe ratio of omega-6 to omega-3 fatty

acids is important since they compete

for the same metabolic enzymes that

convert them into eicosanoids (i.e.

prostaglandins, prostacyclins, throm-

boxanes, and leukotrienes). Eicosa-

noids are hormone-like compounds,

called cellular hormones that control

key functions in the body, such as the

central nervous system, immunity, and

inflammation.

Whereas prostaglandins, leu-

kotrienes, and lipoxins play a regulatory

role in inflammation, thromboxanes and

prostacyclins are important for con-

trolling bleeding. Resolvins and protec-

tins, metabolites of EPA and DHA, help

reduce inflammatory responses [97].

In general, eicosanoids from

omega-3 fatty acids are less inflam-

matory than those from omega-6 fatty

acids. Hence, a disturbed ratio with high

omega-6 versus omega-3 fatty acids

and a low omega-3 intake in general

will tip the balance towards the produc-

tion of pro-inflammatory eicosanoids.

Therefore, a replacement of the ome-

ga-6 arachidonic acid by EPA or DHA

may lead to a less inflammatory active

eicosanoid profile, decreasing the risk

for inflammatory diseases.

ENDOCANNABINOIDSThe endocannabinoid system is based

on the action of endocannabinoids

(ECs) that are hormones made from

omega-6 fatty acids. The binding of ECs

to receptors influences the expression

of proteins in organs (e.g. liver, skeletal

muscle, pancreas, intestine, bone, and

adipose tissue) and affects the action

of the central nervous system. There-

by they can influence not only enzyme

activities, but also appetite, energy

balance, mood, memory, pain percep-

tion, stress response, anxiety, immune

functions, and reproductive processes.

An overactive EC system is believed to

promote increased fat mass and var-

ious markers of metabolic syndrome

[98].

The quantities of ECs made, ul-

timately depend on the amounts of ome-

ga-6 arachidonic acid available in mem-

branes, which depends on the amount of

arachidonic acid ingested. Increased in-

take of fatty acids of the omega-3 family

positively influences the ratio of omega-3

to omega-6 fatty acids in blood and or-

gans. In this way, less arachidonic acid is

incorporated into phospholipids, result-

ing in decreased conversion of arachidon-

ic acid to ECs. Thus, dietary fatty acids

constitute a means to change the body’s

fatty acid composition and thereby EC


levels, ultimately affecting membrane

signaling events and leading to changed

energy metabolism (food intake and en-

ergy processing).

OMEGA-3 DEFICIENCYBoth omega-3 and omega-6 fatty acids

are needed for optimal health. Howev-

er, since there is an abundance in the

Western diet of omega-6 fatty acids

compared to omega-3 fatty acids, the

balance between the two is highly dis-

turbed [99,100]. The underlying reason

is the vast increase in the consumption

of vegetable oils rich in omega-6 fatty

acids, which are present in corn, sun-

flower seeds, cottonseed and soybean

and industrially produced meat. At the

same time, the consumption of omega-

3-rich fish has decreased markedly.

The human body has evolved on a del-

icate balance of omega-6 to omega-3

fatty acids. Cells in the body rely on a

specific ratio of these fatty acids in

order to function properly. If out of bal-

ance, health is affected and it is of no

surprise that our modern unbalanced

diet promotes health issues such as

heart disease, arthritis, depression,

and dementia.

Nowadays, the ratio between omega-6

to omega-3 can be as high as 10-20:1,

whereas historically it was as low as

1-2:1 [101]. The recommendations today

call for a ratio of 5:1 [102]. Some studies

further indicate that the optimal ratio

may depend on the disease state [102].

When it comes to heart disease, a ratio

of 4:1 was linked to a reduction of 70%

in total mortality. Rectal cell prolifera-

tion in patients with colorectal cancer

were reduced at a ratio of 2.5:1, while a

ratio of 2-3:1 suppressed inflammation

in patients with rheumatoid arthritis. A

ratio of 5:1 was needed to induce bene-

fits for asthma patients, whereas a 10:1

ratio had negative effects.

The right amount of omega-6

and the right balance between omega-6

to omega-3 fatty acids is therefore

essential for health, as otherwise too

many pro-inflammatory molecules are

produced from omega-6 fatty acids

that can affect disease outcomes.

Most people do not consume

the recommended twice a week of

fatty fish and hardly reach the recom-

mended daily intake doses of EPA and

DHA. Although the recommended daily

dose varies highly between different

countries (1000mg in Japan and South

Korea, 500mg in France, and 450mg in

Norway), most countries recommend



250mg (Austria, Belgium, Czech Re-

public, Denmark, Finland, Germany,

Greece, Iceland, Ireland, Italy, Luxem-

bourg, Netherlands, Portugal, Slovakia,

Slovenia, Spain, Sweden, Switzerland,

and United Kingdom). While Australia

and New Zealand recommend 160mg of

EPA/DHA per day, other countries like

Canada, Hong Kong, Israel, Singapore,

Taiwan, and the United States do not

provide an official recommendation.

Most people have mean intake levels be-

low the optimal daily EPA and DHA dose

of 250mg recommended by the World

Health Organization (WHO) and the Euro-

pean Food Safety Authority (EFSA) and

could therefore benefit from omega-3

supplementation.

OMEGA-3 FATTY ACIDS IN HEALTH AND DISEASEMore than 20,000 studies on EPA and

DHA have assessed the health bene-

fits of omega-3 fatty acids [103,104].

Through their influence on membrane

integrity, gene expression, the balance

with omega-6 fatty acids and the gen-

eration of eicosanoids and endocanna-

binoids, they have the ability to modify

heart disease risk, inflammatory re-

sponse, neurological and psychiatric

balance, vision, and many more pro-

cesses in the body [105-107].

HEARTMost established is the influence

of EPA and DHA on cardiovascular

risk, since they can modify blood tri-

glycerides, HDL cholesterol, plaque de-

velopment, heart rate, and heart muscle

functions [108]. By doing so, EPA and

DHA reduce the risk for cardiac death.

Moreover, a meta-analysis that sum-

marizes all available research on heart

health found a connection between EPA

and DHA and a reduction in blood pres-

sure (decrease of systolic blood pres-

sure of around 4.5mm Hg and diastolic

blood pressure of 3mm Hg), especially

in those with high blood pressure [109].

Already a decrease of 2 mm Hg blood

pressure is of importance, since it is

linked to a 6% reduced stroke mortal-

ity, 4% reduced coronary heart dis-

ease mortality, and 3% reduced total

mortality [110].


Health area Benefit ReferencesBrain health DHA is highly concentrated in the brain and

is important for cognitive (memory and brain performance) and behavioral function. Effects were reported for: Mood Depression Cognitive function Emotional distress ADHD symptoms Alzheimer disease Memory Age-related cognitive decline Self-harm and suicidal thinking

[117-121]

Cancer Mainly in cancer with gastrointestinal origin work omega-3s as an anti-inflammatory agent.

[122,123]

Table 3: Omega-3 fatty acid health benefits.

BRAINOmega-3 fatty acids have been shown

to be essential for mental health and

brain development and function [111].

Research has indicated that the high-

er EPA and DHA intakes, the lower the

risk for Alzheimer’s disease, age-relat-

ed cognitive decline, depression, ag-

gression, and more [112-114]. Omega-3

fatty acids may improve mental health

by influencing nervous system activity,

memory, serotonin and dopamine lev-

els, neurotransmission, and the forma-

tion of synapses between neurons [115].

It has been shown that indi-

viduals with low blood EPA and DHA

levels have smaller brains and that the

lower brain volume corresponded to

two years of structural brain aging in

dementia-free study participants [116].

DHA was further associated with better

visual memory, executive function, and

abstract thinking. Generally, reduced

brain volume is linked to cognitive de-

cline and dementia. Already at the age

of 30, the brain volume starts to decline

due to the normal aging process, but

at twice the speed, if mild dementia is

present, indicating the need for optimal

omega-3 intake throughout life.

Besides their positive effect

on heart and brain health, EPA and DHA

have been linked to a variety of health

concerns of which a selection is listed in

Table 3.


Eye health Omega-3 supplementation are reported to have a positive effect on macular degener-ation (a serious age-related eye condition that can progress to blindness) and dry-eye syndrome.

[124,125]

Heart health Reduced risk of heart disease by: ↓ Cholesterol ↓ Triglyceride ↓ Plaque development ↓ Arteriosclerosis ↓ Blood pressure ↑ HDL (“good cholesterol”) ↑Omega-3 index

[126-129]

Inflammatory diseases

Reduced inflammatory responses in a range of diseases such as rheumatoid arthritis, inflammatory bowel diseases, systemic lupus erythematosus, and childhood asthma.The effect of omega-3s is due to a reduction in the production of many pro-inflammatory mediators such as: ↓ C-reactive protein ↓ Interleukins ↓ Prostaglandins ↓ Tumor necrosis factor alpha ↑Omega-3 index

[106,

130-132]

Metabolic disorders

By reducing triglycerides and inflammatory markers and improving insulin sensitivity, omega-3s can affect non-alcoholic fatty liver disease.

[133]

Skin health Maintenance of skin health by increasing hydration, reducing sunburn, aging, and skin cancer via photo-protective effects

[134,135]

Women health

Reduced menstrual pain [136]

ADHD, attention deficit hyperactivity disorder; DHA, docosahexaenoic acid; HDL, high-density lipoprotein


Krill Oil: Phospholipids, Choline, And Omega-3 Fatty Acids All In One

Krill live in a very pure environment

WHY KRILL OIL? To fulfill the global

demand for omega-3

fatty acids with grow-

ing pressure on fish

stocks, new sustain-

able sources are need-

ed. Krill oil is such a

source and WWF-Nor-

way clearly says: “Man-

agement of krill is sus-

tainable.”

Nina Jensen, CEO of

WWF-Norway: “WWF-Norway and Aker

BioMarine have worked together since

2008 for a sustainable management of

krill resources in the Antarctica. As a

result of the partnership and the MSC

(Marine Stewardship Council) certifi-

cation, Aker BioMarine has started an

extensive mapping of fish larval by-

catch, and is working with WWF-Nor-

way to document the potential overlap/

conflict between the fishery and land

based predators. WWF-Norway and

Aker BioMarine are also working ac-

tively towards CCAMLR (Commission

for the Conservation of Antarctic Ma-

rine Living Resources) on sustainability

issues. In addition, Aker BioMarine con-

tinues to be the most proactive player

in the krill fishery and has implemented

voluntary measures. This includes mea-

sures such as 100% observer coverage

and real-time reporting procedures to

ensure the continued sustainability of

this fishery. By permitting scientists

onboard at no cost, they are also con-

tributing to science and research. The

krill fishery has been going on for more

than 30 years and the catches have

been relatively stable and low. Howev-

er, WWF-Norway remains concerned

that while the precautionary catch limit

represents a smaller catch limit than

for most fisheries, it may fail to protect

krill predators at the local scale. It is

therefore important to have industry


players, like Aker BioMarine, to commit

to further research to understand the

complex marine ecosystem in the Ant-

arctica.”

The Marine Stewardship Council (MSC)

is an international nonprofit organiza-

tion that focuses on the health of ocean

stocks and how they are managed, in

addition to assessing the effects of

fisheries on the wider ecosystem. The

Aker BioMarine krill fishery has been

evaluated by an independent assess-

ment team, and the evaluators have

certified that the fishery is well man-

aged, that the krill stock is healthy, and

that Aker BioMarine’s krill fishery is

sustainable with minimal impact on the

ecosystem.

While krill oil comes from a sustainable

source, it has also been found to be pure

by extensive analysis for the presence

of contaminants, such as dioxins, fu-

rans, dioxin-like PCBs (polychlorinated

biphenyls), organochlorine pesticides,

PBDEs (polybrominated diphenyl

ethers), heavy metals, PAHs (polycyclic

aromatic hydrocarbons), arsenic spe-

cies, fluoride, trans fatty acids, and ma-

rine algal toxins. The krill’s place at the

bottom of the food chain and its clean

habitat impede accumulation of these

contaminants, which are often found in

marine life higher in the food chain.

The quality of krill oil has

been further increased by reducing

TMA/TMAO and salt contents giving

an almost taste- and smell-free krill oil

concentrate. Phospholipid, choline, and

omega-3 fatty acid concentrations are

increased, providing a special combina-

tion of these important nutrients in the

krill oil concentrate.

UPTAKE OF KRILL OIL IN THE BODY The evidence that phospholipids are

a more effective delivery molecule of

fatty acids to organs than triglycerides

is rising [137-140]. Of particular interest

is the accumulation of DHA into the

brain, since it makes up about 30-40%

of the fatty acids in the gray matter of

the cortex and is particularly concen-

trated in synaptic membranes [141]. In-

deed, in preclinical studies, when given

single-doses of radiolabeled DHA, the

DHA brain accumulation was twice as

high, when DHA was supplied in phos-

pholipid rather than triglyceride form

[137,138].

Omega-3 fatty acids from krill oil are

efficiently transported and integrat-

ed into cell membranes, because they



are bound to phospholipids. As part of

cell membranes, EPA and DHA have the

ability to influence fluidity of the mem-

branes, signaling processes, and meta-

bolic parameters in the cell.

KRILL OIL IN HEALTH AND DISEASEAnimal studies that found benefits for

krill oil supplementation include mod-

els for ulcerative colitis [142], depres-

sion [143], obesity [144-149], myocardial

infarction [150], chronic inflammation

[151], rheumatoid arthritis [152], and glu-

cose tolerance [153]. Highlights from

human studies with krill oil include ben-

efits for a variety of parameters sum-

marized in Table 4 .

OMEGA-3 INDEXThe Omega-3 Index that has been pro-

posed as a novel biomarker for cardio-

vascular risk and is defined as the per-

centage of EPA and DHA in red blood

cell (RBC) fatty acids [161].

Steady-state, but also in-

creased levels of the Omega-3 Index

after supplementation have been

shown to directly correlate with EPA

and DHA levels in human cardiac tissue

[132,162,163]. In contrast to plasma fatty

acid measurements that reveal short-

term omega-3 intake [164], the Omega-3

Index is believed to mirror overall tis-

sue EPA and DHA levels and therefore

a person’s health status. An Omega-3

Index of 8% or above is considered op-

timal [165], while a low Omega-3 Index

indicates a higher risk of sudden cardi-

ac death.

Since increases in EPA and

DHA levels correlate with sudden cardi-

ac death [166], researchers have recent-

ly turned their investigations toward

krill oil to see if it can increase omega-3

RBC levels. In an unpublished clinical


Table 4: Benefits of krill oil in clinical studies.

Parameters Explanation Effects of krill oil ReferencesADHD symptoms

Attention deficit hy-peractivity disorder; a neurodevelopmental psychiatric disorder characterized by attention deficits, hyperactivity, and impulsiveness.

↑ Improvement in behavior and daily function capacity in children

Unpublished data

Cachexia Loss of body mass that cannot be reversed nutritionally (cancer patients) and is characterized by anorexia, muscle wasting, and lipid profile disorder.

↑ Improved blood lipids in advanced cancer patients with cachexia (TG reduced, HDL increased, LDL reduced). Endocannabinoid system parame-ters normalized and inflammation markers reduced

Unpublished data

CRP C- reactive protein; CRP blood levels rise in response to inflam-mation.

↓ Reduced CRP, inflammation, and arthritic symp-toms (WOMAC scores)

[155]

Endocanna-binoids

Lipid signaling molecules made from omega-6 fatty acids involved in a variety of physiological processes including appetite, pain-sensa-tion, mood, and mem-ory. Obese persons have an overactive endocannabinoid system.

↓ Reduced endo-cannabinoids in obese persons

[156]


HDL High-density lipo-protein; the “good” cholesterol, since it removes excess cholesterol from the blood and brings it to the liver for other uses.

↑ Increased HDL (> 50%) in subjects with elevated blood fat levels. HDL/TG ratio improve-ment in healthy subjects

[157,158]

Immune function

Prolonged training periods may cause a down-regulation of the immune system by decreasing natural killer (NK) cells (first line of defense to e.g. bacteria and viruses) and interleukin-2 (IL-2), a signaling mol-ecule in the immune response.

↑ Increased immune function after intense exer-cise via higher NK cell and IL-2 levels ↓ Reduced oxidative damage to red blood cells during recovery from rowing in national team rowers

[22,23]

Inflammation Arthritis is an auto-immune disease char-acterized by inflam-mation, joint pain, and swollen joints.

↓ Reduced inflammation in subjects with ar-thritis symptoms

[155]

LDL Low-density li-poprotein; LDL is often called the “bad cholesterol”, since it picks up cholesterol and fat from the liver and delivers it to artery walls causing atherosclerosis (hardening of the arteries), thereby increasing the risk for heart disease.

↓ Decrease or no change of LDL

[157,158]


Omega-3 index

Percent EPA and DHA in red blood cells. Correlates with amount of EPA and DHA in other tissues. Low Omega-3 index is linked to higher risk of heart disease.

↑ Significant increase of Omega-3 index

[127,159]

PMS symptoms

Premenstrual syndrome; PMS syndrome might have an inflammatory connection.

↓ Significant re-duction in physical and emotional symptoms related to PMS measured as breast tender-ness, stress, irri-tability, depres-sion, joint pain, bloating, swelling, abdominal pain, and weight gain ↓ Significant re-duction in amount of painkillers used for painful cramps

[160]

Triglyceride A lipid molecule consisting of glycerol with three fatty acids bound to it. The fatty acids can be saturat-ed or unsaturated.

↓ Significant reduction of triglycerides in blood

[157-159]

ADHD, attention deficit hyperactivity disorder; CRP, C-reactive protein; DHA, docosahexaenoic acid; EPA, eicosapentaenoic acid; HDL, high-density lipoprotein; IL-2, interleukin-2; LDL, low-density lipoprotein; NK, natural killer; PMS, premenstrual syndrome; TG, triglyceride; WOMAC, Western Ontario and McMaster Universities Arthritis Index


study, healthy volunteers took either 2

grams of Superba™ krill oil for 8 weeks

or 2 grams of an omega-3 enriched

fish oil. The goal of the study was to

compare the delivery of omega-3 fatty

acids, PLs versus TGs, to see if the mo-

lecular form influences the increase in

Omega-3 Index. The results of the study

showed that krill oil increased the Ome-

ga-3 Index significantly more than fish

oil after 8 weeks of supplementation.

In fact, krill oil increased the Omega-3

Index about 70% more than fish oil at

the end of study after dose adjustment

between the two treatment groups.

These results go hand in hand

with another study, which investigated

the effect of 12 weeks daily Superba™

krill oil intake in volunteers with “bor-

derline high” or “high” blood triglyceride

levels [159]. Triglycerides have an im-

portant role in lipid metabolism and are

a central biomarker of heart disease

risk [167].

In this study, a total of 300 vol-

unteers were divided into five groups

and supplemented with krill oil at either

0.5, 1, 2 or 4 grams per day or placebo

(olive oil). The individuals included in

the study had blood triglyceride values

between 150 and 499 mg/dL. Blood lip-

ids were measured at baseline, 6 weeks

and 12 weeks of treatment.

Relative to subjects in the

placebo group, those administered

krill oil had a statistically significant

10% reduction in serum triglycerides.

Moreover, LDL cholesterol levels were

not increased in the krill oil groups rela-

tive to the placebo group, an important

finding considering an increase in LDL

cholesterol has been observed in some

fish oil trials [159]. Additionally, the sub-

jects taking 4 grams of krill oil per day

raised their Omega-3 Index from 3.7%


to 6.3%. Comparable increases in the

Omega-3 Index have been linked to de-

creased risk for sudden cardiac death

in previous studies – in a prospective

cohort study by about 80% [168] and in

a case control study by 90% [169].

Thus, there seem to be ad-

vantages of krill oil, when it comes to

raising a person’s Omega-3 Index. Most

importantly, the mentioned studies

show that krill oil more effectively rais-

es the Omega-3 Index compared to fish

oil, even though krill oil delivers lower

amounts of EPA and DHA on a gram per

gram basis compared to fish oil. Clear

health benefits, in particular for heart

health, have been shown by raising one’s

Omega-3 Index higher than 8%.

CONCLUSION While Superba™ krill oil has demon-

strated its health benefits in numerous

studies, the new krill oil concentrate

holds even more promise in particular

in relation to health concerns that are

characterized by phospholipid and/or

choline deficiency. Reduced phospho-

lipid and choline levels are seen in e.g.

liver and brain disorders, heart disease,

intestinal inflammation, lung and skin

diseases, or after intense exercise.

Krill oil supplementation can

help to heal membranes and to opti-

mize omega-3 fatty acid, phospholipid,

and choline status in the body. The all-

in-one advantage of krill oil delivering

simultaneously omega-3 fatty acids,

phospholipids, and choline gives it a

unique standpoint in the omega-3 mar-

ket. However, the full elucidation of how

much each component benefits human

health must await further study.

ACKNOWLEDGEMENTSI am very grateful for editing help from

Gunhild Yksnøy and Michel Lockhart

and to everyone proofreading the text.

A special thanks for the contribution

of tables from Tove Julie Evjen and

Wenche Rasch.


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