Defiant Health Radio with Dr. William Davis
Defiant Health Radio with Dr. William Davis
Omega-3 Fatty Acids: Facts and Controversies
Over the last 30 years, the question over whether omega-3 fatty acids from fish has been the subject of controversy, swinging from exuberance over its potential benefits to skepticism over whether they provide any benefit at all. It seems that one day we hear that fish oil reduces risk for heart attack, while the next day we hear that there is no such benefit, even harm. We’ve also been subjected to numerous marketing claims for competing products with claims such as “40 times more potent than fish oil” or “You can’t buy this in a health food store” that further muddy the waters. So let’s review all that we have learned over the past 3 decades to decipher just what role, if any, omega-3 fatty acids from fish oil should play in your program to regain or maintain magnificent health.
We dive into the history and outcomes of landmark studies like GISSI-Prevenzione, OMEGA Remodel, and REDUCE-IT, which have left researchers and medical professionals both excited and perplexed. Discover how high-dose EPA might just be the key to reversing coronary atherosclerosis, as outlined in the EVAPORATE trial. Join us as we dissect the data and reveal why omega-3s are more than just a fleeting trend; they could be a cornerstone of heart health backed by decades of research.
Learn about different forms of fish oil supplements, and how the absorption rates can vary, cutting through the marketing jargon that often exaggerates their potency. Personalization is key, and we discuss how the RBC omega-3 index can offer tailored dosing advice. With a recommended daily intake of 3,600 milligrams, omega-3s promise noticeable improvements, but patience is needed as it takes about three months to reach a steady state. Subscribe now, and let us guide you through the science-backed journey to achieving optimal health, naturally.
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OmegaQuant test for RBC Omega-3 Index: https://omegaquant.com/
Books:
Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose Weight
Over the last 30 years, the question over whether omega-3 fatty acids from fish has been the subject of controversy, swinging from exuberance over its potential benefits to skepticism over whether they provide any benefit at all. It seems that one day we hear that fish oil reduces risk for heart attack, while the next day we hear that there is no such benefit, even harm. We've also been subjected to numerous marketing claims for competing products, with claims such as 40 times more potent than fish oil or you can't buy this in a health food store. That further muddies the waters. So let's review all that we have learned over the past three decades to decipher just what role, if any, omega-3 fatty acids from fish oil should play in your program to regain or maintain magnificent health. And later in the podcast, let's talk about Defiant Health's sponsors Paleo Valley, our preferred provider for many excellent organic and grass-fed food products, and BiotiQuest, my number one choice for probiotics that are scientifically formulated, unlike most of the other commercial probiotic products available today. I'd like to also make you aware of a new source for our favorite microbe, lactobacillus roteri, and a skin formulation I designed that improves skin from the inside out.
William Davis, MD:The omega-3 fatty acids epa and dha really started getting attention about 30 years ago or so, when it was noticed that fish consuming cultures, cultures that consume a lot of seafood seem to have less cardiovascular risk, fewer cardiovascular events, and so studies began to be performed that were hoping to prove whether or not omega-3 fatty acids from fish, from fish oil, actually reduce cardiovascular risk. Now recall that omega-3 fatty acids are a component of food, they're not drugs. I point that out because if it's something in food, our expectations should be a little bit lower than if it was a drug, say, or a supplement that provides a necessary nutrient. Well, the first study that really ignited the conversation, ignited the interest around omega-3 fatty acids, was a study called the GISSI-Prevenzione trial, an Italian trial in which 11,000 people were given 1,000 milligrams of EPA, dha, total, and it observed over three to five years, and they reported a 10% reduction in cardiovascular events. Well, several subsequent studies, smaller studies, tried to reproduce these results and could not. They did not show any significant reduction in cardiovascular events. So it was finally decided by a lot of people that fish oil didn't really reduce cardiovascular risk. For example, the OMEGA Remodel study of 358 people who were enrolled after a heart attack and were given 4,000 milligrams much higher dose of EPA and DHA, as the prescription lovaziform and observed over three years, experienced no reduction in cardiovascular events with fish oil supplementation. So a lot of people began to dismiss the value of fish oil. But then some other studies came out, such as the JELIS trial, j-e-l-i-s. This was a study conducted in Japan on 19,000 participants and of course in Japan that's a seafood-consuming culture, so the starting level of omega-3s in the blood was probably pretty high to begin with. Nonetheless, these 19,000 people, all of whom were on statin drugs, were given either 1,800 milligrams of EPA alone so only EPA, no DHA versus placebo and watched for about five years and there was a 19% reduction in cardiovascular events. And then the vital study came out, a Harvard study, another large study of 25,000 people who were given 1,000 milligrams once again a low dose of EPA and DHA, and observed for 5.3 years. So among the bigger studies. And this study showed a marked reduction in heart attack, in myocardial infarction. Then some combined analyses were performed, that is, so-called meta-analyses, that is, taking the results of several dozen clinical trials and then combined and then reanalyzed the combined data. And those analyses showed yes, omega-3 fatty acids do indeed reduce risk for cardiovascular events. And then something odd happened.
William Davis, MD:The drug industry has always been interested in trying to convert fish oil, this component of food, into a drug, using a lot of misleading marketing to do so. Well, one of the products is called Vasepa, and Vasepa is pure EPA. They conducted a clinical trial called the REDUCE-IT trial, in which 8,000 participants were given either 4,000 milligrams of a form of EPA or placebo for five years. Now this form of EPA is called icosapentylethyl. It's a form of ethyl ester, just like other forms of fish oil that you buy in capsule form. I believe they did so in order to obtain patent protection and to make it look like it's something really different and unique, but it's not. It's pretty much the same stuff as conventional fish oil.
William Davis, MD:Nonetheless, 8,000 participants, half given placebo, half given this form of EPA, and there was indeed a 25% reduction in cardiovascular events with this high dose of EPA. So that pretty much clinched the conversation. That is, between the meta-analyses the JEALOUS trial, the GISSI-PREVENTIONE trial and finally the REDUCE-IT trial it's become clear that, yes, omega-3 fatty acids from fish oil do indeed reduce cardiovascular risk. And then there was another study called the EVAPORATE trial, which involved CT coronary angiography and people were put on fish oil, once again 4,000 milligrams of the EPA, and they experienced fairly significant regression or reversal of the various components of coronary atherosclerotic plaque Total plaque was reduced, non-calcified plaque was reduced, calcified plaque was reduced and fibrous plaque was reduced. So that's pretty solid evidence that you actually not only reduce cardiovascular events with omega-3 fatty acids, but you can actually achieve a regression, partial regression or reversal of the various components of coronary atherosclerotic plaque. So there's been a lot of attention paid to the cardiovascular benefits of omega-3 fatty acids.
William Davis, MD:We often forget that there are other conditions that omega-3 fatty acids have been shown to be beneficial for. One good example are autoimmune diseases. The best studied is rheumatoid arthritis, and when people are given omega-3 fatty acids, typically at higher doses, starting at 2,000 milligrams or greater, there is a reduction in the number of joints involved. There's a reduction in pain and swelling in those joints. This has been corroborated several times. That is, omega-3 fatty acids have conclusively been shown to reduce rheumatoid arthritis and perhaps other forms of autoimmune diseases. Now, before we go on, let me tell you a little bit about the sponsors for the Defiant Health podcast. When we return, let's talk about some other conditions in which omega-3 fatty acids can be expected to be beneficial.
William Davis, MD:The Defiant Health podcast is sponsored by Paleo Valley, makers of delicious grass-fed beef sticks, healthy snack bars and other products. We're very picky around here and insist that any product we consider contains no junk ingredients like carrageenan, carboxymethylcellulose, sucralose or added sugars, and, of course, no gluten nor grains. One of the habits I urge everyone to get into is to include several servings of fermented foods every day in your diet, part of an effort to cultivate a healthy gastrointestinal microbiome. Unlike nearly all other meat sticks available, paleo Valley grass-fed beef, pork and chicken sticks are naturally fermented, meaning they contain probiotic bacterial species. Paleo Valley has also launched a number of interesting new products, including extra virgin olive oil, spice mixes, organic coffee, strawberry lemonade, super greens and essential electrolytes in a variety of flavors. And if you haven't already tried it, you've got to try their chocolate-flavored bone broth protein that makes delicious hot chocolate and brownies. See the recipes for the brownies in my drdavisinfinitehealthcom blog. Listeners to the Defiant Health podcast receive a 15% discount by going to paleovalleycom/ Backward slash. Defiant health. And, in case you haven't yet heard, biotiquest probiotics are my first choice for intelligently, purposefully crafted probiotics. I've had numerous conversations with BiotiQuest founders Martha Carlin and academic microbiologist Dr Raul Cano. They have formulated unique probiotic products that incorporate what are called collaborative or guild effects, that is, groups of microbes that collaborate with each other via sharing of specific metabolites, potentially providing synergistic benefits. They have designed their sugar shift probiotic to support healthy blood sugars.
William Davis, MD:support sleep. Ideal Immunity to support a healthy immune response. Heartcentered that supports several aspects of heart health. And Antibiotic Antidote designed to support recovery of the gastrointestinal microbiome after a course of antibiotics. The BioDequest probiotics are, I believe, among the most effective of all probiotic choices you have. Enter the discount code UNDOC15, all caps, u-n-d-o-c-15, for a 15% discount. For Defiant Health listeners and due to demand for reliable, convenient sources of lactobacillus roteri, I created two products my Roteri that contains 20 billion counts of lactobacillus roteri alone, and Gut to Glow that, in addition to the L-Roteri, has added marine sourced collagen peptides, hyaluronic acid and the carotenoid astaxanthin, all combined to stack the odds in favor of favorable skin effects. Of course, you can take these products as is or you can use either product as a starter to make L-rhodorite yogurt to generate even higher counts of microbes for bigger effects. I'll provide a link for these products below in the show notes.
William Davis, MD:Another area of health that omega-3 fatty acids supplementation can be helpful. In fact, critical is reproductive health. So if a woman does not have sufficient omega-3s in her body which is very common, it's the rule in modern American women nowadays who have very low levels of omega-3 fatty acids because of a very poor diet, and many females don't like the idea of eating a lot of fish nor should they because of the mercury content, and so most women of childbearing age are fairly miserably deficient in omega-3 fatty acids, and that has implications for a child should that woman become pregnant. So the child is deprived of omega-3 fatty acids while in utero and that impairs neurological development, neurological maturation. And then, if the mother breastfeeds, that child essentially cannibalizes what little omega-3 fatty acids the woman has for its own purposes, that is, the baby needs those omega-3 fatty acids for neurological maturation, so it makes the mother even more progressively deficient and the baby doesn't get anywhere near as much, and this impairs a child's intellectual and neurological maturation. Children have been studied who did not get supplementation with omega-3s during pregnancy and breastfeeding, and they have lower measures of intelligence and have impaired neurological maturation. Now studies have been performed where mothers were given fish oil to provide omega-3 fatty acids, typically in the last half of pregnancy and then also during breastfeeding, and there are indeed fairly significant effects on childhood development. So omega-3 fatty acids play an important role in reproductive health, especially in the setting of pregnancy and breastfeeding.
William Davis, MD:Another area where omega-3 fatty acids play an important role is in preserving cognitive health. Supplementation of EPA and DHA in people with normal cognition experience a modest increase in measures of intellectual performance, but it also seems to play a role in people with early cognitive impairment, and typically higher doses tend to generate better effects as doses that are higher than 2,000 milligrams of combined EPA and DHA per day. It also appears that, regardless of dose, omega-3 fatty acids appear to not provide any cognitive benefit in people with established dementia. So once dementia is established, omega-3 fatty acids do not seem to provide any benefit. It's the earlier phase. So people with normal cognition and people with early cognitive impairment are those that benefit cognitively by supplementing omega-3 fatty acids at doses of 2,000 milligrams per day or greater. People often ask which is better, epa or DHA, or I think you can judge from the prior studies that both have their role. So DHA may play a bigger role in cognitive health because the brain is made largely of DHA. Epa may play a larger role in cardiovascular health. So both play a role.
William Davis, MD:To further highlight the silliness of the prescription form of EPA, the drug called Vesepa. Think about this If you were taking that drug, that form of fish oil, 4,000 milligrams per day which is very costly, by the way and taking it to reduce cardiovascular risk, if you want the brain benefits, to preserve cognitive health, you'll have to get fish oil, conventional fish oil that contains DHA. So that is, it highlights how silly and incomplete the thinking is has been with that product. So ideally you get both EPA and DHA. The typical ratio is three to two EPA to DHA, because that's that's the ratio that occurs naturally in in most, in most fish that are the source for omega-3s. So most fish oil preparations are a three to two ratio of EPA to DHA, and that's probably the best way to do it.
William Davis, MD:Now there's a lot of marketing going on and therefore a lot of false claims being made, and that's because there's so many products out there that companies feel compelled to exaggerate or misrepresent or actually outright lie about their products. So there's several forms of fish oil. So if you were to eat fish, the fish oil in that fish is in the triglyceride form. That is, three fatty acids connected to a glycerol backbone, so that's called the triglyceride form. That is, three fatty acids connected to a glycerol backbone, so that's called the triglyceride form. That's a naturally occurring form in fish. Should you consume fish and you can get supplements in that triglyceride form.
William Davis, MD:Now, most fish oil is treated with alcohol and it breaks off those fatty acids and it becomes something called ethyl ester. That's another form, typically more common, a little less expensive. Then there's also the phospholipid form. That's the form you typically find in krill. And then you have the icosapentylethyl. That's the varied form that comes from the vasepa product. And then there's also monoglyceride products. That is just one fatty acid. In isolation is an omega-3 fatty acid.
William Davis, MD:Now there's lots of claims about one form or another being superior. They're really not. There are differences though. So the triglyceride form is a little bit better absorbed than the ethyl ester form. Likewise, the phospholipid form is a little bit better absorbed. It doesn't mean the ethyl ester form doesn't work. It just means you might have to take a little bit better absorbed. It doesn't mean the ethyl ester form doesn't work. It just means you might have to take a little bit higher dose of the ethyl ester form to obtain the same blood levels that the triglyceride or phospholipid form provides, or, conversely, you can reduce the dose of triglyceride or phospholipid form to achieve the same effect as the ethyl ester form.
William Davis, MD:Ideally, you go by a blood level at some point in your life. The most common test is an RBC omega-3 index. It's a commercial platform called OmegaQuant and I'll put the link down below. I have no relationship with the company, but it's a very good test. It's been around for many years. So you can always use that blood test to see if, whatever form of fish oil you choose triglyceride, ethyl ester, etc. You can adjust the dose to achieve the blood level you want.
William Davis, MD:Let's talk about the blood level in just a bit. So please ignore all the marketing, the silly marketing. You'll hear things like this our form of omega-3 is 40 times more potent than fish oil, or you can't buy this in a health food store. That's what the pharma people argue. So I want you to ignore all that silly marketing. That's all it is. It's just marketing.
William Davis, MD:So we've reviewed a number of the studies that support the idea that omega-3 fatty acids from fish oil are beneficial, but a lot of these studies have a lot of methodological problems that likely cause the benefits to be underestimated. One of the major problems in almost all these studies nearly all the studies is that no baseline assessment of EPA and DHA were made at the start of the study. In other words, what if people were eating fish once or twice a week and had a pretty good level of omega-3s already? When you give those people additional omega-3s, when you give those people additional omega-3s, you shouldn't expect much of a benefit, and so very few studies have looked at that. So we don't know if, because of that, it may have reduced the potential for seeing effects of omega-3 supplementation. Another problem in these studies is that doses were not adjusted to body size or body fat, and we know that people who are heavier have only half the blood levels of people who are thinner. So if you have a lot of overweight or obese people in your clinical trial and you didn't weight adjust your dose, you can't expect to have full effect. So that's another problem with most of these studies. Have full effect. So that's another problem with most of these studies. Another problem is that absorption of omega-3s varies from person to person, and so it's really hard to know how much a person really absorbs.
William Davis, MD:Let's talk a little bit about that test. I mentioned the RBC omega-3 index, called the omega quant. So all it's measuring is the percentage of omega-3 fatty acids as a percentage of the total fatty acids in the membrane of a red blood cell. Red blood cells were chosen because they're easy to get, but it also reflects tissue levels. That is, the RBC omega-3 index approximates what tissue levels are in other parts of the body in your liver, in muscle, in your eyes and other organs. And so this easy to get and relatively inexpensive test I believe if you buy it from the company, it's $49 for a finger stick and this gives you guidance on whether your dose of fish oil, in the form you've chosen and given your body size and your absorptive capacity, is it giving you an ideal level.
William Davis, MD:So what is an ideal RBC omega-3 index? Well, the average level in the US and North America is 4% or less, and we know that's a high risk level. That puts you at greater risk for cardiovascular events, for autoimmune diseases, for cognitive impairment and problems with pregnancy and breastfeeding. What's an ideal level? This is being debated, but it's probably around 10%, maybe even 11% or 12%, so you can gauge whether or not you've achieved that level. That's the level in the range of about 10% to 12% where you've maximally suppressed risk for heart attack, myocardial infarction, other cardiovascular events, risk for autoimmune diseases, cognitive impairment.
William Davis, MD:Now the dose in pregnancy is not thoroughly worked out, but it is clear that women are not at risk for bleeding. That was a concern some people had early on, but that has never played out. So the best evidence is that 3,000 milligrams of total EPA DHA is a pretty good level. That's very safe for a woman who is pregnant and breastfeeding, and that's a level that gives both the mother and the child a good level of omega-3s. Now here's a little observation that's worth knowing. So in my programs we used to always measure this RBC omega-3 index, but I've been advocating that everybody gets between 3,000 and 3,600 milligrams of EPA and DHA per day, and I found that if people get that dose, they almost always have an RBC omega-3 index of 10% or greater. So I stopped measuring at least habitually measuring the RBC omega-3 index.
William Davis, MD:But you can do that if you like. In case you're uncertain Now, one thing to know is it takes about three months, 12 weeks, to achieve so-called steady state, that is, let's say, you start taking your fish oil. Let's just pretend 3,600 milligrams EPA DHA per day on January 1st. Don't have your RBC omega-3 index tested until April 1st, because it takes about three months for the omega-3s to be fully reflected in your RBC omega-3 index. So there you have it. There's been lots and lots of confusion over the last 30 years about the value or the benefits of omega-3 fatty acids, but, given 30 years of clinical studies, we now know yes, this component of food, not a drug this component of food does indeed provide some significant benefits across a number of health areas. Now, if you learned something from this episode of Defiant Health, please subscribe to your favorite podcast directory. Post a review. Post a comment. Help us spread the word. It is possible to have magnificent health, and you don't need the healthcare system to do it. Thanks for listening.
