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The Peter Attia Drive
#83 - Bill Harris, Ph.D.: Omega-3 fatty acids
Dec 9, 2019
02:02:26
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Quick takeaways
- High doses of EPA and DHA reduce triglycerides significantly, showcasing a lowering effect on heart health.
- EPA in omega-3 displays antiplatelet properties, improving blood flow while DHA could impact LDL receptor function.
- Studies show that high concentrations of EPA and DHA, particularly in four grams a day doses, may alter LDL cholesterol levels.
- Vascepa, with four grams of EPA daily, benefits heart health by reducing triglycerides and maintaining low LDL cholesterol levels.
- Omega-3 supplements, even at 850mg per day, can reduce heart attack risk by 20%, emphasizing their cardiovascular benefits.
Deep dives
High Dose Omega-3 and Effects on Health
Giving high doses of omega-3, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can lead to significant reductions in triglycerides. In a study where subjects were given 25 grams of EPA and DHA daily, triglycerides decreased from about 100 to 75, showcasing the impactful lowering effect. Apart from triglycerides, LDL cholesterol levels also saw a pronounced reduction from 250 to 230, demonstrating a positive impact on heart health.
Effects of Omega-3 on Platelet Function
Additionally, omega-3, especially EPA, showed antiplatelet properties by prolonging bleeding time in subjects. This translates to improved blood flow and could potentially lower the risk of blood clot formation. However, in some individuals, such as a college student in the study, a marked drop in platelet count was observed, necessitating discontinuation of the omega-3 diet for safety reasons.
EPA and DHA Concentration Impact on LDL Cholesterol
It was noted that in studies with high concentrations of EPA and DHA, particularly in higher doses like four grams a day, LDL cholesterol levels might increase. This phenomenon was attributed to potential effects of DHA on LDL receptors, slowing down their removal of LDL particles, leading to elevated blood levels. The findings indicated a nuanced impact on cholesterol levels depending on dose and composition.
Vascepa Study on Heart Health Benefits
A study named Vascepa, administered four grams a day of EPA ethyl ester, demonstrated heart-healthy benefits in patients with elevated triglyceride levels. With subjects on statin drugs but still exhibiting triglyceride levels between 150 and 500, Vascepa showed reductions in triglycerides and maintained low LDL cholesterol levels. This study focused on individuals with existing heart disease or risk factors like diabetes, showcasing the potential of EPA in improving cardiovascular health.
The Benefits of Omega-3 Supplements
Taking omega-3 supplements, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), can significantly reduce the risk of cardiovascular events, including heart attacks. Even at a low dose of 850 milligrams per day, these supplements showed a 20% reduction in heart attacks. The study, compared to the well-known REDUCE-IT trial, demonstrated the benefits of omega-3 supplements for cardiovascular health.
The Importance of Measuring Omega-3 Levels
Measuring blood omega-3 levels is crucial for assessing one's omega-3 status. The Omega-3 Index, which reflects the levels of EPA and DHA in red blood cells, serves as a stable long-term marker of omega-3 status. It is recommended that doctors prioritize measuring omega-3 levels in patients similar to cholesterol monitoring to ensure optimal cardiovascular health.
Differences in Omega-3 Supplement Formats
Pharmaceutical-grade omega-3 supplements, such as epinova, offer a different formulation as free fatty acids compared to ethyl esters found in products like Vascepa and Lovaza. The free fatty acid form facilitates direct absorption without the need for enzymatic conversion in the gut, enhancing bioavailability and effectiveness. However, the availability of pure EPA as a free fatty acid in supplements is expected to be more accessible in the future.
Upcoming Studies on Omega-3 Supplements
The ongoing STRENGTH trial, comparable to the REDUCE-IT trial but using a free fatty acid formulation, is anticipated to provide further insights into the benefits of omega-3 supplements. Scheduled to conclude in October next year, this study aims to evaluate the efficacy of omega-3 supplements, potentially offering a more successful alternative to existing formulations. The results are expected to be released at the American Heart Association in 2022, shedding light on the impact of omega-3 supplementation on cardiovascular health.
The Role of Omega-6 Fatty Acids
Contrary to misconceptions, omega-6 fatty acids, primarily derived from plant seed oils like canola and safflower, play a beneficial role in reducing the risk of heart disease, stroke, and diabetes. While omega-6 levels have been on the rise, studies have shown a significant correlation between higher linoleic acid intake and improved cardiovascular health outcomes. Understanding the balance between omega-3 and omega-6 fatty acids is essential for maintaining optimal health.
The Importance of Long-term Omega-3 Supplementation
Omega-3 levels in the blood take about four months to stabilize after a change in supplementation, reflecting the turnover rate of red blood cells. Regular monitoring of omega-3 status through red blood cell tests ensures an accurate assessment of one's omega-3 levels, guiding dietary adjustments for long-term cardiovascular health benefits. Choosing a reliable omega-3 supplement and maintaining consistent intake can lead to sustained improvements in cardiovascular well-being.
In this episode, Bill Harris, Ph.D. in human nutrition and expert on omega-3 fatty acids, sets the table by clearly defining the families of fatty acids (saturated, monounsaturated, polyunsaturated) before diving into the current landscape of polyunsaturated fat (omega-6 and omega-3) with a particular focus on EPA and DHA (the two main elements of fish oil supplements). Bill gives a historical overview, updates us on the latest science related to the health benefits, and provides plenty of insights as to how we should think about increasing our EPA and DHA intake.
We discuss:
- Bill’s long history of studying fatty acids [6:30];
- Defining the fatty acids—SFA, MUFA, PUFA, omega-3, omega-6, and more [9:45];
- What is the significance of fatty acids? Why should we care? [19:45];
- History of fat phobia, saturated fat, and does PUFA reduce cholesterol? [23:45];
- Breaking down the conversion process of omega-6 and omega-3 fatty acids including how we get to EPA and DHA [28:00];
- Takeaway from Bill’s 1980 study looking at how salmon oil affected cholesterol and triglyceride levels [36:15];
- History of our understanding of omega-3 and its effect on LDL cholesterol [45:00];
- Prescribed fish oil drugs vs. OTC supplements—Differences and recommended brands [52:00];
- Health benefits of EPA [57:45];
- Potential benefits of ALA and how it compares to taking EPA and DHA directly [1:12:45];
- Health benefits of DHA [1:17:15];
- Cell membrane omega-3 index—What is it, the role of genetics, how to increase it, and a recommended target [1:19:00];
- Is EPA or DHA neuroprotective? Can it help with depression? [1:23:30];
- Recommended fish to eat for EPA and DHA - Any mercury concerns? [1:25:45];
- Can omega-3 mitigate risks associated with smoking? [1:29:15];
- The problem with the omega-6 to omega-3 ratio [1:30:00];
- The problem with labeling any kind of fatty acid as “bad” [1:36:00];
- Why increasing EPA and DHA intake matters more than reducing omega-6 intake [1:38:00];
- Important takeaway from the VITAL study [1:46:30];
- Importance of testing your omega-3 index [1:53:00];
- Exciting study coming out soon, and why you need to take your fish oil with food [1:57:15]; and
- More.
Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/billharris Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
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