If that is the case, then how do we reconcile with overwhelming data that increasing one\u2019s Omega-3 Index by increased intake of EPA\/DHA in randomized controlled trials improves a number of surrogate parameters of cardiovascular risk:<\/p>\n
- \n
- reduces heart rate<\/li>\n
- increases heart rate variability<\/li>\n
- reduces blood pressure<\/li>\n
- reduces platelet reactivity<\/li>\n
- reduces triglycerides<\/li>\n
- increases large buoyant low-density lipoprotein (LDL)-particles and reduced small dense LDL-particles<\/li>\n
- increases large buoyant high-density lipoproteins (HDL)2<\/li>\n
- reduces very low-density lipoprotein (VLDL1)<\/li>\n
- reduces pro-inflammatory cytokines<\/li>\n
- increases anti-inflammatory oxylipins<\/li>\n<\/ul>\n
I had to settle this conundrum in my mind, in order to implement sound clinical practice when caring for our patient population. \u00a0I took my years of experience screening Omega-3 Index on all patients, carefully dissected industry guidelines, and came to the conclusion that 4 top factors influence the ill-fated discrepant attitudes toward omega-3 supplementation.<\/p>\n
- \n
- Bioavailability and standardized dosage of omega-3 fish oil<\/strong><\/li>\n
- Funding of major studies by large organizational food companies, i.e. Monsanto, and pharmaceutical makers of statins.<\/strong><\/li>\n
- Baseline characteristics of study population prior to and after 2002<\/strong><\/li>\n
- None of the studies had measured Omega-3 Index<\/strong><\/li>\n<\/ol>\n
Bioavailability & Lack of Standard Dosing of Omega-3 Fish Oils<\/strong><\/p>\n
When you walk down the aisle of any natural food market, pharmacy, vitamin store or online retailer of vitamins, you will come across 30+ forms of fish oil to choose from.\u00a0 Omega-3, omega-6, omega-3,6,9, esterified, ethyl form, krill, encapsulated, triglyceride form, least expensive, 6 capsules per serving, etc.\u00a0 And if you\u2019re a novice at picking out the right fish oil for you and your family, which pretty much makes up 90% of us,\u00a0you might as well place a blind fold on take any off the shelf\u00a0and call it a day. \u00a0This is exactly the same bestowal expert\u00a0investigators face when they determine\u00a0the correct\u00a0fish oil to use in their respective studies. \u00a0Table 1 depicts\u00a0a simplified breakdown:<\/p>\n
![\"omega](\"https:\/\/www.seasidemedicalpractice.com\/dev\/\/dev\/wp-content\/uploads\/2017\/07\/omega-3-index-img-1.png\")
<\/p>\nThe very smart analysts at the\u00a0American Heart Association (AHA)<\/a>\u00a0took into consideration numerous studies where they concluded in their 2017 Scientific Advisory Paper that the benefit from omega-3 supplementation is only seen among 2 of the 11 patient subsets, those with heart failure, and those with heart disease to prevent sudden cardiac death. \u00a0However, a glaring dissimilarity among the studies examined was no consistent omega-3 dosing or bioavailability consideration.\u00a0 In addition, some of the studies had a worrisome conflict of interest, bringing us to the next point:<\/p>\n
Funding of major studies by large organizational food companies may have confounded the negative results. \u00a0<\/strong><\/p>\n
A pivotal\u00a0study in New England Journal of Medicine<\/a>\u00a0used olive oil capsules as their placebo pill against only 1gm of EPA\/DHA capsule; study funded by pharm giants Pfizer, maker of Lipitor, and Sigma-Tau maker of Zocor and Zetia.\u00a0 Those of us who are measuring cholesterol panels and Omega-3 Index know 1 gram of fish oil will not make much of a dent in any lab measure. To put this in perspective, a 3 oz. serving of farmed Atlantic salmon has over 2 grams of omega-3 fatty acids, and 835 mg of omega-6.\u00a0 In fact, none of the 40 plus studies except the JELIS Trial which did show a positive correlation, used greater than 1gm fish oil to test effectiveness of fish oils against conventional treatment.\u00a0\u00a0 Furthermore, how can we really trust a study funded by the opposing treatment modality using an olive oil placebo? \u00a0Isn\u2019t olive oil packed with omega-3\u2019s? \u00a0Another example of conflict is Monsanto, makers of GMO soybeans and soybean based oil for sources of omega-3 capsules, funding the 2009 Advisory Committee on omega-6 and CVD report from the AHA.\u00a0\u00a0The proper way to perform a randomized control trial on whether omega-3 supplementation helps improve cardiovascular outcomes, is to use 3gm of a high quality, esterified and micro encapsulated omega-3 fish oil capsule, from an unbiased source.\u00a0\u00a0 Unfortunately, these researchers did not have a level playing field to start with, thus their conclusions must not be taken at face value.<\/p>\n
Baseline characteristics of study population before &\u00a0after 2002<\/strong><\/p>\n
Before 2002, the panel of studies on fish oil show more robust statistically significant difference among treated groups.\u00a0 What happened in 2002, the\u00a0Institute of Medicine<\/a>\u00a0passed guidelines for intake of omega-3 and omega-6, and the AHA advised all Americans to increase fish consumption.\u00a0 The theory is that people inherently started consuming more fish intake, therefore less degree of change was noticeable in future studies conducted after 2002.<\/p>\n
Also, Statin use was much less prevalent 2 decades ago, when studied populations had more chance of seeing a statistically meaningful change.\u00a0\u00a0 With widespread Statin use in our society, clearly a powerful drug in management of cardiovascular disease, meaningful change was less noticeable.<\/p>\n
No study\u00a0measured Omega-3 Index<\/strong><\/p>\n
Perhaps the most important and relevant factor is centered on the index itself. \u00a0None of the major randomized controlled trials before or after 2002 ever took into consideration actual measurement of omega-3 levels.\u00a0 When Omega-3 Index was first described in 2004, there was variability in laboratory methodologies rendering the results unreliable.\u00a0 Much stride and improvement has taken place since then, and guidelines have been established to determine optimal and dangerous levels.\u00a0 One lab company,\u00a0OmegaQuant<\/a>\u00a0measures the index most accurately by focusing on the fatty acids in the denominator of this equation.\u00a0 They claim measurement of fatty acids which are esterified in a particular physiologically-active subset of the membrane glycerophospholipids gives us the most meaningful measure of the index, whereby only the crucial fatty acids are included in the denominator.\u00a0 For example, if your omega-3 level is 40, and your total fatty acids is 1000, you will have an index of 4%.\u00a0 If you take the same omega-3 level, and you divide against only the crucial fatty acids in the glycerophospholipid membrane of 500, then your index will be 8%, a crucial difference.\u00a0 Turns out the greatest cardioprotection according to acclaimed omega-3 expert, Dr. William Harris of Sanford University, is an index of 8%.\u00a0 And we know that whole blood index is an excellent correlate for myocardial (heart) tissue. \u00a0Therefore, the higher the concentration of these fatty acids within cell membranes, particularly of the heart tissue, the better are cells\u2019 malleability and resilience to arrhythmias.\u00a0 A closer look at the mechanism of action at the molecular level shows us that omega-3\u2019s reduce inflammatory mediators via an orchestrated set of membrane effects, which may ultimately result in reduced arterial plaque fragility.\u00a0 This is likely the reason behind the\u00a0JELIS<\/a>\u00a0Trial led by a group of Japanese researchers who looked at 18,000+ hypercholesterolemia patients and found that a 1.8gm dose of EPA\/DHA added to statin therapy compared with statin therapy alone, lowered risk of sudden cardiac death by nearly 20%.<\/p>\n
In\u00a0Western countries, the average range of omega-3 index is 5%, whereas in countries known to have higher fish consumption, like Japan, the index is 9%. \u00a0In Japan,\u00a0there is less heart disease than US. \u00a0The preventive cardiologist Dr. Clemens van Schacky who was one of the original inventors of Omega-3 Index says\u00a0it best:\u00a0\u201cIn the future, incorporating the Omega-3 Index into trial designs by recruiting participants with a low Omega-3 Index and treating them within a pre-specified target range (e.g., 8%\u201311%), will make more efficient trials possible and provide clearer answers to the questions asked than previously possible.\u201d \u00a0<\/em><\/p>\n
Now that we have accurate testing method plus data showing higher dose omega-3 supplementation can save lives, and if prevention is truly a sacred principle we want to uphold as clinicians, we must begin incorporating Omega-3 Index into research studies, and in clinical practice. \u00a0We must screen Omega-3 Index not just for our patients with heart disease, but even those at risk.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"
by Nasimeh Yazdani, M.D The\u00a0Omega-3 Index\u00a0is the sum of 2 prominent long-chain omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acids (DHA) in red blood cell membranes and is expressed as a percentage of total erythrocyte fatty acids (FAs).\u00a0 It has been postulated that Omega-3 Index is the best predictor of sudden cardiac event if […]<\/p>\n","protected":false},"author":1,"featured_media":1909,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"none","_seopress_titles_title":"Omega-3 Index and The Heart","_seopress_titles_desc":"It has been postulated that Omega-3 Index is the best predictor of sudden cardiac event if one\u2019s level is less than 4%. Click to learn more....","_seopress_robots_index":"","_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[10],"tags":[],"class_list":["post-2037","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"_links":{"self":[{"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/posts\/2037","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/comments?post=2037"}],"version-history":[{"count":0,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/posts\/2037\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/media?parent=2037"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/categories?post=2037"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/tags?post=2037"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
- Funding of major studies by large organizational food companies, i.e. Monsanto, and pharmaceutical makers of statins.<\/strong><\/li>\n
- Bioavailability and standardized dosage of omega-3 fish oil<\/strong><\/li>\n