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October 15, 2024 21 mins

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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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
William Davis, MD (00:06):
Over the last 30 years, the question over
whether omega-3 fatty acids fromfish has been the subject of
controversy, swinging fromexuberance over its potential
benefits to skepticism overwhether they provide any benefit
at all.
It seems that one day we hearthat fish oil reduces risk for
heart attack, while the next daywe hear that there is no such

(00:26):
benefit, even harm.
We've also been subjected tonumerous marketing claims for
competing products, with claimssuch as 40 times more potent
than fish oil or you can't buythis in a health food store.
That further muddies the waters.
So let's review all that wehave learned over the past three
decades to decipher just whatrole, if any, omega-3 fatty

(00:50):
acids from fish oil should playin your program to regain or
maintain magnificent health.
And later in the podcast, let'stalk about Defiant Health's
sponsors Paleo Valley, ourpreferred provider for many
excellent organic and grass-fedfood products, and BiotiQuest,
my number one choice forprobiotics that are

(01:10):
scientifically formulated,unlike most of the other
commercial probiotic productsavailable today.
I'd like to also make you awareof a new source for our
favorite microbe, lactobacillusroteri, and a skin formulation I
designed that improves skinfrom the inside out.

(01:32):
The omega-3 fatty acids epa anddha really started getting
attention about 30 years ago orso, when it was noticed that
fish consuming cultures,cultures that consume a lot of
seafood seem to have lesscardiovascular risk, fewer
cardiovascular events, and sostudies began to be performed
that were hoping to provewhether or not omega-3 fatty

(01:53):
acids from fish, from fish oil,actually reduce cardiovascular
risk.
Now recall that omega-3 fattyacids are a component of food,
they're not drugs.
I point that out because ifit's something in food, our
expectations should be a littlebit lower than if it was a drug,
say, or a supplement thatprovides a necessary nutrient.

(02:15):
Well, the first study thatreally ignited the conversation,
ignited the interest aroundomega-3 fatty acids, was a study
called the GISSI-Prevenzionetrial, an Italian trial in which
11,000 people were given 1,000milligrams of EPA, dha, total,
and it observed over three tofive years, and they reported a

(02:37):
10% reduction in cardiovascularevents.
Well, several subsequentstudies, smaller studies, tried
to reproduce these results andcould not.
They did not show anysignificant reduction in
cardiovascular events.
So it was finally decided by alot of people that fish oil
didn't really reducecardiovascular risk.
For example, the OMEGA Remodelstudy of 358 people who were

(02:59):
enrolled after a heart attackand 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 fishoil supplementation.
So a lot of people began todismiss the value of fish oil.
But then some other studiescame out, such as the JELIS
trial, j-e-l-i-s.

(03:20):
This was a study conducted inJapan on 19,000 participants and
of course in Japan that's aseafood-consuming culture, so
the starting level of omega-3sin the blood was probably pretty
high to begin with.
Nonetheless, these 19,000people, all of whom were on
statin drugs, were given either1,800 milligrams of EPA alone so

(03:42):
only EPA, no DHA versus placeboand watched for about five
years and there was a 19%reduction in cardiovascular
events.
And then the vital study cameout, a Harvard study, another
large study of 25,000 people whowere given 1,000 milligrams
once again a low dose of EPA andDHA, and observed for 5.3 years

(04:03):
.
So among the bigger studies.
And this study showed a markedreduction in heart attack, in
myocardial infarction.
Then some combined analyseswere performed, that is,
so-called meta-analyses, that is, taking the results of several
dozen clinical trials and thencombined and then reanalyzed the
combined data.

(04:23):
And those analyses showed yes,omega-3 fatty acids do indeed
reduce risk for cardiovascularevents.
And then something odd happened.
The drug industry has alwaysbeen interested in trying to
convert fish oil, this componentof food, into a drug, using a
lot of misleading marketing todo so.
Well, one of the products iscalled Vasepa, and Vasepa is

(04:44):
pure EPA.
They conducted a clinical trialcalled the REDUCE-IT trial, in
which 8,000 participants weregiven either 4,000 milligrams of
a form of EPA or placebo forfive years.
Now this form of EPA is calledicosapentylethyl.
It's a form of ethyl ester,just like other forms of fish
oil that you buy in capsule form.

(05:06):
I believe they did so in orderto obtain patent protection and
to make it look like it'ssomething really different and
unique, but it's not.
It's pretty much the same stuffas conventional fish oil.
Nonetheless, 8,000 participants,half given placebo, half given
this form of EPA, and there wasindeed a 25% reduction in
cardiovascular events with thishigh dose of EPA.

(05:28):
So that pretty much clinchedthe conversation.
That is, between themeta-analyses the JEALOUS trial,
the GISSI-PREVENTIONE trial andfinally the REDUCE-IT trial
it's become clear that, yes,omega-3 fatty acids from fish
oil do indeed reducecardiovascular risk.
And then there was anotherstudy called the EVAPORATE trial

(05:50):
, which involved CT coronaryangiography and people were put
on fish oil, once again 4,000milligrams of the EPA, and they
experienced fairly significantregression or reversal of the
various components of coronaryatherosclerotic plaque Total
plaque was reduced,non-calcified plaque was reduced
, calcified plaque was reducedand fibrous plaque was reduced.

(06:13):
So that's pretty solid evidencethat you actually not only
reduce cardiovascular eventswith omega-3 fatty acids, but
you can actually achieve aregression, partial regression
or reversal of the variouscomponents of coronary
atherosclerotic plaque.
So there's been a lot ofattention paid to the
cardiovascular benefits ofomega-3 fatty acids.

(06:34):
We often forget that there areother conditions that omega-3
fatty acids have been shown tobe beneficial for.
One good example are autoimmunediseases.
The best studied is rheumatoidarthritis, and when people are
given omega-3 fatty acids,typically at higher doses,
starting at 2,000 milligrams orgreater, there is a reduction in
the number of joints involved.

(06:55):
There's a reduction in pain andswelling in those joints.
This has been corroboratedseveral times.
That is, omega-3 fatty acidshave conclusively been shown to
reduce rheumatoid arthritis andperhaps other forms of
autoimmune diseases.
Now, before we go on, let metell you a little bit about the
sponsors for the Defiant Healthpodcast.
When we return, let's talkabout some other conditions in

(07:20):
which omega-3 fatty acids can beexpected to be beneficial.
The Defiant Health podcast issponsored by Paleo Valley,
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(07:41):
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(08:01):
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(08:45):
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(10:11):
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.

(10:32):
Another area of health thatomega-3 fatty acids
supplementation can be helpful.
In fact, critical isreproductive health.
So if a woman does not havesufficient omega-3s in her body
which is very common, it's therule in modern American women
nowadays who have very lowlevels of omega-3 fatty acids
because of a very poor diet, andmany females don't like the

(10:54):
idea of eating a lot of fish norshould they because of the
mercury content, and so mostwomen of childbearing age are
fairly miserably deficient inomega-3 fatty acids, and that
has implications for a childshould that woman become
pregnant.
So the child is deprived ofomega-3 fatty acids while in
utero and that impairsneurological development,

(11:16):
neurological maturation.
And then, if the motherbreastfeeds, that child
essentially cannibalizes whatlittle omega-3 fatty acids the
woman has for its own purposes,that is, the baby needs those
omega-3 fatty acids forneurological maturation, so it
makes the mother even moreprogressively deficient and the
baby doesn't get anywhere nearas much, and this impairs a

(11:37):
child's intellectual andneurological maturation.
Children have been studied whodid not get supplementation with
omega-3s during pregnancy andbreastfeeding, and they have
lower measures of intelligenceand have impaired neurological
maturation.
Now studies have been performedwhere mothers were given fish
oil to provide omega-3 fattyacids, typically in the last

(12:01):
half of pregnancy and then alsoduring breastfeeding, and there
are indeed fairly significanteffects on childhood development
.
So omega-3 fatty acids play animportant role in reproductive
health, especially in thesetting of pregnancy and
breastfeeding.
Another area where omega-3 fattyacids play an important role is
in preserving cognitive health.

(12:21):
Supplementation of EPA and DHAin people with normal cognition
experience a modest increase inmeasures of intellectual
performance, but it also seemsto play a role in people with
early cognitive impairment, andtypically higher doses tend to
generate better effects as dosesthat are higher than 2,000
milligrams of combined EPA andDHA per day.

(12:42):
It also appears that,regardless of dose, omega-3
fatty acids appear to notprovide any cognitive benefit in
people with establisheddementia.
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 cognitionand people with early cognitive
impairment are those thatbenefit cognitively by

(13:04):
supplementing omega-3 fattyacids at doses of 2,000
milligrams per day or greater.
People often ask which isbetter, epa or DHA, or I think
you can judge from the priorstudies that both have their
role.
So DHA may play a bigger rolein cognitive health because the
brain is made largely of DHA.
Epa may play a larger role incardiovascular health.

(13:25):
So both play a role.
To further highlight thesilliness of the prescription
form of EPA, the drug calledVesepa.
Think about this If you weretaking that drug, that form of
fish oil, 4,000 milligrams perday which is very costly, by the
way and taking it to reducecardiovascular risk, if you want
the brain benefits, to preservecognitive health, you'll have

(13:49):
to get fish oil, conventionalfish oil that contains DHA.
So that is, it highlights howsilly and incomplete the
thinking is has been with thatproduct.
So ideally you get both EPA andDHA.
The typical ratio is three totwo EPA to DHA, because that's
that's the ratio that occursnaturally in in most, in most
fish that are the source foromega-3s.

(14:11):
So most fish oil preparationsare a three to two ratio of EPA
to DHA, and that's probably thebest way to do it.
Now there's a lot of marketinggoing on and therefore a lot of
false claims being made, andthat's because there's so many
products out there thatcompanies feel compelled to
exaggerate or misrepresent oractually outright lie about

(14:32):
their products.
So there's several forms offish oil.
So if you were to eat fish, thefish oil in that fish is in the
triglyceride form.
That is, three fatty acidsconnected to a glycerol backbone
, so that's called thetriglyceride form.
That is, three fatty acidsconnected to a glycerol backbone
, so that's called thetriglyceride form.
That's a naturally occurringform in fish.
Should you consume fish and youcan get supplements in that

(14:52):
triglyceride form.
Now, most fish oil is treatedwith alcohol and it breaks off
those fatty acids and it becomessomething called ethyl ester.
That's another form, typicallymore common, a little less
expensive.
Then there's also thephospholipid form.
That's the form you typicallyfind in krill.
And then you have theicosapentylethyl.

(15:13):
That's the varied form thatcomes from the vasepa product.
And then there's alsomonoglyceride products.
That is just one fatty acid.
In isolation is an omega-3fatty acid.
Now there's lots of claims aboutone form or another being
superior.
They're really not.
There are differences though.
So the triglyceride form is alittle bit better absorbed than

(15:34):
the ethyl ester form.
Likewise, the phospholipid formis a little bit better absorbed
.
It doesn't mean the ethyl esterform doesn't work.
It just means you might have totake a little bit better
absorbed.
It doesn't mean the ethyl esterform doesn't work.
It just means you might have totake a little bit higher dose
of the ethyl ester form toobtain the same blood levels
that the triglyceride orphospholipid form provides, or,
conversely, you can reduce thedose of triglyceride or

(15:55):
phospholipid form to achieve thesame effect as the ethyl ester
form.
Ideally, you go by a blood levelat some point in your life.
The most common test is an RBComega-3 index.
It's a commercial platformcalled OmegaQuant and I'll put
the link down below.

(16:15):
I have no relationship with thecompany, but it's a very good
test.
It's been around for many years.
So you can always use thatblood test to see if, whatever
form of fish oil you choosetriglyceride, ethyl ester, etc.
You can adjust the dose toachieve the blood level you want
.
Let's talk about the blood levelin just a bit.
So please ignore all themarketing, the silly marketing.
You'll hear things like thisour form of omega-3 is 40 times

(16:36):
more potent than fish oil, oryou can't buy this in a health
food store.
That's what the pharma peopleargue.
So I want you to ignore allthat silly marketing.
That's all it is.
It's just marketing.
So we've reviewed a number ofthe studies that support the
idea that omega-3 fatty acidsfrom fish oil are beneficial,
but a lot of these studies havea lot of methodological problems

(16:58):
that likely cause the benefitsto be underestimated.
One of the major problems inalmost all these studies nearly
all the studies is that nobaseline assessment of EPA and
DHA were made at the start ofthe study.
In other words, what if peoplewere eating fish once or twice a
week and had a pretty goodlevel of omega-3s already?

(17:19):
When you give those peopleadditional omega-3s, when you
give those people additionalomega-3s, you shouldn't expect
much of a benefit, and so veryfew studies have looked at that.
So we don't know if, because ofthat, it may have reduced the
potential for seeing effects ofomega-3 supplementation.
Another problem in thesestudies is that doses were not

(17:40):
adjusted to body size or bodyfat, and we know that people who
are heavier have only half theblood levels of people who are
thinner.
So if you have a lot ofoverweight or obese people in
your clinical trial and youdidn't weight adjust your dose,
you can't expect to have fulleffect.
So that's another problem withmost of these studies.

(18:01):
Have full effect.
So that's another problem withmost of these studies.
Another problem is thatabsorption of omega-3s varies
from person to person, and soit's really hard to know how
much a person really absorbs.
Let's talk a little bit aboutthat test.
I mentioned the RBC omega-3index, called the omega quant.
So all it's measuring is thepercentage of omega-3 fatty

(18:23):
acids as a percentage of thetotal fatty acids in the
membrane of a red blood cell.
Red blood cells were chosenbecause they're easy to get, but
it also reflects tissue levels.
That is, the RBC omega-3 indexapproximates what tissue levels
are in other parts of the bodyin your liver, in muscle, in
your eyes and other organs.
And so this easy to get andrelatively inexpensive test I

(18:47):
believe if you buy it from thecompany, it's $49 for a finger
stick and this gives youguidance on whether your dose of
fish oil, in the form you'vechosen and given your body size
and your absorptive capacity, isit giving you an ideal level.
So what is an ideal RBC omega-3index?
Well, the average level in theUS and North America is 4% or

(19:11):
less, and we know that's a highrisk level.
That puts you at greater riskfor cardiovascular events, for
autoimmune diseases, forcognitive impairment and
problems with pregnancy andbreastfeeding.
What's an ideal level?
This is being debated, but it'sprobably around 10%, maybe even
11% or 12%, so you can gaugewhether or not you've achieved

(19:33):
that level.
That's the level in the rangeof about 10% to 12% where you've
maximally suppressed risk forheart attack, myocardial
infarction, other cardiovascularevents, risk for autoimmune
diseases, cognitive impairment.
Now the dose in pregnancy is notthoroughly worked out, but it
is clear that women are not atrisk for bleeding.

(19:53):
That was a concern some peoplehad early on, but that has never
played out.
So the best evidence is that3,000 milligrams of total EPA
DHA is a pretty good level.
That's very safe for a womanwho is pregnant and
breastfeeding, and that's alevel that gives both the mother
and the child a good level ofomega-3s.
Now here's a little observationthat's worth knowing.

(20:15):
So in my programs we used toalways measure this RBC omega-3
index, but I've been advocatingthat everybody gets between
3,000 and 3,600 milligrams ofEPA 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.

(20:37):
So I stopped measuring at leasthabitually measuring the RBC
omega-3 index.
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, toachieve so-called steady state,
that is, let's say, you starttaking your fish oil.
Let's just pretend 3,600milligrams EPA DHA per day on

(20:58):
January 1st.
Don't have your RBC omega-3index tested until April 1st,
because it takes about threemonths for the omega-3s to be
fully reflected in your RBComega-3 index.
So there you have it.
There's been lots and lots ofconfusion over the last 30 years
about the value or the benefitsof omega-3 fatty acids, but,

(21:20):
given 30 years of clinicalstudies, we now know yes, this
component of food, not a drugthis component of food does
indeed provide some significantbenefits across a number of
health areas.
Now, if you learned somethingfrom this episode of Defiant
Health, please subscribe to yourfavorite podcast directory.
Post a review.
Post a comment.

(21:40):
Help us spread the word.
It is possible to havemagnificent health, and you
don't need the healthcare systemto do it.
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