Episode 95 – Omega 3 Part 2

Today is part 2 to last weeks episode on omega 3 supplementation  

Last week we touched on omega 3 in relation to heart health, body composition, depression and anxiety, Alzheimer’s, pregnancy and joint health  

This week we will cover, the debate around omega 3 to 6 ratios, plant based omega 3 & deep dive into supplementation types, dosages and all of that  

Omega 3 vs omega 6 ratio 

  • There is likely some merit of truth here, but it is not as clear cut as it is made to seem. 
  • One argument is that humans historically consumed a 1:1 ratio of omega 6 to omega 3, but now consume a 5-15:1 ratio.  
  • I don’t really like evolutionary arguments, because it makes less sense to look at what humans previously did, largely out of food availability, instead of looking at evidence in modern humans.  
  • Some weaknesses in the simplified ratio argument are: 
    1) Different levels of consumption. If you had high intakes of both, the ratio is the same as if you had low intakes of both. 

2) The ratio implies that omega 3 is good and omega 6 is bad. 

3) The ratio alone doesn’t account for food sources. 

  • Taking that a step further – nuts and seeds contain omega 6. But they are clearly linked with positive health outcomes.  
  • From the other angle – a lot of high omega 6 foods are refined/process foods. 
  • There are some arguments that it is less important to reduce omega 6 and more important to increase omega 3. 
  • Looking at the research a few studies stand out: 
  • 1) A 2019 meta analysis found that higher linoleic acid (omega 6) levels in the body was correlated with lower CVD risk. Arachidonic acid was mostly unlinked, but was slightly favoured towards reducing CVD risk too. If omega 6 was really bad, this outcome would seem unlikely. 
  • 2) Previous meta-analysis results had found that replacing saturated fat with omega 6 reduced coronary heart disease risk by around 24%. But a more recent meta-analysis using more tightly controlled variables found no change in risk.  
  • I think it makes sense to 1) Increase omega 3 intake if it is low. 2) Reduce intake of omega 6 in the form of processed/refined foods, if consumed in large amounts currently. 3) Not stress too much about omega 6 in foods like nuts and seeds. 

Plant based vs fish oil omega 3 

  • There are three forms of omega-3 fatty acids:
    • Alpha-linolenic acid (ALA) 
    • Eicosapentaenoic acid (EPA) 
    • Docosahexaenoic acid (DHA) 
  • When we are talking about health outcomes from omega 3 supplementation, we are talking specifically about direct forms of EPA & DHA 
  • ALA on the other hand needs to be converted into EPA & DHA in the body once consumed – which is a pretty inefficient process 
  • So you need to consume ALOT of ALA to get a little bit of EPA & DHA 
  • Now why am I going on this tangent? It is because most of the omega 3 in plant based food is ALA (such as in walnuts, chia seeds, hemps seeds and flaxseeds) 
  • Due to this, vegans typically have significantly lower levels of long-chain omega-3 fatty acids (EPA and DHA) in their blood.  
  • But good news is that there is actually a vegan source of EPA & DHA
    • And that is microalgae which is available in supplement form  
  • For some plant-based people such as those with heart disease, athletes looking to improve recovery and pregnant and breastfeeding people, supplementation with microalgae may be beneficial and/or necessary. 

Dosage: 

  • Most people who are talking about the benefits of omega 3 supplements recommend higher dosages than what is typically researched.  
  • Arguaby the research seems to favour higher dosages too. 
  • A great example of this is the research on omega 3 for reducing triglycerides. The most positive research involves ~4g of either EPA or EPA + DHA 
  • For context, a random 1g fish oil capsule usually contains 300mg of combined EPA and DHA. So that study is the equivalent of more than 10 standard capsules (exlcluding the other content in the capsules e.g. triglycerides). 
  • There is no standard recommendation I have. I usually recommend 1-3g fish oil per day. But I can see benefits for going higher under certain circumstances.  
  • Going too high is rare. But downsides could be 1) The unpleasantness of taking a lot 2) Some people get GI upset if large amounts are consumed. Or reflux/nausea. 3) It would have to be a lot – but the calories still count. 10g would be 90kcal.   

If supplemented, does it need to be consumed alongside food? 

  • Taking omega 3 alongisde food appears to improve absorption a bit. Particularly if the food contains a decent amount of dietary fat. 
  • BUT Consistency is the most important thing though. It would be better to take it daily at any random time, than to get caught up on having it alongside meals and forgetting. 

Omega 3 Index 

  • Omega 3 index is a measure of how much EPA and DHA is in the red blood cells membranes. It gives a percentage, that is the percentage of the total fatty acids in the membrane.  
  • It theoretically is better than other methods of quantifying omega 3 status because red blood cells last for 3-4 months. Other methods are skewed more by shorter term intake. 
  • The risk factors are defined as <4% being high risk, 4-8% being moderate risk and >8% being low risk. 
  • Theoretically, at a glance this is great concept. It could also be super useful for research since it helps with improving baseline data.  
  • My interpretation is that it is a good idea – but I’m cautious for a few reasons: 

1) It is heavily driven by one person – Bill Harris. He is one of the biggest omega 3 researchers. And his whole company (Omega Quant) is based on omega 3.  

2) Why hasn’t the concept gained more mainstream popularity if it is so helpful? 

3) The marketing is a little aggressive. Even those ranges I mentioned. They say that most people are <4% on the test and are at high risk of all of these issues. But why is the research on omega 3 supplementation so mixed?  

4) The >8% being ideal is also a mild red flag since I think there almost always is a range that is excessive. Is going >12% detrimental? Or is that still fine? 

  • I think it has practical applications and has benefits. But I’m personally not reading too heavily into it yet. 

Food vs Supplements 

  • Eating fish that contains omega 3’s has consistently been linked with positive health outcomes, arguably even more than omega 3 itself. 
  • For those who eat fish, eating it 2-3x per week is a solid recommendation. High fat fish such as salmon and sardines has more omega 3 than low fat fish, so that is the better option in this context  
  • 100g of salmon contains just over 2g of combined EPA and DHA on average.  
  • Theoretically, the lower the intake of omega 3 somebody has through their diet, the more benefit they would get from supplementing 

And as I stated previously, I think there is even a bigger case for plant based people to supplement, simply to there not being a common food source of EPA & DHA available  

Grass Fed vs Grain Fed Omega 3 Content in Meat 

  • Grass fed meat is often pushed as superior to grain fed, for a variety of reasons. I won’t address the overall topic since it is complex.  
  • Specifically addressing claims about omega 3 though:  
  • Often percentage differences are used e.g. grass fed beef is 300% higher in omega 3. 
  • One main issue with that is that red meat is pretty low in omega 3. If you look at the TOTAL number, it is barely anything in comparison to other options like salmon. 

Relevant Links/Resources

Studies Mentioned