Podcast Episode 94 Transcript – Omega 3 Part 1

Aidan:

Hello, and welcome to the Ideal Nutrition Podcast. My name is Aidan Muir, and I am here with my co-host, Leah Higl.

And this is episode 94, where we are going to be talking about Omega-3. And honestly, this is probably the podcast I’ve spent the most time prepping for.

It is a big topic. And I always feel cautious saying stuff like that, because obviously I’m now 10 years into reading as much as I can about nutrition. I’ve obviously spent a lot of time researching Omega-3’s over those years, and I’ve spent as much time as I can learning about the topic. And forming my own opinions and interpreting the research.

But to do a podcast on it, I wanted to go quite deep because it is a big topic. And the research on the topic can be difficult to interpret in terms of situations where supplementing Omega-3’s would be beneficial. How much should we be consuming through food and everything like that?

Situations where it might not be beneficial. Differences between the different forms of Omega-3’s. There’s so much to cover. So we will also be splitting this up into two parts. Where this first part, we’re more going to be looking at the research on Omega-3’s, particularly supplementation on individual situations.

And then in the second part, we’re going to be covering some common themes that come up in the research, about things like dosages, types of Omega-3’s, all of those little details.

Starting off, I’m going to give the briefest introduction about Omega-3 stuff, and then we’ll go into those individual situations. So as a brief introduction, Omega-3 is an essential fatty acid, which means we don’t create it in our body. That’s important, because it obviously tells us that Omega-3 is important, we have to get it through food.

So as a baseline, consuming at least a minimal amount of Omega-3 is super important. The bigger question is just how much do we need to have to optimize it with the downsides of having too little? All of those things. There are also three main forms of Omega-3 as well. There is Alpha-linoleic acid, so that’s called ALA, DHA, which is Docosahexaenoic acid.

And EPA, which is Eicosapentaenoic acid. So ALA, DHA, and EPA. ALA is mostly found in plants, and DHA and EPA are mostly found in animal products, mainly fish. We’re going to talk more about those details and everything like that probably in the second part, but we’ll cover that more in detail.

Leah:

So I think a good place to start when we’re talking about Omega-3 would be cardiovascular disease and heart health. So we were looking at Wikipedia, and I think their summary was interesting in that it just summarizes that there is no high-quality evidence that fish oil reduces the risk of strokes, heart attacks, or any vascular disease outcomes.

Without context and just having a very brief overview, that’s not a bad summary by Wikipedia to be honest. But once you start digging into the details of this research and coming at it from different perspectives, it shows a little bit of a different outcome. So it’s a little more nuanced than that.

So firstly, we do have pretty strong evidence that fish oil lowers triglyceride levels, and we know there is a link between lower triglyceride levels or having that within a normal healthy range and positive heart health outcomes.

So in studies, looking at the treatment of very high triglycerides, with four grams per day of EPA and DHA, so that is quite a lot. Triglycerides were reduced by over 30%. That’s pretty massive, and that could potentially have quite significant impacts on overall heart health and cardiovascular disease risk.

We think an interesting gap that has been identified in the heart health space is that often statins are used when we’re talking about high blood pressure, cardiovascular disease, et cetera, but statins do not necessarily lower triglyceride levels as much as they do say LDL cholesterol.

So some people propose that by adding Omega-3 supplementation alongside utilizing the medication group statins would be even more beneficial to the outcomes of these patients. And there is some research backing that idea as well.

Aidan:

So clarifying one thing about how high that dose of four grams per day is. One gram of fish oil typically has about 300 milligrams of combined EPA and DHA.

So four grams, we’re looking at over 10 capsules of fish oil.

Leah:

Yeah, it’s not just four grams of fish oil, it’s four grams of EPA and DHA.

Aidan:

Yeah, exactly.

And I’m going to talk about some of the studies that have looked at this kind of stuff, and the dosages they’ve then used and how they got there and everything like that. The first one I’m going to talk about is called the reduce it trial, which involved four grams of straight EPA, so not even EPA and DHA, just EPA.

So once again, that’s a really high dosage of that. And it resulted in a 25% reduction in basically cardiovascular events over a five-year period in those who were also on statins and were at high risk.

Obviously even with large sample sizes, we’re more likely to see positive outcomes in situations where people are at risk of having cardiovascular events. For example, people who are on statins often already are at higher risk. They would be at higher risk without the statins, but there’s a reason they are on the statin. So they’re already at higher risk in comparison to the general population.

Another great example is the secondary prevention kind of situation. If somebody’s already had a cardiovascular event, they’re at higher risk than the average person of having a second one. So official, it has been consistently being shown to be having benefits in those secondary prevention situations, which is why when we look at that Wikipedia analysis of being like, it doesn’t have clear evidence of helping with CVD risk.

When you look at it through the right lens, at the right angle, you can find situations where it is a bit of a higher likelihood. There is another study called the GISSI-Prevenzione trial. I’ve heard people talk about that, just say GISSI.

So GISSI, which involved 11,000 people who had myocardial infarction less than three months ago, and they utilized one gram of Omega-3 per day. Once again, that’s Omega-3, not fish oil. And they found a significant reduction in all CVD risks. So this is where we were talking about that secondary prevention.

There have been multiple meta analyses that have been done on this topic in general, and they all have different findings, which really complicates the topic. And you can see why people form different opinions.

When you go through the meta analyses you can see reasons why they have different findings. One clear example is that higher dosages are often more effective than lower dosages. So studies that use higher dosages were more likely to find benefits, as we talk about that four grams of EPA, that’s a really high dosage.

If you only include studies with higher dosages, they’re more likely to find positive findings. The other one is that some of the meta analyses seem to have been skewed by their weighting system. And what I mean by that is some of these studies had really large sample sizes and didn’t find benefits.

Some of them had large sample sizes, but not as large as the other ones, and did find benefits. But based on the weighting, if their weighting sample size above all else, the studies that didn’t find benefit would be weighted heavier in that scenario. Which is something that skewed some of the meta analyses. One of them from memory got rid of one of the major studies, it just excluded it and it made it for sure look better.

And they obviously had logical reasons for excluding that.

They’re not just trying to cherry pick or whatever. But I think it’s relevant to be aware of that, being like it’s a topic where we’re often seeing not much benefits, sometimes we are seeing benefit. And if you look at it through the right lens, you see more benefit than if you don’t look at it through the other lens. I’m not saying either approach is right or wrong, but that’s the situation we’re dealing with with cardiovascular disease and fish oil.

Leah:

Yeah, I think I guess an overall summary is if I have a client that is at higher risk of heart complications, I’m going to recommend Omega-3. So in terms of an outcome and recommendations, even though the research isn’t super clear, I think it is strong enough for me as a dietician to recommend it.

Aidan:

If we’ve got some research showing a 25% reduction in a secondary event situation, another researcher showing zero, we’re either at zero or it’s [inaudible 00:09:13].

Leah:

And it’s one of those things that doesn’t have necessarily a risk. So why not? The next aspect we’re going to look at Omega-3 from is body composition. So the research on Omega-3 and body composition is not overly promising, so definitely less promising than when we’re looking at the heart health stuff.

Most studies in this found no difference when they were looking at Omega-3 supplementation and body composition outcomes. Some studies have found differences, but often it was only in very specific portions of their overall sample size. Some studies found only differences in men. Some studies found only differences in women, so there wasn’t a common theme amongst the overall breadth of research that would be promising in terms of recommendations.

There is a small amount of research indicating that Omega-3 supplementation can help minimize muscle loss while immobilized after an injury or surgery. I wouldn’t read too much into that just yet, but it’s also in terms of recommendations, if someone comes to me and goes, “Look, I’m injured. I’m an athlete. What can I do when I’m immobilized to maintain my muscle mass?”

It’s one of those things that I’ll be like, “Look, the research isn’t super clear on this, but again, it’s like, well, what’s the harm? Why don’t we add this in if it’s something that you are concerned about?”

Aidan:

Yeah, 100%.

The body composition stuff, just in general, outside the immobilization stuff. I really think there has been a nail in the coffin on that one for a while, is it not really mattering. In the Sports Dietician’s Australia CPD wrap up, I think this month a new study was released on this topic, relatively small sample size resistance training, and it showed a pretty significant increase in muscle and strength.

And even seeing that, I pretty much ignored that study. Not because I’m dismissive of it or anything like that, just because it’s like we have thousands and thousands and thousands of participants who’ve been through all of these studies, and on average the findings have been zero change.

And then say one study comes out with say 20 people showing an improvement, what do I trust? The new study or the…

Leah:

It’s the outlier.

Aidan:

It’s the outlier, exactly.

So we’re going to talk about another topic. So we’re going to talk about depression and anxiety. So a systematic review of Omega-3 and depression found that supplementing could help. Specifically as we also see in a lot of other areas, EPA helped a lot more than DHA.

The dosage they found to be beneficial was less than one gram’s total DHA and EPA, with EPA making up greater than 60% of the dosage. So this is a bit of a lower dosage than what we are seeing with the cardiovascular disease stuff.

But once again, there’s a lot of thoughts and interpretations we can add on to this. This is why I say such a deep topic. For example, has there been a lot of research that’s been done on higher dosages? Not really. There is some that exist, but there is not a lot with higher dosages. To the best of my knowledge, we haven’t seen four grams of straight up EPA being studied.

So how can we rule that out being better? At the moment, that research isn’t really showing that, but it’s another area to potentially look at.

Researchers who have looked into this have also mentioned that it would be interesting to see more research on specific subgroups. For example, what if people have higher levels of inflammation? We know that fish oil can reduce inflammation. Will we see better benefits for depression and anxiety in those situations if we’re measuring that at the baseline?

And another way we could look at it is like, what if people have low Omega-3 intake at the start or low Omega-3 levels at the start? Would they get more benefit than others? That was on depression specifically, but a systematic review of Omega-3 and anxiety also found benefits. They found the opposite. They found that greater than two grams per day had more benefits than less than two grams per day. So it’s really hard to identify the dosages, but that is just a summary of what the research has shown so far.

Leah:

Moving on to the next topic, we’re going to look at Alzheimer’s. So I’m not going to spend too much time here, because we can summarize this quite quickly. But there is pretty solid evidence for Omega-3 supplementation and helping with mild Alzheimer’s at the onset of the condition. A systematic review on the topic highlighted that there was inconsistent evidence in more advanced cases though, so it seems to be more beneficial at the onset of the condition, more so when it’s more advanced.

Although I don’t necessarily think it would be a bad thing to, as a recommendation across the board with this condition, or even if it’s something that you know runs in your family and you are concerned about it, just taking a higher dose Omega-3 supplement could be beneficial to perhaps preventing that condition from coming to be.

Aidan:

Talking about joint health now, there is a bit of a tier list, I would say with joint health. So all causes of joint pain, there’s always a cause. Going through this tier list. I’m going to start off with rheumatoid arthritis, which is where Omega-3 really shines the most.

We have really clear research that Omega-3 helps with rheumatoid arthritis. How much does it help? It’s not a game changer. I’m always skeptical saying this, that it shines here, because what if somebody with rheumatoid arthritis listens to this. And I’m going to take this, I still have pain.

No, it’s not magical, but it consistently helps. If you get a group of a thousand people with rheumatoid arthritis, Omega-3 is going to help a large percentage of them, and it’s going to help enough that you can measure the change. That doesn’t mean it’s solving everything, but it helps consistently.

The next tip will be osteoarthritis. So a different form of arthritis, a little bit more common form of arthritis. Omega-3 seems to help a little bit with pain. It seems to help a little bit with morning stiffness and stuff like that.

This one’s a little bit less clear. It’s not a game changer, but once again, if I did have osteoarthritis, I 100% would be taking it because the research seems to support that. The next tier, I’m going to call tendons, ligaments, other random joint pains.

Starting with tendons specifically, there is actually not much research on Omega-3’s and tendons. This is an area that if you’ve listened for a while, you know I’m pretty interested in tendons, particularly tendinopathy.

Yeah, and to the best of my knowledge there’s not a legitimate study on tendinopathy and Omega-3 yet. So it’s speculative based on animal research, which is pretty positive. But I mostly ignore animal research when it comes to stuff like this for a variety of reasons, even if it’s as simple as the differences in metabolism, but also the differences in rehab.

Humans can do dumb stuff in rehab, whereas animals are less likely to. There’s a lot of variables that go on, but there’s not much research on Omega-3s and tendons.

But one study found that those with rotator cuff tears had way lower levels of Omega-3 on a blood test than those about any rotator cuff issues. That’s interesting. I wouldn’t read too much into it, but it’s something that’s worth paying attention to.

Another study, once again on rotator cuff rehab, found that supplementing 1.5 grams of EPA and one gram of DHA per day was linked with slightly improved outcomes.

Another thing I wouldn’t read into too much, but if we’re looking at the small amount of research, it looks positive. If we had a group with a thousand people with knee pain, and we supplemented Omega-3, I would focus more on those outcomes than these outcomes.

But because we don’t have something like that, I’ll focus on these outcomes a little bit. And then if I was just interpreting the research, I would say that Omega-3 helps with joint stuff a little bit.

Definitely with rheumatoid arthritis, probably with osteoarthritis to a certain degree. And with general stuff, I would say it probably does help a little bit, but it’s not magical and it’s likely not overly consistent with the overall joint stuff.

And as with other areas, I would suggest that people who have lower baseline levels would probably get a little bit more benefit than those with higher baseline levels.

Leah:

I think that’s all interesting, because I think a lot of people would assume a stronger correlation between joint health and Omega-3.

And the final topic we’re at least going to cover in this episode is going to be pregnancy. So a systematic review found that Omega-3 supplementation helped reduce the rates of pre-term deliveries. That’s awesome.

So I think from that perspective, it’s probably worth taking. But we also know that Omega-3 does play quite a large role in the development of a baby’s brain. So it’s just best to avoid low Omega-3 intake whilst you’re pregnant.

I don’t work with a ton of pregnant people. I don’t think you do either. But when I do occasionally have someone who is pregnant, usually an athlete who just happened to get pregnant and still working with me.

Yeah, I’m like, look, it’s not a bad thing to add on, particularly if maybe they’re not eating a lot of food sources of Omega-3. And look, let’s just add it.

But more so also, we’ll talk about this later, but I work with mostly plant-based people, less likely to get good Omega-3 food sources on a plant-based diet.

So it is definitely something I’m adding in to a plant-based pregnancy supplement regime.

Aidan:

So next episode we’re going to cover the plant-based nutrition stuff. We’re going to cover ALA in detail, why didn’t we talk about ALA at all in this topic or in this episode?

We’ll also cover little things like blood tests and Omega-3. Can you test your status, should you test your status? We’ll cover dosages, and in what situations you should take it, and any other common themes we can think of.

Leah:

This has been episode 94 of the Ideal Nutrition Podcast. If you haven’t yet left a rating or review, it would be greatly appreciated if you do. But otherwise, thanks for tuning in.