Podcast Episode 95 Transcript – Omega 3 Part 2

Leah:

Hello and welcome to the Ideal Nutrition Podcast. I am Leah Higl, and I’m here with my co-host Aiden Muir. And today is part two of last week’s episode on omega-3 supplementation. So last week if you didn’t catch that one, we did cover omega-3 in relation to heart health, body composition, depression, anxiety, Alzheimer’s, pregnancy and joint health. So it was a pretty packed episode. And this week we will cover firstly the kind of debate around omega-3 to six ratios, which is quite a big one. So we’ll start there. And then we’ll move on to plant based omega-3 and then a deep dive into supplementation types, dosages, food, all of that.

Aidan:

So starting with the omega-3 to omega-6 ratio, there is some merit of truth to it. And it is also not as clear cut as it might seem, like a lot of people talk about it as if it is super clear cut and it’s got a lot of nuance. So I’m going to go through that. So one argument is that humans historically consumed a one to one ratio of omega-6 to omega-3, but now consume, depending on the source, somewhere between five and 15 to one ratio. So a lot more omega-3 than omega-3 right now. I have a lot of thoughts on that, my first thought is that I do not evolutionary arguments. That’s not to dismiss the ratio thing. That’s more to just be like, let’s pay less attention to what humans did in the past with less food, like basing their choices on food availability and stuff like that. And more focus on the evidence we have in modern humans when we have the evidence. If we don’t have the evidence, it’s a different topic, but we do have a lot of evidence on this topic in humans.

So I think it makes sense to look at that research and see what is optimal in humans in today’s era. So some weaknesses in the simplified ratio argument are different levels of consumption. If you had a high intake of both omega-3 and omega-6, the ratio would be the same as if you have a low intake of both. In isolation, that’s not a massive flaw. But it’s something to be aware of being like you could argue that one out of both of those scenarios would be better than the other. The ratio implies that omega-3 is good in omega-6 is bad, particularly in today’s modern era where we consume a lot more omega-6 than omega-3, which when we go through the research it’s not that clear cut obviously. And the ratio alone doesn’t account for food sources as well. So in isolation that’s another flaw because are we talking about refined foods that contain omega-3 or are we talking about other stuff?

So taking that a step further, nuts and seeds contain a omega-6, but they’re so clearly linked with positive health outcomes. If you find me a random study on pretty much any health topic, and you do a randomized control trial where you give people 30 grams of nuts and seeds per day, on average I would expect to jump to a conclusion and find an improvement in those health outcomes. It’s something you need to see time and time again. If omega-6 in isolation without any other context was terrible for us, we wouldn’t be seeing these improvements. From another perspective, a lot of high omega-6 foods are refined/processed foods. A lot of people criticize seed oils and everything like that in the modern food supply. And the most common sources of seed oils are refined foods. If you go on packaged foods and look at the back of them and everything like that, you’ll see that they’re containing some form of seed oil and everything like that.

Yeah, that’s another topic in isolation, but that real driver of the whole seed oil debate is the whole omega-3 to omega-6 ratio. So we’re kind of indirectly covering seed oils with this topic as well.

Leah:

A whole other wormhole.

Aidan:

Yeah, exactly. So yeah, food for thought there. So going deeper down the rabbit hole, let’s look at this topic more directly. A 2019 metal analysis found that higher linoleic acid, which is an omega-6 acid, so higher linoleic acid levels in the body was correlated with lower cardiovascular disease risk. Arachidonic acid, which is another omega-6, was mostly unlinked but was slightly favored towards reducing CVD risk too. If omega-6 was really bad, this outcome would seem unlikely. We’re literally seeing higher intakes correlated with lower risk. Full context because we haven’t really mentioned already, but omega-6 and omega-3 are both polyunsaturated fats as well.

Previous meta-analysis results have 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. So this is part of why previous health advice was always pushing increasing polyunsaturated fats. It’s never this simple. I hate narratives around being like this study showed this and this is why public health advice. That’s because it’s always way more complex than that. It’s one factor being like, previous marrow analysis has had found improvements in coronary heart disease, more recent ones didn’t find a reduction. If I was going to simplify everything because the main thing I’ve been saying here is that, it’s not super clear cut, but going through my interpretation of all of the research on a omega-6 to omega-3 ratio is it makes sense to one, increase a omega-3 intake if that is low.

Two, reduce intake of omega-6 in the form of processed and refined foods if consumed in large amounts. Currently, if you are eating a lot of refined processed foods with large amounts of omega-6 coming through that, it makes sense to reduce that. And three, not to stress too much about omega-6 in foods like nuts and seeds. I’ve seen other people say it’s less about the ratio and more about just increasing omega-3 in general. We know in Australia and most Western countries and everything like that, that our omega-3 intake is probably too low in comparison to where it ideally would be. I would just extend it to being like, we should also we should reduce our intake of refined foods that are high in omega-6 as well. And that’s probably going to get the majority of the health outcomes out of this, and you don’t really need to think about it too deeply beyond that.

Leah:

Yeah, the last thing we want is people going, I’m not going to eat any nuts and seeds because of omega-6. So I think that’s a good take away. The next topic we’ll touch on is definitely more in my wheelhouse, and that’s talking about plant-based omega-3 versus fish oil omega-3. So I’m just going to quickly recap the different kinds of omega-3 fatty acids. So we did go over this briefly at the start of the last episode, but I think in this context it makes sense to recap. So there are three forms of omega-3 fatty acids. There is ALA, EPA and DHA. So we’ve talked a lot about EPA and DHA so far, but very, very little about ALA. When we are talking about health outcomes from omega-3 supplementation, we typically are always talking about a fish oil form of supplementation, which is a direct form of EPA and DHA and contains very little to no ALA.

So that’s why we’re talking mainly about those two things and rarely about ALA in isolation. So ALA itself it needs to be converted to EPA and DHA in the body. So when we eat ALA specifically, which is mostly your plant-based sources, it then is converted into EPA and DHA once consumed. But we know that that’s a pretty inefficient process. So we actually have to eat quite a large amount of ALA to get even just a little bit of EPA and DHA. And there are a lot of different factors that affect the conversion of ALA to EPA and then DHA. But without going too deeply, it is a pretty inefficient process. So you do need to consume a lot of that ALA and that’s why we don’t kind of see that so much in the research being kind of a main thing we’re looking at.

So why am I going on this tangent of all the different kinds of omega-3? Bringing it back to that plant-based thing is, because omega-3 in plant-based foods is mostly ALA. So we’re talking things like walnuts, chia seeds, flax seeds, hemp seeds, they’re kind of like the main sources of omega-3 on a plant-based diet and that is ALA omega-3. So we know that you need to eat quite a lot of that ALA from those plant-based sources to get, like I said, even just a little bit of that EPA and DHA. And it’s the EPA and DHA that is linked to those positive health outcomes that we’ve been talking about. So vegans are more likely or typically have a significantly lower omega-3 level in their blood as opposed to people who follow a fully omnivorous diet, and that have things like oily fish in their diet so those direct food sources of EPA and DHA.

Now, in terms of where we can actually get direct sources of EPA and DHA on a plant-based diet, there’s no real food sources but there are supplements. So a really good way to get EPA and DHA as a vegan is through microalgae. So you’re probably not going to eat microalgae as a food, but you can take it in the form of a supplement and those are pretty widely available these days. And microalgae supplements are pretty much like the vegan version of fish oil. So we are looking at that direct source of EPA and DHA. So for some plant-based people such as those with heart disease or high risk of cardiovascular disease, maybe athletes looking to improve recovery, pregnant and breastfeeding people, I would say supplementation could sometimes be beneficial and in some cases necessary for overall good health outcomes.

Aidan:

If you get a generic vegan client who’s not looking to optimize stuff but they just want general health, how do you go about this? Do you look and be like are they consuming heaps of walnuts, flax seeds, et cetera? If they’re not, do you look at increasing that or do you go straight to the microalgae supplement?

Leah:

I think it’s a good question because I don’t have… I suppose looking at the research, there’s very little research looking specifically in vegans and omega-3 supplementation versus food sources, et cetera. So honestly, when it’s kind of a general person, I will mostly look at food sources of ALA and ensure that they are adequate. So we’ll try to get some daily flax seed, chia seed, walnuts, those kinds of things. It’s something we will discuss and go, “Look, you should probably have a serve or two of these foods daily to meet your omega-3 requirements.” But if then we’re adding in other conditions or other reasons why we would want higher omega-3 intake, then that’s when I would more so consider a microalgae supplement.

Aidan:

Cool. Let’s talk about dosage. So most people who are talking about the benefits of omega-3 are usually recommending higher dosages than what is typically researched. It’s pretty rare for people to say one gram of omega-3 or one gram of fish oil or anything like that, usually they’re looking at higher dosages. And arguably that is what the research seems to show as well. A great example of this is when we’re looking at research on triglycerides, where the most positive research involves around four grams of either EPA or EPA plus DHA. And it’s a common theme I see amongst a lot of the omega-3 research, that a lot of them are studying around the one gram dosage or less in a lot of cases. So I reckon if you did get a meta-analysis of all of the research showing three plus grams, it’s going to look a lot more positive than it does.

That’s a bit of a statement. It’s not a hill I’m willing to die on, but it’s something that I do believe and that’s my current interpretation of the research. It’s pretty mixed, like when we talk about the depression stuff last episode as well, the research found that in depression dosages of lower than one grams of combined EPA and DHA looked more promising in the research we have so far. So it’s a bit mixed and that’s kind of why it’s hard to recommend something specifically. Another thing we touched on last episode that I’ll refresh you is that, a one gram fish oil capsule usually contains around 300 milligrams of combined EPA and DHA. So obviously to get something like a four gram combined dosage of EPA and DHA takes over 10 capsules. So that’s some context to think about when you are trying to implement that yourself.

How do we get this kind of dosage in Australia is an interesting question. It’s something that I was thinking about as I was going through this, because I noticed that say the four gram of just straight up EPA, that study used prescription omega-3. And that was in America. And it seems like it’s a pretty common recommendation if somebody’s on statins and still has relatively high triglycerides, to be given prescription omega-3 over there. How do we access something like that in Australia? I’m not sure if prescription omega-3 is a thing, but what I would be looking at is highest strength omega-3 supplements of some kind. Tyler who works on our team sent me one from Chemist Warehouse, which has about 960 milligrams of combined EPA and DHA per capsule. And a point he made was that it’s a little bit more expensive than the average omega-3 supplement. But when you actually do the price based on the EPA and DHA, it comes out cheaper. It’s more expensive per capsule, but if you’re trying to get to a certain dosage, it actually does come out cheaper.

Leah:

And logistically it would be a lot easier. It’s like not taking 10 fish oil capsules, which are huge.

Aidan:

Yeah, 100%. So there is no standard recommendation that I have. If I was looking at the triglyceride situation, I’d go higher in the dosage I’m about to recommend. But for most people I usually recommend one to three grams of fish oil per day. I can see benefits are going higher. And I could also see arguments as to why I am wrong with my recommendation and everything like that. It’s a little bit lower than other recommendations, and one is the logistical thing of how many fish oil capsules are you going to consume. Two is that there can be some downsides, which we’ll talk about in a second.

It’s more of a conservative thing. And another thing is a lot of people I speak to will probably take this recommendation and then do it for years to come, whereas some of the research we looked at particularly on the CVD risk was long term. But a lot of other studies on fish oil are a bit shorter term than that. So that’s why my recommendation’s a little bit lower, but I’m pretty open to being wrong on that and I can see a lot of arguments for higher. Do you have any specific recommendations on dosage or anything like that?

Leah:

I also tend to recommend one to three grams of fish oil per day. Again, it’s just a logistical thing, how do we logistically and easily get much higher than that?

Aidan:

Yeah, cool. So going too high is rare, but downsides could be one, the unpleasantness of taking a lot. I remember, do you remember Zyzz, the famous-

Leah:

Of course, I do.

Aidan:

I saw him recommend 10 grams once when I was new to the lifting weight scam and I took 10 grams a day for a little bit. It’s not the most pleasant thing.

Leah:

Yeah, I can imagine it wouldn’t be.

Aidan:

Yeah, I didn’t have any of the other issues, but some people can get GI upset if large amounts are consumed. That’s a common one. And reflux and nausea is another common one when people are having really large amounts. And another thing is that you’d have to take a lot before this is an issue, but the calories still count. 10 grams of fish oil is still 10 grams of fat, and that is around 90 calories.

Leah:

Yeah, something to consider especially if you have a lower calorie budget or just kind of counting it towards your overall calorie intake. Another thing as a bit of a side note is, a common question is if you are supplementing omega-3, does it need to be consumed alongside food or at a certain time, et cetera. So taking omega-3 alongside food does appear to improve the absorption of that omega-3 by a little bit, particularly if the food does contain a decent amount of dietary fat. But overall the difference isn’t huge. And if your intake of omega-3 is high enough for the outcomes that you are wanting, then again it probably shouldn’t really matter.

And consistency with your intake is going to be the biggest thing. So I know we talk about in this context, well, you talk about creatine a lot in terms of it doesn’t matter when you take it, just take it consistently, kind of how we feel about omega as well. So take it any time of the day, it doesn’t matter if it’s alongside a meal or not. But just take it at a time of day where you’re going to be consistent with it.

Aidan:

We are going to talk about the omega-3 index now. And this is a topic that I’ve looked pretty deeply into but I don’t have strong opinions on, and there’s a few reasons why which we might go through. So basically the omega-3 index is a measure of how much EPA and DHA is in the red blood cell membranes. It gives this as a percentage and that is a percentage of the total fatty acids in the membranes. The reason why this is a better test than most other forms of testing for omega-3s is because red blood cells last somewhere between three and four months. Other methods are usually more sued by shorter term intake. E.g, if you had salmon two days ago, it’s going to skew the ratio to show higher omega-3. Whereas this, if you had salmon two days ago but you hadn’t had anything like the three months prior to that, you’re still going to have low levels.

Leah:

It’s going to be more of an overview of your recent intake.

Aidan:

Yeah, the company who sells this testing kit or the main company driving it is called OmegaQuant. And they define the risk factors as being less than 4% being high risk of issues associated with lower omega-3 status, four to 8% being moderate risk and greater than 8% being low risk. Theoretically at a glance this is a great concept. It could also be super useful for research since it helps with improving baseline data. That’s why I have such mixed opinions about it because I’m like, if this is a legitimate thing, this could dramatically help improve one, testing for yourself. I could do this test and be like, oh, I’m less than 4%. I should supplement way more omega-3 or anything like that. And that could improve all the things omega-3 helps with. Or alternatively it could help with testing baseline levels before studies.

If we did randomized control trials of people with really low omega-3 baseline status and cardiovascular disease outcomes, we’re probably more likely to find positive outcomes and we can find a better use case scenario. It’s kind of like how I view vitamin D, being like if somebody’s got a low vitamin D status of the baseline, they’re probably way more likely to benefit from vitamin D supplementation. And all the research that assesses baseline data finds that it’s likely more beneficial under those circumstances. If I think Aidan, this is a great concept, why am I not pushing it super hard? There’s a few things. So one is that it’s heavily driven by one person.

His name is Bill Harris. He’s one of the biggest omega-3 researchers. And his whole company is OmegaQuant and that is based on omega-3 and selling products around omega-3. I don’t know anything about Bill Harris beyond reading his research and stuff like that. So this isn’t me saying anything more than that, just being like it’s driven by one person. Which leads me to the second point, why hasn’t this concept gained more mainstream popularity if it’s so helpful? Bill Harris has been around for a long time. OmegaQuant has been around for a long time. Omega-3 index testing has been around for a long time. Why is it that he can’t just go into a GP and get them to test Omega-3 index?

I’m not a skeptic who has his tin foil hat on and is like, doctors don’t want you to know about this one hack that could improve your heart health. Whether I’m right or wrong, whether I’m naive or anything like that, I think doctors genuinely have the best interest at heart of their patients, they’re trying to help people. We get into the health industry to try and help people. You might think I’m an idiot for saying that, but that’s just what I truly believe in a lot of circumstances. So because I look at the world through that lens, I therefore think with this topic it’s either a situation where the mainstream doesn’t know that this exists and they don’t know about the benefits of it, or there is a reason it hasn’t gained popularity in the mainstream. Which leads me to my third point of the marketing is a little bit aggressive from OmegaQuant.

Even those ranges I mentioned, they say that most people who are less than 4% on a test are at high risk of all of these issues. If that’s true, why is the research on omega-3 supplementation so mixed? If you look at their marketing, they say the majority of people are less than 4% on the test. If people who are less than 4% on the test are at risk of all these things and most people are at less than 4%. And then we do a study where we supplement general population, why are we not seeing huge improvements? That’s why I say it’s aggressive marketing. This is not a right or wrong situation. This is something that I’m just looking at from an open-minded perspective being like, it seems like that’s a bit heavily marketed. If greater than 8% is ideal, one red flag I see with that is in almost every area we have an excessive range. Even with vitamin D we have this 50 to 150 range and some people could make arguments for 180 and stuff like that.

But not many people are out there being like, yeah, being 300 is fine. There’s always a cutoff somewhere and you can argue about where the line is, but there’s always a cutoff somewhere. The marketing for them just says, greater than 8% is ideal. What percentage of your triglycerides in your red blood cell membranes is too high? Is greater than 12% detrimental or is that still fine? We don’t have a cutoff point there, which is something that I think about. So if I’m interpreting this, and you may or may not have the same interpretation as me, but my interpretation is I think it’s practical applications and benefits. I do actually believe that. But I’m also personally not reading into it too heavily yet. And I’m just looking at it from a theoretical perspective. I’m also not at a point where I’m even recommending my own clients or anything like that, take this test and then use the information from that. I’m more just assessing their intake and being like, do I think they have a good intake or not? And do I think they could benefit from omega-3 for whatever their goals are?

Leah:

Yeah, I think you have a very healthy level of skepticism. And we were talking about this a little bit off-air in terms of the omega-3 index testing and I just hadn’t really thought about why it’s not widely used because I don’t use it, I don’t recommend it. But I always thought it was something that was super interesting and could be an awesome tool. But I think it is interesting that yeah, it’s not widely used by GP practices and it’s also not widely used in research, and why is that? Something to think about.

Aidan:

And yeah, as we were talking about off air it’s kind of like, I don’t know, just question everything. And the worst case that comes out of this is that it is as good as it seems to be and I’m wrong.

Leah:

Which would be awesome because it would be a great tool.

Aidan:

Exactly.

Leah:

So next topic we’re going to talk about is looking at food versus supplements when it comes to omega-3. So eating fish that contains omega-3 has consistently been linked with positive health outcomes, arguably even more than omega-3 direct supplementation itself. So for those who eat fish, eating it two to three times per week is a pretty solid recommendation. And particularly focusing on those higher fat fish such as salmons, sardines because they are obviously going to have higher fat amounts and therefore higher omega-3 amounts than are low fat fish. That’s to mean a bit leaner. So in this context, those are better options. Looking specifically at salmon. So 100 grams of salmon contains just over two grams of combined EPA in DHA on average.

So that’s a really good source food source of omega-3 and could be used instead of supplementation. Personally, I find those kinds of higher fat fish do tend to be pretty expensive and sometimes it is cheaper to supplement. But I guess it really depends on how much you’re supplementing with and kind of what outcomes you are wanting from increase in your omega-3 intake. Theoretically, the lower intake of omega-3 coming through food sources in your diet, the more of an argument there is to supplement as well. So if someone doesn’t eat fish, so talking about maybe my plant-based clients, there’s more of a reason why you may want to directly supplement

Aidan:

Going opposite to the plant-based area. We’re going to talk about grass fed versus grain fed omega-3 content in meat. This is probably the last topic we’ll cover. And when I was doing the prep for this, I liked that I put so much work into prepping for these two podcasts that we’ve just done. And this last one is so simple. I didn’t prepare much for this. I’m not even going to talk about grass fed versus grain fed in general. I’m only going to talk about the omega-3 thing. So grass fed is often pushed to superior to grain fed for a variety of reasons. I’m not going to touch on that topic. We may talk about that as a separate topic because I think it’s a deeper topic than omega-3s. There’s so many variables that go into that.

So I’m just going to pretend that topic doesn’t exist. I’m just going to talk about addressing claims about omega three. So often percentage differences are used when people are pushing grass fed beef for example, being higher in a omega-3. They will say it is 300% higher in omega-3 than grain fed for example. And this is another thing people talk about change in the food supply and everything like that. But there’s one obvious issue with this and you don’t need to look too far to see this issue. Red meat is low in omega-3.

Leah:

I was just thinking about that. I’m like, are we talking fish, like grain or grass fed?

Aidan:

No, we’re simply talking about grass fed… And I’ve seen this argument a few times around over the years. It’s not a super common argument, but it’s something that I see. And it’s usually slipped in there amongst a lot of other potential benefits of grass fed versus grain fed meat. It’s just slipped in there being like, oh, it’s higher in a omega-3, it’s 300% higher. If you look at the total omega-3 content of either grass fed or grain fed beef, it is barely anything in comparison to other options like salmon. So the way I view it is I would just ignore that component of the grass fed versus grain fed kind of situation, and just focus about any other aspect of that conversation that you want to look at. If we are looking to get omega-3s, like if we are looking to get it from an animal source, it is just marine sources that we’re really looking at.

Leah:

Awesome. So this has been our full recap of Omega-3 over these last two episodes. This has been episode 95 of the Ideal Nutrition Podcast. As always, if you could leave a rating and review, super appreciated. But otherwise, thanks for tuning in.