Dr. Harris: We've been fascinated recently to look at what's called the RDW, the red cell distribution width, and we're just preparing a paper on this now. The red cell distribution width is just a metric that comes out whenever you do a complete blood count, a CBC on a patient, they get their hemoglobin, the hematocrit, the mean cell volume on the red cells, and they get this thing called RDW, red cell distribution width, which is really just how varied are the red cell sizes in your blood? Ideally, red blood cell sizes should be all the same size. So the coefficient of variation would be very thin, very narrow. So if you divide the standard deviation by the mean, you get a coefficient of variation. And that's the red cell distribution width. So it's expressed as a percent, if you have a high percent distribution, you've got...it's a remarkable predictor of all kinds of adverse outcomes, independent of everything else. I mean, this is in the last 10 years. This has been discovered that for some reason, how your red blood cells, the variation size of your red cells is a big predictor of outcomes, bad outcomes. And if you have a lot of little cells and a lot of big cells, and so a wide bell curve of red cells, that is bad. You want to have a very steep, sharp distribution of red cells and the omega...

So we were interested in, since we measured the omega-3 in red cells, you know, maybe instead of just being a passive vehicle that's carrying omega-3s around the blood allowing me to measure omega-3 status, maybe they're actually affecting red cell biology. Maybe they're really changing the way red cells carry oxygen, pick up CO2, squeeze through capillaries because, you know, red cells got to squeeze through half its diameter as it goes through a capillary. So it's got to be very flexible, and omega-3s will help make that membrane more flexible. So it could be that we're mainly delivering more oxygen to tissues when you have a high omega-3, haven't tested this, this is all... I mean, I'd love to test this. So it is really very cool that... Again, we've seen that we've got a data set of 40-some thousand people. We see the very strong correlation between high omega-3 and lower, healthier RDW, and we're getting ready to submit that now. But the ways that omega-3s may be protective, we may have never thought of yet, which makes it hard to explain to people how they work. It's easy to say they lower triglycerides, and I get that. But so what?

Dr. Patrick: Exactly. So many mechanisms are doing so many things and that membrane fluidity with the red blood cell membranes itself, that's super interesting. Another thing I'm sure you're familiar with Dr. Ronald Krauss' work on small dense LDL particles and how those are more atherogenic and the larger buoyant LDL seems to be more cardioprotective because it is transporting fatty acids and cholesterol and things to cells and it's the small dense ones that really kind of get stuck in the arteries and start this inflammatory cascade. What he's also shown, him and his collaborators and colleagues, that inflammation can basically cause a larger buoyant LDL to form a small dense LDL. The inflammation plays a role in that process. And so what I would love to see, I guess, this answers my question, you haven't looked at this yet, but the omega-3 index and small dense LDL particle.

Dr. Harris: We can look at that.

Dr. Patrick: Yeah. Because...

Dr. Harris: We'll get back to you on that.

Dr. Patrick: Yeah. Awesome. I think that would be because right now people go, when they go and get their cholesterol measured, it's usually just total LDL and there's some good LDL there like, you don't want no LDL.

Dr. Harris: Well, is it good LDL or just not as bad LDL?

Dr. Patrick: Well, the reason I say good is because when you have a damaged cell, you want to repair that damage and your LDL is going to bring triglycerides and cholesterol and fatty acids and everything that cell the building...another membrane every time you make a new cell. I mean like, so it's serving a function, right? And so I guess, I don't know if good is the right word to describe it, but yeah. I mean, it's got a function that's important for normal health. So that would be very interesting to see if there's a correlation between omega-3 index and small dense LDL particle size. I would imagine you're going to see an inverse correlation.

Dr. Harris: I would think so. I would guess too, but we'll see.

Dr. Patrick: And it would be great to have that sort of panel in the physician's toolbox, right, where they measure the omega-3 index, they're measuring the small dense LDL. And, it's like, "Oh, your omega-3 index is 3%. Well, you got to take some fish oil or..."

Dr. Harris: Right. And raising your omega-3 index is going to have implications all over the body that may not be even measurable in a blood test that are good, good things like this red cell biology, it just behaves better. It's a more efficient mover of gases or something like that.