Low Omega-3 Status and the Risk of Early Death

Thomas DeLauer: Dr. Rhonda Patrick, what is possibly worse than smoking when it comes to life expectancy?

Dr. Rhonda Patrick: It's funny because we were talking about this a moment ago and it blew my mind to see some data. This is out of Bill Harris's group that looked at life expectancy and the omega-3 index, which is a really good way of measuring your omega-3 levels. Everybody knows smoking is bad for you, right? I mean, that's like common knowledge.

Everybody knows that. However, when you look at life expectancy and you sort of stratify the data according to smokers and non-smokers, smokers with a high omega-3 index, in other words, they have high levels of omega-3 have the same life expectancy as non-smokers with low omega-3. And if you look at the data, there's this beautiful graph. The curve, the life expectancy curves overlay where those two are the same.

And it's just kind of mind-blowing because not getting enough omega-3, not having a high omega-3 index was as bad as smoking with respect to life expectancy. Now, a lot of people when they think about smoking being bad, they think about, oh, cancer. Smoking increases cancer and lung cancer, but that takes sort of decades to accumulate the kind of damage you need, to increase that risk of cancer. It's your cardiovascular health that's at high risk with smoking.

And it's not a linear risk like cancer is like the more packs of cigarettes you smoke, the higher the cancer risk. But with risk of heart attack, the risk of cardiovascular disease, it doesn't take as much. So, it's one of those things where smoking really negatively affects cardiovascular health. And that's the actual thing that omega-3s are very beneficial for.

So, it's just kind of a mind-blowing way to think about because I think this came out back in like 2009. It was a study out of Harvard and I remember reading this study and the headline was top six preventable causes of death. And these are things like, okay, not smoking, that's a top preventable cause of death, right? Early death, early mortality.

Hypertension, right? So avoiding hypertension, those things were obvious, but what was up there was low omega-3 from marine sources. In other words, from fish, right? So there's omega-3, there's DHA, EPA, those are from marine sources, and then there's ALA from plant sources.

And low omega-3 from fish was identified as one of the top preventable causes of death. That was very intriguing because it is an easy nutritional factor to address. Most people think of things to avoid or cut out, but I like to focus on what you're not getting. What are you not getting in your diet?

And scientists from Harvard had attributed about 84,000 deaths a year to not getting enough omega-3, predominantly from cardiovascular-related mortality. But what was also interesting was that about 82,000 deaths a year were attributed to eating trans fats. Again, everybody knows trans fats are not good for you, right?

I mean, it's on every grocery shelf like that you walk into, it's like zero trans fat, zero trans fat, right? You buy a bottle of water, it's like zero trans fat, right? But no one's thinking about that when they go to the grocery store. Oh, am I getting my fish today?

Am I getting my omega-3 today? Because the same number of deaths were attributed to not getting enough of that as to consuming trans fats. Again, this is a way of thinking about it, and we're just scratching the surface. So there's just been so much data, a lot of data have come out of Bill Harris's group, by the way.

He now has a great research institute, the Fatty Acid Research Institute, where I'm an associate researcher. We study a variety of fatty acids, predominantly omega-3 and their effects on human health. And Bill's done a lot of great work. He is the co-inventor of the omega-3 index, which I like because it's a biomarker of long-term omega-3 status.

In other words, plasma phospholipids are more reflective of your recent diet, like whether you ate fish in the last week. If you measure omega-3 in your red blood cell membranes, those cells have a lifespan of roughly 120 days. So you're talking about longer-term omega-3 status, right?

Very similar to HbA1c versus fasting blood glucose.

Thomas DeLauer: That was going to be my question. How long would it take someone to change their omega-3 index? If I had never consumed fatty fish or taken an omega-3 supplement and I started today, would I see a pretty quick increase, or is it a lagging indicator where I need to take it for three months and then measure? Also, in terms of benefit or risk, if someone had a low omega-3 index for three months, is that potentially equivalent to three months of smoking? How does the time scale compare?

Dr. Rhonda Patrick: To address your first question, about three months is a good time range. Like let's say you're now deciding I'm going to increase my omega-3 intake through supplementation or by increasing sources of EPA and DHA, such as fatty fish and wild Alaskan salmon, you would wait about 3 months again because it takes about that long for your red blood cells to turn over. So, you have to wait that long before you can get an omega-3 index test done. And the question is well omega-3 index why do you want it to be higher?

When I say higher, most of the studies are like 8 percent omega-3 index or more. And when I say low omega-3 index, most studies are 4 percent or lower. Average omega-3 index in the United States is about 4 to 5%. So, we're really low.

Compare that to Japan. They're like 10 or 11 percent omega-3 index. The average Japanese person on average has a five-year increased life expectancy compared to the average American. Now, Bill Harris has done some research looking at huge, huge sample sizes looking at the omega-3 index and life expectancy.

And people that have the 8 percent omega-3 index or higher have a five-year increased life expectancy compared to people with the low omega-3 index of 4 percent. Now, how much omega-3 would it take to go from 4 percent to 8 percent. Right? Obviously there's individual variation.

Omega-3s are compounds that we make in our bodies from ALA. We also have to get ALA from our diet to make them. But we have a lot of gene variations that regulate the way we metabolize it. With that said, on average, it takes people about two grams of omega-3s a day to go from a 4 percent to 8 percent.

And those studies have been done. So whether or not your omega-3 index is low for 3 months and then you go up to, from 4 percent to 8 percent, we don't know what effect that has, right? Like you're asking a very complicated question in terms of like time kinetics and oh I was low omega-3 during development and through my early adult life but then I at some point I increased it. We can then go to randomized controlled trials.

We also have data on people that are at high risk for myocardial infarction so heart attack or people that have existing cardiovascular disease they are taking medications like statins, for example, to treat it. A lot of studies have taken these populations of people that presumably do not take omega-3s. Unfortunately, studies don't often measure the omega-3 index at the start of a trial. I wish they did, but they don't.

It costs more money, and the age-old problem with randomized controlled trials is not measuring nutrient levels before the trial starts. It is one of my pet peeves because we have different gene variations that regulate how our bodies metabolize nutrients, right? It's not like a drug. You don't have to measure someone's baseline level of a statin that you're going to give them because nobody has statins at the start of a trial.

But people have different intakes of fish. They have different genes that regulate how much they convert if they eat a lot of walnuts or flax seeds which are high in ALA the plant omega-3 and whether they convert it well like there's reasons why we need to measure these nutrients at the start of a trial anyway it's not done but we do know for example there's been the reduced trial that was the big trial that looked at people with existing cardiovascular disease and it was a 5-year trial where people were given a high dose of purified EPA. So, it was just one of the omega-3s and it was in an ethyl ester form, which we can talk about. It's not very bioavailable or a placebo.

In this case, the placebo was mineral oil and there's all sorts of controversy over that being actually pharmacologically active and not being a great placebo. Regardless, after the 5 years, people taking the EPA, it's called Vascepa, a prescription form of omega-3 that people are given for example with high triglycerides and cardiovascular risk. Those people had a 25% decrease in heart attack or death from heart disease compared to placebo. So that was quite robust.

And regardless of all the arguments that maybe the placebo was actively harmful, even if you just look at the baseline risk reduction, it was very significant. It was also reducing triglycerides. There were effects independent of comparison to the placebo group that were like, wow, this is unbelievable. It's taking, like you were saying, this unhealthy group of people, giving them a form of omega-3 over several years, and dramatically lowering their risk of dying from a heart attack, which is the number one killer in the United States.