What the Omega-3 Index Reveals About Heart Health

I want to just get started with the first slide here, which really highlights the prevalence of omega-3 insufficiency and deficiency. People are not getting omega-3 fatty acids from their foods. About 90% of the US population does not eat enough seafood, and about 80% globally of the population is not getting enough omega-3 from their diet. Which leads me to this really important study that was published out of Harvard several years ago that identified low omega-3 intake as one of the top six preventable causes of death.

There are three types of omega-3 fatty acids. There's alpha-linolenic acid, ALA, that is found in plant foods like walnuts, flaxseeds, chia seeds. And then there's the marine type of omega-3 fatty acids, eicosapentaenoic acid, EPA, and docosahexaenoic acid, DHA. Those are found primarily in seafood. What this Harvard study identified was that people weren't eating enough of the EPA and DHA from seafood. Why is that important? What do I mean by top six preventable causes of death?

What these researchers did was they looked at all the different things that people have control of in their life and diseases that increase early mortality. Top six of those were things like smoking. If you avoided smoking, you would live longer. If you didn't, you would shorten your life expectancy. Hypertension, type 2 diabetes, cardiovascular disease, and not getting enough omega-3 from your diet, right? Nobody is thinking about that. Everyone's thinking about all these other diseases, not thinking about what they're not getting from their food.

It was actually found that 84,000 deaths a year were attributed to people not getting enough omega-3, and by people I mean in the United States, were not getting enough omega-3 from their diet. Compare this to people eating trans fats. Trans fats, everyone knows it's terrible for cardiovascular health. It leads to cardiovascular disease. That was attributed to 82,000 deaths per year.

When anyone walks into a grocery store, you can pull into any aisle and pick up food, and it'll say zero trans fats, zero trans fats. It's marketed everywhere. Everyone's thinking about not consuming trans fat because it leads to early mortality. But nobody's walking into a grocery store and thinking, am I getting enough omega-3? Am I getting my fatty salmon? Am I getting enough seafood? Nobody's thinking about that, but they should be. It's very important for our health.

There's many reasons why omega-3 fatty acids are beneficial for cardiovascular health. At the top of the list would be inflammation. Inflammation is a driver of heart disease. It's a driver of atherosclerosis. Omega-3 fatty acids are, in my view, the most potent naturally occurring dietary compound that has anti-inflammatory effects. It has it through a variety of ways.

Both EPA and DHA get metabolized, and their metabolites help resolve inflammation. If we're looking at EPA, they make resolvins, the E series of resolvins. DHA makes the D series, but it also makes the protectins and the neuroprotectins. These molecules, they're not blunt-force stopping inflammation. You need inflammation, right? There's a reason why your immune system is active. You want it to be active, but you want it to shut off when it's supposed to shut off. That's what these omega-3s are really doing. They're keeping inflammation in check.

The other way that omega-3 fatty acids are cardioprotective has to do with the cells and the fluidity of them. I told you we talked about this. Both DHA and EPA get incorporated into our cell membranes. They're a very important part of our cell membranes. These are lipid bilayers that surround our cell, and they really change the way our cells are moving. What they do is they make them more flexible instead of really stiff. Trans fats make cell membranes really stiff, and omega-3 fatty acids do the exact opposite.

It's very important if you're talking about the endothelial cells that are lining your vascular system, your arteries, if you're talking about the cells that are surrounding your myocardium, your pericardium, surrounding your heart. You want all those cells to be flexible and not stiff. In fact, the stiffening of our heart with age has to do with that pericardium and myocardium stiffness. Omega-3 fatty acids are really doing the opposite of what the stiffening is. It's making them more fluid. That's another mechanism by which omega-3 fatty acids are very protective for the heart, so cardioprotective.

Let's talk about how we can measure omega-3 and how we know it's important for health. There's large studies that have been done, longitudinal studies, Framingham cohort being a big one, where lots of different blood biomarkers have been measured in individuals, including the omega-3 index. The omega-3 index is a marker of your omega-3 fatty acid levels in blood cells. It's a long-term marker because your red blood cells take about 120 days to turn over. It's nice to have more of a long-term marker of omega-3 versus just looking at omega-3 in plasma phospholipids, which to some degree could be reflective more of what your recent diet was versus more of your long-term omega-3 status.

Dr. Bill Harris and his colleague, Clemens von Schacky, had identified this omega-3 index back in, I think it was like 2002, 2004, something like that. When they measured thousands of people's omega-3 index, what they found was that those people with a high omega-3 index, that's indicated as 8% or more, so 8% of the fatty acids in the red blood cell membranes were composed of these omega-3 fatty acids, they had a 90% lower risk of sudden cardiac death compared to people with a low omega-3 index, being a 4% or below. 90% lower risk of sudden cardiac death.

That means if someone had a heart attack and they had a high omega-3 index, they were 90% less likely to die from that heart attack than someone who had a heart attack that had a low omega-3 index. That's a big difference. If you think about heart attacks, every 30 seconds someone in the United States is having a heart attack. This is a really important finding.

But it's not only important for reducing the risk of sudden cardiac death, it's also been linked to our life expectancy. Yet again, looking at the omega-3 index in people, I think this was maybe the Framingham. Yeah, this is the Framingham cohort. Again, this is a very large population of people where a variety of different biomarkers have been measured. Those individuals with a high omega-3 index of 8% or higher had a 5-year increased life expectancy compared to people with a low omega-3 index of 4% or lower. Five years is a big difference in life expectancy. Really, all we're talking about here is the difference between having a high omega-3 index and a low omega-3 index.

If you think about other countries that actually do eat a lot of seafood, like Japan, for example, in Japan their average omega-3 index is 10%. They're in that high omega-3 index range. In the United States, our omega-3 index on average is about 5%. We're pretty close to that 4%, which is the low range. If you look at the difference in life expectancy between people that are in the United States versus people that live in Japan, it's about a 5-year difference. People in Japan have a 5-year increased life expectancy compared to people in the United States.

From that same Framingham cohort, and this is the data that I find so compelling, and you may have heard me speak about this before, and I really like to talk about it. I like people to see the graph because visually it's just so clear. What Bill and his colleagues did was they took this Framingham cohort, and they took the people with the high omega-3 and the low omega-3 index. They said, "Okay, I want to look at these individuals, and I want to specifically look at smokers versus nonsmokers with a high and low omega-3."

As we know, one of the worst things you can do for your cardiovascular health is smoke cigarettes. A lot of people associate cancer, lung cancer, with smoking, when in fact lung cancer increases in a dose-dependent manner. The more cigarettes that you smoke, the higher the risk of lung cancer, and that sort of compounds over time. When it comes to cardiovascular disease risk, that's an exponential increase. It doesn't take much. That is because the damage that the tobacco smoke is doing to the endothelial cells and the inflammation that's being generated. Really, really bad for cardiovascular health.

If you look at individuals that have the highest life expectancy, that would be in green. They were nonsmokers with a high omega-3 index. They lived the longest. Big surprise. People that lived the shortest life expectancy is what you would expect: smokers with a low omega-3 index. That's red. They're dying sooner. But what's so fascinating is that when you take the smokers that actually have a high omega-3 index, they have the exact same life expectancy as the nonsmokers with a low omega-3 index.

Really, you can look at this data and go, "Wow, I don't smoke, but it's like I smoke." Low omega-3 is like smoking when it comes to at least our overall life expectancy. Of course, all the smokers, when I present this data, think, "Oh yes, I got to take omega-3." Of course, that's the wrong way to look at it, right? Because you want to be at that green curve. You want to be the nonsmoker with a high omega-3 index.

But it really just highlights, we know, and we're going to talk a lot about this today, that omega-3 fatty acids play a very, very important role in cardiovascular health. That is why I think not getting enough of that in your diet is very similar to consuming trans fats. We're always worried about the things that we're, the toxins that we're getting, when also we should be worrying about what we're not getting. Because what we're not getting, our body needs certain nutrients to function normally and optimally. What we're not getting is also like a toxin.