Weight Maven

Chris: I think the benefits of fish oil supplementation have been pretty overstated. Most of those studies that show benefits are short term, they generally last less than one year. Even those don’t necessarily show the benefit that most people think. The Cochrane Group did a meta-analysis on almost 80 trials lasting more than six months and the only statistically significant effect they were able to find was a reduced risk of heart failure, but there was no reduction in cardiovascular and total mortality.

One of the things that worries me the most is that the only fish oil study lasting more than four years, which is the DART 2 trials, showed an increase in heart disease and sudden death. So of course the question is why and how could this happen?

Well, if you understand the structure of fats, fish oil is a omega 3 polyunsaturated fat, which is the most unstable and the most vulnerable to oxidative damage of any fat, even more unstable than the dreaded omega 6 polyunsaturated fat.

And what we know is that when fat particles oxidize, they break down into smaller compounds like MDA, and MDA is dangerous because it can damage proteins and DNA and other cellular structures. And in fact, studies do show that oxidative damage by compounds like MDA increases as the intake of omega 3 fat increases.

For example, one study found that 6g of fish oil per day, which is not a huge dose, but it’s more than a maintenance dose, increases lipid peroxides and MDA regardless of whether those people supplemented with vitamin E or not.

To be fair, some shorter term trials have shown a benefit, like the Gissi and DART 1 trial, found that fish oil can prevent arrhythmia in patients with chronic heart failure and a recent heart attack, but there’s really not much evidence that people other than those with chronic heart failure and arrhythmia benefit and there’s no evidence that higher doses above 1g provide a benefit over smaller doses over the long term.

It’s logical to assume that the effects of oxidative damage would take a while to manifest and actually that they would increase as time goes on, which is probably why we see a benefit in the short term studies, as omega 3 displaces omega 6 in the tissue. But then the benefit declines and even turns to harm in the longer term studies as the oxidative damage increases.

My thing with balancing the omega 6/3 ratio is to just dramatically decrease omega 6 as much as you possibly can and then eat fish 3x a week, fatty fish 6 oz, 3x a week, and maybe take some fermented cod liver oil.

If you do that, and your intake of nuts and dark meat poultry is moderate and you’re not eating any seed oil, you can have a 2/1 or 1/1 omega 6 to 3 ratio.

So I’m in favor of doing that rather than big, big doses of fish oil because of the danger of oxidative damage.

Robb: What about somebody coming in as a client, lots of systemic inflammation, pretty overweight, maybe like some depression, just kind of classic metabolic syndrome.

This is where my thought, based in part off a couple of papers, one of them is this glucose hysteresis paper which is talking about gene expression, the totality of gene expression kind of having a drift. If you imagine a big supertanker, like the Titanic, the genetic expression starts getting almost momentum or inertia to it, and in order to flip things around, sometimes you need a pretty dramatic input. And so the authors of that paper were actually talking about omega 3 as a means of righting course on that ship gone awry.

So for a long time, I was thinking generally higher intakes of omega 3s would be beneficial and then started re-evaluating that. Where I am right now is that if the individual is sick, inflamed, has some problems, do that rather large dose of fish oil to right the ship but then the rest of the dietary and lifestyle factors should fall into place such that it’s essentially what you’re describing: a low linoleic acid intake, short-chain omega 6 intake, everything else should follow into place. I think for a long time, the thought was that large amounts of omega 3s could simply counterbalance omega 6 or could undo systemic inflammation, which I think we’re pretty sure that that’s inaccurate at this point.

But what do you think about that short-term punctuated use, or would you prefer just dial down the omega 6s and tackle it that way?

Chris: That’s my preference, but I can see the logic behind that. I just want to remind people that we’re talking about the last 10% here probably. What I mean by that is I don’t think that taking high doses of fish oil for a short period of time, like a month or 6 weeks, is going to have a serious lasting negative consequence.

Robb: But you’re also not sold that it has significant benefit.

Chris: I’m not sold, I’m not sold that it doesn’t. I’ll try to keep an open mind on that. But I can just tell you that my preference in terms of working with patients is what I said. I think dramatically lowering omega 6 is going to alter the tissue ratio in a similar way.