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- Omega-3 Part Two
After posting last week’s newsletter about the benefits of marine source omega-3 fatty acids, it came to my attention that there’s been a new study that’s taken off in the media about possible negative effects of omega-3 supplementation. Specifically, the study found that there is a small, but statistically significant association between omega-3 supplementation and the development of a heart arrhythmia known as atrial fibrillation.
Atrial fibrillation is a condition in which the upper chamber of the heart pumps irregularly with a “flutter” rather than a steady, unified beat. While by itself, it is more disconcerting than dangerous due to the physical sensation it causes, it does present an increased risk of blood clots, and the subsequent problems they may cause, such as strokes and heart attacks.
Given the relatively solid body of research supporting the use of omega-3 supplementation, I was interested to see the details of this study, and when I did, I will say my mind was completely blown… but more on that shortly!
The details started out quite impressively – it was a study of over 400,000 people conducted over 10 years and it separated the participants into a few groups based on their general health and any existing disease conditions. The primary aim of the study was to determine what effects omega-3 supplementation had, good or bad, on the various groups, ranging from those in good health to those with existing cardiovascular issues.
At the beginning of the study, the participants completed a questionnaire which, among other things, asked if they were taking omega-3 supplements. But it was just a yes or no question. There was no information obtained as to what brand/form, nor any information about dosage or frequency. There was no inquiry about dietary intake of omega-3 from food either. So, perhaps you can see problem #1 I had with this study – no information about form or quantity of omega-3 that the subjects were getting.
The statistical analysis done was quite in-depth, but the very summarized version is:
1) Those with pre-existing cardiovascular issues who were taking omega-3 at the beginning of the study appeared to fare better (including a decreased risk of atrial fibrillation and associated strokes, heart attacks, etc.) than those with similar conditions who were not taking omega-3.
2) Among healthy people with no pre-existing cardiovascular issues, those who were taking omega-3 had a slightly increased risk of developing atrial fibrillation than healthy people who had not reported omega-3 use at the beginning of the study. Interestingly, these subjects had a DECREASED incidence of stroke and heart attack – the opposite of what would be expected in people with atrial fibrillation.
Now, besides the type, dosage, and frequency of supplementation not being investigated at all, the other huge glaring omission in this study is that they only gathered information about supplementation at the very beginning of the study – a 10 year long study! There’s no way to know if the supplementation status changed in any members of the groups – whether some of those initially taking omega-3 stopped, nor whether some of those not initially taking omega-3 started, at some point later in the study!
So, the short story is, they did this massive 10 year study on the effects of omega-3 supplementation… without bothering to find out which participants were taking what supplements in what doses and for how long!!!
Like I said, my mind was completely blown!
Although I’m tempted to dismiss this study as basically meaningless and useless, the authors of the study did suggest a mechanism for why some might develop atrial fibrillation from omega-3 supplementation – which actually has been shown by a few other much smaller studies on high-dose omega-3.
The cells of the heart have a special membrane which uses something known as a sodium-potassium pump to trigger the heart muscle to contract and relax rhythmically. Omega-3 fatty acids make up part of this membrane, but need to be present in the right proportion for things to work properly. So, the speculation is, an excessive intake of omega-3 may throw off the composition of the membrane, altering the function of the sodium-potassium pump, thereby throwing off the heart’s rhythm.
Now, before you decide to just avoid omega-3 as a precaution, it’s important to be aware that too little omega-3 intake is associated with the same problem. This is potentially why those study participants who had pre-existing atrial fibrillation and/or other cardiac problems benefitted from omega-3 supplementation. It seems that too much or too little omega-3 is potentially problematic for the heart.
This brings me back to dosage, as discussed in my last article.
There is no established recommended daily allowance for omega-3, but most experts recommend a minimum intake average of 500 to 1000 mg per day for young, healthy people, and suggest 1000 to 2000 mg per day for those middle-aged and older. Bear in mind, this is the total omega-3 milligrams (EPA plus DHA), not the fish oil or krill oil milligrams in the supplement.
It appears that the small risk of atrial fibrillation in healthy adults is primarily associated with intakes of 4000 mg of omega-3 per day or higher.
For those with inflammatory health conditions, depression, cardiovascular disease, and/or neurodegenerative disorders (or have a family history of them), higher dosages may be indicated of 2000 to 4000 mg per day, but I would suggest working with a health care provider who can do regular lab work and monitor you when taking doses on the higher end of this range. It’s also advisable to consult with a pharmacist as to potential drug interactions.
One other thing to bear in mind is that if you regularly eat cold-water fish like salmon (especially 3 or more times per week), you may need less omega-3 supplementation, if any. Salmon has about 4000 mg per 3.5 ounce serving, so you can probably skip any omega-3 supplement for a day or two when you have that kind of dietary intake.
Finally, after my last article, someone asked me about brand recommendations. On non-specialized supplements, I avoid getting tied down to one brand, but my general recommendation for omega 3 supplements is to look for brands that test for contamination with things like PCBs and heavy metals, as some fish stocks have issues with them.
Until next time…
George F. Best, D.C.