Can THIS Supplement Prevent Heart Disease? Surgeon Reacts to Dr Boz

Are omega-3s really the #1 supplement for heart disease prevention? In this reaction to Dr. Boz, I break down the nuance: atrial fibrillation risk, rancid oils, DHA vs EPA, heavy metal testing, delivery forms, omega level testing, and why small fatty fish may beat supplements for most people.

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Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.
  
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Transcript

SPEAKER_01 0:00

Hey guys, Dr. Lily Johnston here. In my feed was a video from Dr. Boz about the number one supplement to prevent heart disease. And you guys know how I feel about heart disease prevention. I don't know what the supplement is, but let's find out together.

SPEAKER_00 0:18

95% of Americans are deficient in this nutrient. When this is low, people get more heart disease, die more often from heart attacks, and have an increased risk of dementia. The number one supplement to prevent heart disease and improve your brain is fish oil. Wait, before you rush out and start taking that random fish oil that you bought online or Amazon, let's cover the potential dangers of taking fish oil supplements. My inbox filled up last year when a publication said that supplementing with fish oil can increase your risk of atrial fibrillation. Adding that abnormal heart rhythm to someone makes their heart problems worse, not better. However, the same review showed that getting those omega-3s by eating real fish decreased the AFib. So which one's right? Let's focus on the major fact that we know, and that's that omega-3s in our bodies are a major protective unit. The risk of them being low is a huge risk, increasing your risk of heart disease by 40% and the risk of dementia by 20% when they're really low.

SPEAKER_01 1:15

I teach So I think it's important to recognize that fish oil is a way that people get omega-3 fatty acids. Omega-3 are a subset of polyunsaturated fatty acids. And the two key omega-3 fatty acids that we're really talking about with respect to cardiovascular health and brain health are actually not usually the same. So DHA is the one that typically is related to brain health. And the one that has been most often studied for cardiovascular health is EPA. And interestingly, the recent guidance from the American College of Cardiology and the American Heart Association is not recommending supplementation with omega minus 3 fatty acids. Now, this may be for a couple of reasons, but one for sure is that the supplementation group and the high dose EPA only group, which is what is commercially available now, does have this increased risk for atrial fibrillation, which does seem to be dose dependent. So let's go through and see what else Dr. Boz is going to teach us about omega-3 fatty acids.

SPEAKER_00 2:33

For instance, if you have low omega-3s, but you don't smoke, you have the same risk of death as a smoker who has high omega-3s. The lining around each cell in your body is a common place to find these special pockets of fat. When I see patients with low levels, I can tell. Their skin cells aren't soft and flexible, they're dry and crusty. Brains without good levels of omega-3 show signs of mood swings, memory problems, and fatigue. Joints built without omega-3s hurt more. And those patients have this sluggish circulation that is found throughout their body without this special fat. That list of problems hits a lot of people. And most patients are low. But here's where it gets tricky. Simply popping fish oil pills could backfire. The problem with fish oil supplements can be seen when you look carefully at that magic string of fat. The omega-3 fat is fragile, and when it sits around too often in the presence of oxygen, it breaks down. Most fish oil supplements sit on shelves or warehouses for months, even years. During this time, the oxygen oxidizes that fat and turns it rancid. Consuming rancid fish oil introduces toxins, causing harm, accelerating the inflammation, increasing the oxidative stress, and worsening the risk for heart disease rather than preventing it. So should you avoid the fish oil supplements? Not necessarily. If you take fish oil supplements, you should start with this list. Supplements must be fresh, consumed well before their expiration. Rarely do you find jugs of fish oil because it's too hard to keep that oil away from the air and the oxygen. Instead, they put the oil in soft gels, and that individualized wrapping around the oil protects its contact with the oxygen. This increases the shelf life. It must be stored properly. Heat makes this reaction happen faster. You don't see people cooking with fish oil for this reason, and that heat changes the oil. It doesn't taste good. The best brands store their oil in air-conditioned warehouses. You should help this by when you receive your supplement, put it in the fridge. Choose products derived from smaller fish like anchovings or sardines, rather than those predatory fish that are larger, like tuna. This decreases the amount of mercury found in the fish oil. Look for brands that have third-party testing, looking for that oxidation level as well as heavy metals. But remember, these tests were done before those brands sat on the shelf for 18 months. Here's a tip bite into the soft gel. Your tongue has years of ancestral evolution to tell you if an oil is rancid. You will know if this oil is bad. Choose.

SPEAKER_01 5:00

That's funny. I have never tried that, but I might do that. Thanks, Dr. Boss, for that good tip. The other thing, and so if you're looking for testing, IFOS, IFOS tends to be the big testing for heavy metals for the fish oil groups. So that's worth checking. If it's IFOS tested and certified, that's a good supplement. The other thing is that's worth thinking about is the dose and again how it's delivered. So fish oil omega-3s can be delivered in one of several different forms, and absorption is very different. The least bioavailable are the ethyl esters. So I would really never recommend that somebody get an ethyl ester form of omega-3 fatty acids. Not very useful. You'd have to take a lot to get that absorbed. The triglyceride or monoglyceride forms tend to be very well absorbed. And for most people that I would recommend fish oil too, I typically recommend a monoglyceride that has very good absorption. The last component, though, is if you're taking this specifically for brain health, right? You might be an APOE4 carrier or have a history of dementia or be very concerned about cognitive issues, then you might consider a phosphaticylcholine grouping on your DHA because that actually has much higher penetration through the blood-brain barrier and may allow you to deliver that DHA where you want it most. So again, while fish oil and omega-3s are an important component to health, there are a couple key points about how you are going to supplement them that's worthwhile. For cardiovascular purposes, EPA is the one that we think of most often. That's also the one that seems to be the most anti-inflammatory if you're thinking about it for joint pain or health. There is something called acosopent ethyl, that is the prescription version of EPA that is given and indicated for patients with highly elevated triglycerides. And in a randomized controlled study, that did show a significant reduction in cardiac events relative to the sham group. Unfortunately, the sham group was perhaps a more inflammatory omega-6 fatty acid, and it could be a little confounded by that. Again, they did see uh elevation in atrial fibrillation in that group, but they were taking four grams a day, which is uh quite a bit of that fatty acid. Maybe not everybody needs as much. And the last thing about this that I want to talk about is Dr. Boz keeps saying, well, if your levels are low, your levels are high. We have a general sense about this, and there is, you know, uh there are several different labs that offer an omega-3 test. We think that those thresholds are reasonable, but I will say that they are not nearly as well established as other lab thresholds or like our blood pressure thresholds, lipids, fasting insulin or fasting blood sugar. The omega-3 story is a lot less concrete. And we are much more basing this on general levels in the population and kind of translating that and hoping that supplementation is gonna bring us forward and make this better. The evidence for that is a little sparse. Now, I don't think at modest dosing, the risk of supplementing omega-3s is all that high. I do completely agree that the more we can get from our whole food sources, the better off we will be. And making sure that we are getting non-oxidized versions of these supplements if we're gonna take them is critically important.

SPEAKER_00 8:40

Stabilized oil. Two omega-3s have captured my attention. The first is triglyceride form of omega-3s. To stabilize the oil and improve absorption, chemists put three of those omega-3s onto one handle. Now, three of those magic bullets get into your circulation without breaking down and with a high rate of absorption.

SPEAKER_01 8:58

The key Sorry, Dr. Boss jumped the gun on you there, but good point. The monoglyceride is also excellent.

SPEAKER_00 9:04

Key is to look for the word triglyceride form on the label. Last year, AhiFlower became the first plant-based omega-3 that I would recommend for my patients. Usually, plant-based omega-3s come from algae, and they don't deliver for that magic fat getting all the way into your cell walls. AhiFlower has published human studies showing that it delivers. So let's get back to aphib. Those studies showed that the patients with high risk for cardiovascular disease increase their risk by 1% when supplementing with fish oil. The safest and most beneficial way to boost your omega-3s is simple. Eat real fish. Small fatty fish like mackerel and sardines are the best. Sardines aren't just safe, they're a bona fide superfood, packed with omega-3, vitamin D, essential proteins, all without the risk of the increased mercury from those larger predatory fish. And unlike supplements, whole sardines contain natural antioxidants where those omega-3s are not oxidized. They stay protected because they're in the fish. The number we care about to reduce your risk is not the volume of fish you eat per week, it's your omega-3 index. And although it would be easy for me to say, eat five cans of sardines a week, I'd be guessing, because patients absorb omega-3s differently. Eat the fish. But if you want the confidence for improving your health, measure your omega-3 and your vitamin D. I have links in the show notes. I recommend both. Once you have a baseline, run an experiment, eat the same amount of fish for the next three months, and then check again. There is no question that if you have an omega-3 index in the good zone, your heart and your brain will benefit. If you're trying to reduce your risk for heart disease and your doctor says to lower your LDL, I disagree.

SPEAKER_02 10:41

Check out the next video to see why.

SPEAKER_01 10:49

Thanks for that great video, Dr. Boz. Uh the ahi flower was actually news to me. I didn't realize there was another really good plant source for omega-3 fatty acids. I will absolutely be checking into that for my patients. I really appreciate your work here and great video. Thanks so much. Until next time, guys.