Video summary
In this discussion, Dr. Rhonda Patrick addresses whether low omega-3 levels are comparable in severity to smoking cigarettes, citing a pivotal study from Dr. Bill Harris's group at the Fatty Acid Research Institute. The core metric highlighted is the Omega-3 Index measured in red blood cells rather than plasma, as RBCs provide a long-term marker reflecting intake over 120 days compared to the short-term snapshot of plasma levels. The data reveals that individuals with an index below 4% face significantly higher all-cause mortality rates, whereas those maintaining an index above 8%, such as populations in Japan who consume more seafood, enjoy increased life expectancy. When stratifying this data by lifestyle factors like physical activity and BMI, the results show a stark correlation: non-smokers generally live longest, while smokers with low omega-3 levels have the shortest life expectancies. Notably, smokers who maintained high omega-3 indices through diet or supplementation exhibited similar longevity to non-smoking individuals with adequate levels, suggesting that severe deficiency in these fatty acids may be as detrimental to mortality risk as smoking itself regarding cardiovascular health. Dr. Patrick clarifies that while observational data establishes a strong correlation rather than definitive causation due to potential healthy user bias, the biological mechanisms supporting omega-3s are robust and independent of lifestyle factors like exercise or diet quality alone. Smoking is widely recognized for increasing lung cancer risk in a dose-dependent manner, but its impact on cardiovascular disease appears non-linear; even minimal smoking can drastically elevate heart attack risk. Omega-3 fatty acids serve as a primary defense against this specific threat by reducing inflammation, which is a major driver of cardiovascular disease. Randomized control trials have demonstrated that purified forms of EPA and DHA significantly lower the risk of dying from cardiovascular events compared to placebos. Therefore, while one cannot rule out confounding variables entirely in observational studies, there is clear evidence that optimizing omega-3 status provides critical protection against heart disease regardless of other health behaviors. For individuals struggling with seafood consumption due to cost or cooking difficulties, Dr. Patrick recommends supplementation as a viable strategy to reach the target Omega-3 Index of 8%. She notes that physicians often prescribe ethyl ester forms like Vascepa (pure EPA) or Lesa (DHA and EPA), typically at doses around four grams daily, but suggests that two grams per day is an effective starting point for most people to bridge the gap from a standard American diet level of roughly 4% up to the optimal range. This dosage is considered safe for the general population and can effectively raise red blood cell levels within three months. When selecting supplements, consumers should look for third-party testing data regarding purity and oxidation; specifically, products with total oxidation below 10 are preferred to avoid consuming rancid fats that could negate health benefits. The quality of a supplement is further determined by its molecular form, primarily triglyceride or ethyl ester. Triglyceride-form omega-3s mimic the natural structure found in fish and offer superior bioavailability compared to purified ethyl esters, though some manufacturers reconvert ethyl esters back into triglycerides for enhanced absorption regardless of cost. Crucially, Dr. Patrick emphasizes that these supplements must be taken with a meal containing fat to ensure proper absorption; taking them on an empty stomach renders the dose largely ineffective. For those attempting to meet their needs through diet alone, wild Alaskan salmon is highlighted as one of the best sources due to its low contaminant levels like mercury and PCBs per ounce. However, because cooking methods can degrade heat-sensitive omega-3s and dietary intake may not be sufficient for everyone without supplementation, a combined approach often yields the most realistic results: consuming fish meals twice weekly while taking approximately two grams of high-quality triglyceride-form supplements daily to maintain optimal blood levels.
Read the full video transcript
are low Omega-3s worse than smoking
cigarettes um I don't know that they're
worse so omega-3 fatty acids are in you
know they're essential for many things
and um I think you're referring to one
specific study that came out of uh Dr
Bill Harris's group he's the head of the
fatty acid Research Institute and he's
actually the pioneer of the omega-3
index test which is how you should
measure your omega-3 levels um there
measured in our red blood cells rather
than which you'll 99% of the time find
if you get a omega-3 test it's plasma
levels so red blood cells take about 120
days to turn over so it's a long-term
marker of your omega-3 whereas if you go
and get a omega-3 plasma test it's kind
of like what did I eat for dinner in the
last week right so you you may have had
a bunch of salmon but maybe you don't
usually eat salmon so so anyways the
omega-3 index is a way to measure
omega-3 levels and he had done a study
looking at
omega-3 levels and what's called all
cause mortality so people dying from all
sorts of non-accidental causes
cardiovascular dis disease is always at
the top of the list because that's
pretty much what everyone's dying of
that's like the number one cause of uh
death in most developed countries and so
um he was looking at all cause mortality
and correlating that with the omega-3
index which essentially is measuring
omega-3 fatty acid levels and um what he
found was that so people that have a low
omega-3 index so that would be 4% or
less H and then comparing it to people
that had a high omega-3 index so that
would be 8% or higher so people that had
the high omega-3 index had a fiveyear
increased life expectancy compared to
people with the low now people in the
United States on average have about a
four to 5% omega-3 index so it's pretty
pretty standard pretty standard I would
say in terms of like what people in the
US have in terms of their omega-3 versus
Japan where they eat a less Seafood
their omega-3 index is like 10 % so and
they have a 5-year increased life
expectancy by the way compared to people
in the United States um so what he also
did uh him and his his colleagues looked
at they stratisfied the data and looked
at other factors physical activity you
know BMI
smoking and this is where it got super
interesting because um and I I I just
the graph of this data does it like more
Justice you know because you can
visually see it but he looked at all
cause mortality and people that like
lived the longest were of course the
high omega-3 index with no smoking right
so like non-smokers they had the longest
life expectancy and then people with the
lowest life expectancy were smokers with
a low omega-3 index but then when he
looked at people that smoked but had a
high omega-3 index either they're eating
a lot of fish or supplementing they had
the same life expectancy as people with
low omega-3 but didn't smoke so in other
words having a low omega-3 index was
like smoking with respect to all cause
mortality and that's you know and of
course I get all the smokers out there
going oh so all I have to do is
supplement with omega-3 I'm like no no
no no no that's the wrong way to think
about it you know I think I think most
people now know smoking is terrible for
your health and it and it goes back to
this idea this framework that I like to
think about nutrition which is what do
we need right instead of like always
focusing on what to avoid because if you
focus on what to avoid you still may not
getting what you need to run your
metabolism to run you know
neurotransmitter synthesis and all of
that so omega-3 fatty acids are hugely
important for many things and we could
talk hours for that but with respect to
smoking it's really quite you know it's
it's kind of AST astounding when you
just look at that graph and they're like
overlaid where you're like oh wow
non-smokers are with omega-3 are living
as long as smokers with high omega-3 do
you think that this is a direct cause of
the Omega-3s or is there some healthy
user bio that's Upstream from the kinds
of people who are the kinds of people
that are like people that will have
omega-3s in their diet great question so
um with this type of data which is
observational data it's always a
correlation so you can never you know
definitively say it's cause right a
causation so yes there could be it could
be a healthy user bias there were other
factors that were accounted for but I
will say
this smoking everyone thinks about
smoking and lung cancer or like cancer
right risk right actually the biggest
problem with smoking is heart disease it
is a huge it's so when you so here's the
thing that I like to think about like
with respect to smoking and disease risk
smoking in a dose dependent manner will
increase your risk for lung cancer so in
other words the more cigarettes that you
smoke the higher the risk of cancer but
it's not a linear increase with respect
to cardiovascular disease and heart
attack risk so you can just have a
little bit of cigarettes and your your
heart disease risk
skyrockets and omega-3 is one of the
biggest things that it protects against
is heart disease right doctors prescribe
it so there's been randomized control
trials where people are given high do
omega-3 purified omega-3 um in the form
of either EPA which is one of the Marine
sources or a combination of DHA and EPA
um and and and a variety of Studies have
shown that like heart attack risk um
risk of of dying from card card vascular
disease is dramatically lower in people
that are given Omega-3s compared to a
placebo so you know the fact that the
the nonsmokers with um a low omega-3
index are probably affect it's affecting
their cardiovascular health inflammation
is a big also a Big Driver of
cardiovascular disease and Omega-3s are
really good at lowering inflammation in
many different ways so yeah to sort of
the long-winded you know answer to your
question is no you can't definiely say
that healthy user bias isn't involved
but there's a mechanism that we could
see how it would work there is and you
know again there is adjustment for other
health factors so you would think that
that would show up let's say that
someone goes I hadn't even thought about
Omega-3s I should probably optimize
those what's the 020 of getting good
Omega-3s in your diet someone might
struggle with seafood it's kind of hard
or expensive to cook at home where would
you send them for getting it from diet
getting it from supplementation what do
they need to know so I think um I talked
about the omega-3 index and again you
want to get 8% or higher it's always
good to measure things but there's been
studies done where people with a low
omega-3 index so the standard American
basically 4% if you give them about two
grams a day of Omega-3 they can raise
their omega-3 index from 4% to 8% so
that would be a supplemental form pretty
two gram so I'll just give you to give
you some perspective you know Physicians
prescribe um what's leesa which is a DHA
and EPA ethylester form we can talk
about different forms of Omega-3 um of
omega3 and they also prescribe uh vispa
which is a highly pure EPA form and they
prescribe them at gr um in the gram dose
of four grams per day so that's twice as
much as two grams a day which so what
I'm getting at it's a fairly safe dose
and um so two grams a day can raise
people from 4% to 8% I think that's a
really good sort of just starting point
or the average person now I take
experimentally higher doses but but you
know I think generally speaking it's
pretty safe for most people to take two
grams a day and you're going to get that
high Omega 3 index at 8% where are they
going to go how are they going to assess
without getting some Norwegian farmer
that's squeezing fish into a barrel and
and doing it holistically himself what
can you say about assessing the quality
of I I even remember cod liver oil
tablets back in the day there's all
sorts of uproar before there was even a
podcasting Universe to kind of
scrutinize it what do people need to
know if they're choosing their omega-3
supplement I think choosing omega-3
supplement is um we actually have a lot
of data now a days and we have access to
that data quite easily because there's a
lot of third party testing sites that go
out and they just randomly get fish oil
supplements off the grocery store
shelves and they say I'm going to take
this supplement I'm going to measure
important things I'm going to measure
the concentration of the Omega-3s EPA
and DHA is the concentration in there
what is stated on the bottle I'm going
to measure you know so fish it's being
isolated it's like it's an oil it's in
the fat right so um fish also have
contaminants they have pcbs they have
mercury among others and so measuring
those contaminants is important because
fish oil is generally purified but you
want to make sure a good job was done so
those contaminants are measured and then
um oxidation so Omega-3s are a
polyunsaturated fatty acid prone to
oxidation and so you don't want to get
something that has an oxidation greater
than 10 so anything greater than 10 of
total oxidation you want to avoid
because it's like consuming rancid fat
right rancid lipids like you don't want
to do that so so you those things are
all measured and um there's sources out
there so consumer lab is a you know
thirdparty testing site that you know
they just there's a lot of affordable
brands that you can find because some
supplements are just very expensive so I
do like to kind of send people there
because I have no affiliation with
consumer lab by the way I just like that
I I like I use them so I like that you
can go and find a a pretty decent
quality fish oil supplement if you're a
data nerd like me you can take this up a
level and you can go to the
international fish oil standard site
ifos they just I mean it's like data
party like they give you so much data
but like you have to like know what to
do with it so they measure all these
things but like and everything else
right um and they also tell you the form
it's in so I mentioned ethylester for
the prescription form there's also
triglyceride form those are the two main
forms that you can find fish oil
supplements or Omega-3 supplements in
and um generally speaking triglyceride
form is is the most bioavailable
triglyceride form is what is the form if
you're eating fish the Omega-3s are in
triglyceride form when the Omega-3s are
purified they take it out of the
triglyceride form and they purify it and
it's in an ethylester form some
companies then reify it back into that
form to make it Supreme and more
bioavailable both pure and bioavailable
exactly but not everyone does that and
so if you get an ethylester form which
is what is prescribed most people that
are getting prescription form of Omega-3
to help prevent cardiovascular disease
they're taking aester form that's what
I've got the thing to know is you have
to take it with a meal and preferably
with a higher fat meal because it is
absorb it you will absorb so little if
you're taking it on empty stomach it's
very important and um I didn't want to
get into all the new ones but I
mentioned two grams a day of Omega-3
will raise your omega-3 index from low
to high right 4% to 8% well if you
really kind of look at the form people
were taking triglyceride versus
ethylester you know they had to take
you know less of the triglyceride form
to get there but so I like to just
average it out and say two but um so if
you can get triglyceride form it's it's
a great form to
get how much salmon or Cod or halbot do
I need to eat per week if I was going to
try and get this through my diet right I
mean that's that's a question that I
don't have empirical data to back up but
Al so so here's my sort of thoughts on
that um I do think that wild Alaskan
salmon is one of the best sorts of
Omega-3 because um that is a fish that
has a very low level of contaminants
like Mercury um pcbs per gram or per
ounce I guess is usually measured per
ounce of of the fish right so salmon
would be a great source now how much of
that do you have to eat uh it's really
you know depends on the cooking method
like how how cooked was it because you
can degrade some of the Omega-3s are
somewhat heat sensitive so I don't know
how much you You' have to do a test
right so you'd have to say okay I
typically eat salmon two nights a week
or three nights a week and and then you
want to wait 120 days right because it
takes that long for your red blood cells
to turn over okay I know here's the pro
Ronda just just tell me how much salmon
I need to eat come on please I I don't
know I a week at least at least I would
I would say you probably have to
supplement on top of that I don't know
that twice a week is NE necessarily
going to go from 4% to 8% got you but if
you were to do you know I would imagine
a lot of the people that care about this
listening to this protocol will think
right I'm going to find a good quality
uh low
oxidation triglyceride version of
Omega-3s that are responsibly sourc that
I like the look of I'm going to take two
Gams of that per day and I'm probably
going to try and have some sort of fish
meal twice per week does that seem
realistic that's absolutely that's kind
that's what I do I mean I that's what I
I do I do up the dose a little bit more
but like I said you know I like eat it
like I take it throughout the day the
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