Omega 3’s – a good thing or a risk for atrial fibrillation?

Omega 3 fatty acids appear to be critically important for vascular and brain health, but do they increase your risk of atrial fibrillation?  Is the form of Omega 3 important?  

If you keep up with health news, some alarming reports on Omega 3’s might have come up on your news feed.  I’d start with this study: https://jamanetwork.com/journals/jama/fullarticle/2777450

One of the issues to consider is whether the Omega 3 is the esterified version (e.g. the prescription version) or a natural product such as fish oil or algae based Omega 3 without modification.  Much of the data seems to be on esterified Omega 3’s.

The middle ground seems to support little risk elevation at 1 gram of fish oil daily, and questions regarding whether higher dosing should be limited to those at low risk of developing atrial fibrillation.  A decent review is available here: https://www.cedars-sinai.org/newsroom/omega-3-supplements-could-elevate-risk-of-atrial-fibrillation/#:~:text=%E2%80%9CFor%20patients%2C%20the%20risk%20of,following%20your%20doctors'%20advice.%E2%80%9D

This review in JAMA has a useful graph of Atrial Fibrillation risk versus Omega 3 fatty acid intake – there is a sweet spot, where too little increases risk and too much also seems to increase risk.  https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.058596

The Omega 3 Index is an interesting test which looks at percent of EPA/DHA blood levels.  Typical Americans have around 3-4%, with Vegans often being on the lower end of this.  We know mortality, and potentially brain health, is optimized with an Omega 3 index of >8% (or if you have an ApoE4 then 10%).  Mortality is increased in those who have a low omega 3 index.  We routinely test this in our patients!  Here is a nice summary on this topic.  

https://www.news-medical.net/news/20210423/People-with-a-higher-Omega-3-Index-lived-longer-than-others-study-shows.aspx

A nice additional summary in Nature is here: https://www.nature.com/articles/s41467-021-22370-2

An excellent review in regard to concerns about atrial fibrillation is available here in video form from Simon Hill on the Proof.

One of the important details is ALA (Omega 3) which is Omega 3 present in vegetables is likely not helpful, as it must be converted to DHA/EPA to generate health benefits.  The conversion of ALA to DHA/EPA is probably competed for with Omega 6 fatty acid intake.  Directly consuming DHA/EPA is our recommendation, with consumption of fish/fish oil in non-vegans, and algae oil products with DHA/EPA in vegans.

The take home message of this blog is the Goldilocks Principle.  We need the right amount of the right compounds, too little or too much is risky.  Testing and sensible dosing is important.  This is a corollary to hormones, where too little or too much leads to health complications.  We need to hit the sweet spot with our diet and lifestyle, with evidence based measured approaches are needed to maximize benefit and limit harm!

We recommend patients have their Omega 3 Index measured, which is a blood test that costs from $37-$69 which we can order for you. The goal is 8% for those with no ApoE4 (a marker for developing Alzheimer's Dementia) or 10% for those with a copy (or 2 copies) of ApoE4. There is huge complexity around what to do in individuals with and ApoE4. One of the problems is that individuals with ApoE4's have a defective DHA transporter into the brain. 30% of the brain is DHA and this defect is likely part of the issue that leads to Alzheimer's Dementia. Here is a good discussion around this topic. We recommend a discussion with Dr. Fraser on this topic as we are currently recommend an LPC-Omega 3 plus a version with a lot of phospholipids as a way to get around the DHA transporter issue, at least partially.

Disclaimer:

This blog provides general education only and should not be used to diagnose or replace the advice of a qualified medical professional. This content is not intended to be a substitute for consultation with a qualified and licensed physician or other medical provider. Readers should consult a medical professional for advice, diagnosis and treatment relating to their individual case.

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