11/08/2023
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%. 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
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!
