Fish. Everyone knows they should eat more fish, right? Why is that? Fish is good for your heart, but why? And what kind of fish? Turns out FATTY fish intake reduces cholesterol and, more importantly, there is a strong link between fish oil and inflammation.
Seems I have been talking to EVERYONE this week about fish oil, diet and inflammation. When a patient’s cholesterol is high I often check a profile called an essential fatty acid (EFA) panel which gives a nice peek into their diet. Often I just get confirmation of what I already know – their diet stinks and we need to get to work ASAP!
Ultimately I really don’t care about an individual’s cholesterol. I really don’t. High cholesterol in and of itself is not a disease. I care about their risk of OTHER diseases either directly related to the high cholesterol levels (like pancreatitis from super-high triglycerides) or for which high cholesterol is a marker (like heart disease).
High cholesterol is like the fire alarm going off. When the fire alarm goes off, do you just go turn it off and go back to bed? No, of course not, you go figure out what made it go off in the first place. Find the fire, right? When a person’s cholesterol is high, that means we need to go search for the fire, and an EFA panel is one of my first steps in hunting for the fire.
One of the calculations I can make based on the EFA panel is a quick-and-dirty check of overall inflammation levels in the body. The ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA) is directly tied to inflammation in the body. The higher the ratio, the higher the levels of inflammation.
Why do we care so much about this ratio? Higher ratios are also associated with higher risk of heart disease, as reported in the Journal of Cardiology.
I tell patients (and my students) that over the next 10 years I believe we’re going to be paying much less attention to cholesterol and much more attention to inflammation. Inflammation hurts the cardiovascular system over time. It damages the insides of the artery walls and when they heal they scar, which causes plaque.
Arachidonic acid is a precursor for a lot of pro-inflammatory signaling molecules in the body. EPA is a precursor for ANTI-inflammatory molecules. So you want MORE EPA and LESS AA.
Where does EPA come from? The richest dietary source of EPA is fatty fish, although it is also found in low levels in seaweed. When I’m talking to patients I tell them there are 6 fish that are “fatty” fish: salmon, mackerel, anchovies, sardines, herring and tuna. (The mnemonic is SMASH-T.) All other fish (like cod, whitefish, tilapia, catfish, etc) are meat and should be eaten sparingly, if at all. The human body can make small amounts of EPA from alpha-linolenic acid (ALA) which is found in walnuts, seeds like flaxseed and chia seed, and canola oil.
What about arachidonic acid? AA can be made from another essential fatty acid, linoleic acid, which in humans must come from the diet. The only dietary sources of AA are animal foods like meat, dairy and eggs.
Here comes the question I keep expecting: Dr. Jen, you keep telling us that the healthiest diet is completely plant-based. If we need EPA and the best source is fish (which are undoubtedly animals), why is a completely plant-based diet so heart-healthy?
That’s a great question. First of all, scientists are still working on the “why” but there is no doubt that a completely plant-based, whole-foods diet is the best choice if your goal is overall health and avoiding heart attacks and strokes. My patients who choose to try a plant-based diet find their blood pressure goes down, they feel better and they usually lose some weight.
My personal interpretation of current research is that if you give the body ALA and LA from plant sources, it will manufacture the EPA and AA that it needs for its purposes. The ratio of AA to EPA will be low because the body won’t make extra AA. However, if you eat a lot of meat you get a lot of AA from the diet and the body isn’t so much in control of how much is floating around.
The best choice for those who want to reduce their risk of heart disease is to eat NO animal foods at all. Adding a small amount of fish oil as a supplement is good insurance to further reduce inflammation in the body.
If you have high cholesterol, ask your doctor to order an Essential Fatty Acid profile or a Boston Heart Diagnostics panel. If it is coded with a high-cholesterol or high-triglyceride diagnosis code, it will almost certainly be covered by your insurance.The results should look something like what is shown at this link. Calculate the ratio of arachidonic acid to EPA. The goal is <3, an elevated level is >10 and a high level is >15. I’ve seen it over 30.
Then look at the ratio of omega-3 to polyunsaturated fatty acids (w3:PUFA). The healthiest people in the world have a ratio of about 50%, but we eat so many omega-6 oils in the USA that I’m usually content with a ratio of 15-20%.
The last thing to look at is the total saturated fat level. If it is high you REALLY need to think about how much meat you’re eating. The main sources of saturated fat in the body are animal foods (meat, dairy and eggs). Palm kernel oil is found in many processed foods and is also a big dietary source of saturated fat. Read your ingredient lists. There is currently a big craze to eat coconut oil, which is also a rich source of saturated fat. No research suggests adding more coconut oil to your diet improves health at all.
You are what you eat. Your body is 100% created from the food and drink you put in your mouth. Your health is 90% determined by lifestyle factors, mostly diet. Now is the time to look at what you’re choosing to feed your body and make good choices. It’s up to you!
QUESTION: Will you change your diet based on this information?