The Birth of the Omega-3 Index

8 Feb 2017 | Under Heart Health, News, Omega-3 Index | Posted by | 0 Comments

If you have searched the depths of our website, you will be able to find a publication list that provides ample evidence for the use of the Omega-3 Index as a marker of omega-3 intake and disease risk. However, you may not have had time to scour the scientific literature and we don’t blame you! For this reason and in honor of Heart Awareness Month, we decided to provide the abridged version of the creation of the Omega-3 Index (and OmegaQuant).


“Over a beer at a conference”


Scientific conferences are supposed to be a place for science to be shared and scrutinized as well as a decent amount of schmoozing. Great ideas certainly emerge during regularly-scheduled conference programming but, as with most brilliant ideas, some of the real innovation begins “over a beer.” Bill Harris, then a research professor at the University of Kansas (now the President of OmegaQuant, shown in the picture on the left), and Clemens von Schacky, a cardiologist from Germany (shown on the right), got together at a bar during the 2002 American Heart Association’s Scientific Sessions in Chicago to discuss a particularly exciting day of presentations.


Seminal Paper #2 – Albert et al. 2002


A 90% reduction in risk of sudden cardiac death.” 90%?? A 90% reduction in a major cause of death should get anyone’s attention, but for Bill, a researcher who had already been in the field of omega-3 fatty acids for over 20 years, this was a revelation. What’s more is this was the second paper to report this striking relationship, which we will get to in the next section. Here are the study details of the presentation that caught both Bill and Clemens’s attention. Dr. Christine Albert from Brigham and Women’s Hospital in Boston in collaboration with the School of Public Health at Harvard presented their findings from a prospective case-control study called the Physician’s Health Study (PHS). PHS began in 1982 with over 20,000 healthy, male physicians and measured their health outcomes (heart attacks, strokes, etc.) and as well as their lifestyle choices (nutrition, exercise, medications, etc.) and biomarkers (cholesterol, blood levels of omega-3s, etc.) over many years. At the time of Albert’s study, the men had been followed for 17 years and 94 had died of sudden cardiac death. The research team compared the baseline whole blood fatty acid profiles of the deceased men with 184 men who were still living, matched on their age and smoking status. A strong relationship between blood omega-3 levels (EPA+DHA+DPA) and risk of sudden cardiac death was significant, even when the researchers took into account other lifestyle factors that are related to heart health. They also found that men with high whole blood levels of omega-3s had a 90% reduction in risk of sudden cardiac death as compared to their counterparts with low omega-3 levels (equivalent Omega-3 Index [EPA+DHA in red blood cells]: 3.9% vs. high: 7.3%).


Seminal Paper #1 – Siscovick et al. 1995


As I had mentioned in the previous section, the Albert paper was the second to demonstrate a dramatic reduction in death from a sudden heart attack. The first was a paper published in 1995 by Dr. David Siscovick of the University of Washington- Seattle. This paper ALSO reported 90% reduction in death when comparing individuals with higher and lower blood omega-3 levels. Here are the study details: Dr. Siscovick and colleagues worked with local paramedics in King County, Washington to collect blood samples of 82 individuals who were having heart attacks and had called 911. The researchers then recruited 108 healthy “controls” (people who were not having a heart attack) and matched them by age and sex to those who did have heart attacks (cases). After adjusting for other important variables, having a red blood cell omega-3 levels in the highest quarter of the group resulted in a 90% risk reduction of sudden cardiac death as compared to those in the lowest quarter (equivalent Omega-3 Index: 6.5% vs. 3.3%).


The Omega-3 Index: a new risk factor for death from coronary heart disease?


So, back to the bar in Chicago. After ingesting both of these studies (and a few beers!), and considering the growing body of literature about heart disease and fish or omega-3s in general, Bill and Clemens had their collective “A-Ha!” moment! Blood EPA+DHA levels were not just markers of fish intake (as they’d typically been seen in the past), but were actual, bona fide “risk factors” – like serum cholesterol – that could be measured by doctors and used to manage risk for heart attacks in their patients. And they agreed that it should not be “blood” EPA+DHA, but specifically “red blood cell (RBC)” levels of these omega-3 fatty acids that should be measured. This is because the omega-3s in RBCs are found in the cell’s membranes (not just floating free in blood), and it’s in cell membranes throughout the body where EPA+DHA exert their beneficial effects. What’s more, they realized that creating a standardized and uniform method of analysis that could be applied worldwide was critical to the success of this dream.


So it was time to move from theory into practice. Over the next year, they went to work to establish a uniform laboratory method for doing the test, and they wrote a scientific paper outlining their hypothesis that was published in 2004 in Preventative Medicine. The paper was entitled, “The Omega-3 Index: a new risk factor for death from coronary heart disease?” In addition to coining the term “Omega-3 Index,” Bill and Clemens needed to arrive at cut points that indicated risk for a heart attack. The figure below from the 2004 paper shows how they arrived at the current cut points of 4% for higher risk and 8% for lower risk, using estimated Omega-3 Index levels from a variety of studies that were available at the time.



After many years of working within the academic system, Bill was able to open OmegaQuant Analytics in 2009 as an independent lab focusing on measuring the Omega-3 Index for healthcare providers, individuals and, yes, research groups. Clemens started a sister laboratory in Munich called Omegametrix to do the same. Both labs run the identical test so their results are directly comparable.


As of today, Bill and Clemens (and one of Bill’s previous students, Dr. Yongsoon Park, Professor of Nutrition in Seoul, Korea who also runs this test) have published around 200 scientific papers on the Omega-3 Index. Their seminal 2004 paper has now been cited by at least 679 other research papers (according to Google Scholar), so the scientific and medical world is taking notice.


The Omega-3 Index test has now become the gold standard for omega-3 biostatus testing. It is used as a compliance marker for randomized controlled trials with fish oil supplements, and in epidemiological research. At the same time, its ease of use and actionable results have made it a popular option for individuals at home and doctors to get an objective measure of their omega-3 levels. Moreover, in 2008 Dr. Bernadine Healy (cardiologist, a past President of the American Heart Association and the first woman Director of the National Institutes of Health) wrote an article about the Omega-3 Index in US News and World Report. She concluded, “Before long, your personal Omega-3 Index just could be the new cholesterol—the number you want to brag about.” Dr. Healy was prescient – she “got it” – and now the Omega-3 Index has been measured in millions of patients around the world. The dream born over a beer has become a reality.

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