Omega-3 for Athletes & Military Personnel

OmegaMatters: Episode 27

Hosts: Drs. Bill Harris & Kristina Harris Jackson

Guest: Jeff Heileson, PhD, RD, CSSD

Background and Key Takeaways:

Jeff Heileson, RD, CSSD, got his Doctorate in Nutritional Sciences at Baylor University, and is Registered Dietitian and a Certified Strength and Conditioning Specialist. Now, he’s a Deputy Director in the Nutrition Services Division at the Walter Reed National Military Medical Center. We first found out about Jeff and his mentor, LesLee Funderburk, from Baylor, when they contacted us about analyzing samples for their studies. And then we found out the area he was working in was really interesting and really important, and that’s omega-3s and athletics and more specifically, in concussion areas and strength building. For more information on OmegaMatters, visit:



Dr. Kristina Harrison: All right. Welcome to OmegaMatters, everyone, where we talk about all things Omegas. I’m Kristina Jackson, this is Bill Harris, and today, we are talking with a fantastic young researcher, Jeff Heileson. Jeff got his Doctorate in Nutritional Sciences at Baylor University, go Bears, is a Registered Dietician like me and a Certified Strength and Conditioning Specialist. Now, he’s a Deputy Director in the Nutrition Services Division at the Walter Reed National Military Medical Center.

We first found out about Jeff and his mentor, Leslie Funderburk, from Baylor, when they contacted us about analyzing samples for their studies. And then we found out the area he was working in was really interesting and really important, and that’s omega-3s and athletics and more specifically, in concussion areas and strength building. We wanted to bring Jeff on to talk about just three of his really interesting and impactful papers today, so let’s get into it. Welcome, Jeff.

Jeff Heileson: Yeah, thank you. Thank you for the introduction. I appreciate being on OmegaMatters because obviously, I listen to it all the time. It’s always on in the background, so I appreciate being able to have a platform to talk about some of my research.

Dr. Kristina Harris Jackson: Yeah, we’re excited. We like to put a spotlight on the researchers because we’re always in the background just writing papers. Can you give us a little bit of your background? How’d you get interested in this and land where you are?

Jeff Heileson: Yeah. I was a little bit of a late bloomer from a PhD standpoint. I was the Old Man Winter when I got into my PhD program. I had already been a registered dietician for a little over 10 years, and then I decided to pursue a degree. I made the decision in early 2018, and then I started looking at work I’d potentially go to. I was on a very short timeline. Most people, they can sit around and probably do PhD in five, three years or longer. I had three years. I only had three years to do it, so I had to be very, very selective on where I chose that was able to get all that through. I selected Baylor and it worked out great.

Dr. Kristina Harris Jackson: Wow.

Jeff Heileson: The rest is history. Yeah.

Dr. Kristina Harris Jackson: That’s fantastic.

Dr. Bill Harris: Did you actually do it on site, in Waco?

Jeff Heileson: Yes, sir, I did. Yeah, I definitely did it there. Spent three years there. What was good about it is that I started working with my mentor. This is probably what most PhD students do before they even get in, is I had been working with my mentor probably about nine months before I even joined the school, just to start working on some small projects together. Because again, I had almost a full career behind me, halfway through a career already. I was pretty experienced and so it was easy for me to slip into that position.

Dr. Bill Harris: Great.

Dr. Kristina Harris Jackson: You’re working with military now. You’ve started to work more with military. Was that always what you thought you were going to be going towards with the PhD or was that …?

Jeff Heileson: Yeah. Yeah. Actually, so I joined the military in 2008, and so I was a military dietitian up until then. I spent my first two years in the military doing a master’s degree through Baylor. That program is actually at Fort Sam Houston, Texas, in San Antonio, the graduate program in nutrition, which currently still exists to this day. We did 10 years of military service, and they have a program called Long-term Health Education and Training, and you can apply. They’ll send you to a school of choice to go get a PhD essentially. I competed for that and that’s why I was on a three-year timeline.

Dr. Kristina Harris Jackson: Yeah, that makes sense.

Jeff Heileson: Because the military has very strict … They’re like, “We’ll let you get a PhD, but you’re on a timeline.” Yeah. I’m now at Walter Reed, and I’m a research director here.

Dr. Kristina Harris Jackson: That’s fantastic, and that makes sense. You’ve been so productive so recently. You were also doing your studies over COVID, if I remember correctly.

Jeff Heileson: Yeah. Right. Yeah. Yeah. Yeah, it was a tough experience. I’ll tell you that right now. It was very tough doing a PhD in the middle of the pandemic. It was very difficult.

Dr. Kristina Harris Jackson: When you’re not working on rats and you’re trying to do technical work.

Jeff Heileson: I couldn’t hang out with humans for a while. That’s what my research is, so it was tough.

Dr. Kristina Harris Jackson: Oh, that’s great. Thank you for sharing that. The first paper I wanted to talk about is a review, and it just sets up this whole area. I thought it was a really nice review. I’ve used it in some presentations, but it was published in 2020 within Nutrition Reviews. The effect of fish oil supplementation on the promotion and preservation of lean body mass, strength, and recovery from physiological stress in young, healthy adults: a systemic review. This had a military focus. Can you tell us why you guys decided to do a systematic review on those outcomes in this population?

Jeff Heileson: Well, there’s a lot of research. Well, I guess I’ll backtrack a little bit. A lot of the research when it comes to the promotion of preservation of lean body mass, strength, is really centered around the other macros. The fat gets left out of the equation a lot of times. It’s pretty well-established that if you increase your protein intake during times of basically physiological stress, protein is going to be your biggest bang for your buck. Make sure you’re taking in adequate carbohydrates on top of that, and then the fat’s like, okay, just fill in the rest with what you need with your fat. But we really wanted to dive into see what the literature said when it came to outcomes.

There was a lot of really good mechanistic data that was very positive on the use of fish oil and how it could impact muscle protein synthesis. There was some human data at the time that I actually put this together, but it wasn’t very clear about what the other data said when it came to these outcomes. I wanted to put the data together and basically see how it all panned out, really.

Dr. Kristina Harris Jackson: Yeah. Can you also define preservation and promotion of muscle mass?

Jeff Heileson: Yeah, I definitely need to clarify that. Because that’s one thing that I find in the literature is that you’ll have a group of studies and they’ll have particular outcomes. But just because the outcome is looking at lean body mass, it matters the context of when that occurs. If you look at muscle damage protocols, for example, where you should have different outcomes related to strength, for example, versus a resistance training protocol, those are diametrically opposed. One’s in a state of preservation or you want to preserve strength, and the other one is, you’re actively trying to build strength.

That’s where the promotion and preservation came from because I found that a lot of reviews would put all the studies together. Basically, they would have the studies talk to each other like we do in the literature, but they were talking past each other. I was like, “Why are they comparing those two studies?” I was like, “You know what? Let’s do a little bit better job of defining which studies are the most similar and which ones are trying to, for example, increase lean body mass versus preserve lean body mass.” So we try to do that.

Dr. Bill Harris: Jeff, you mentioned that protein has been one of the most focused nutrients in this area. Can you just briefly tell us how much protein is needed for preservation versus growth of muscle?

Jeff Heileson: Really, if you want to cap it off, it’s about 1.6 grams per kilogram with a resistance training protocol. I will say though, nutrition’s only going to help a little bit. Resistance training is king when it comes to any type of lean body mass or hypertrophy or strength outcomes.

Dr. Bill Harris: Right.

Jeff Heileson: What was your other question, sir?

Dr. Bill Harris: Right. Just preservation. You’re not trying to build.

Jeff Heileson: Right. Yeah. The military has done a lot of really good studies. There’s a real good paper in nutrients that discuss mitigating the loss of muscle-mastering field exercises. A lot of that research really gave us some good ideas on how much protein actually can help preserve lean body mass. In that context, they were able to preserve lean body mass as with protein intakes as high as, I want to say it was 30% of their daily calories. It’s tough to use percentage. It’s better to use grams per kilogram, but I cannot remember off the top of my head how much grams per kilogram they used.

Dr. Kristina Harris Jackson: More typically, 20% of a diet is protein?

Jeff Heileson: Right.

Dr. Kristina Harris Jackson: Yeah.

Jeff Heileson: Right.

Dr. Kristina Harris Jackson: It’s a pretty big difference?

Jeff Heileson: Right. Yeah, it’s a pretty big difference. Right.

Dr. Kristina Harris Jackson: Yeah.

Dr. Bill Harris: 50% increase? Okay.

Dr. Kristina Harris Jackson: Yeah. Yeah.

Dr. Bill Harris: We can go back to fat now, but I was just having that protein question.

Dr. Kristina Harris Jackson: All the nutrients, they have their role. I really think that you’re dead on with this promotion versus preservation of muscle mass because they also see this in the elderly and sarcopenia-type focused things. What did you find in the effects of omega-3s in these two.

Jeff Heileson: Yeah. Well, it was unfortunate. Because really what we found is that mostly, it was unclear. We really couldn’t hang our hat on either results. There wasn’t a lot of information out there. However, we were very confident that it would help in situations of recovery. In that study, specifically how we measured recovery was we looked at soreness measures after muscle-damaging exercise, range-of-motion outcomes, different types of swelling measures.

Generally speaking, fish oil tended to do a very good job of helping folks recover faster after an actual muscle damage protocol. The second finding we had was that it was clear there was definitely something there for preserving strength in instances, in different contexts, wherever there was some kind of stressor.

For example, one of the most, probably the most well-known studies now is the McGlorry study from 2019, looking at immobilization in females. There was a preservation of strength in that study. Basically, it protected the decline in strength, despite immobilization. It was about a 35% decrease in strength in the fish oil group, and the placebo group was a 50% decrease, I believe.

Dr. Bill Harris: Does that match with muscle mass? Is strength and muscle mass the same thing?

Jeff Heileson: No, it’s really not. There’s a very big difference between. Now, there tends to be in younger individuals, they tend to be somewhat leaner, but it’s not always the case. What that study found specifically, they actually found that it preserved lean body mass as well. Basically, the ability to rebound after … Well, let me correct that. Basically, after fish oil supplementation and immobilization, they lost approximately the same amount of muscle mass based on MRI in their leg. But in the fish oil group, they gained or they preserved some of that lean body mass a lot faster after two weeks when they measured compared to placebo. They were able to recover faster.

Dr. Kristina Harris Jackson: Okay. Building back up?

Jeff Heileson: Right. It was the strength and the lean mass. Similarly, there’s a Philippot study where I think they decreased calories by 40%, a pretty substantial amount of calories. The whole goal was for them to lose weight, and what they found is that fish oil did not preserve lean body mass compared to placebo. However, it did preserve strength, and strength actually slightly increased in the fish oil group, which was a really interesting finding. There was something there related to fish oil being able to preserve strength.

Dr. Kristina Harris Jackson: Yeah. I think it’s a really important mind shift when you’re looking at these studies and looking at the graphs. Like you said, in that one study, both groups declined technically in their strength, as they were supposed to, being immobile. You’re trying to damage the muscle and immobilize and all of these. When you get injured in real life, you have to do those. You have to stop using that muscle or that joint. But the omega-3s attenuate.

They don’t decrease as much, and we see this in the aging research, is omega-3s will help attenuate memory loss and the placebo group will have a decline. It’s not making you smarter or whatever. It’s not making you stronger just by taking this supplement. It’s helping your body recover. Just through the natural stressors of life, it’s helping your body maintain and be able to recover thereafter. Very different thing than, I think, is what maybe is portrayed media-wise. It’s different. It’s a very different thing.

Jeff Heileson: Completely agree. Yeah.

Dr. Kristina Harris Jackson: I think that is fantastic. Since we’ve clarified where this is happening, with this information, how do you use it as an RD with who you work with? How does it change your recommendations or how you explain why a military person would take it?

Jeff Heileson: It definitely clarifies for me because it’s one of those things where I’ve known for a very long time. I’ve been an RD since 2010, and we’ve known for a very long time that people just need to eat fish. We all need fish. But what I found through my practice is that it was very difficult, no matter what type of motivational interviewing techniques you’re using, it’s very difficult to get folks to eat fish if they just don’t want to eat fish. What I found in practice is that linking nutrition to performance outcomes while you’re counseling someone, it actually motivates them even more to try to do certain things. And this is a great example.

Now that this evidence is starting to come out and it’s starting to come together in different types of systematic reviews, I actually do break it down to any kind of patients that I may have, and I’m speaking more to the young folks. I’m seeing typically 18 to 30-year-olds, majority from an outpatient standpoint. I actually talk to them about some of the performance implications or the potential implications. I link it to that and all of a sudden, they start ticking up their fish intake a little bit. I definitely have seen that, seen from my research, a little bit of benefit of me being able to discuss that with patients.

Dr. Kristina Harris Jackson: Yes.

Jeff Heileson: Now, I will say all my research has been in young individuals, but I will tell you the biggest bang for the buck when it comes to fish oil and fish oil research is definitely in older individuals. The evidence is even a lot clearer in that population.

Dr. Kristina Harris Jackson: Yeah. Yeah, I would agree with that. But I think a lot of the stuff that you’re looking at still, it’s impressive, but uses such an overwhelming variable that it’s harder to see those effects. In the military, are you only allowed to counsel for food? You aren’t able to provide any supplementation at this point, is that correct?

Jeff Heileson: Yes, we can only just counsel. We can’t provide actual supplements or anything like that. Yeah.

Dr. Kristina Harris Jackson: We’ve worked with a few people in the military about trying to increase fish options in the mess hall and things like that and how to do it without supplementation.

Dr. Bill Harris: Jeff, you can’t even recommend omega-3, nevermind prescribe it? But you can’t even suggest if you don’t want to eat fish, you could do this?

Jeff Heileson: Oh no, we definitely can recommend it. For sure.

Dr. Bill Harris: Okay. Okay.

Jeff Heileson: Yeah, we just can’t provide it.

Dr. Bill Harris: Gotcha.

Jeff Heileson: Yeah. Yeah.

Dr. Kristina Harris Jackson: Okay. That’s a good clarification. All right. Any other questions on the review that we want to go over? I think that’s it. Oh, the only other thing I noted was that you were looking at making sure you’re getting a higher EPA supplement review. You want to discuss that just a little bit?

Jeff Heileson: Right. Yeah, I definitely should have said that from the outset. Yeah. That was actually the bend we actually took with this systematic review, is that we specifically only looked at studies that had an equivalent EPA to DHA or a higher EPA. We did not include any other studies. And the reason for that is because a lot of the muscle protein synthesis data that’s related to a lot of these outcomes was based on the EPA component. For example, the early cell studies and actually the studies that are done in … There was a study in steers, there’s a study in pigs, and the early cell studies were very clear that the component of omega-3s that’s actually increasing muscle protein synthesis was, in fact, the EPA component. In one cell study, it showed it increased muscle protein synthesis and decreased breakdown as well, which was pretty interesting.

Again, that’s not human data. But then fast-forward to 2011, I would call them Seminole papers now, from Mittendorfer’s work, the first author is Gordon Smith, and his two papers are very famous (2016 and 2011). They found that in older individuals and in young individuals, fish oil substantially increased muscle protein synthesis for the response. Or basically, it was really, it sensitized the muscle to basically take in more of the available amino acids. That was a very important finding. Because of that data, and again, they used an EPA-biased supplement or infusion in that study, we decided to go with, okay, we’ll hedge our bet and we’ll look at EPA-only, the EPA only. Yeah.

Dr. Kristina Harris Jackson: Nice. Yeah, that’s interesting. That’s the mechanism they’re thinking. One of the mechanisms, there’s lots, is the membranes being enriched and EPA and DHA having a better uptake of the protein, carbs, all the other things that we know build muscle, or maintain.

Jeff Heileson: Right.

Dr. Kristina Harris Jackson: Cool.

Dr. Bill Harris: What’s the effect on mitochondrial function?

Jeff Heileson: Yeah, there’s actually been a couple of really good studies. I believe it was the same cohort from the McGlorry 2019 paper, but Miyata actually looked at mitochondrial function. They were looking at potentially, is that the reason why we’re seeing these preservation effects in that immobilization model that they used?

They did in fact find that essentially the mitochondria was functioning more efficiently because of that. Because of that, it’s utilizing less ATP, and so you’re having less energy being expended at that point. What’s happening is downstream, you’re having all these other positive effects as well.

Dr. Kristina Harris Jackson: Interesting.

Jeff Heileson: Right. There is some stuff out there about respiration and mitochondria that it’s a little bit outside my expertise, but it’s very interesting data that’s out there now.

Dr. Kristina Harris Jackson: This review is very focused on the strength and recovery piece, and then there’s this whole other area which is around endurance.

Jeff Heileson: Oh, right. Don’t even get me started on endurance. Oh, no.

Dr. Kristina Harris Jackson: It’s too big. It’s too much. But let’s shift gears. Now, so that was EPA-heavy, and then we’re going to talk about your work in concussion research, which is DHA-heavy. Yeah. The next paper is a randomized control trial that you are first author on. The paper is called the effect of omega-3 fatty acids on a biomarker of head trauma in NCAA football athletes: a multi-site, non-randomized study. Or I guess it’s a clinical trial, not a randomized trial. This is the Journal of International Society of Sports Nutrition, 2021. Tell us how this study came about.

Jeff Heileson: Yeah. Yeah. I always thought it was interesting whenever I went back and I looked at the 2016 Oliver paper … Dr. Oliver was the man in charge basically for this paper as well. I thought after 2016, of course, I was in practice, I thought there would be a slew of studies following the 2016 paper. Because I remember, in our world, how big of a paper that really was. But wow, fast-forward a few years and there was nothing out. I couldn’t believe it. The goal of this paper was essentially to expand upon what was already shown in the previous paper, so I have to go back a little bit to explain the genesis of this paper.

In 2016, Dr. Oliver showed that compared to placebo, two grams, four grams and six grams of DHA only significantly decreased neurofilament light, which is a marker of head trauma. It has a high agreement in the CSF or spinal fluid, for example, and in serum. It was an easy way to measure how someone was doing over time with repetitive and impacts. But what he also found, not only that though, when you collapse the groups upon each other, there was a clear effect where omega-3 significantly decreased neurofilament light.

But another interesting finding on top of that, whenever you separated the groups, the two-gram group actually outperformed four-gram and the six-gram group, so it seemed to be the most effective dose. Fast-forward to the study that we’re currently discussing, that we just published a couple of years ago, we knew we wanted to go with two grams of DHA, but we don’t know what’s going to happen when you add EPA and DPA to the equation. That’s why fish oil is really complicated because it’s complex.

It goes into the body, it has multiple different targets. It can go into multiple different tissues. We wanted to know if you added EPA to the equation, and we actually had, I think it was about half a gram of EPA and about half of that of DPA as well, and we wanted to see if it decreased the effect. Really, what we found is we found very similar results to that 2016 paper where it did actually, despite adding EPA, it did actually decrease neurofilament light compared to the control group. Again, we didn’t have a placebo. We had a control team.

Because that’s another difficult thing with working with D-1 programs or D-2 programs or D-3, is that essentially, when it came time to do a study, they were like, “Well, I want all of our guys to have omega-3 because we know it works. We don’t want to have a group that has a placebo.” We had to have a control team and that’s how that worked out. Yeah.

Dr. Kristina Harris Jackson: Yeah. Also, the main finding, so you preloaded … I like the design of this study because you guys started in preseason, taking blood levels. And then you took it all the way through the season, right?

Jeff Heileson: All the way, yep.

Dr. Kristina Harris Jackson: All the way through?

Jeff Heileson: Yep.

Dr. Kristina Harris Jackson: You have six different blood…. from whom you took blood?

Jeff Heileson: Yeah.

Dr. Kristina Harris Jackson: You’re able to plot the increase in neurofilament light over the course of the season. That helps just more data to show that as a football season goes on, there’s constant … What are those called? Small head traumas. Like every time you line up and run into another player, you’re shaking your head a little bit and it’s got a little more brain damage. It’s really building up over the course of the season. And then you’re also able to measure the omega-3 index over the course of the season, to make sure that that’s hitting the targets that we would expect.

I’m going to show this. I think this is the one I like. Well, both of these. This is the same thing going on, where we’re seeing attenuation. What happened in neurofilament light with the control team versus the supplemented team, and then you also looked at starters only because they are getting more of the hits than non-starters. You can talk about all that.

Jeff Heileson: Right. Yeah. Yeah. No, it was great because] if you look throughout the season, our are omega-3 group, and this is extremely interesting, their neurofilament light on average only changed about 10%, an increase of only 10%. If you look at any study that is a longitudinal design that looks at head trauma and neurofilament light, you’d think I was making that up. Because usually, the difference is about double, right.

Dr. Kristina Harris Jackson: Really?

Jeff Heileson: And then in our control team, we found that on average, it was above 50% increase from baseline. So pretty substantial attenuation. It was really interesting to replicate the findings essentially of the Oliver 2016 paper. Now, what was really interesting, so it is important to look at starters and non-starters in this context because of course, they have more time. So there’s more repetitive of head impacts. Instead of getting hit by a truck three times, you’re being hit by a truck 20 times. That’s essentially what football players are doing. You’re going out there and you’re getting … In American football, that’s essentially what it is, and we cheer for it. We cheer for it.

Dr. Kristina Harris Jackson: I know. It’s fun problem solving.

Jeff Heileson: Right. We did find that there was a difference when we only accounted for starters. There definitely was a difference, but it wasn’t as clear of a relationship. But definitely, we did find some. For example, in the control team, there was a significant elevation of neurofilament light when there was not a significant elevation in the omega-3 group still. Right.

Dr. Kristina Harris Jackson: Got it. Yeah. Yeah., So that’s this top one. You can see there’s a lot bigger difference. That’s that 10% versus 50%. And then the starters, it’s a little messier.

Jeff Heileson: It is messier. Yep, absolutely.

Dr. Kristina Harris Jackson: But that’s real.

Jeff Heileson: Yeah. Because I always tell people, it’s an expectation with any type of nutritional strategy, that it’s not going to remove … There’s nothing we can do to stop, for example, a concussion. No nutritional strategy is going to stop that. It can only attenuate certain things, and this is one way of looking at that as well.

Dr. Kristina Harris Jackson: Yeah. It’s really important that it is analyzed and shown in this way. The other great thing is that you had blood levels that you were able to …

Jeff Heileson: Right.

Dr. Kristina Harris Jackson: I think they were given. You have individual blood level changes, which I also like to see. Because then you do see some people don’t go the right way. That’s real data. But on average, you see a big increase in the Omega-3 Index for the one supplementing. Two grams a day, I’m grateful that was the most effective dose because six grams a day, it’s a ton. It’s too much.

Jeff Heileson: That is a lot.

Dr. Kristina Harris Jackson: For a lifetime. Two grams a day is something that, it’s just to see those effects and these big guys who are doing lots of activity, because we do see in some other … Like in soccer players, we’ve seen just over the course of the season, a natural decline in the omega-3 levels in their blood if they’re not supplementing.

Jeff Heileson: Right.

Dr. Bill Harris: Did you see that in your control group, too?

Dr. Kristina Harris Jackson: Yes.

Dr. Bill Harris: Your control team? 

Dr. Kristina Harris Jackson: It’s, I think, an overall decrease, too.

Dr. Bill Harris: Small drop in the Omega-3 Index. Okay.

Jeff Heileson: Yeah. Yeah.

Dr. Kristina Harris Jackson: Yeah. That just adds the validity to this paper, that this is truly people taking the supplements and getting it incorporated into their body, which is really necessary. Did you guys do any analysis of the change in Omega-3 Index and change in NFL, just those correlation type of thing?

Jeff Heileson: Actually, no, we didn’t. That probably would’ve been nice to do because fast-forward to 2022, there was another paper published on this by Mullins. They did that type of analysis and they did find that there was a relationship. I believe the correlation was … I think it was 0.4, an RF 0.4, which is just not bad. It’s good stuff, 0.4.

Dr. Kristina Harris Jackson: Yeah. Messy biological markers. That’s good.

Jeff Heileson: Yeah. They found a pretty good moderate-to-strong correlation related, too. As the Omega-3 Index goes up, neurofilament light goes down, and the Mullins paper showed that.

Dr. Kristina Harris Jackson: Yeah. That kind of consistency is critical. Not only concussions are a problem in sports, but in the military as well.

Jeff Heileson: Absolutely.

Dr. Kristina Harris Jackson: Implementation-wise, again, is this data, is it the same thing of like, this is good, but it’s not like we really need to get our guys who are most at risk for concussion who are like … I don’t know if that’s the people who are actually out on missions or what, but how does this information change how you work and maybe how your colleagues work with individuals?

Jeff Heileson: Well, yeah, it has the biggest impact on our Special Forces contingencies. It’s easier to influence a smaller group. Because when we talk about the conventional forces, that’s a large number.

Dr. Kristina Harris Jackson: Yeah, it’s too big.

Jeff Heileson: Half a million individuals. But Special Forces, and they’re exposed to these types of environments more often as well, to where they could potentially have a lot more repetitive head impacts, blast injuries, those types of things. I wrote a sort review paper called the Applications of Fish Oil Supplementation for Special Operators, and that’s the reason, because that’s probably where the biggest bang for a buck is when it comes to educating our forces. It’ll definitely be in our Special Operators. Yeah. I’m currently on a working group right now, working on trying to figure out the omega-3 issue, trying to see if there’s a way we could  leverage this knowledge to help our Special Forces get everything they need.

Dr. Bill Harris: You can’t recommend supplements to them, but you can recommend omega-3-enriched foods, right?

Jeff Heileson: I can do both. I can recommend supplements for sure.

Dr. Bill Harris: But you can’t probably provide omega-3-enriched foods?

Jeff Heileson: Right. Right. Yeah. They’ve done a couple of dining facilities studies where they’ve tried to increase the omega-3 environment, but the way they’ve gone about it though, unfortunately, is that they’ve just decreased the N-6 items, like the oils and those types of things. I think the better way to do it would probably be to increase the omega-3 footprint. But again, that costs a lot of money, too, honestly, to increase the amount of N-3s. Because I think that’s a better strategy.

Dr. Bill Harris: Very probably.

Dr. Kristina Harris Jackson: Yeah. Are there smoothies being served to people? Because that’s usually an easy place to get extra protein, and sometimes you can put omega-3s in there. Is that something that’s considered food? Or is that…

Jeff Heileson: Yeah, it would literally have to be given as a self-contained. Yeah. It could be self-contained, but that’s definitely something to look into for sure. I know they just did a study with the enhanced recovery, which contains protein and omega-3 as well. There’s definitely something to look into for sure.

Dr. Kristina Harris Jackson: Yeah. Implementation is a whole … You have the study, you find it, and then all of these structures in the real world that you have to work around and figure out. It’s wild, but these controlled trials are really important and hopefully, do push implementation. Because it is going to cost money. Prevention costs money. A lot of these, again, you are somewhat preloading with omega-3s, is that right? And then you need to have a high level in your body when the impact happens to have a lower NFL.

Jeff Heileson: Yeah. The whole thought process is to have a membrane-driven hypothesis, and part of that is essentially preconditioning. I did a talk and I called it Nutritional Armor because someone called omega-3 nutritional armor in 2014. I just like, “Oh, that’s a great name. Let me use that.” That’s what it is. You’re preconditioning the tissues to ensure they have adequate amounts of omega-3. So when there is an assault, we talked about the preservation, whether that’s through head trauma, just so the issue has that ready to go essentially for those effects to occur.

Dr. Kristina Harris Jackson: Yeah. Yeah. That’s where it’s one of those things. You can’t just start taking it after you’re injured and expect to see these effects. It’s having it on board so you don’t know when you’re going to get injured half the time. It’s like an investment in your health that you … It’s a lot harder to convince people of that than, “I’m injured, give me something.” Or, “I’m hurt.”

Jeff Heileson: Very true. Yeah.

Dr. Kristina Harris Jackson: Yeah, so it’s tricky.

Dr. Bill Harris: We do know that there are products being developed, and intravenous emulsions that can be administered immediately after a concussion.

Dr. Kristina Harris Jackson: Right. And that’s high, huge doses.

Dr. Bill Harris: They’re high doses directly into the blood. Right.

Dr. Kristina Harris Jackson: Yeah. But that’s really interesting and cool. And they used that on, I think, Shazier, the NFL player with the massive back injury.

Jeff Heileson: Oh, okay.

Dr. Kristina Harris Jackson: They did cold treatment and infusion of omega-3, I’m pretty sure.

Dr. Bill Harris: Yeah.

Dr. Kristina Harris Jackson: But it worked, out of one.

Jeff Heileson: Yeah. That’s an area of research that we definitely would like to do more on, is the recovery phase. So acute and chronic recovery phase after a concussion. The research is very difficult to do, but that would be a very interesting … Because there are certain protocols I know that are out there. I know Dr. Lewis, Mike Lewis, has a protocol that he uses as well. So it’d be good to actually formally test that if possible. Yeah, I agree with that.

Dr. Kristina Harris Jackson: Those doses are likely going to be very high.

Jeff Heileson: Nine grams or higher I think is what they’re-

Dr. Kristina Harris Jackson: Yeah.

Dr. Bill Harris: Right.

Dr. Kristina Harris Jackson: Yes.

Jeff Heileson: Yeah.

Dr. Kristina Harris Jackson: It’s not something that you can recommend to just anybody, obviously.

Jeff Heileson: No.

Dr. Kristina Harris Jackson: They have two different purposes. Now, so we’ve talked about EPA and muscle preservation and things like that, and then DHA in the brain. How do you reconcile that where you get like, oh, DHA is good for this, EPA is good for this? And then of course it’s like, just take both. But do you tailor it all when you’re talking to people on that?

Jeff Heileson: Really, I don’t. I really don’t. I’m just like, “You know what? You need to take them both.” If I’m ever working one-on-one with someone that’s in that type of environment, like Special Forces, I definitely would give recommendations that are more tailored to the individual. If it’s someone that I know that is exposed to a lot of head impacts, then I definitely would recommend a DHA via supplement. If it’s someone that is just working out in general, I would go with a standard fish oil supplement, which is higher in EPA typically, your standard off-the-shelf. I would probably just recommend that in general because it’s still going to get them some DHA as well.

Dr. Kristina Harris Jackson: Right, having both. We get asked about what’s the ratio of DHA to EPA all the time, or should I just do one or the other? It always ends up like, they come together in nature and they both do really important … In research, it’s nice  to tease it out a little bit, but at the recommendation stage, it just changes a little bit. But most of the time, we want both happening and both in the supplement.

Jeff Heileson: At the end of the day, we just want them above 4% of omega-3. From a-

Dr. Kristina Harris Jackson: Let’s not-

Jeff Heileson: … public health and a population standpoint, they got to get above 4%. That’s basically-

Dr. Kristina Harris Jackson: Right. A lot of different outcomes. Pregnancy is where I focus mostly. It’s just all of the action when you supplement is happening at the lower levels, where you can see those big effects in the research. There’s more and more and more probably subtle effects as you get to higher levels and comparing. And then when we look at the longitudinal data, we see a dose response where you’re still getting lower and lower risk for heart attacks and dementia and things like that at that 8%.

But for other things, if we can, just population-wise, get out of the deficiency state for most people, that’d be a big step. And that’s more around the recommendations of the 200 or two servings of fish a week. That’s what that would do, is it would get you out of 4%. It won’t get you to 8%.

Jeff Heileson: Absolutely, it won’t. It takes a lot to get there.

Dr. Kristina Harris Jackson: Also, that’s confusing to people. But they do have two different purposes, I think. Anyway, that’s my soap box. Let’s talk about your last paper. This is the  Journal of International Society for Sports Nutrition again. 2023, so hot off the presses. This is the effect of fish oil supplementation on resistance training-induced adaptations. You’re going into the land where you’re like, “We don’t have enough research in this area where I feel good about talking about muscle promotion.” Tell us about the study. Tell us what you found.

Jeff Heileson: Exactly. Coming straight from the systematic review, that’s why this exists today. We wanted to do a resistance training protocol because we know that’s going to increase strength and lean body mass, especially in young individuals. There was some question marks because McGlorry published two papers, one in 2014 and one in 2016. And the 2014 papers showed that, well, look, if we have young individuals, give them fish oil, they actually increase certain markers of, I’ll say muscle protein synthesis. But I’ll just say that for ease. But there were very specific markers that they looked at to see the influences. It was like, okay, well, this data exists. Well, in 2016, he published another paper and it showed that it does not increase muscle protein synthesis in resistance-trained individuals.

After that paper got published, there was almost no data and no one was working on it. Because everyone saw that paper and they’re like, “Well, there’s nothing there. It’s smoke and mirrors. We’re going to move on and go to older individuals where we can see some of those effects.” I was like, “Well, there’s something there, though.” Because the difference was nearly 30%, a 30% difference in the increase in muscle protein synthesis. Although it didn’t reach statistical significance, I wasn’t ready to give up on it. Fast-forward, after our systematic review, we put together the study. It’s a 10-week resistance training protocol, which is tough to do. It’s tough to do a resistance training protocol. We followed folks for the whole 10 weeks, and we did DEXA scans as our proxy for muscle mass. We used lean body mass from that.

We did dietary food logs to track their nutrition, and we did dried blood spots through OmegaQuant before and after as well. And then every two weeks, we would just distribute their supplements. We had multiple ways to track compliance. Obviously, because we’re measuring red blood cell, or excuse me, the whole blood through a dry blood spot before and after, and then obviously we were doing supplement distribution, so when they would bring it back, we’d know how much supplements they actually took in. We had multiple different ways to track that. At the end of the day, what we found after a very long time and a very tough … We had seven dropouts, unfortunately. I think I cried after every dropout. We found some really interesting results though, because our hypothesis hinged on muscle protein synthesis. That was our primary hypothesis for almost everything.

Well, interestingly enough, we found that there was no statistical difference in lean body mass between placebo. Again, resistance training is king, and they both significantly increased their lean body mass. What was even more interesting though is that there was a differential effect that favored fish oil related to strength. We found that absolute strength was increased in bench press, and then relative strength was increased in both metrics, in bench press and the back squat, which was a very-

Dr. Kristina Harris Jackson: The absolutely, and this is relative. What does that mean exactly?

Jeff Heileson: Yeah. Absolute is just, how much weight did they actually lift regardless of their own weight? How much weight did they lift before and after? Relative was relative to body weight.

Dr. Kristina Harris Jackson: Oh.

Jeff Heileson: Right. We know that there’s differences, for example, because we included both men and women in this study. We weren’t looking at sex differences. We included both. Looking at relative is really good when you have a mixed cohort with men and women, because they tend to increase relative strength similarly, and there’s without anything else changing. Absolute strength though, can favor males a majority of the time, and so we wanted to look at both metrics. That was something we planned previously when we put the protocol together.

It was really interesting because some of the research in older individuals looking at anabolic resistance and how fish oils could potentially help older individuals overcome that anabolic resistance, part of that hypothesis is that it increases muscle quality. Basically, the amount of force you get per gram of muscle increases, and our results hint that that might actually be the reason why we see differential effects related to strength outcomes in older individuals. Even though our study was in young individuals, it lends definitely some credence to that belief regarding anabolic resistance and how it improves strength.

Dr. Kristina Harris Jackson: That is so interesting. It’s a quality versus quantity type of thing.

Jeff Heileson: Right.

Dr. Kristina Harris Jackson: I think most people in their heads, like you said, the more muscle you have, the stronger you are. That’s what people think. But that muscle can be more or less efficient, and that’s where the strength really comes in. What you actually really want is that function of strength. This is maybe off-topic, but when it comes to bone health also, the resistance training is really important.

Is the strength aspect of muscles more or less important for the bone health, or is it just the lifting of … Is it totally separate, or do you think there’s some kind of connection between how much bones are being strengthened with weight training and how well the muscles are functioning?

Jeff Heileson: There’s definitely some crosstalk, I believe. Yeah, there’s definitely some crosstalk, and I think they’re both really important. And having the weight-bearing. Because we have certain mechanisms also in the muscle that hinge on being able to just like you add weight to something, right?

Dr. Kristina Harris Jackson: Right. Right.

Jeff Heileson: Yeah, so that’s part of it. You have nutrients and stimuli that affects certain things. Well, in this circumstance, you also have any kind of weight-bearing also up-regulates a lot of those proteins synthetic machinery essentially. And it’s up-regulated by just adding weight. Actually having an opposable force actually does it. Yeah. I think there is some crosstalk though, related to bone health as well.

Dr. Kristina Harris Jackson: That’s interesting. Yeah. At the end of the day, you did confirm what you found in the review, and that it was strength that was affected by fish oil. Do you have anything else you want to talk about on that paper? And if not, what’s next for you? What are you looking at and studying?

Jeff Heileson: Oh, yeah. Well, just related to that paper, it was absolutely insane. We had someone with an Omega-3 Index of 16. That was wild. I had to point that out. It was absolutely wild.

Dr. Kristina Harris Jackson: What was the dose you were on? This one was, I think I looked at this. Was this seven pills a day?

Jeff Heileson: Yes.

Dr. Kristina Harris Jackson: Yeah, that was a big one.

Jeff Heileson: These poor souls. It was almost four grams of DHA.

Dr. Kristina Harris Jackson: Yeah. Yeah.

Jeff Heileson: Substantial. A substantial dose.

Dr. Kristina Harris Jackson: You’re really hitting them hard to release something.

Jeff Heileson: Yeah. Well, the reason why we did that too is because again, everything’s related to the membrane. We know from previous studies that it takes about four weeks to significantly increase and clinically, towards clinically meaningful, to increase omega-3 status in the muscle. We really had to give them a substantial dose because the studies that show that, actually gave five grams of EPA plus DHA. So a very substantial dose.

We wanted to make sure that even though we’re measuring the blood, we wanted to make sure it was increased in their muscle. We knew we had to give a substantial dose, and that’s why the study was 10 weeks long. It’s because we know the first four weeks, we’re slowly increasing. For us, it probably took about five weeks for them to maximum, or get close to what I guess would be considered a maximal amount of omega-3 in their muscle. And so we wanted to make sure we had enough time to get there.

Dr. Kristina Harris Jackson: Yeah.

Dr. Bill Harris: Yeah. Were you at steady state in a month or five weeks? Or 10 weeks was at no higher in the muscle than it was at five?

Jeff Heileson: Well, see, that’s the problem. We did not measure muscle. We only measured the dried blood spots. So we only have dried blood spot data. Yeah. That would’ve been nice to measure muscle, but we couldn’t do biopsies at the time.

Dr. Bill Harris: Yeah.

Dr. Kristina Harris Jackson: Yeah. But we have seen red blood cells, which the whole blood metric is very well estimating that are highly correlated. The membrane changes in the red blood cells are really highly correlated with muscle and spleen. And not the brain.

Jeff Heileson: Right, not the brain. Yeah, that’s the interesting one.

Dr. Kristina Harris Jackson: Part. Yeah.

Jeff Heileson: But we still don’t really know how it increases in the brain. That’s a whole different conversation, but that’s a tough one, how it gets into the brain or if it even does. That’s tough. But yeah, the correlation between red blood cell and muscle in humans, I believe one study showed it was like a 0.9, an RF of 0.9. So very strong relationship between those two.

Dr. Kristina Harris Jackson: For EPA and DHA specifically?

Jeff Heileson: Right. Right.

Dr. Kristina Harris Jackson: Yeah. Yeah.

Jeff Heileson: EPA and DHA.

Dr. Kristina Harris Jackson: Yeah, those two are different. These are fantastic. Are you working on any new studies that you can talk about, or are you going in this direction? What is your next step?

Jeff Heileson: Yeah. Actually, I’m just now trying to get around to publish my final study from this. I actually had another study that’s muscle damage. We also did a muscle damage study.

Dr. Kristina Harris Jackson: Nice.

Jeff Heileson: And we looked at to backtrack all the way to the systematic review we first talked about, because that’s where it comes from as well. We found that that was a clear finding. You’re like, “Well, why in the world would you want to look at recovery if someone’s already done it?”

Dr. Kristina Harris Jackson: Yeah.

Jeff Heileson: Well, we found a big gap in the literature was we don’t know which omega-3 is having that effect. Is it DHA? Is it EPA? Is it EPA plus DHA? So we studied it. We had four groups. A placebo group. Yeah. We had a placebo group, an EPA-only group, DHA-only group, and then the EPA plus DHA. Hopefully, we’ll get that published-

Dr. Kristina Harris Jackson: All in the same dose?

Jeff Heileson: Very high dose-

Dr. Kristina Harris Jackson: Per grams? Yes.

Jeff Heileson: Four grams.

Dr. Kristina Harris Jackson: Okay.

Jeff Heileson: We use Carlson’s because they have one-gram pills. They have capsules that are actually one gram of EPA and then one gram of DHA. Unfortunately, they’re not the same form. The EPA is ethyl ester and the DHA was triglyceride.

Dr. Kristina Harris Jackson: Huh.

Jeff Heileson: Yeah. But we substantially increased the Omega-3 Index regardless, right? It still-

Dr. Kristina Harris Jackson: Right. Right.

Jeff Heileson: Even with EPA, it went up quite a bit, too.

Dr. Kristina Harris Jackson: Yeah, four grams.

Jeff Heileson: Yeah, so I’m hoping to get that study out. We did find some differential effects with EPA and DHA. Yeah, some interesting findings. So I’m hoping to get that published out soon.

Dr. Kristina Harris Jackson: Yeah. Well, this is all great stuff, and we hope you keep publishing. This is such an important area and really, we need it in a lot of the areas that you’re in, the military and sports and our athletes. Also, looking at our younger athletes. We’ve wanted to do studies in youth football teams because we want to start preserving that brain earlier, but it’s hard. It’s really hard to run these studies, so good job. Thanks for running them, and thanks so much for talking to us today.

Dr. Bill Harris: Absolutely.

Jeff Heileson: Yeah. Oh, yeah. No, and thank you guys so much for the opportunity. Because anytime I get a chance to talk more … You guys are probably the only ones that want to hear me talk about omega-3, so I really appreciate it.

Dr. Kristina Harris Jackson: Yeah. This is all. Everyone loves this stuff. This is great. Thanks so much, Jeff, and we’ll be in touch.

Dr. Bill Harris: Thank you, Jeff.

Jeff Heileson: All right. Thank you. Bye.

Dr. Bill Harris: Bye-bye.

Dr. Kristina Harris Jackson: All right. That was great.

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