How Omega-3s Really Affect Athletic Performance

OmegaMatters: Episode 29

Hosts: Drs. Bill Harris & Kristina Harris Jackson

Guest: Dr. Gregory Peoples, Medical Sciences Researcher, University of Wollongong, Australia

Background and Key Takeaways:

Dr. Gregory Peoples is a senior lecturer and researcher in medical sciences at the University of Wollongong in Wollongong, Australia. He is prolific in the field of omega-3s and heart, lung and skeletal muscle physiology. In this episode of OmegaMatters, the conversation focuses on some just a few of his 145 peer-reviewed papers on the topic of if and how omega-3s affect physiology in highly trained individuals. For more information on OmegaMatters, visit: https://omegaquant.com/omegamatters-broadcasts/

 

SHOW TRANSCRIPT

Dr. Kristina Harris Jackson:(00:00:07):

Welcome to OmegaMatters, where we talk all things Omegas. I’m Kristina Jackson, this is Bill Harris, and today we’re talking to Dr. Gregory Peoples, who is a senior lecturer and researcher in medical sciences at the University of Wollongong in Wollongong, Australia. He is prolific in the field of omega-3s and heart, lung and skeletal muscle physiology. And today we’ll be focusing on just a few of his 145 peer reviewed papers on the topic of if and how omega-3s affect physiology in highly trained individuals. Greg does human clinical trials as well as mechanistic work, so we’re going to try to connect the two in our conversation. Thanks for coming on, Greg.

Dr. Gregory Peoples:(00:00:54):

Thanks, Kristina and thanks, Bill. And just to explain to everyone, Wollongong is about 100 kilometers or around 60, 70 miles south of Sydney. It sometimes doesn’t come up on the map for a lot of people internationally. But that’s where we’re sitting, just below Sydney.

Dr. Kristina Harris Jackson:(00:01:11):

That is good to put it in perspective because basically everything is on that east coast of Australia and then there’s-

Dr. Gregory Peoples:(00:01:18):

Yeah, that’s right.

Dr. Kristina Harris Jackson:(00:01:19):

… is it Perth? That’s the only one on the west.

Dr. Gregory Peoples:(00:01:24):

Perth’s on the other side. And we try and get across there, but it’s actually quicker to get to New Zealand from where we are ironically.

Dr. Bill Harris:(00:01:29):

My gosh.

Dr. Kristina Harris Jackson:(00:01:31):

Yes. So it is early evening for us here in South Dakota and it’s the morning the next day for you all.

Dr. Gregory Peoples:(00:01:39):

Yeah, we just arrived early on Friday morning our time.

Dr. Kristina Harris Jackson:(00:01:41):

Yeah, yeah, that’s pretty wild. So we’re so glad we get to talk to you. We’ve actually, we started to get to know you through doing research with you because we do have some connections and labs that we work with in Australia, and you’ve done some of the most interesting studies that we’ve participated with because you work in athletes and you’ve worked with the military and you’ve worked all over the place. And we did one with you, it was the Tour de France that we were trying to take samples.

Dr. Gregory Peoples:(00:02:13):

Yeah, that’s right. We’ve actually got the paper under proofing at the moment, two papers out of that. We had a case study on three of the cyclists from one of the professional UCI teams. And the other is that we tracked that particular team for the whole season as well. And working closely with their performance nutritionist, Marcel Hesley, who’s from the Netherlands. And that was really fascinating because it was really good insight into athletes in Europe with different cultures and different diets. And it’s probably one of the athletic groups would notice that there’s a consistent message that a lot of athletes don’t consume enough long chain omega-3s.

(00:02:55):

But we did see some really good evidence that some of the riders were already consuming high amounts. And it wasn’t necessarily through supplements. Some of the cultural diet, particularly through fish intake for example, some of the Spanish riders meant that they were tracking pretty well even before we even considered taking a supplement. And the big story there was that obviously they consume a huge amount of energy expenditure over three grand tours, Tour de France, all of the other races. And so the question is can they maintain and sustain a high Omega-3 Index, a good omega-3 status during those really high intensity periods? And look, I think the outcomes is that we can certainly say that they can do that and certainly heart and muscle through the red blood cell really does preferentially take on those omega-3s when you present it in the diet. So yeah, hopefully we’ll see that paper coming out pretty soon.

Dr. Kristina Harris Jackson:(00:03:54):

That’s really cool. And just so you are really in the elite athlete, at least some of your research has been in elite athletes. But the papers we’re talking about today are highly trained individuals, but they aren’t elite, right?

Dr. Gregory Peoples:(00:04:09):

That’s right, yeah. So it’s actually a really good point about our lab. I can probably say that we’re fairly unique in that we work from animal models and we bring them into, let’s call them laboratory trials and you don’t always get access to elite athletes. So we try and work with physically fit and trained individuals within reason, and then we like to sort of transfer that information out to some of the elite groups and have a look at how that might play out in, let’s call it real world physiology, real world nutrition, all of the challenge that comes with being an elite athlete.

(00:04:46):

So we’re trying to take bench top science and then eventually take it into the populations. And look, that includes some of our defense force research as well, which we’re kind of just starting off at the moment. But we’ve done a few small trials looking at the omega-3 profiles of military recruits as they go through, just like elite athletes, strenuous training over the course of 12 or 16 weeks. And I guess as a spoiler there we published one paper, but we certainly know that they could do with let’s say a modification to their diet as well.

Dr. Kristina Harris Jackson:(00:05:23):

And so I guess let’s back up a little bit. How did you get into this field and into research in this area?

Dr. Gregory Peoples:(00:05:31):

Yeah, look, Bill knows this particular professor very well, Professor McClennan. It was a chance situation that I was in my final year of biomedical science at the University of Wollongong. And Peter, professor McClennan, he just transferred from our Commonwealth Agency of Research to CSRO and he’d moved across into tertiary education and his expertise is in cardiac physiology and he’d already done some of that preliminary work and observations that omega-3, particularly DHA was improving cardiac function potentially at that point looks like it was acting as a antiarrhythmic or sort of a protective effect against arrhythmia, particularly in ischemic fusions.

(00:06:23):

So he was starting up a subject in our university called cardiorespiratory physiology, and I just happened to enroll in that subject. I was in my final year and he introduced me this topic of omega-3. In fact, he passed me a paper at the end of the session and said, I think you’d like to do an honors with me. And the paper is, I’m not sure if you’re aware, not many people talk about this paper. It’s the Leef and Roche paper from 1988, which claimed that being on omega-3 oil could improve VO2 max in athletes. That’s really the the first time we ever have seen anything in the literature that sort of suggested that omega-3 fatty acid could improve a physiological characteristic of an athlete.

(00:07:09):

And he said, “Look, this paper’s from 1988, there’s really not been much done. What about we retest this?” And he gave me the challenge in my honors year to feed some pretty elite cyclists in that particular project a DHA oil. And we looked to see whether or not omega-3 was actually in fact improving VO2 max. And look, if anyone has looked at that paper, it’s our 2008 paper I think it is. And we didn’t actually agree with Leef and Roche. We didn’t find an increasing VO2 max. But one thing that we did start to observe is that the heart rate effects in terms of a heart rate reduction. And there was some early evidence that the efficiency of the exercise was going to increase. So I blame Peter, he sent me off on the trail, he then gave me a PhD topic and 20 years later, here we are.

Dr. Bill Harris:(00:08:07):

Great, great.

Dr. Kristina Harris Jackson:(00:08:09):

That’s how it happens a lot of the time, just right place, right time.

Dr. Gregory Peoples:(00:08:13):

It is. It’s a sliding door moment, isn’t it?

Dr. Kristina Harris Jackson:(00:08:15):

Yeah, yeah, it’s great. Well, we’re glad you’re in it. Let’s get to your first paper that you picked out for us. So it’s from 2014, the British Journal of Nutrition, very good journal, entitled intrinsic heart rate recovery after dynamic exercise is improved with an increased omega index in healthy males. Mouthful, but it actually does cover a lot of the study. Can you give us a brief synopsis of the study design and the rationale of this paper?

Dr. Gregory Peoples:(00:08:46):

Yeah, so to set the scene, I’m no longer the honor student, I’m the supervisor. Peter was also a supervisor and we had two students approach us during the year before and they’d said that they’d like to do an honors project with us on a topic of omega-3. So Peter and I came up with the idea that we could put together a project that would satisfy both students and we could give both students the opportunity to look at the effects of omega-3 on heart function during exercise, which we’ll talk about first.

(00:09:21):

And then the second student, we said, “Well, why don’t you look at the skeletal muscle? Why don’t we have a look at their oxygen consumption and the performance?” So the two students were Michael McCartney and he’s the first author on this particular paper and then Lachlan Hingley. And it’s interesting, isn’t it, because out of those two first authors, Lachlan’s gone on to, he’s now a medical doctor, Michael, we’ve obviously provided the omega-3 bug. You might notice he’s got some publications now and he’s now working in the area too. So Peter and I have generated our, let’s call it our third generation of our group.

Dr. Kristina Harris Jackson:(00:09:56):

You’re replacing yourselves.

Dr. Gregory Peoples:(00:09:57):

So just onto the study. What it is was we decided to look at exercise from the basis of it’s not always in steady state. If you consider a lot of the exercise performance trials, it often includes does it improve the aerobic capacity? Does it improve the endurance performance? But when they consider endurance performance, it’s often like a marathon running activity. It’s very steady state, it doesn’t change much. But we know in sport, in exercise, our body can increase its energy and then we need to recover and then it increases its energy and we need to recover. So we came up with a study design that included that concept. And so what you’ll notice is that it’s a design where we asked our trained participants to go through a series of very high intensity, we call them wing gates.

(00:10:56):

They’re 30 second intense efforts. We also tracked to determine that those intense efforts were causing fatigue. And so they were asked to do some before and after muscle contractions and also peak cycling performances over around about six seconds. And we confirmed that absolutely these wing gates cause fatigue. And then the final thing we asked them to do is once we confirmed fatigue, we actually then set them a task of five minutes of endurance cycling where we said, “Now that you’re fatigued, we want you to cycle as hard as you can for five minutes.” And there’s a couple of reasons behind that. And it links primarily also to the second paper, that we wanted to wanted stress the skeletal muscle through all the different fiber types because as you know, we’ve got skeletal muscle that can help us sprint and we’ve got skeletal muscle that can help us run marathons.

(00:11:51):

We wanted to hit those fibers in the middle that are both high power fibers, but they actually require oxygen. And we also wanted to put the trained participants in a state of fatigue. And so that last five minutes, they weren’t particularly comfortable let’s say. The final part of the trial is that we then took them after that very fatiguing activity and we purposely rested them under very controlled conditions. So as I mentioned before, we were just as interested in the recovery phase as we were as interested in what is actually happening during exercise. So for this paper, we were particularly interested in heart rate recovery, and that’s what we asked Michael to focus on as part of this particular paper that he first raised.

Dr. Kristina Harris Jackson:(00:12:42):

Yes. And that cycling workout is, it sounds awful. The five-minute ending is rough. So let’s look at what did you do for your intervention, your due dose?

Dr. Gregory Peoples:(00:12:55):

Yeah, so look, this is an ongoing story, but it’s one that we’ve tried to keep pretty consistent in our lab. So when we talk about the omega-3 oil that we use in our animal studies, we in fact actually use the same oil in the human studies. So it’s a DHA rich oil and it comes from Nu-Mega, which is a company here in Australia, Clover Corporation. And they produce this through a tuna fish oil. In fact, now they’ve actually micro encapsulated down to a powder as well. And that’s quite unique that it’s a really rich DHA oil. But the other thing you’ll notice is that we’ve come in at a dose that is equivalent to roundabout two fish meals per week, fatty fish meals per week. And that’s also something that Professor McClennan has been quite consistent with. The idea that if we’re fairly well devoid of long chains in our diet, what happens if we take it from near nothing to something, rather than ramming it up to some sort of therapeutical dose and they’re not really understanding where those subtle changes come?

(00:14:09):

And the analogy that we like to explain that on is if you are looking for a exercise training effect and you’re looking for that in people that don’t take part in exercise, you actually see some of the biggest gains from taking part in an excise training intervention when you go from not much at all to something. And so that’s been our consistent approach. We always go with that first level. What happens if we add something, around about two fish meals per week? And then we can understand where we’re actually getting our initial changes. It’s not to say we can’t go onto higher doses, but I think it’s important that in this study we acknowledge that this is our first step dose rather than just ramming up to a therapeutic level straight away. Does that make sense?

Dr. Bill Harris:(00:14:53):

What is that dose?

Dr. Kristina Harris Jackson:(00:14:53):

Yes.

Dr. Gregory Peoples:(00:14:57):

So the Nu-Mega oil is two capsules per day and it’s delivering the 545, 60 milligrams a DHA and about 140 EPA. So overall, it’s hitting around about that 750 milligrams, so it’s under 1,000, Bill. And the idea is that we’ve also used the same doses down in our rat models as well. The idea that we can reach that through potentially a dietary achievable dose to start with. It’s not to say you can’t add a supplement on top, but just adding that question, what if someone was to engage a pescatarian based diet on a consistent basis, does that give them any benefit as opposed to adding a therapeutic dose of omega-3 in the first instance?

Dr. Bill Harris:(00:15:42):

Makes sense.

Dr. Kristina Harris Jackson:(00:15:43):

Yeah, and the great thing you guys do is you do measure blood, you measure the omega-3 index and you’re also screening, I don’t remember if you’re screening for the omega-3 levels through blood or questionnaire. But you’re making sure your baseline characteristics is a low omega-3 level, so that dose can show in effect.

Dr. Gregory Peoples:(00:16:05):

Yeah. Look, that’s a good point, isn’t it? And we’ve written a paper recently, a review where we’ve looked at all of the studies that have come out in say the last 15 years, that it’s something that groups don’t necessarily think about. The idea that if you take a population, look on average, if it’s a western population, you’re probably going to get something that’s low, but there’s always a chance that you can be infiltrated by a supplement taker. And if you’re not checking that, you can get spread in your initial baseline.

(00:16:36):

So we like to either through, as you say, using that screening, if we can do the bloods early enough, screen early. And we always try to do that now, come up with criteria for exclusion if we do happen to have someone slip through. But certainly try and get that baseline as low as possible. So it brings us back to that analogy of exercise training. What if you’re taking somebody from a low level of not being engaged in exercise and you’re actually giving them exercise for the first time? So we’re doing the same with omega-3. What if you’re giving them that omega-3 for the first time in a very consistent way? What is the physiological effect of that?

Dr. Kristina Harris Jackson:(00:17:12):

You’re basically going out of deficiency instead of the higher end, you’re just getting out of deficiency.

Dr. Gregory Peoples:(00:17:18):

Yeah, yeah, yeah. And so just to summarize, the oil is a DHA rich oil, it’s two capsules per day. And we’re hitting sort of around about that 540 DHA and we’re under 1,000 milligrams in these particular studies.

Dr. Kristina Harris Jackson:(00:17:34):

Yeah. So what did you all find? You did what, 12 weeks of supplementation in the-

Dr. Gregory Peoples:(00:17:42):

These ones were eight, and it’s interesting you raised that. We’ve actually moved to 12 weeks going forward, and I can talk about that a little bit later. But these early ones around this 2010 to 2014 era, we were working on an eight. And so the primary things that we’re looking for in this particular study was some evidence that a change in omega-3 index, which we know is tracking changes in the myocardial tissue, does that show up as changes in heart function? And heart function was primarily the easiest one to obviously observe is heart rate. And we know that having a modification of heart rate can be advantaged to during exercise as well as recovery. What we then looked at in the paper is we measured their heart rate at three or four different states of rest. We measured it at a sub maximal steady state exercise.

(00:18:44):

We measured it during the five-minute time trial. We also measured it during the very precise heart rate recovery episode right at the end. So what we observed is we didn’t see any changes to the resting heart rate of this particular group, and we didn’t also see any changes to the peak heart rate. So when they’re cycling as hard as possible for that last five minutes, they’re actually reaching close to maximal heart rate. Not quite there, but certainly very close. So the two ends of the heart rate scale weren’t changed. We did notice in the sub maximal heart rate, which was operating at around about 120 beats per minute early in the trial, there was a reduction in the number of beats required during that. And that’s fairly consistent with the rest of the literature that we’re actually seeing some continuity around this theme that there is a heart rate reduction for a given amount of sub maximal activity.

(00:19:37):

The big outcome that we were focused on was that heart rate recovery, because if an athlete needs to go from being on court to off court and back on court like a basketball player, is there an advantage to having a faster heart rate recovery? And we know physiologically the answer is yes. But could we deliver that through an omega-3 supplement? Traditionally it’s always been, well, I’ll use the exercise training to deliver faster heart rate recovery. We wanted to know whether that nutritional approach did. What we did is we measured the recovery heart rate in a supine position straight after it, a very controlled condition, quiet room. And we used a mathematical model called a logit recovery to assess how quickly they’re recovering in what’s called their halftime. And the reason why we do that is if you think of heart rate recovery, it doesn’t come down in a linear line, it comes down quite quickly initially, and then it kind of curves off like a decay and that can be quite difficult to assess. And there’s basic methods like how many beats in the first minute? How many beats in the second minute?

(00:20:46):

But we wanted to actually mathematically look at the entire line. So we performed what’s called a logit recovery and we looked at the halftime, and we did it in a double-blind manner. And what we observed was that the halftime was quicker in the omega-3 loaded trained individuals. So really to summarize, that’s an important part. These guys were already trained, they already had pretty efficient hearts, they already had a fairly low resting heart rate, but we were able to speed their heart rate recovery after an intense exercise. So our application from that is that certainly in those bouts of exercise where you might have to, like the basketball example I gave, you go on and off court and you’ve got maybe two or three minutes to recover, there is a potential that you can get that heart rate a little bit lower during that recovery phase and that might help you then go back on the court in that next bout of exercise. So that tries to tie together why we’ve used quite a unique study design in that repeat bout and then mix that with the recovery phase and then target that-

Dr. Bill Harris:(00:21:58):

Have you tried with people who are not trained?

Dr. Gregory Peoples:(00:22:01):

Sorry, what was the question, Bill?

Dr. Bill Harris:(00:22:03):

Have you tried it in people who are not trained? And just-

Dr. Gregory Peoples:(00:22:06):

Ah, yeah. Look, it’s a good point and I was going to raise this. We’ve done a further study. Ryan Anthony was a master student a couple of years ago in 2021, and we didn’t use such an intense bout because we looked at the same dose, but over 12 weeks in older adults. And we supplemented them using the same two capsules, but we asked them to perform a 400-meter paced walk as fast as they can. And we saw a similar observation that the adults, the older adults were able to perform that pace walk after 12 weeks at just the same speed and have the same performance, but they had a lower heart rate after being on the high DHA oil. So they weren’t elite athletes, they weren’t trained, they were just older adults. And so it was another good example of where you can move some of these observations off into other groups, for example.

Dr. Bill Harris:(00:23:05):

So do people have a fixed number of heart rates that are assigned at birth and then that’s it?

Dr. Gregory Peoples:(00:23:10):

Yeah, that’s a really good question.

Dr. Bill Harris:(00:23:12):

You want to use them up?

Dr. Gregory Peoples:(00:23:13):

Yeah, that’s the inevitable question. Do you not want to use them up? I don’t know. Anyone that actually can absolutely say that the heart’s there and you’ve got so many trillions of beats and that’s it. But we certainly know that if you have a lower heart rate during activity, for example, it certainly enables the heart to feel better. And if it’s feeling better, it can sustain a greater stroke volume. And therefore, obviously it’s probably likely to be also utilizing the oxygen that you’re delivering through that coronary artery a bit better as well. So anything that reduces a heart rate either at rest or during exercise is going to improve cardiac mechanics.

(00:24:02):

It’s going to improve the filling of that heart and it’s going to allow just that little bit of extra coronary flow because we know that coronary flow is occurring during the resting phase of the heart. And a lower heart rate means we have a longer resting phase. So that’s been the common theme that we’ve pushed, is the idea, and that goes back to Peter’s work, looking at the cardiac efficiency, looking at the oxygen consumption, looking at the antiarrhythmic effects of omega-3. It’s an improved oxygen efficiency of those cardiac myocytes and the ability to use the coronary flow seems to be the mechanism that’s sitting behind this.

Dr. Kristina Harris Jackson:(00:24:38):

Interesting. And then the term vagal tone has also come up in this group and in pregnancy. And can you describe it in this setting, what it’s doing?

Dr. Gregory Peoples:(00:24:51):

Yeah, so the parasympathetic nervous activity we know enables a more bradycardic environment, a lower heart rate. But we also know that the heart has its own intrinsic beat. So it’s a combination of the intrinsic beat of the heart and also the autonomic nervous system that’s influencing the overall function of the heart with its sympathetic or parasympathetic that kind of dictates where you are currently sitting in terms of your heart rate. So if we just go back to the training again, if you take exercise training, the common thought is that if you go through endurance training, you increase your parasympathetic drive, your vagal tone improves and your heart rate’s lower.

(00:25:39):

But we also know that exercise training lowers the intrinsic beat of the heart, that SA nodal cells that are stimulating the beat to beat activity and they have their own firing rate. So if we just go across to the omega-3, again, we know that omega-3s are modifying cell membranes and that includes the auto arrhythmic cells as well. So what we were aware of, there was pretty good evidence that rather than seeing it as a vagal tone activity per se, that if you consider transplant patients or isolated hearts that are being investigated, the lower heart rate can actually be assigned to the potential that the intrinsic beat rate is falling.

(00:26:23):

And if that’s the case, then there’s potentially been a modulation in the autonomic nervous system. So we also looked at heart rate variability in this particular group, and heart rate variability is just an indirect proxy of the autonomic nervous system. So it’s one thing to keep in mind. You’re not looking at vagal tone specifically, but certainly you can make some assumptions out of that. So we looked at the heart rate variability under two conditions in this particular group after being on omega-3. We looked at it during the resting conditions. And in fact, we had them take home heart rate monitors and they’re actually sleeping in heart rate monitors and we looked for their very lowest heart rate during the evening. And what we noticed is that the trained individuals that were been on the DHA for the eight weeks, actually the heart rate variability indicated that the vagal tone was actually pulling back a bit despite no change in resting heart rate.

(00:27:25):

So if you look at the cell-based evidence and the animal-based evidence, and then you actually have a look at this proxy of heart rate variability that suggests that there’s potential that less vagal tone is required at rest to deliver the same resting heart rate. And the other part that we looked at is we looked at the heart rate variability during that recovery phase, and what we noticed is that despite a faster heart rate recovery, there was no evidence that there was increased vagal tone or vagal nerve activity during that. So again, pulling those two bits of evidence together suggests that in line with the change to the cell membrane, structural change with DHAs presented that there is in fact a potential for DHA to be working intrinsically in the heart rather than from an autonomic nervous system perspective. So again, we can’t answer all of that question, but I think we can puzzle that together with the cell and the animal to come up with a hypothesis certainly around that idea.

Dr. Kristina Harris Jackson:(00:28:28):

Okay, so go ahead.

Dr. Bill Harris:(00:28:30):

No, I was just going to say you mentioned that transplant hearts, it does remind me of a study we did back in Kansas City where we gave omega-3 to post transplant patients who don’t have any innervation, there’s no nerves to the heart.

Dr. Gregory Peoples:(00:28:43):

That’s right.

Dr. Bill Harris:(00:28:44):

It’s somebody else’s heart and you can’t hook a nerves up to it. And we saw a drop in heart rate in those patients given omega-3. So it had to be intrinsic to itself, right?

Dr. Gregory Peoples:(00:28:59):

Yeah, absolutely, yeah. And look, I like the idea that we’ve got a nutritional approach and then you could have an additive training approach. And the idea that endurance training can actually then alter the ion gates of those auto arrhythmic cells in combination with nutrition, that’s quite a powerful thing if you’re actually mixing diet with exercise and having a direct effect on the heart. That’s really unique.

Dr. Bill Harris:(00:29:27):

Are there other nutrients that you know of that affect the heart like this? I mean-

Dr. Gregory Peoples:(00:29:34):

No, not off the top of my head. And look, that just really boils us right back to those observations, whether it’s human heart tissue or any of the animal work that we’ve done or others have done looking at the propensity of DHA uptake into those cardiomyocytes. As long as you present it, you can get big, big changes in those cardiomyocytes, which obviously in these studies we’re not directly measuring, we’re using the red blood cell as a proxy for that. But we know certainly from the bench animal studies that you can increase DHA concentration by two and a half fold in a myocyte tissue, no problems in a rat. So the chances that the physiology is also changing is really high. And I think the observations collectively across cells, animals, and humans are pointing to that really critical role of DHA in heart function.

Dr. Kristina Harris Jackson:(00:30:31):

Great, really cool. So this was the one half of the findings, it was heart focused, heart rate focused. Do we want to move on to the other half of the findings or are there any other mechanistic studies that link? You’ve already given us a lot of good mechanisms around the heart part. Is there any other mechanistic study that you want to link to this side of this half of the research?

Dr. Gregory Peoples:(00:30:58):

Yeah. Look, I guess going forward a little bit now, because Mike McCartney was the primary author on this. I’d like to just acknowledge and shout out some of his PhD work as well because he’s taken it back to the bench top again as part of his PhD. And he then used a controlled dose, a dose similar to what we’re seeing here around that two fish meals per week and a supplemental dose. And he fed that to rats over the course of his PhD. And then he looked at the arrhythmic protection from DHA when he opened up the chest of the animal and he was tying off the coronary artery, and then looking for both ischemic arrhythmias and reperfusion arrhythmias. But what made his PhD quite special was that he put a pressure volume catheter down into the left ventricle of the animal.

(00:31:57):

So he was able to actually look at the cardiac mechanics of that animal fed both a dietary equivalent and also a supplemental dose of DHA during the ischemic episode and during the reperfusion episode. And so he’s got two or three papers that are now published across nutrition journals really also explaining how important it is to episodes where the heart’s not receiving enough oxygen or it’s struggling to receive enough oxygen, but the cardiac mechanics can be maintained, it doesn’t lose as much cardiac function. And equally, there’s less arrhythmic events are occurring. And that takes us all the way back to Peter’s work in the 1990s that showed those original observations in isolated heart, that the number of episodes of arrhythmia are reduced when the heart cells have increased. So it takes us a full circle.

(00:32:50):

It just really shows that if athletes are wanting to use this pump, and as Bill says, potentially it’s only got so many beats, that they’re going to have to keep it as well conditioned as possible. And we know that when, for example, endurance athletes put that pump under pressure, it adapts, it hypertrophies. But also, there are some evidence that athletes themselves actually push the heart a little bit too far sometimes. And we see increased instance of AF in some of the endurance athletes later. We know that their cardiac function is quite put under a decent amount of strain during both training and competition. So look, my take on this is that whether you’re an older master’s athlete, whether you are a recreational athlete or an elite athlete, that you really want to be optimizing the heart’s structure to best support its physiological function.

Dr. Bill Harris:(00:33:53):

Yeah. So it’s using oxygen more efficiently. It sounds like a mitochondrial-

Dr. Gregory Peoples:(00:34:02):

That’s right. So Peter’s early observations is that the efficiency of oxygen use in the isolated heart. So it’s a bit like your transplant example you’ve given, Bill. You take the heart out of the animal and you hang it up in a chamber and you perfuse it, and you can either stimulate and drive it under a controlled beep rate or let it have its own beep rate. The oxygen efficiency is improved after you load those cells with DHA. The links there are that we know that calcium handling is a high energy requirement of a cardiomyocyte. So every time the heart beats, calcium has to be released into the cell and that has to be taken back up into the sarcoplasmic reticulum and it’s happening every single time.

(00:34:49):

So obviously lowering heart rate means that you can not only improve its mechanics, but you’re actually changing the way that calcium is being required. So that gets down to, as you say, combinations of sarcoplasmic reticulum and mitochondrial function. But the common theme there from animal through to human is that there’s potential that oxygen efficiency is being improved. In terms of myocardial oxygen efficiency, it’s interesting, a nice proxy for myocardial oxygen efficiency is heart rate times cystoid blood pressure, the rate pressure product. And certainly one of those things, even if cystoid blood pressure is being maintained or equivalent, if you lower heart rate, that’s an indirect indication that myocardial oxygen requirement is now lower because of that correlation between rate pressure product and myocardial oxygen consumption.

Dr. Bill Harris:(00:35:42):

Cool, cool. I don’t want to get off track here, so [inaudible 00:35:46].

Dr. Kristina Harris Jackson:(00:35:46):

It’s not off track, but it is very cool and it’s very, like you said, for you to have the human all the way down to the bench science and are trying to stay, it’s just really cool and helpful. But let’s talk about the other findings from the study that were published in 2017, and this was by Hingley and this is called DHA rich fish oil increases the omega index and lowers the oxygen cost of physiologically stressful cycling and trained individuals. So here we go into the oxygen consumption results from the human trial.

Dr. Gregory Peoples:(00:36:24):

That’s right. So the link again interestingly, is the calcium handling. So my PhD was actually using a rat hind limb where we stimulated the muscle using the sciatic nerve. I had a bypass system going around and we looked at the oxygen consumption of a rat hind limb going through fatigue. And similar observations to the heart was that we noticed that the skeletal muscle of the rat was performing just as well, but the A-VO2 difference or the arterial venous difference was being modified. In other words, the rats hind limb required less oxygen to perform the same amount of contractile work. So what I wanted to do is take that bench top observation from those rat hind limbs and come up and say, well, I wonder if we can see something similar in terms of the human? Noting that when you’re exercising really hard skeletal muscle makes up the majority of the oxygen consumption. We can put a hands [inaudible 00:37:28] to a valve on the participant and we can then collect the amount of oxygen that they’re requiring.

(00:37:33):

So in combination to all the heart rate data that we described and collected, we had continuous oxygen consumption, breath by breath consumption on these participants over the course of the activity. And then we were hypothesizing that there is a potential that they would require less oxygen to perform the same amount of work after being on the DHA oil. So we measured work through the cycle odometer, so we knew how many watts though were performing on the bike, and then we looked at the amount of oxygen that it cost. So the control group showed near to no change, and then when we looked at the relative oxygen consumption to the work that was being performed in the omega-3 group, there was a statistical reduction in that oxygen consumption. So that’s interesting, isn’t it? It’s a little bit like the heart rate that we don’t necessarily see a change to resting metabolism.

(00:38:31):

The studies, I think whether it’s my original 2008 paper or the Leef and Roche paper that suggested the VO2 max could increase is we now know that athletes aren’t going to get increased capacity at the top end. But the story of efficiency seems to be playing out in that middle area where you’re having to use oxygen over a long period of time, like heart rate, there’s an improved oxygen efficiency of use. And so again, the question is what’s potentially driving that? Is it a change in the substrates, the glucose and the fatty acids? But enter the calcium story again. What’s really interesting about this is that the stimulus in that five minute time trial was under fatigue, it was also over five minutes, which really requires the fast oxidative glycolytic fibers to be used.

(00:39:24):

So those fibers are requiring oxygen, but they’re still quite powerful, they can last for several minutes before becoming fatigued. And it’s very similar to the rat model that I was talking about before. What we’ve noticed in animal tissue is that when you feed rats the same DHA oil, that the muscle fibers then all take up DHA, whether it’s a slow twitch fiber, a fast oxidative fiber, or a fast glycolytic fiber. But the fast oxidative fibers actually take up the most. And that’s a really interesting concept because those fibers not only have high mitochondrial density, but they also have high sarcoplasmic reticulum density because they’re trying to do two things. Perform powerful activity, but perform it using oxygen.

(00:40:16):

So sorry to step back to the animal studies again, one of my PhD studies was that when I fatigued the rat hind limb, I actually then gave it a dose of caffeine straight into the arterial system to look to see whether or not the recovery through a caffeine stimulated calcium release was better or improved through a DHA animal. And lo and behold, it was. So we’re trying to take that evidence that again, calcium could be part of this story, come forward into the human, and then have a look to see whether the calcium handling could be part of that. So yes, we couldn’t actually prove that it’s calcium handling. But at least we’ve made some observations that under high intensity exercise where we know fast glycolytic fibers are being used, that the amount of oxygen required to do that task is a little bit less. So it improves the economy, I guess is the best way of putting it, of the exercise.

Dr. Bill Harris:(00:41:12):

Yeah. So do you recommend coffee along with-

Dr. Gregory Peoples:(00:41:13):

Yeah, [inaudible 00:41:14]. Well certainly caffeine is in the group A ergogenic aids. It’s a good point actually, Bill, because I am not sure if it’s the same in North America, but at the Australian Institute of Sport we have categories of supplements now. Caffeine is in your category, a supplement list here in Australia. It’s an ergogenic aid. omega-3s are in what we call category B. And it’s similar to what we’re seeing here in the outcomes of these studies. Category B supplements for athletes are supplements that show physiological potential to help support the athlete, but they don’t necessarily say that, “Hey, you’re going to improve your performance on this.” Compared to a caffeine supplement. Caffeine we know that performance is increased by X percent if ingested in an acute form. So I guess what these two studies are actually doing is further supporting the category B supplement for omega-3s and fish oils in that they can certainly provide physiological and health support for athletes that are putting their body under a decent amount of stress and strain through competition and training on a daily basis.

Dr. Bill Harris:(00:42:30):

So the A list, are those illegal? They can’t be.

Dr. Gregory Peoples:(00:42:33):

No, they’re not illegal. So it’s all the ones that an athlete can take, like your nitrates, your caffeines, your bicarbonates, all of those ones that are ergogenic aids and they’ve been shown in the literature to improve performance. There’s an established consensus on performance change, whether it’s running 10K faster or whatever. The category B are all more directed towards absolutely you’ve got evidence around health benefits, supporting stress and strain, but doesn’t necessarily mean that you’re going to run the marathon faster at this stage.

Dr. Kristina Harris Jackson:(00:43:12):

We’ve seen in other interviews, just talking about how it’s really not the power and performance, it’s always just the body’s functioning better to whatever the training, the other aspects of what’s affecting the performance. And it also really ties into the longevity work it seems like because your body’s being put under stress, which is good to an extent. But if it’s not recovering fully, then you’re damaging parts of your body and over time that’s going to shorten your life potentially, especially the heart, if you’re talking about the heart. So it’s just all really tying together nicely.

Dr. Gregory Peoples:(00:43:50):

Yeah. And look, that’s actually one of the ones that I’ve constantly thought about, is how do we communicate that to say that this is about a career long change and a career support. And it’s such a difficult thing to prove because most studies are 12 weeks long or a couple of months long, six months at most. But the idea that this is actually an area where we could be talking about career performance improvements, which are so difficult to measure, you would have to actually track quite longitudinal studies that we’ve seen in other areas, whether it’s cardiovascular disease or any other pathological state. We’re actually looking at is there chances that careers can be changed in elite athletes rather than just individual events? And that’s my idea or hypothesis is that we’re trying to actually change behavior around omega-3 intake for the longer term, yeah.

Dr. Kristina Harris Jackson:(00:44:51):

And interesting that you are also using mostly DHA. Can you talk about that, EPA, DHA?

Dr. Gregory Peoples:(00:44:55):

Yes.

Dr. Kristina Harris Jackson:(00:44:59):

All the heart stuff has been around EPA for other stuff.

Dr. Gregory Peoples:(00:45:01):

Yeah. So our DHA theme, again very much comes back to the work that Peter did in the 1990s and that the observations through the animal studies that if you feed the animals in the lab different mixes of oils, that the skeletal muscle and the cardiac muscle does preferentially incorporate DHA to a greater extent. So another one of Mike McCartney’s studies from his PhD and I mentioned the different muscle fiber types is that we certainly saw that there was without DHA at all, so in the control animals there was certainly a correlation between the muscle fiber type and the DHA where the fast oxidative glycolytic fibers did bank the most or fiber type, whether it’s slow, fast or in between. They will all increase with a DHA present in the diet, but we don’t see the same extent of change in EPA.

(00:46:09):

And so that combination of evidence through both cardiomyocyte and the skeletal muscle fiber types does tend to push us towards a DHA mechanism. It’s not to say that EPA is not important and certainly has a role in different areas. And I know people like Jeff have worked on the inflammatory side, Chris McGorry also with the muscle atrophy areas as well. And I think certainly between both of those things, I think we’re probably talking about different types of physiological outcomes. But our consensus is that DHA, certainly from the point of view of high energetic metabolism certainly plays a very strong and stringent role in terms of both heart and muscle cell.

Dr. Kristina Harris Jackson:(00:46:58):

Yeah. And you guys are mimicking fish because fish are higher in DHA, right? I always-

Dr. Gregory Peoples:(00:47:06):

Yeah, that’s right. So we’ve gone with the whole concept of the salmon and the tuna. And so as I said, the oil that we use through Nu-Mega is tuna based oil and that’s what gives us a higher proportion of DHA. So there is EPA still present in it, but we don’t see the same changes in the EPA that we see in the DHA in terms of the propensity of uptake into the skeletal muscles. So again, just to emphasize, that’s the kind of unique area of our lab is we’re actually giving the same oil to the animals as to what we do to the humans because it can be packaged up into a animal diet or we can encapsulate it into a dissolvable capsule to then feed through our studies as well.

Dr. Kristina Harris Jackson:(00:47:57):

That’s really nice because you never know what you don’t know when it comes to whatever you’re using. You can match EPA and DHA, but if there’s something else in the treatment, then it’s hard to know. And I just always think about DHA as structural and EPA as it’s going to get metabolized quickly for all the inflammatory things. And you just keep coming back to it’s in the membranes, it’s changing how it’s maybe making the channels more efficient, it’s changing how it’s acting in the physical membrane.

Dr. Gregory Peoples:(00:48:34):

Yeah, that’s right. And again, we don’t necessarily do that really cellular stuff. But the evidence around the cellular is that iron channel behavior, the way that calcium has handled it in the sarcoplasmic reticulum, that all comes through that we then observe it in the animal model and then we can then create those hypotheses and see if we can pick apart some of those, at least physiological differences, whether it’s oxygen consumption, heart rate, independent of any sort of improved athletic performance at this stage. And look, it’s an interesting overall common message to the literature so far that has considered whether omega-3 is indeed an ergogenic aid. So again, if you go back, the first study is that Leef and Roche in 1988 pilot data that suggested that a VO2 max could increase. If you come forward into the 1990s, there was probably two scattered papers that disagreed with Leef and Roche and said, “No, we don’t think VO2 max has increased. But there’s a couple of evidence that there’s some physiology that might change.”

(00:49:45):

Post 2000, that’s when we really started to see an increase in the number of studies, either through our lab or multiple labs that have caught onto this as a strong potential. I think without doubt, there’s no study, collective groups of studies that have said that your marathon time’s going to improve or your swim time’s going to improve. But there certainly is, we’re talking about 75 plus studies really now that have looked at different types of athletes, different types of trained populations, and collectively come up with the idea that there is certainly a combined physiological improvement of the athlete that’s putting the body under stress and strain, whether as you say the inflammatory side of the story that I know Jeff’s been chasing up quite a bit through his PhD. There’s been lung function studies also done out of the US as well. Tim Mickelbar I think was performing some of those too. We’ve attacked the skeletal muscle and the heart a little bit more. But certainly the exercise damage and the delayed onset muscle soreness is probably the hottest topic, I would say, that’s going around at the moment, yeah.

Dr. Kristina Harris Jackson:(00:50:59):

Well, it’s one of those you can feel.

Dr. Gregory Peoples:(00:51:02):

Yeah.

Dr. Bill Harris:(00:51:03):

[Inaudible 00:51:04] more to the point, yeah.

Dr. Kristina Harris Jackson:(00:51:06):

You can feel if your heart is not slowing down, it’s not a comfortable thing, but you have to really be aware to notice a difference.

Dr. Gregory Peoples:(00:51:17):

Can I just drop in that we’ve actually got a PhD student working on the delayed onset muscle soreness at the moment? So yeah, we chat with Jeff quite a bit and we’re quite supportive of the work he’s done as well. But we’ve got a PhD student that’s decided that he wanted to chase that story up around the inflammatory markers. It’s Ryan Anthony, it’s the same author of the omega-3 DHA 400 meter walking study that I mentioned before. So Ryan’s now finishing up his PhD at the moment, he’s just coming to the end of his data collection. It’s been an interesting one. We have attacked that again through the Nu-Mega oil. But this time we’ve used their micro encapsulated DHA and we’ve converted that into a chewable tablet.

Dr. Bill Harris:(00:52:12):

Oh, really?

Dr. Gregory Peoples:(00:52:12):

So they’ve been chewing the tablets for 12 weeks, our participants. And in this one we’ve taken a baseline and it gets down to that study design you mentioned before, Christina. We’ve screened them really particularly through the omega-3 index and also the surveys. We’ve made sure that they’re really low at baseline. We’re giving them 12 weeks of the DHA chewable tablet. But we’ve got an algal version and we’ve also got a fish version and we’ve got a control group. And what we’re doing is we’re also using the omega-3 index at week four, eight and 12, so we can track the changes in the tablet over that time. And then we’re bringing them back into the lab to re-damage the muscle. So we’re damaging the muscle beforehand, giving them the 12 weeks, having a look at the inflammatory at baseline, giving the 12 weeks coming back and re-damaging the muscle.

(00:53:04):

We’re using quite a unique model to damage the muscle. We’re using an eccentric bike, I don’t know if you’ve heard of any eccentric bike. So what it is, it’s got a motor on it and the pedals go backwards. And the idea is that the subject has to, yeah, it sort of gets back into the idea we give them fairly strenuous activity in our lab. The participants have to resist the pedals as they’re coming back towards them. And so what happens is that creates an eccentric damage through the eccentric cycling. And generally the participants find it pretty difficult to walk for three or four days afterwards.

(00:53:39):

And we’re tracking their inflammatory markers, we’re also tracking their performance markers. So we’ve got them to do a isometric mid-thigh pull and an counter movement jump before. And then we get them to do that for the days afterwards, so we can track their performance as it declines and then comes back you. We bring them back after 12 weeks, we’re damaging the muscle and we’re reassessing their performance afterwards to see whether or not there’s any changes to, as you say, the soreness, the inflammation or the actual performance of strength and power. So hopefully that kind of links in with Jeff’s work a little bit and we can collectively add to that little body of knowledge and collaborate with Jeff along those lines as well.

Dr. Kristina Harris Jackson:(00:54:26):

Yeah. And that’s Jeff Heileson and at Baylor?

Dr. Gregory Peoples:(00:54:29):

Yeah, that’s right. Exactly, yeah.

Dr. Kristina Harris Jackson:(00:54:30):

You guys have so much overlap. And of course you’re working on the same kind of stuff, so working together. So that study you’re talking about is one that is currently being done or will be published?

Dr. Gregory Peoples:(00:54:43):

Currently being done. We’re in the last stages of data collection and Ryan should be finished his lab study on that by Christmas and then he’ll be writing all that up in 2024, both for thesis and the papers. So yeah, watch for that one. Hopefully we can add a little bit of information around that damage inflammatory story. And Jeff and I are looking to work together on a number of different fronts in that area as well going forward. So hopefully there’s more coming on that story too.

Dr. Bill Harris:(00:55:13):

[inaudible 00:55:17].

Dr. Kristina Harris Jackson:(00:55:16):

The micro encapsulated tablets, same dose I assume ish.

Dr. Gregory Peoples:(00:55:22):

Yeah, yeah, same dose. It’s been a challenging one actually. It’s really good R and D working with Nu-Mega because they’ve got the data and then converting that into chewable tablets been quite an interesting challenge, I guess is the best way of putting it. But we’re coming in again at that dietary equivalent dose where we’re trying to get very depleted subjects to start with and at least bringing them up and presenting that DHA for the first time to see whether or not we’re getting some initial changes. And that, as I said, I’ve tried to emphasize that a couple of times.

(00:55:53):

That’s been the common theme of our lab is the whole concept of what’s the initial change rather than just slamming someone with a couple of thousand milligrams and not really knowing where is that subtle change to start with. And in fact, we could be seeing the greatest amount of change, but we’ll never know if we go to the high dose. So let’s go with that first dose. And if it’s not quite enough, we can always step it up again. But at least we know that we have to go beyond, say two fish meals per week or whether or not two fish meals per week might be enough if someone just doesn’t take in any omega-3 at all.

Dr. Kristina Harris Jackson:(00:56:25):

Yeah. And there’s a lot of EPI does show that that two fish meal target is significant. We also see that higher and higher blood levels does have a dosed dependent response for other things. But It’s more in the traditional nutritional mindset of getting out of deficiency. And then there’s this huge range of normal and then optimal nutrient status is very new and there is not official guidelines around those for any nutrient that I know of. And so I’m glad you’re being so specific about that part and consistent, because measuring just so many different outcomes and doing a different physical stress. But you’re keeping the nutritional dose and the product and all of that the same. So at least you have some consistency to be able to tie everything together.

Dr. Gregory Peoples:(00:57:27):

And it’s interesting tying it back to the athletes, isn’t it? Because a lot of the omega-3 index knowledge that we have about athletic populations are out of NCAA North America and it’s a few out of the Europe. But we see a general message, don’t we? They’re not taking it enough. And in fact, they just completely ignore it to be honest. We’re currently screening 500 Australian athletes at the moment. We’re up to about 130 overall, and we’re purposely getting them across a range of different sports and we’re purposely getting them from Australia because obviously the most amount of literature at the moment comes from your part of the world in terms of the American college and the college diets and the American diet and so on. And just as a spoiler, obviously we’ll publish this next year as well when we finally get to our 500 athletes, we’re seeing a similar, I guess, trend in Australian athletes like the North American.

(00:58:28):

If you look at the omega-3 index of the group, it sits in that high 4% range. Very rarely do you see an athlete in Australia over 8% at all. It’s probably less than 5% of our group so far have got anywhere close or above 8%. If they have, they are showing evidence within the diet that they do randomly take a supplement over a period of time. But it’s probably not very consistent. Or the other interesting observation that we’ve made in particularly the contact sport athletes so far, like we’ve got three contact sports in Australia. We have Rugby League, Rugby Union, and AFL. And I don’t know if you’re aware of those three sports, probably Rugby Union you’re aware of, AFL is the Australian Football League, which is absolutely brutal. They have injuries every day of the week. But what we notice is that the male athletes tend to eat tin tuna if their omega-3 index is anywhere above 5%.

(00:59:31):

So what we’ve seen is the male teams that we’ve sampled, their average is more like 6.5%, which is probably better than most of the other literature. And so when you look closely, it’s not that they’re taking a supplement, it’s actually they’re eating tin tuna three or four times a week. And the reason why they’re eating tin tuna is that they see it as a protein source. What they actually say is they’re eating it because they perceive it to be low fat. So they actually are perceiving the fat to be important, but they perceive it as, I’m eating tuna because it’s not a fatty meat and I want to be really lean from the point of my anthropometry. And they don’t think of the omega-3 and then they eat it with rice because they want to sort of consume some sort of lean carbohydrate.

(01:00:17):

So it’s been interesting that the male athletes have been a little bit higher than the female athletes. And it’s generally a trend towards eating more tuna. It is another interesting equity debate that’s around at the moment as well is male teams versus female teams. What we’re seeing is all the female teams are below 5% and they generally don’t get access to any supplement at all. And that’s just an equity issue between male and female sports, isn’t it? In terms of sponsorship and support and all these sort of things. So on average, the males at least have some sort of supplement tub there with omega-3 written on it and they may take it now and then. Females don’t seem to eat the tuna as much and they have no sponsorship around omega-3 supplements and they seem to be a bit lower. So again, that’s another one just to keep an eye out where hopefully we can add a little bit more from an Australasian point of view to that Athlete omega-3 status story that you guys have been leading in terms of a North American emphasis so far.

Dr. Kristina Harris Jackson:(01:01:22):

Right, yeah. A lot of the North American stuff had to be done because the NCAA was not allowing omega-3 supplementation and NCAA.

Dr. Gregory Peoples:(01:01:32):

Yeah, that’s fascinating, isn’t it?

Dr. Kristina Harris Jackson:(01:01:33):

So who knows? No one really knows why. I think they just didn’t know, so they put it on the don’t take it and it’s finally proven.

Dr. Gregory Peoples:(01:01:41):

Yeah. Look and, Bill, I know you’ve published a couple of comments on this as well. Is it fear around the platelet story and the bleeding? Or what was the NCAA, is it-

Dr. Bill Harris:(01:01:54):

I don’t know. Certainly in the surgery world, yeah, they’re afraid of bleeding, so they just… But I don’t know why the NCAA… I don’t know.

Dr. Kristina Harris Jackson:(01:02:06):

I think they were saying-

Dr. Bill Harris:(01:02:07):

[inaudible 01:02:07] know.

Dr. Kristina Harris Jackson:(01:02:07):

They get enough ALA, they’re meeting ALA requirements, so they should be fine. It’s part of the issue of the EPA and DHA, not having its own specific DRI and being acknowledged. But that’s fixed now. We’re working with more and more athletic groups at OmegaQuant for testing and they’re doing it as athletic departments usually. So it’s hopefully becoming equitable. But it’s only the really big ones right now that are cutting edge, but yeah.

Dr. Gregory Peoples:(01:02:41):

Yeah. And obviously the inflammatory story is probably a big one. And particularly, obviously I know Jeff’s done work on this as well is the potential around the concussion story for the contact athletes too. So a combination of those. And that’s an interesting one because again, go back to our contact groups in Australia where the Rugby Union, Rugby League, AFL, they’re certainly interested from a concussion point of view too. But it’s been counteracted through a little bit of fear around the potential that, well, this athlete might need surgery. Which is exactly what Bill’s suggesting. And the surgeon has a box that says that, “Hey, have you been taking fish oil? You need to come off your fish oil.” So there’s a bit of push and pull here in Australia at the moment between dieticians wanting to include omega-3, but maybe potentially the clinical support team that says, “Oh, well no, we can’t afford to do that because what if the athlete needs surgery?” And so trying to break through some of that messaging is going to be part of the challenge here in Australia.

Dr. Kristina Harris Jackson:(01:03:41):

Wow, that’s fantastic. Unfortunately, we need to wrap up. We were at about an hour and it’s just been a great conversation. We really only talked about one of your studies and we were able to bring in all of this information. And anyone can go actually check out your papers on PubMed or looking at Google Scholar. And it’s just a whole story around this and it’s been fantastic. So thank you so much, Greg, and we look forward to all of your studies coming out. And maybe we’ll have to have you come back and we’ll deep dive into another area.

Dr. Bill Harris:(01:04:17):

The military, talk about the military.

Dr. Gregory Peoples:(01:04:19):

More than happy to come back and talk about those chewable tablets at another time.

Dr. Kristina Harris Jackson:(01:04:28):

Yeah.

Dr. Bill Harris:(01:04:28):

All right, thank you.

Dr. Kristina Harris Jackson:(01:04:28):

Thanks so much.

Dr. Gregory Peoples:(01:04:29):

Excellent. Look, yeah, thanks for your time guys and we’ll catch up again soon.

Dr. Kristina Harris Jackson:(01:04:31):

All right.

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