The Omega-3 Index in Clinical Practice.

OmegaMatters: Episode 5

Hosts: Drs. Bill Harris & Kristina Harris Jackson

Guest: James O’Keefe, MD

Background and key takeaways:

The Omega-3 Index test is a tool that has been used by a variety of healthcare providers in their clinical practice. In this episode, Drs. Harris and Jackson talk about the utility of the test with Dr. James O’Keefe, a preventive cardiologist based in Kansas City. He has been a proponent of omega-3s in his cardiology practice for more than two decades. His personal journey through the omega-3 world during the publication of some of the landmark studies in the 1980s and 90s fundamentally changed the way he viewed fat. Once omega-3s had been validated in several large trials, he launched a concentrated product of his own as a way to offer high quality omega-3s to his patients. Dr. O’Keefe is also well versed on omega-3 research, having been an investigator himself. Today, Dr. O’Keefe guides his patients on a path toward heart wellness, using the Omega-3 Index to help them track and monitor the impact of omega-3s in their diets. To Dr. O’Keefe, the first step in changing anything is measuring it.

Guest Bio:

James H O’Keefe:

James H O’Keefe, MD, is Director of the Duboc Cardio Health & Wellness Center and Director of Preventive Cardiology at Saint Luke’s of Kansas City, Mid America Heart Institute. He is Co-director of the Haverty Cardiometabolic Center and Professor of Medicine at the University of Missouri-Kansas City. His postgraduate training at the Mayo Clinic in Rochester, Minnesota included a cardiology fellowship and internal medicine residency. Dr O’Keefe is board-certified in Cardiology, Internal Medicine, Nuclear Cardiology, and Cardiac CT Imaging. Dr O’Keefe has contributed 430 articles to peer-reviewed journals, and his articles have been cited over 40,000 times in the medical literature. He has authored best-selling cardiovascular (CV) books for health professionals, notably The Complete Guide to ECGs, which is used by CV fellowship training programs as the preferred teaching text for the ECG section of the ABIM Cardiology Board Certification Exam. USA Today has listed Dr O’Keefe among America’s Most Influential Doctors. Dr O’Keefe is a member of Phi Beta Kappa and Alpha Omega Honor Societies.

Transcript:

Kristina Harris: Welcome to Omega Matters. This is our little show where my dad and I have casual conversations about health and nutrition, research statistics and of course, omega-3 fatty acids. I’m Kristina Harris Jackson. I’m the director of research at OmegaQuant Analytics. We’re a clinical lab that specializes in fatty acid analysis and I’m a nutritional science researcher and a registered dietitian.

And I’m here with my dad, of course, Bill Harris, who is a world-renowned scientist in the field of nutrition, specifically in the realm of omega-3 fatty acids and has recently started a non-profit called the Fatty Acid Research Institute or FARI for short. He started OmegaQuant Analytics over 10 years ago to be able to offer to clinicians omega-3 index testing, which is a biomarker of omega-3 intake and related to risk for cardiovascular disease. And he developed the Omega-3 Index with his colleague Clemens von Schacky in 2004. Most recently, he has been ranked the top 2% of scientists in the world based on impact in his publications. So that was exciting news.

Today we’re joined by Dr. James O’Keefe, who’s another giant in his own field. He’s a preventative cardiologist and director at the Duboc Cardio Health & Wellness Center and the director of Preventative Cardiology at St. Luke’s of Kansas City Mid America Heart Institute. Dr. O’Keefe did his medical training at the University of North Dakota, his home state, and his internal medicine residency and cardiology fellowship at the Mayo Clinic, so, mid-western. He’s listed as one of America’s most influential doctors by USA Today and is a regular on the SiriusXM show, Doctor Radio. He’s also been on Dr. Peter Attia’s podcast, given several TED Talks, written several books, and also founded a nutraceutical company with his wife, a dietitian, called CardioTabs.

So, today we’re going to talk to Dr. O’Keefe about omega-3’s in the clinic and whatever else comes up. So, thank you for joining us, Dr. O’Keefe.

James O’Keefe: Yeah. My pleasure, Kristina. It’s great to be here with you and Bill. You know, Bill and I have been friends for decades and it’s kind of funny because it is not an exaggeration to say everybody in the world knows when we talk about the Codfather, as in C-O-D Codfather of the omega-3 story it’s Dr. Bill Harris.

Bill Harris: I stole it from somebody, but anyway.

Kristina Harris: You do have the omega-3 license plate in South Dakota.

James O’Keefe: Oh really? Wow. Okay.

James O’Keefe: Yeah, I’ve been trying to talk him into coming back, move back to Kansas City. I actually lured him away one time when he was at the University of Kansas, I lured him over to St. Luke’s Mid America Heart Institute to work with us and do research and we collaborated on a bunch of projects including some omega-3 study that I think is still really relevant too was a randomized placebo controlled trial where we took a relatively small number of people and randomized them to I think it was just one gram per day as I recall.

James O’Keefe: So, we looked at like beat-to-beat variability and peak exercise heart rate and resting heart rate and, you know, it showed that omega-3 lowered resting heart rate by, like, three to four beats per minute and so anyway, it’s yeah, we’ve been friends and collaborators for a long time.

Bill Harris: Yeah, what was cool about that study I think we also did that in heart transplant patients, right, that are denervated? We lowered heart rate even in people without nerves to the heart, which was pretty amazing.

Kristina Harris: So, that was one of my first questions is how you guys met and started collaborating,  have a history together. Do you remember you first met?

Bill Harris: I was at, I think I was at KU in the mid 90s when, and James was a cardiologist at St. Luke’s Hospital, still is, and we just got to be friends,  because of our interest in omega-3’s and he found a way to create a, endowed chair for me and then lured me over to St. Luke’s UMKC and,  it was a fantastic change for me. I really appreciated it.

James O’Keefe: Yeah. Ben McCallister, the late great Ben McCallister helped us with that.

James O’Keefe: I think we had met at some conferences, you know,  that we were speaking at or something like that. But yeah, we hit it off right away and have been good friends ever since.

Kristina Harris: Excellent. Well Dr. O’Keefe, how did you originally get interested in omega-3’s in the world of preventative cardiology?

James O’Keefe: I mean, it’s just such an organic, natural connection, you know? It’s if you look through the history the omega-3 story like, in the 1960s,  you know, Jörn Dyerberg and his colleagues were, he was a MD-PhD, he was doing some research over in Greenland and studying the Greenland Eskimos which, you know, Greenland had been part of the Danish empire in the, in the remote past and so they had this connection. So they went over there, they were studying the Greenland Eskimos and comparing them to the Danes, who eat a lot of fish on their own, but they noticed some some striking differences in their fatty acid profiles and they saw this stuff, EPA, DHA, that they hadn’t seen before and then they theorized that this came from fish and that this was the reason why they saw very little to no coronary heart disease or atherosclerosis in general in these,  in these Eskimos, Inuit.

So when I was in medical school in the 80s, in the early 80swell the late 70s, there was this school of thought that fat was bad for you and that the ideal diet, you know, was the Pritikin Diet and old American Heart Association diet and there’s still the Ornish Diet that’s still trying to convince us that all fat is evil and, you know. So being an impressionable,  medical student, I start following that diet and I realized this is not working for me, you know? I was getting skinnier and I was weak and my triglycerides were always normal, suddenly they were high, and my HDL went down and I thought, you know, this is not right, you know?

So I started looking into diet and it became obvious that fat was good for you was omega-3 even at that early stages in the 80s and then the GISSI-Prevenzione study came out in, like, 1998 and there’s just one gram of,  of an ethyl ester mixture of EPA and DHA that provided about 850 milligrams of EPA, DHA, one capsule.

They studied 11,000 Italians who had just survived a heart attack —myocardial infarction — and they randomized to this or not and it showed this really robust, like, 25% reduction in the primary endpoint which was major adverse cardiovascular events including cardiovascular mortality and I just thought, wow, this is really impressive. It’s just like a, like a mega-trial with a simple little nutrient and so I started, you know, recommending it for my patients.

My fellow colleague Brian Curtis back then was complaining about this as we were sending our patients to, you know, go get omega-3 and they’d come back with all sorts of, you know, usually kind of the standard, you know, 30%  EPA / DHA 120-180. So he suggested, “Maybe we should start a company that markets high quality omega-3.” So that’s when we founded CardioTabs around 1999 and that’s been sort of our centerpiece is to have a real good highly purified, you know, concentrated omega-3.

It’s also a great excuse for me to go to Norway or Copenhagen or Iceland or, you know, about once a year I go over there and through a lot of connections from, that Bill introduced me to, a lot of the luminaries and the omega-3 sort of folklore history and you know, smart scientists. It’s fun to interact with them and then it’s also fun to be able to, you know, to choose and find what I think are the best omega-3 products to offer for our customers and patients.

Kristina Harris: That’s a really good point about clinically using omega-3. First thing I get asked all the time is, “What should I take?” and I’m just like, “It depends.” And it’s really excellent that you know exactly what you can recommend, you know what’s in it and it just makes it so much easier because there’s so many products and they’re changing all the time.

James O’Keefe: Dose matters is probably the major factor in determining how much omega-3 you have in your cell membranes, like the red blood cells (RBCs). But the latest data would really suggest, you know, that the dose matters, and so you need to get enough omega-3 and maybe as little as 500 milligrams of EPA, DHA will protect you from fatal myocardial infarctions like these unstable rhythms, you know, VT/VF, that sort of thing.

But for the broader range of cardiovascular health, like reducing risk of myocardial infarction or revascularization or total coronary heart disease events or even stroke, ischemic stroke, it seems like a higher dose is better. And then it really matters, you know, to be able to find a product that’s concentrated. And of course it always helps to have a compliant patient, as you know, because it’s hard getting people to take their fish oil.

Kristina Harris: And that’s one thing I really like with testing is to be able to show people what you’re taking is actually getting into your body, or not if they’re not taking a good product . So it’s that motivation and proof that I think is really powerful.

James O’Keefe: I mean, it’s one of the fundamental axioms of economics is the first step in changing anything is measuring it, or the first step in managing something is measuring it. It’s really pretty much an epidemic of sorts that 90% of Americans don’t have an Omega Index in the ideal range.

Kristina Harris: Our estimate is that the average Omega-3 index in the US and Canada is  4.5%.

James O’Keefe: Yeah, if you’re thinking ideal would be 8 to 11, right? Then, is that what you’d call ideal?

Kristina Harris: Yeah.

Bill Harris: 8 to 12, yeah, basically.

James O’Keefe: 8 to 12?

James O’Keefe: And the Japanese would have about the average…

Bill Harris: 9.

James O’Keefe: Japanese would be 8 or?

Bill Harris: 9 or 10.

James O’Keefe: Oh, 9.

Bill Harris: Koreans are around 9 or 10 too.

James O’Keefe: And, and maybe no coincidence, these are among the longest lived people in the world. You know, I don’t know about Icelanders, if you have them, but they also have a pretty remarkable longevity. Now, it’s a pretty tight genome there on the on the island of Iceland and they have a lot of other good sort of healthy habits, but I bet their Omega Index is pretty high too.

Bill Harris: Yep.

Kristina Harris: You mentioned the GISSI trial, and we’ve had more very large trials come out since then, obviously, and there’s been some mixed results. We’ve had VITAL and REDUCE-IT and STRENGTH all fairly recently. How do you take those studies and how does it affect how you think about omega-3’s with your patients? What context do you put them in more generally?

James O’Keefe: So as you know, Kristina, the gold standard in scientific evidence is,  randomized placebo control trials. But lots of times they’re done on, you know, variable populations with variable doses and all sorts of other sort of differences that make them not necessarily generalizable.

James O’Keefe: So, if you can put together a bundle, you know, the entire experience of randomized placebo control trials and do a good meta-analysis on it, that’s really the gold standard of medical and scientific evidence. And so, and this is such a frustrating field, the omega-3. I know you guys feel it too but physicians, and I’ll just apologize, you know, off the bat, physicians tend to have sort of like the expert syndrome where, you know, just because they went to school ‘til they were 32, they know everything about health and they’ll let you know their opinion. And there’s nowhere that’s more incomplete than our knowledge base in nutrition. I mean, like, I went to school til I was 32 to become a cardiologist, which, you know, arguably, nutrition is among the very most important determinants of cardiovascular health. And I didn’t get a single hour of lecture on nutrition.

Kristina Harris: Right.

James O’Keefe: I mean, it’s crazy and it’s still like that. But then people see the advertisements encouraging people to “Ask your doctor about whether” … So doctors because they have no formal nutritional training, tend to be very skeptical about anything nutrition. I mean how important could it be if they never taught us anything about it. It’s like they know diet can help but nobody follows it. And the omega-3 thing, because some studies are positive, some studies are negative, they tend to be skeptical anyway.

So doctors have really done a disservice to the science, in my opinion, because they’re always telling them omega-3 is not important. But omega-3 is so important. It’s like, especially when 95% of people aren’t taking it and, and soso g- back to, like, the gold standard,  Aldo Bernasconi who’s at the mountain Heart Center in Utah is a very bright PhD and he worked with Tripp Lavie and some other people. Bill, were you on that study as well, that meta-analysis that came up recently?

But anyway it was a meta-analysis, it included all the data, like the STRENGTH data which had,  you know, the fatty acids,  un- unesterifiedand it’s four grams of EPA plus DHA and, and all these other, you know, randomized trials that were sort of nominally called negative, but if you look closely there’s several endpoints where they’re positive, even with low doses. And then of course, the home-run REDUCE-IT trial which used the EPA ethyl ester at four grams that showed the 25% [reduction in heart attack, stroke or cardiac death.

But going all the way back to the GISSI-Prevenzione trial. And so there’s 150,000 people in this meta-analysis and sure enough they saw a 35% reduction in fatal, MI, so highly statistically significant reduction in  coronary heart disease events and I believe stroke. But in any event, you know, this, these were highly statistically significant reductions. And this was a dose-dependent thing, so as you go from 500 to 1,000 to 2,000, 4,000 milligrams per day of EPA plus DHA, you see more significant benefits.

And the, interestingly, in that study, which kind of fits with my perspective is that you couldn’t say for sure whether EPA was better than DHA or not. Most of the trials use some mixture and when you put that all into a complex, really well-done meta-analysis, you know, it looks like, as a mix it is fine. But I would love to hear Bill’s thoughts on this and whether the mix of EPA and DHA should be different. It’s an open question.

Bill Harris: Right.

James O’Keefe: The amount of EPA and DHA in fish varies from one species to the next. And this is what we’re meant to eat and def- what we have been eating. These are really important compounds and they do have somewhat, you know, subtly different actions. But I kind of feel like a mixture is ideal because you get the anti-inflammatory effects from both. But, you know, DHA functions mainly for the brain and eyes. But the EPA thing is also important as well. Bill, what’s your thoughts on that?

Bill Harris: I would’ve said the same thing, that this what we’re designed for — EPA plus DHA. Both play a role, you get the resolvins and protectins from the two different molecules, and then, of course the oxylipins. They’re very highly anti-inflammatory and so I think you need both.  It’s fine to show that EPA works and REDUCE-IT appears to have shown that. But I would love to see a DHA-only trial but I don’t know that that’s coming. But when it comes down to just, you know, day-to-day, what do you recommend to people? I think you gotta have both of them.

James O’Keefe: Right. And is it safe to say that,  of the two, DHA has a more sort of milligram per milligram effect on raising your Omega Index than EPA?

Bill Harris: Yeah, it does. Right, and you know whether that means it’s better or not is not the question, but it does have a different impact, but only slighly. It’s partly because when you give DHA, EPA levels tend to go up too.

Bill Harris: But when you give EPA, DHA levels don’t go up.

Kristina Harris: Right.

James O’Keefe: In many ways, they’re sort of complementary. As you say, we’re sort of designed to be eating both together.

Bill Harris: So, do you recommend most of your patients be on omega-3?

James O’Keefe: So when this topic comes up, as it does with most of my patients, I always make sure I give them full disclosure that I started a supplement company called CardioTabs. I also pay close attention to the literature and I always ask them, “How much fish and seafood do you eat?”

James O’Keefe: Because if they’re eating, if they’re like a typical Japanese person, they’re eating fish twice a day and their Omega-3 Index is 9 or 10, it’s like and they have normal triglycerides, I, I would say, “You’re good. This is a super important nutrient and you’re doing great with it.” But almost always people tell me that they eat fish, you know, once a week or they hate fish or whatever and then I’d say, “Okay,” and then I’d look at their triglycerides because for sure we know that there’s a dose-dependent benefit for lowering triglycerides.

Triglycerides is of the blood parameters that we look at as an athrogenic protein,  lipoprotein, in the blood. And all the other agents that we’ve used for triglycerides, like the fibrates, even though they lower triglycerides significantly, have not been shown definitively to improve cardiovascular prognosis.

Whereas I think that was the most important message from the REDUCE-IT trial is these are people that had triglycerides above 135 — I think it was 7,000 people — and had either coronary heart disease or diabetes with other risk factors. And it showed that when you gave them four grams of EPA and lowered triglycerides, I think it was about 20%, that you did see this substantial reduction. And, you know, the people that did the study kind of made the point that it wasn’t all due to triglyceride lowering. But you could also look at the people who had significantly high triglycerides above 200 versus below 200, they had a more significant benefit if they had higher triglyceride compared baseline. I mean, I think, I think it’s the best evidence ever for a triglyceride-lowering compound,  for improving cardiovascular prognosis.

But getting back to your question, so if their triglycerides are high, like, above 150,  I use four grams of EPA plus DHA. And then if they’re, say, above the level for most people I would like to get them on two grams of EPA plus DHA per day. I mean, in our Cardio Wellness Center, we have a Cardiometabolic Center — these are people with diabetes or pre-diabetes, lots of times with heart disease, and the vast majority of those folks will have atherogenic lipoproteins, you know, with high triglycerides and low HDL. So it is a pretty standard thing for me to recommend that. I always tell them to take it with food because it’s better absorbed.

James O’Keefe: We work on optimizing people’s lipid profile with diet, I mean, from a medication and supplement standpoint, it’s pretty simple now. If your LDL’s high, statins and PCSK9 inhibitors all do different things. They have a synergistic effect, like one plus one plus one equals six. And they all have event reduction capabilities. They reduce heart attack, stroke, cardiovascular death, and they’re complementary, they really work well together.

I use one or more of those, enough to get their LDL to the goal, for a lot of people it’s less than 70 and it almost always gets there. And then for triglyceride, which is, I think, another different parameter, I use omega-3. A strong statin like atorvastatin plus omega-3 that has a good dose of  EPA plus DHA.  Not only do they work well for optimizing the triglycerides and LDLA, but they also optimize the larger risk, the risk profile.

Bill Harris: Yeah.

Kristina Harris: Yeah. And the other side of lot of the omega-3 work that we do, we look at long-term risk outcome, risk, and blood levels and predicting that.  People ask what can you notice in the shorter term, if you are at a low omega-3 status (i.e. Omega-3 Index) and you go to a higher status by taking two plus grams? Do you have any experiences with people who started very low and then progressively took omega-3’s and had higher status and had other with more subtle changes in their health?

James O’Keefe: Yeah, I think that there’s a very real sense of omega-3s’ brightening effect on your mood. Artemis Simopolous has been writing about this for decades, but you know, your brain is 60% fat by weight, if you exclude the water weight, and the preferred fat is omega-3. And the brain tends to work better, it’s less inflamed, mood is better, and a lot of people notice that it really does have an effect. My wife Joan is really on a mission. She thinks, you know, everybody in the country should be on enough omega-3 to get their Omega Index into a good range because mental health is such a huge, growing problem in America.

Bill Harris: Yeah.

James O’Keefe: When she sees these mass shootings or something like that, she says, “I would love to know what his Omega Index is,”  and, and I think she makes a good point that you don’t know what your baseline function is until you get those levels up to normal, so that your neurons and cell membranes aren’t inflamed and and highly communicative. I mean, it’s a simple thing; there’s really no downside to it.

A lot perceptive people will notice it doesn’t happen overnight but I would say in a matter of a few weeks of supplementation a lot of people notice that their mood is better and their cognition is just sharper.

Bill Harris: How about joint pain?

James O’Keefe: Oh, there’s no question about that too. One interesting way to think about this is by looking what the vets are recommending for their patients’ dogs  and cats.

James O’Keefe: For instance, they’ll say, “Oh yeah, get him on an omega-3 supplement because that oftentimes will help with arthritic joints and whatnot,” and it does. It reduces inflammation for things like post-workout,  muscle soreness, you know, even in younger athletes. But certainly it reduces musculoskeletal inflammation, whether it’s, you know, osteoarthritis or rheumatoid arthritis or just, you know, wear and tear from,  a heavy workout.

Kristina Harris:               Yeah, it’s the kind of day-to-day things that if you can start, you kind of have to be mindful enough to notice it at some point that “oh, I do feel better in these cases.” And that helps motivate to continue to take it and feel those effects. Sometimes it’s hard to just say, “Oh if you take this, in 30 years you won’t have a heart attack.”

James O’Keefe: Yeah.

Kristina Harris: Shorter timeframes, especially with younger people, it helps if they see more immediate results in body functioning. And then there’s also, like, the heart rate variability that you guys started with. We also just published another paper on that topic showing that omega-3s help your heart function better even as a young person, as an athlete.

James O’Keefe: Yeah.

Kristina Harris: It helps with the whole system.

James O’Keefe: That’s where I get really frustrated because I know that this makes a big difference and then when people hear this mixed messages, and then patients say something like, “Oh, yeah, I used to take omega-3, but my doctor told me it’s not important so I don’t take that anymore.”

James O’Keefe: One of the things that we fight against in prevention in general, which in my opinion is the most important, is that it should be the foundation of health activities. It’s just so much better to prevent a stroke or a heart attack or not to mention Alzheimer’s disease, depression, or suicide. I mean, this stuff is very preventable. Developing into a disease is a process, and it gets much messier and much more expensive and less pleasant. Not to mention in the meanwhile, it may have ruined or ended your life.

James O’Keefe: But the tricky thing about that is that when we put people on omega-3 and then they come back the next year and they’ve been taking their omega-3 they don’t say, “And by the way, thanks so much for preventing that stroke I would’ve had. They just assume they’re healthy.

And so that’s why you have to, you have to look at these giant studies and extrapolate to your own life and then do the intelligent thing to keep to just stack your odds in the right direction for staying healthy. But even when you do that, you sort of take for granted that it’s luck or, or genetics or whatever. Most people totally take their health for granted so they assume that they never would’ve had a heart attack or a stroke or Alzheimer’s or whatever.

Bill Harris: Right.

James O’Keefe: And that’s where as healthcare providers and educators, I feel like it’s my mission to tell people that your health is very much in your control. Some of it is out of your control, but you will be better off if you use the latest science and stack these things on like nutrition and sleep and social support and track your blood pressure and your lipids and other health parameters.

Bill Harris: Yep.

Kristina Harris: Yeah.

James O’Keefe: If you collect the right data and focus on the important things, then I would say omega-3 is among the most important things from a nutrition standpoint to really focus on. It makes a huge difference. And not just for your longevity but also for your day-to-day sense of well-being.

Kristina Harris: Yeah, I think so too. It has for me, I think.

Bill Harris: Before we go, I want to hear your thoughts on Afib.

James O’Keefe: This circles back to what we were talking about at the beginning, Bill, that study, you know, I did 20 years ago that showed it did improve,  beat-to-beat variability and, and augmented vagal tone and slowed resting heart rate. Those are good things. Those are all parameters that tend to correlate pretty strongly with good cardiovascular prognosis.

James O’Keefe: The heartbeat slows down and speeds up like an accordion. I mean, it’s, it’s pretty interesting to look at. But this is a marker of a healthy,  cardiovascular system. Afib (atrial fibrillation) is like a lot of conditions — it’s a very multi-factorial. As the heartbeat slows down and the vagal tone goes up, it can make the heart more vulnerable toAFib.

So like in the REDUCE-IT study, AFib rates went up from 2% in the placebo population to 3% in the folks who got 3-4 grams of EPA. This was around a 50% relative risk increase. But at the same time, stroke went down 29% in that study. But if you do a big meta-analysis, I think you’ll find a dose-dependent increase, modest increase, but probably significant increase in AFib.

And in those people, you know, hopefully those aren’t the same people who have triglycerides of 400 where you need to use four grams of EPA. I think at 1 gram per day you won’t have much of an increased risk of AFib and you’d still get, you know, the reduction in fatal heart attack.

Bill Harris: Right, risk vs. benefit. I’m not an expert in AFib by any means, but you’re right about the absolute change, the absolute effect in those trials was quite small.

James O’Keefe: Right.

Bill Harris: Going from 2% of people to 3% of people — it gets magnified when you do relevant risk reduction, relative increase.

James O’Keefe: Right.

Bill Harris: But your point about people who have very high triglycerides, they need about four grams a day, so would you then talk to them a little bit more about AFib, and then are there other risk factors that they need to consider in recommending that dose in those people?

James O’Keefe: Well, we have a paper we’re just sending in this week about how to prevent AFib with lifestyle and dietary modifications. What we do now  is talk about anti-rhythmic drugs which are potentially toxic and catheter ablations where you go in and burn parts of the left atrium to try to make the AFib go away.

Turns out that AFib is quite prevalent, with one out four people over age 40 having this in their lifetime and it does increase risk of stroke and it’s highly modifiable by treating things like sleep apnea, obesity and consuming less alcohol. Previous generations of cardiologists called AFib “holiday heart syndrome” because people would show up,  you know, New Years Day or the day after the  4th of July with AFib.

We’re still trying to figure out what role omega-3 plays in there, but there’s a lot of ways you can reduce risk of Afib. I mean, if they need their omega-3, which most people do, I would use lower doses. And maybe for somebody who’s really got a resting heart rate of 50 or 60 beats per minute and high triglycerides, you know, I might think about using fibrates in that person. But this doesn’t really affect my general pattern about how to prescribe omega-3 for my patients.

Bill Harris: Great.

Kristina Harris: Excellent, yeah. I think there’s gonna be some meta-analyses coming out on the AFib question this year. So that’ll be good. Well, we probably should wrap up here. Thank you so much for talking with us, Dr. O’Keefe.  It’s just great to talk to someone who is using omega-3’s in the real world and knows so much about the research too. Thanks so much.

Bill Harris: Thanks, James.

James O’Keefe: Well, it’s my pleasure and,  yeah, I,  as I mentioned before, I love to collaborate with Bill and we’re always sort of strategizing about other things we can,  we can [00:40:30] look at. But this is,  it’s definitely a personal and professional passion. Keep up the great work there at OmegaQuant.

Bill Harris: Thank you.

Kristina Harris: Thanks.

Bill Harris: Have a great day.

Kristina Harris: Bye.

James O’Keefe: Okay, you too. Bye-bye.