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Omega-3 Fatty Acids in Cardiovascular Health: A Functional Medicine Guide

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Omega-3 Fatty Acids in Cardiovascular Health: A Functional Medicine Guide

One person dies every 33 seconds in the United States from cardiovascular disease. Heart disease is the leading cause of death in the United States. (19) It doesn't need to be this way; heart disease is often considered preventable because many of its risk factors, clearly defined in scientific evidence, are associated with lifestyle choices and behaviors. 

Interested in making proactive changes to prevent cardiovascular disease? Using omega-3 fatty acids for heart health may be one good place to start.


What Are Omega-3 Fatty Acids?

Omega-3 fatty acids are a group of essential polyunsaturated fats that play a crucial role in maintaining overall health. These fatty acids are classified into different types, with the primary ones being eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA). EPA and DHA are found naturally in fatty fish like salmon, mackerel, and tuna, as well as in fish oil supplements. On the other hand, ALA is predominantly present in plant-based sources such as flaxseeds, chia seeds, and walnuts. While ALA is a precursor to EPA and DHA, the conversion rate in the body is limited, making direct consumption of EPA and DHA-rich foods or supplements essential for obtaining optimal levels. (10, 12)

Omega-3s and Cardiovascular Health

Epidemiological studies dating back to the 1970s have observed notably low rates of cardiovascular events in populations with high fish consumption. Subsequent research has continued to corroborate these findings, and the benefits of omega-3 fatty acids, specifically EPA and DHA, for heart health are now well-established. (28

Omega-3 fatty acids exert several key mechanisms of action that support cardiovascular function and prevent cardiovascular diseases. Firstly, omega-3 fatty acids reduce inflammation by inhibiting the production of pro-inflammatory molecules and promoting the synthesis of anti-inflammatory compounds, thereby modulating immune responses and contributing to overall inflammatory balance (33). This anti-inflammatory effect is crucial to heart health, as chronic inflammation is closely linked to the development and progression of atherosclerosis and other cardiovascular conditions. In people with high cardiovascular risk, consuming high levels of omega-3 fatty acids from oily fish results in modest reductions of hs-CRP, an inflammatory protein positively associated with cardiovascular risk.

The evidence so strongly supports omega-3 fatty acids' ability to reduce triglycerides that the FDA has approved prescription omega-3 fatty acid medications for treating hypertriglyceridemia. Triglycerides are a type of fat (lipid) that can cause acute inflammation and contribute to the hardening and thickening of arterial walls, increasing the risk of atherosclerotic cardiovascular disease and related events. Omega-3s are thought to lower triglycerides primarily by decreasing the secretion of very low-density lipoproteins (VLDLs) from the liver. The REDUCE-IT trial showcased a substantial decrease in triglyceride levels in response to high-dose EPA supplementation. More importantly, this translated to a significant reduction in cardiovascular events by 25% and cardiovascular death by 20%. 

Functional Medicine Approach to Omega-3 Supplementation 

Functional medicine approaches supplementation with a holistic perspective, emphasizing an individualized and root-cause-oriented strategy to support overall health and well-being. In this paradigm, the goal is not merely to address symptoms but to identify and address the underlying imbalances that may contribute to health issues. Supplementation is viewed as a targeted intervention guided by thorough assessments of an individual's health status, lifestyle, and nutritional needs.

Inflammation and oxidative stress are known drivers of cardiovascular disease. Therefore, as potent anti-inflammatory molecules, omega-3 fatty acids are recognized as essential components for preventing and treating cardiovascular diseases. Based on a comprehensive medical intake and laboratory assessment, healthcare practitioners may conclude that omega-3 fatty acid supplements are beneficial to address nutritional deficiencies, optimize cardiovascular function, and reduce cardiovascular risk.

The pathogenesis of cardiovascular disease is a multifaceted process influenced by a range of factors beyond omega-3 status alone. A holistic approach to heart health emphasizes the interconnected nature of various factors, including dietary choices, exercise, sleep, stress, and comorbid conditions. Each of these elements contributes to cardiovascular well-being, and their synergistic integration is vital for a more robust preventive strategy. Omega-3 supplementation, when incorporated into this broader health plan, complements the overall objective of mitigating cardiovascular risk factors.

Functional Medicine Lab Testing for Omega-3 Levels

Integrating lab testing for omega-3 levels can be an important aspect of preventive cardiovascular healthcare. These tests require a simple blood draw to measure the levels of omega-3s in the blood to indicate whether an individual is getting an adequate amount of omega-3s from their diet or if supplementation is necessary. Moreover, monitoring omega-3 therapy through repeated lab testing assesses the efficacy of supplementation over time and helps healthcare providers adjust the dosage or modify dietary recommendations accordingly. This targeted approach allows for precise recommendations based on individual needs rather than a one-size-fits-all approach.

Plasma Essential Fatty Acids

Plasma omega fatty acids tests, such as the Omega-3 and -6 Fatty Acids panel by Access Medical Laboratories, are valuable tools in determining an individual's omega-3 status by measuring the levels of specific fatty acids in the blood. These tests provide insights into the immediate and recent intake of omega-3 fatty acids, offering a snapshot of the individual's dietary habits and potential nutritional deficiencies. Lower levels may indicate a need for dietary adjustments or targeted omega-3 supplementation. 

Omega-3 Index

The Omega-3 Index Complete by Ayumetrix measures the amount of EPA and DHA in red blood cell membranes. The omega-3 index offers a more accurate reflection of long-term omega-3 intake (weeks to months) compared to measuring levels in plasma or serum, which can fluctuate based on recent dietary intake. A higher omega-3 index, ideally over 8%, is associated with a reduced risk of heart disease. 

Dietary Strategies for Optimizing Omega-3 Intake

To naturally increase omega-3 intake, individuals can incorporate various foods rich in omega-3s into their diet. Fatty fish such as salmon, mackerel, sardines, and anchovies are high in omega-3 fatty acids. The American Heart Association recommends eating at least two servings (3 ounces cooked or ¾ cup flaked) of fatty fish per week. Grilled or baked preparations are healthier alternatives to fried options. (15

For ALA, consider including plant-based sources such as flaxseeds, chia seeds, hemp seeds, and walnuts in your meals and snacks (35). Adding these to yogurt, smoothies, salads, or oatmeal can be a tasty and convenient way to boost ALA intake. 

Incorporate omega-3-rich oils into your cooking routine. Use flaxseed oil for salad dressings or drizzle over-cooked vegetables to enhance both flavor and nutritional value.

If you're not a fan of fish, consider omega-3-enriched foods such as fortified eggs or dairy products. These products are supplemented with omega-3s and can be a suitable option for those with dietary restrictions.

When planning meals, focus on a balanced and heart-healthy diet that includes a variety of fruits, vegetables, whole grains, and lean proteins. Limit the intake of saturated and trans fats, added sugars, and processed foods, opting for healthier cooking methods like grilling, baking, or steaming. Making dietary changes can feel overwhelming, so establishing care with a functional nutritionist can help navigate dietary intricacies related to omega-3 intake and a balanced, healthy diet. 

While obtaining nutrients from whole foods is ideal, supplements may be recommended in certain situations to meet specific health goals. It is always advised to consult with a healthcare professional before making significant dietary changes, especially if considering omega-3 supplements.

Managing and Preventing Cardiovascular Disease with Omega-3s 

Scientific research consistently supports the role of omega-3 fatty acids in both managing existing cardiovascular disease and preventing potential heart-related issues. Numerous studies have demonstrated the cardiovascular benefits of omega-3s, particularly EPA and DHA. The GISSI-Prevenzione trial, for instance, found that omega-3 supplementation significantly reduced the risk of major cardiovascular events, including death, in individuals with a history of heart attacks.

In managing existing cardiovascular disease, omega-3s exhibit anti-inflammatory and anti-arrhythmic properties, improving cardiac function. The REDUCE-IT trial, focusing on supplemental high-dose EPA, showed a substantial reduction in cardiovascular events in individuals with elevated triglyceride levels.

For prevention, the American Heart Association recommends consuming fatty fish at least twice a week as part of a heart-healthy diet. The DART (Diet and Reinfarction Trial) study suggested regular fatty fish consumption could reduce the risk of recurrent heart attacks. Additionally, the Nurses' Health Study revealed an inverse relationship between omega-3 intake and the risk of coronary heart disease in women.

Integrating omega-3s into a cardiovascular disease management plan involves dietary modifications and supplementation. The ORIGIN trial emphasized the potential benefits of omega-3 supplementation in individuals with diabetes or impaired glucose metabolism. Combining omega-3s with other components of a heart-healthy lifestyle, such as exercise and stress management, enhances the overall effectiveness of cardiovascular disease prevention.

Potential Risks and Considerations

While omega-3 supplements are generally considered safe in combined EPA and DHA doses of 3 grams per day or less for most people, some potential risks and considerations should not be overlooked. One concern is the risk of bleeding, as omega-3 fatty acids have blood-thinning properties, and older research suggests that doses greater than 3 grams daily can potentially increase bleeding risk. While more recent and up-to-date evidence shows that daily fish oil does not affect blood clotting parameters, it is still advised for patients with clotting disorders or on anticoagulant medications to speak to a healthcare provider before taking omega-3 supplements. 

Mild side effects of omega-3 supplements have been reported, including unpleasant taste, diarrhea, indigestion, and headache (10).  

Additionally, the quality and purity of supplements vary, and there is a risk of exposure to contaminants such as mercury in fish oil supplements. Choosing high-quality, third-party-tested supplements can mitigate this risk.

It is paramount to consult with healthcare providers before initiating omega-3 supplementation, especially for those with pre-existing health conditions or individuals taking medications. Healthcare professionals can provide personalized advice based on individual health status, ensuring supplementation is safe and aligns with overall health goals. 


Omega-3 and Heart Health: Key Takeaways

Embracing omega-3s is one aspect of a comprehensive and holistic approach to heart health. Scientific evidence overwhelmingly supports the use of omega-3 fatty acids to manage and prevent cardiovascular disease. The functional medicine approach underscores the importance of optimizing omega-3 intake through a holistic strategy involving personalized assessments guided by professional advice. Incorporating fatty fish, nuts, seeds, and high-quality supplements into a heart-healthy lifestyle can enhance overall cardiovascular health. 

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
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