Although the degree of atherosclerosis (hardening/narrowing of the arteries) correlates with the risk of heat attack, the correlation isn't perfect. In fact, if you read my previous post on 20th century coronary heart disease trends in the U.K., you know that the frequency of heart attacks rose dramatically during the first half of the century, while the prevalence of severe atherosclerosis stayed the same or even declined.
If you accept the standard idea of how a heart attack occurs, first the coronary arteries become narrowed due to atherosclerosis. Then a clot forms, which lodges itself in a narrowed artery, blocking it and cutting off the blood supply to part of the heart muscle. The clot may be the result of a ruptured atherosclerotic plaque.
If you're unlucky, the loss of blood to your heart causes arrhythmia, or a loss of coordination of the heart muscle. This can cause it to pump blood inefficiently, sometimes resulting in death. Arrhythmias are estimated to account for about half of all heart attack deaths in the U.S. Sometimes they occur without a coronary blockage as well.
Omega-3 fatty acids seem to affect all three parts of the process: the atherosclerosis, the clot formation and the arrhythmia. Supplementing fish oil, even in the absence of reduced omega-6, may slow the progression of atherosclerosis according to a controlled trial.
Where omega-3 really shines is its ability to prevent clots and arrhythmias. In the DART and Lyon trials, the benefits of improving omega-6:3 balance appeared much more quickly than would be possible if it were acting by reversing atherosclerosis. This may have involved the blood-thinning properties of omega-3. The most dramatic effects were on sudden cardiac death, often the result of arrhythmia. Omega-3 fatty acids potently suppress arrhythmias in animal models.
You can have severely narrowed and calcified arteries, but if a clot never shows up, you may never actually have a heart attack. The modern industrial diet is extremely thrombotic (clot-promoting), probably in large part due to the combination of excessive omega-6 and insufficient omega-3. If the artery blockage doesn't cause an arrhythmia, the heart attack may not be fatal.
Omega-3 fats seem to prevent heart attacks on multiple levels.
The Lyon Diet-Heart Study: Background
The Lyon Diet-Heart Study
The Lyon Diet-Heart Study: Implications
Polyunsaturated Fat Intake: What About Humans?
21 comments:
Stephen,
Don't forget the OTHER cause of arrhytmias--autonomic nerve dysfunction.
Most older people have significantly elevated blood sugars, though very few are diagnosed with diabetes because the diagnostic standard for diabetes was set very high. So high that most people diagnosed for diabetes already have significant diabetic nerve damage on the day of diagnosis--damage that takes a decade to appear.
The autonomic nerves are also damaged by exposure to post meal high blood sugars, including the ones that control heart beat.
I am starting to think this is a huge, and completely ignored, cause of heart attack.
This comes down to something I've been thinking of for awhile now: you need the synergy of several negative factors to actually manifest heart disease. You have to have the immune system suppressants to actually form the plaque from bacterial infection, you need to have calcium disfunction to harden the plaque, and then you need some clotting disfunction to get a thrombosis stuck in the occluded section of artery. The French, for example, smoke a lot but even though they must be getting Chlamydia Pneumoniae infections fairly often they aren't hitting the other two points often.
Could someone recommend good sources of Omega 3 supplementation. I've received conflicting information on this subject and I trust the people at this site. Also, what would be the best strategy for decreasing omega 6 levels and raising omega 3 levels? Would eating fish 5 or 6 times a week help, and what are the best types of fish for this purpose? Thanks in advance for any suggestions.
Madmax,
You'll find all of the answers to your questions by reading through prior posts and comments on this blog. But the short answer is: consume fish-oil (e.g., capsules) to increase your omega 3s and chuck all of the industrial vegetable oils (cotton seed, soybean, corn, and I'd say even canola) and margarine which are high in omega 6 (and oxidized (i.e., damaged) at that) and replace them with natural fats such as animal fat (lard, tallow, chicken and other fowl fat, butter, ghee) and coconut oil and olive oil. And avoid processed foods or restaurant foods, especially fast food.
Jenny,
I'm interested in learning more. Do you have references I can check out?
Madmax,
I don't think you need to eat fish that much if you keep your omega-6 low. Maybe twice a week (wild fish, not farmed), or take small doses of high-vitamin cod liver oil or fish oil. Shellfish is great too. Eating seafood is probably superior to taking fish oil in my opinion. Industrial vegetable oils are the worst source of omega-6, as Aaron mentioned. Processed food of all kinds is full of the stuff.
I don't know if there are real differences in fish oil quality. I'd go for as minimally processed as possible. Some salmon oils fit that description. Then there's high-vitamin cod liver oil, which has the advantage of vitamins A and D, but is not available in the grocery store. Green Pastures sells good CLO.
Madmax,
The best Omega 3 supplements are those with 5 Stars from International Fish Oil Standard (IFOS).
http://www.ifosprogram.com/IFOS/5StarReports.aspx
I believe the best Omega 3 supplements in the world are from
- ZoneLabs www.zonediet.com
- Life Extension www.lef.org
- Nordic Naturals www.nordicnaturals.com
Personally I have the best are from ZoneLabs and Life Extension since both have sesame lignans, which has so similar anti-inflammatory action like Omega 3 EPA.
I really would never recommend 'cod liver oil' (I have never taken this kind of poor products) since it has detectable mercury and other heavy metals. The gold standard in Fish Oil is IFOS Standard.
Thanks for this blog again.
Adolfo,
The level of mercury in cod liver oil is negligible. Quality high-vitamin cod liver oil also has the added benefit of fat-soluble vitamins, which fish oil generally lacks.
"How fish oil is rated", by Barry Sears Ph.D. [specialist in lipid biochemistry and author of THE ZONE and THE OMEGA-Rx ZONE and one of the first proponents of inflammatory theory of chronic disease 20 years ago]
http://www.zonediet.com/tabid/130/itemid/738/How-fish-oil-is-rated.aspx
Regards from Europe!
Hi Stephan, you have some RxOmega with fat soluble vitamins like Ultimate Omega-D3 from Nordic Naturals.
But anyway the best is taking a 5 Stars IFOS RxOmega plus 1000-2000 vitamin D3 and if one like there are very good fat soluble supplements with wide spectrum carotenoids, ascorbyl palmitate, wide spectrum tocotrienols and tocopherols.. all in one simple formula. But if you can take and pay the best possible, why to take a product not so good. Simply. :D
Wow, Jenny, you really know your stuff!
Yes, autonomic neuropathy is hugely correlated with arrhythmias (& sudden cardiac death.) Yet it's largely unrecognized, IMHO because it's hard to test for. The lack of awareness reminds me of that old joke about the guy who looks for his missing car keys under the streetlight -- not because he thinks he lost them there, but because the light's better. And even neurologists will miss subtle cases of diabetic autonomic neuropathy.
And DAN can be well advanced before patients know anything is wrong other than just "getting older." ie, they think they have digestion problems because of a poor diet, or they can't get erections because "it happens to everyone" -- they don't realize it's because their brain can no longer control their stomach, sex organs, etc.
By the time vision starts to go, they do realize it's not just old age, and they finally insist on seeing a neurologist -- but by then much of the damage is irreversible.
Cardiac autonomic nerves are particularly susceptible because they are extremely fine. And the only "symptom" for autonomic neuropathy of the cardiac nerves is -- sudden cardiac death!
There is a way to detect autonomic neuropathy -- even early-onset -- by looking at the heart. That's because when people have autonomic neuropathy, their heartbeats become excessively regular. (That might sound like a good thing, but it's normal for heart-rhythm to be constantly changing -- "jittering" back and forth in time -- because in healthy people, heartbeats are being endlessly advanced and retarded (to respond to bodily needs) by chatter from several independent autonomic feedback loops. When the pulse gets too metronomic, it's a sign that that the heart is losing touch with the autonomic control system and is reverting to its own internal "clock." When that happens, it's a major marker for increased likelihood of v.tachycardia, v.fibrillation, & SCD.
Stephan and Adolfo:
Fyi, I actually have some facts on fish oil & mercury.
Nine years ago I started LC on zone, and used cod liver oil for four years. Then I had my mercury levels checked from hair (thanks to a colleague who works on analytical services complementary to my field).
Result: The mercury level in my hair was second lowest of all that the lab had ever measured. So, I stopped worrying about the mercury or other heavy metals on standard cod liver oil.
Regards,
LeenaS
(However, I had to quit fish oils alltoghether soon after this, due to extra runny blood. So I'm now on my fourth or fifth year without any supplements, including the fish oil... So, my "supplements" now come from butter, bone marrow and egg yolks :))
Hi Leena, in all case RxOmega is more concentrate in EPA and DHA, which is the active part of Omega 3. Second, there are cod liver oils and cod liver oils, not all are the same. And generally RxOmega tend to be cheaper per gram of EPA and DHA.
Jenny wrote:
"Don't forget the OTHER cause of arrhytmias--autonomic nerve dysfunction. ... I am starting to think this is a huge, and completely ignored, cause of heart attack."
I totally agree! Dr. Jan Kwasnieski of "Optimal Diet" is big into this too, you should find his books interesting!
There seems to be a link between blood glucose spike --> insulin spike --> adrenal hormones spike --> thyroid --> increased blood clotting being a vital part of the stress reaction in the anticipation to injury and blood loss)
All those are considered, as far as I know, to be governed by the "Sympathetic Autonomous Nervous System". If you keep that overactive then you have all or some of the above overactive as well.
What are the most common activators of the Sympathetic System? - Nicotine, caffeine and also glucose+insulin!
What are the most powerful activators of the opposite Parasympathetic System (PS) that can balance the other one out? - Fat seems to be one (that's only my opinon based on my personal observations). The other common PS activator is Cannabis (that's not based on my personal observation).
Stan, i think you may be going out on a limb to say that fat is always Parasympathetic and that glucose and insulin (from carbs) is sympathetic. I am always relaxed and lazy after carbs, while I have lots of energy and usually don't feel like sleeping after a high fat meal. Carbs can also dilate blood vessels after a meal.
Leena,
Thanks for sharing your results.
I think Adolfo David is more of a teller than a listener.. I am more inclined to go with Stephen, Green Pastures makes an excellent high vitamin CLO. Mary Enig is also an expert on lipids and she leans to them amongst others.. I am happy with my choice. I love this site Stephen, i found it in a comment on Natural News. Great Work
We have to remember that this study used patient WITH coronary artery disease.
The way I understand it Stephan is that fish oil has never, ever been proven for PRIMARY prevention of CAD.
That is still an unknown.
Take Care
Raz
We really need to fully understand what is happening at the cellular level before we know the best diet for CAD prevention or a good diet in general.
Having persons shovel in various foodstuffs and then tracking their mortality for a few years doesn't cut it.
I wouldn' put too much weight in this study.
We have to rember that for CAD primary prevention fish oil has never ever been proven to be effective.
We really need to understand fully what is going on at the cellular level. These studies where you have poeple shoveling in various foodstuffs then tracking their mortality for a few years doesn't cut it.
Until we understand cellular biochemical operations we are just groping in the dark - and that is a fact.
Razwell/Dirk,
Your point is well taken about the primary/secondary prevention distinction and the need to understand the underlying mechanisms.
I think the observational data are very consistent with the idea that omega-3 is protective in the long term. Just look at the fish-consuming countries; they nearly all have low rates of infarction. Tissue n-6 HUFA percentage correlates well with infarction risk, as well or better than any other marker we have.
"There is a way to detect autonomic neuropathy -- even early-onset -- by looking at the heart. That's because when people have autonomic neuropathy, their heartbeats become excessively regular. (That might sound like a good thing, but it's normal for heart-rhythm to be constantly changing -- "jittering" back and forth in time -- because in healthy people, heartbeats are being endlessly advanced and retarded (to respond to bodily needs) by chatter from several independent autonomic feedback loops. When the pulse gets too metronomic, it's a sign that that the heart is losing touch with the autonomic control system and is reverting to its own internal "clock." When that happens, it's a major marker for increased likelihood of v.tachycardia, v.fibrillation, & SCD. "
IMO this is important stuff and probably explains why HbA1c has been associated with C/V disease in several studies (and metastudies).
Despite being technically "not diabetic" by a whisker, I still had significant symptoms of peripheral neuropathy, and what I now know to be symptoms of autonomic neuropathy.
One was my heart rate being locked to around 60 - 80 bpm - on exertion it would beat harder to the point of feeling like it was going to burst through my chest, but not speed up properly.
Over time with tight glucose control and Alpha Lipoic Acid, and maybe a better balance of fats including Omega 3s was a part of it, the peripheral neuropathy went away quite rapidly (though it returns if my BG goes over 140 - 150).
The autonomic stuff took significantly longer but suddenly I realised my heart was back to increasing its rate properly again.
I still occasionally get an extrasystole when falling asleep but this also appears to be significantly less frequent than it was.
My decline was rapid on the Heart Healthy High Carb Low Fat diet and my improvement on a rational diet not so rapid - but it can be done!
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