ASK DR. BAUGHAN                                             December 8, 2000

HOLY MACKEREL

‘Tis the season to eat a lot of fat.  Gravies and cheeses, sausage, bacon and egg nog, fruitcake and nuts and candies are part of our holiday tradition of honoring the dietary habits of our ancestors who worked the land and died in their forties and fifties.  I don’t intend to try to compete with Jim Carrey for the Grinch Who Stole Christmas Dinner, but I would like to review an article by O’Keefe and Harris in the American Journal of Cardiology, May 15, 2000 entitled “Omega-3 fatty acids: time for clinical implementation?”  I hope this may offer a little seasoning to our comestibilation that may bring joy rather than distress to our hearts and blood vessels.

Drs. O’Keefe and Harris review the studies that have looked at the effects of omega-3 fatty acids on preventing heart disease, either by supplementing with fish oil capsules (1-3 grams per day) or eating a diet that includes 12 ounces per week of oily fish (salmon, herring, sardines, and holy mackerel).  Initially we thought the benefits of omega-3 fatty acids were directly connected to their effects on cholesterol, and I have had several patients who lowered their cholesterol levels with fish oil after they were not getting good results from medicines.  More systematic study, though, in several studies involving thousands of patients followed for several years, shows that the effects of fish oil are separate and independent of total cholesterol.  Omega-3 fatty acids do significantly reduce very-low-density lipoprotein triglycerides (VLDLs), which play a strong role in cholesterol-deposit formation, but they are not routinely measured in clinical practice.

Fish oil seems to work several ways to benefit the heart, although we cannot fully explain how they work.  They improve the ability of arteries to dilate when they need to supply more blood to the heart or other parts of the body.  This is one of the areas where the effect of saturated fats is becoming more apparent.  For several hours after a Big Mac with fries, even despite strong drug stimulation, our arteries do not dilate like they would need to if we go skiing or have a touch football game.  So if you are going to exercise the day of a heavy holiday meal, please do it before the meal, not after.

Omega-3 fatty acids also help prevent irregular heartbeats and lower the types of chemicals and cells that can form blockages in our blood vessels.  Men who took fish oil supplements after a heart attack had a 29% reduction in death from all causes over the next two years.  They had fewer recurrent heart attacks as well.  This is as big a benefit as the studies showing fewer heart attacks with cholesterol-lowering medicines.  Interestingly, this benefit seems to be additive to other interventions known to benefit the heart, such as taking aspirin, cholesterol medicine, and blood pressure medicine.  Don’t think of fish oil as a substitute for any of these medicines.  Think of it as another piece in the heart disease puzzle, another insurance policy (thankfully relatively inexpensive) to protect your heart.

Enjoy the holiday meals with thankful hearts, which are more likely to be healthy hearts.  Consider a Christmas salmon instead of pig, or a bottle of fish oil capsules for a loved one might make a good stocking stuffer.  Hey, if Christmas isn’t about a new way of living that can save your life, what is it about?