Omega-3 Supplements May Increase Risk of Cognitive Decline, Scientists Warn

#21

Yes, AF is a known risk, but how do you adjudicate between competing effects from different drugs. For example, I take 80mg/day of telmisartan.

Effect of High-dose Telmisartan on the Prevention of Recurrent Atrial Fibrillation in Hypertensive Patients

And if worried about AF should I switch from empagliflozin to dapagliflozin?

Differing Efficacy of Dapagliflozin Versus Empagliflozin on the Risk of Incident Atrial Fibrillation in Patients With Type 2 Diabetes: A Real‐World Observation Using a Nationwide, Population‐Based Cohort

Point being, that when looking at benefits and side effects, we should always look at the totality of our drug and supplement stack (plus diet, exercise, lifestyle etc.).

#22

You are absolutely correct IMO.
Based on what I know (which is not much), the health experts that I respect the most take far fewer supplements than I do. I don’t know that many of the polypharma drugs and supplements I take are actually extending my life or health span.

Matt Kaeberlein, PhD, “Supplements don’t fix a poor lifestyle.”

Michael Lustgarten: “He is a minimalist who only supplements based on demonstrated need identified through frequent blood testing.”

Gil Carvalho, MD, aligns with experts who are skeptical of large stacks, taking a “biomarker-driven, add-one-change-at-a-time approach” when considering any supplements.

Brad Stanfield, MD, Trial-Backed / Practical

IMO, the minimalist economic approach is:

  • Eat healthy; there is no definitive best diet, IMO. Just don’t overdo the calories.
  • Exercise. There is nothing other than lucky genes that beats exercise.

Most people should just go to the gym because they are more likely to comply than doing it at home. Though even a gym membership doesn’t have a high compliance rate. There are many gyms that are incredibly cheap, costing less than many supplements.

Two gyms with widespread availability in the western US are Eos Fitness and Planet Fitness; they both offer memberships at less than $20/month. And many insurance companies will pay for them, especially if you are over 65.

If you are healthy and physically fit, you need nothing more than

  • A daily vitamin, such as the one Dr. Stanfield sells or any other reputable, not overly loaded daily vitamin-mineral supplement, such as the One A Day brand. (Because nobody’s diet is perfect.)

Secondary with some proof:

  • Creatine

is especially beneficial for aiding exercise results, but it may also be good for the brain.

All other drugs and supplements must address health issues. cholesterol, blood glucose, blood pressure, etc.

Proactives include (once again, my personal opinion):

  • Statins, though I prefer Brillo EZ 180mg/10mg (bempedoic acid/ezetimibe) tablets from India. If you want to take a statin, the current flavor of choice seems to be pitavastatin, which you can source from India if you can’t get your doctor to prescribe it.

  • Telmisartan if your blood pressure is too high.

  • Imeglyn (I source from India), if you need to reduce fasting glucose and A1C

Some gurus are still taking omega-3s even though there is very little evidence of their efficacy, and recent papers suggest they may be causing harm.

Yes, I take a much longer stack based on speculation and FOMO.

1 Like
#23

That’s a separate, unrelated question IMO, and is unanswerable at this time due to lack of studies showing how those meds interact on afib risk. Even if you assume mitigation by the other medications, high dose fish oil is still an additional risk factor so should be taken into account, so it’s perfectly rational/reasonable to me to keep supplementation less than 1g per day.

2 Likes
#24

What are the benefits you expect with ~570 mg/d of EPA?

#25

Hopefully the same benefits seen in epidemiological studies with oily/fatty fish consumption 2-3 days/week since I don’t eat fish very often.

#26

Regarding that Telmi study:

Double the Dose, Half the A-Fib? A Small Japanese Trial Tests Whether More Telmisartan Is Better
The Bottom Line: A small randomized trial found that hypertensive patients taking the maximum dose of telmisartan (80mg) had fewer atrial fibrillation episodes over two years than those on the standard dose (40mg) — even though blood pressure dropped the same in both groups. It’s an intriguing signal, but 100 patients is nowhere near enough to change medical practice. Don’t adjust your medications based on this 2010 study.

If higher-dose telmisartan genuinely prevents AF beyond its BP effect, that’s clinically meaningful — AF is a leading cause of stroke and a major driver of hospitalizations. But this study can’t confirm that. It can only suggest it.

#27

Ok. Of note here after 6 weeks they didn’t find benefits with 600 mg/day EPA but they found with 1.8 mg/day. (Of note: DHA only increased LDL!) https://www.sciencedirect.com/science/article/abs/pii/S002604951630083X

The only evidence we have for EPA only is at a few g/day (and it’s still weak evidence). But maybe 600 mg/day is a “safe bet” that at worst does nothing.

2 Likes
#28

@desertshores Wow, thanks, what a generous reply. Your reply included quite a few takeaways: the quest for the "right’ multi-vitamin. Will surely give Dr. Stanfield’s one a try. Creatine - I took that in my 30s when I was seriously about the gym and building muscle. But now, for us older folk, what dosage do u recommend? I, too, thanks to this thread have used Brillo EZ w/ 1/2 dose of Atorvastatin (5mg) -I’ve had a terrible history with statins - muscle soreness, but also, half of the lips of my mouth would become numb (weird, right???!!) But the good news is I’ve had my best cholersterol tests in years. Even better than in my 30s! (Full disclosure - I have been on Mounjaro for past 6 months to squelch 25 lbs that just would not disappear, and let me tell u - that stuff is no joke.) But I’m still heavier than when I was in my 30s w/ better cholesterol tests. The pitavastatin sounds promising. The exercise and the minimalist approach makes too much sense. Living in Hong Kong, I can get 10k in walking no problem - I swore off buying another car since abandoning traffic hell Los Angeles (there is traffic in HK, but also amazing, cheap, and abundant mass transit.) Getting to the gym for muscle building still is a challenge. Some things never change -lol. Keep the sharing. Great stuff!

#29

Right, I’m treating it more as a true “nutritional supplement” for long term health than as a medical intervention like you’d see in a clinical trial. 4 grams/day is a pharmacologic dose.

2 Likes
#30

One problem is that 4 portions/week does seem notably more protective than 2 portions against neurovascular disease.

I eat oily fish 2 or 3x weekly (usually sardines/salmon) but struggle to eat consistently more.

“For participants who were in their 60s, eating fish 2 to 3 times a week reduced risk as effectively as not having hypertension would. Eating fish 4 or more times a week doubled that benefit.”

I suspect that Phospholipid DHA is the answer but the evidence isn’t clear yet.

#31

Yeah, you can always optimize further, 4 instead of 2. I personally stick to 2, occasionally 3.

But this kind of thinking is something I’ve long since shifted away from. My continuous preoccupation is the concept of “totality of effects”.

We don’t take (most of the time) one drug, or one supplement, or eat one food. It is common to focus on each element individually, whereas it’s all the elements together that matter, influencing each other.

So, if for example, I regularly consume a BP lowering food that keeps my BP in optimal range, do I need a high dose BP med?

Think of diet, there are studies showing a vegan diet as healthiest. Would you suggest a vegan start consuming fish? What if fish is healthy in the context of a specific diet, and would be superfluous or worse in a different diet.

Imagine that your aim is transportation from A to B. You can pick a car, a truck, a helicopter, a jet, a bike. But it would make little sense to sit on a bike that’s in a car and the car is on a truck, the truck is on a jet and then the jet is transported by a helicopter.

With a given diet fish 4 times a week is best, but if I am, say, achieving my BP goals with telmisartan which I also take for other “off target” reasons, then I’m not motivated to consume fish 4 times a week instead, just because it lowers BP.

Years ago - 20 at this point - on the CRSociety email list, there was a long discussion of the possible benefits of fish consumption. The epidemiological data seemed good. But there is a tension between healthspan and lifespan (illustrated by mouse studies cited on this site), and the concept of antagonistic pleiotropy. Fish might be healthy - at the cost of extreme longevity. Or at least that is a possibility. What worried us back then, was that long chain omega-3 FA get incorporated into mitochondrial membranes where it has some benefits medium term, but at the cost of greater instability, which ultimately limits the lifespan of the mitochondria longer term. There are shades of this in the brain study and fishoil - it’s highly unstable (oxidation) and incorporation can be a double edged sword. So for some longevity extremists, fish and fishoil were to be strictly avoided. Instead, relying on short chain n3 vegetable derived FA. Others tried to split the difference with a pescatarian diet of fish 1-2 times a week (that was ultimately my choice). But fish daily or 4 times a week and EPA+DHA fishoil - I’m going to pass on that. Is it an open and shut case? Nope, but that’s true in both directions - there is no proof that very frequent fish consumption is the very best approach. The fact is, we’re operating with too little information. The science is still not there. Therefore there is a degree of speculation and intuition involved in making these choices. My choice is fish 2 times a week. YMMV.

2 Likes
#32

That’s a great philosophical approach. And the healthspan/lifespan trade off from fish is new to me - fascinating.

I will now keep to my 2/3 portions a week with a more sanguine mind!

2 Likes
#33

I decided to limit Alaska wild caught salmon to no more than twice a week because of Mercury, PCBs, dioxins and now microplastics. So I added Nordic Naturals Omega 3s which are at least free of all but the microplastics. This has been a very informative discussion. It may not be worth keeping the fish oil. For me it had been a minor player in a stack rich with anti-inflammatories I am taking for long Covid and inflammaging. Thanks!

1 Like
#34

Here’s a wild one for you, Antoine. So, do we believe that statins might modestly lower dementia risk as seen in the recent large study? Are higher serum DHA levels deirable in dementia prevention? Because guess what, statins such as pitavastatin and rosuvastatin significantly lower serum DHA levels. Does that mean that one mechanism by these statins lower dementia risk is by lowering serum DHA, or despite lowering serum DHA?

Statin treatment alters serum n-3 to n-6 polyunsaturated fatty acids ratio in patients with dyslipidemia

“A total of 46 patients who were not receiving lipid-lowering therapy were randomly assigned to receive either 2.5 mg/day of rosuvastatin or 2 mg/day of pitavastatin. Serum PUFAs levels were measured at baseline, at 4 weeks, and at 12 weeks. Rosuvastatin was used to treat 23 patients, and the remaining 23 patients were treated using pitavastatin. Serum docosahexaenoic acid (DHA) levels decreased significantly at 12 weeks in both groups (rosuvastatin: from 169.6 to 136.3 μg/mL, p = 0.006; pitavastatin: from 188.6 to 153.9 μg/mL, p = 0.03). However, serum levels of eicosapentaenoic acid (EPA) and arachidonic acid (AA) did not change. In addition, the EPA/AA ratio did not change, whereas the DHA/AA ratio decreased significantly at 12 weeks in both groups (rosuvastatin: from 0.99 to 0.80, p = 0.01; pitavastatin: from 1.14 to 0.91, p = 0.003). No adverse events were observed during the study period.”

5 Likes
#35

Very very nice, thanks!

1 Like
#36

The risk of AFib is actually quite easy to manage. It all comes down to the core anti-aging philosophy I constantly emphasize: the risk-benefit ratio. Between 1 and 3 grams, cardiovascular benefits climb rapidly. Beyond 3g, the benefit curve flattens out, while the risk of AFib spikes. Therefore, the 1-3g range is the sweet spot. Of course, this is far from the final answer—not even close. Formulating a truly perfect protocol takes a considerable amount of time.

Additionally, assuming that the risks and benefits of different compounds can simply cancel each other out is a misconception. It has to be backed by specific clinical trials. It’s quite a hassle to explain, so I’ll just say: if you know, you know.

1 Like
#37

Please let us know then!

1 Like