DHA: the crucial omega-3

Of the two omega-3 fatty acids that are best explored, EPA and DHA, it is likely DHA that exerts the most blood pressure- and heart rate-reducing effects. Here are the data of Mori et al in which 4000 mg of olive oil, purified EPA only, or purified DHA only were administered over 6 weeks:

□ indicates baseline SBP; ▪, postintervention SBP; ○, baseline DBP; •, postintervention DBP; ⋄, baseline HR; and ♦, postintervention HR.

In this group of 56 overweight men with normal starting blood pressures, only DHA reduced systolic BP by 5.8 mmHg, diastolic by 3.3 mmHg.

While each omega-3 fatty acid has important effects, it may be DHA that has an outsized benefit. So how can you get more DHA? Well, this observation from Schuchardt et al is important:

DHA in the triglyceride and phospholipid forms are 3-fold better absorbed, as compared to the ethyl ester form (compared by area-under-the-curve). In other words, fish oil that has been reconstituted to the naturally-occurring triglyceride form (i.e., the form found in fresh fish) provides 3-fold greater blood levels of DHA than the more common ethyl ester form found in most capsules. (The phospholipid form of DHA found in krill is also well-absorbed, but occurs in such small quantities that it is not a practical means of obtaining omega-3 fatty acids, putting aside the astaxanthin issue.)

So if the superior health effects of DHA are desired in a form that is absorbed, the ideal way to do this is either to eat fish or to supplement fish oil in the triglyceride, not ethyl ester, form. The most common and popular forms of fish oil sold are ethyl esters, including Sam's Club Triple-Strength, Costco, Nature Made, Nature's Bounty, as well as prescription Lovaza. (That's right: prescription fish oil, from this and several other perspectives, is an inferior product.)

What sources of triglyceride fish oil with greater DHA content/absorption are available to us? My favorites are, in this order:

Ascenta NutraSea
CEO and founder, Marc St. Onge, is a friend. Having visited his production facility in Nova Scotia, I was impressed with the meticulous methods of preparation. At every step of the way, every effort was made to limit any potential oxidation, including packaging in a vacuum environment. The Ascenta line of triglyceride fish oils are also richer in DHA content. Their NutraSea High DHA liquid, for instance, contains 500 mg EPA and 1000 mg DHA per teaspoon, a 1:2 EPA:DHA ratio, rather than the more typical 3:2 EPA:DHA ratio of ethyl ester forms.

Pharmax (now Seroyal) also has a fine product with a 1.4:1 EPA:DHA ratio.

Nordic Naturals has a fine liquid triglyceride product, though it is 2:1 EPA:DHA.

Comments (5) -

  • Jakub Polec

    5/22/2013 5:59:53 PM |

    In some DHA, or DHA+EPA supplements one can find additions with for lipase-enhanced digestion which support absorption of n-3 FA. Therefore any supplements with > 1g/d DHA+EPA (or purely DHA) should influence our health.

  • Susie

    5/30/2013 1:02:21 PM |

    Dr. Davis,

    Very happy to learn this distinction between forms of the fats. Are triglyceride and phospholipid two different forms or are they the same? Do you happen to know anything about the Swanson brand which has an EcoMarine trademark?

    Thank you,


  • john pop

    6/11/2013 12:33:21 AM |

    Dr Davis, what about Nordic Naturals DHA Xtra Strawberry softgels?

  • Annette

    6/11/2013 2:35:31 AM |

    I've been totally grain-free and dairy-free for over a yr.  My total chol is 177, HDL is 83, LDL is 88, Triglycerides are 30 and risk factor 2.7, but a 64-slice heart scan done in May 08 showed plaque to two coronary arteries.  I had a stroke in my 40's and lost the sight of one eye.  My dad died of a stroke at age 35.  My grandfather died at 68 of a heart attack.  I'm 70+.  On my insulin sensitivity score ranging from 0-100, I scored 1.  Dr Douglas Brown, Brookfield said, "I've never seen such a low score for insulin sensitivity or triglycerides.  My BP fluctuates wildly.  Some days I don't require any Lisinopril and other days I require 20+ mg.  He thinks I should have a heart cath, but with such great labs, I highly doubt that Medicare would approve.  I wish I knew what to do about the BP.  I do go to Pulmonary Rehab classes for bronchiectasis, but I'm chronically fatigued.  We've had both radon and mold remediation done at our home and a Naturopathic dr told me I have an extreme amt of lead toxicity.  I need advice.

    I have your book and your CD's.  Listening to the CD's is what made my husband decide to go off grains, other than a little rice occasionally.  He dropped 20lbs fairly quickly.

  • DDR

    6/23/2013 12:59:33 PM |

    I get very itchy skin when taking more that 2 capsules of Nordic naturals. Any reason for this? Advice?

Track Your Plaque in the news

Track Your Plaque in the news

The NPR Health Blog contacted me, as they were interested in learning more about health strategies and tools that are being used by individuals without their doctors. The Track Your Plaque website and program came up in their quest, as it is the only program available for self-empowerment in heart disease.

Several Track Your Plaque Members spoke up to add their insights. The full text of the article can be viewed here.

How's Your Cholesterol? The Crowd Wants To Know
Mainstream medicine isn't in favor of self-analysis, or seeking advice from non-professionals, of course. And anyone who does so is running a risk.

But there are folks who want to change the course of their heart health with a combination of professional and peer support. Some are bent on tackling the plaque that forms in arteries that can lead to heart disease. They gather online at Track Your Plaque, or "TYP" to the initiates.

"We test, test, test ... and basically experiment on ourselves and have through trial and error came up with the TYP program, which is tailored to the individual," Patrick Theut, a veteran of the site who tells Shots he has watched his plaque slow, stop and regress.

The site was created in 2004 by Bill Davis, a preventive cardiologist in Milwaukee, Wisc. Davis is also the author of Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health, which argues that wheat is addictive and bad for most people's health. Davis recommends eliminating wheat from the diet to most new members of Track Your Plaque.

"The heart is one of the hardest things to self-manage but when you let people take the reins of control, you get far better results and far fewer catastrophes like heart attacks," Davis tells Shots.

Doctors typically give patients diagnosed with heart disease two options: take cholesterol-lowering statin drugs, or make lifestyle changes, like diet. It's usually far easier for both parties — the doctor and the patient — to go with the drugs than manage the much more difficult lifestyle changes, Davis says.

"Doctors say take the Lipitor, cut the fat and call me if you have chest pain," he explains. "But that's an awful way to manage care."

TYP has members submit their scores from heart CT scans, cholesterol values, lipoproteins and other heart health factors to a panel of doctors, nutritionists and exercise specialists. Then they receive advice in the form of an individualized plaque-control program. But the online forum, where users share their results with other members and exchange tips, is where most of the TYP action happens.

The community currently has about 2,400 members who pay $39.95 for a quarterly membership, or $89.75 for a yearly membership. Davis says all proceeds go towards maintaining the website.

Ilaine Upton is a 60-year-old bankruptcy lawyer from Fairfax, Va., and a TYP member. At a friend's suggestion, Upton decided to get a heart CT scan in July. Her score was higher than it should have been (22 instead of 0), so she decided to get her blood lipids and cholesterol tested, too, and sent a sample off to MyMedLabs.com.

She learned that her LDL particle count was over 2,000 ("crazy high," she says), and she posted her results on TYP. Davis advised her that a low-carb diet would reduce it, so she decided to try it.

Since July, she says she has had "excellent results" with the program, and her LDL counts are coming down.

"It would be nice to have a [personal] physician involved in this, but [my insurer] Blue Cross won't pay if you are not symptomatic, and I am trying to prevent becoming symptomatic," says Upton. "I feel very empowered by this knowledge and the ability to take better control of my health by getting feedback on the decisions I make."

Comments (6) -

  • Ali

    9/24/2012 8:24:33 PM |

    Dear Dr. William Davis,

    You have been a tremendous force in helping me recapturing my life. I called your office today. Let them know that I live in Baltimore Maryland and would like to see if it is possible for you to review some details of my cardiovascular disease status. I can send you my history and blood test information through email. You can interview me over the phone if you feel it is necessary. I can pay the bill related to the “virtual” visits using check, money order, visa, etc and in advance; however the preference is.

    Please advise. Thanks again for having made TrackYourPlaque possible. It is truly a practical tool for shifting the paradigm in health management.

    Ali Khorramshahi
    DigitaLogic, Inc.
    711 West 40th Street.  Suite 315 Baltimore, MD 21211
    t: 410.662.9500 Ext. 2545 o I o f: 410.662.9400 o I o e: ali@DigitaLogic.com
    c: 443.845.6033
    h: 410-669-3266

  • Dr. Davis

    10/3/2012 1:41:56 AM |

    Thank you, Ali.

    But I would urge you to use the resources here and in the Track Your Plaque program, as well as the information in the Wheat Belly book and blog.

    Given the pressures on my time, I am no longer able to see new patients and am barely able to provide any more teleconferences, as I am traveling to speak and consult for the development of new, alternative, wheat-free foods.

  • Gene K

    10/10/2012 2:43:39 PM |

    Dr Davis,

    It would be nice if your 2nd edition of the Track Your Plaque book were actually published. I've been using it in PDF, but your TYP followers need it as a real book, on par with Wheat Belly. Do you have plans to do it?

    Thank you so much for everything you are doing!

  • Jim Stewart

    11/21/2012 5:41:48 PM |

    I have been scouring your website and have not found what I am looking for.

    I want to lay out for my cardiologist a clear and detailed request as to why he should support the required testing in TYP.  They do not have respect for any course of action other than the current generally  accepted, woefully inadequate, standard of care. I recently had 3 stents to correct 2 100% blockages (RCA and Circumflex).  Kaiser will not pay for scans nor any lipid testing other than total cholesteral since they say the results will not alter their proscribed treatment.  I want to undestand why I have the CAD and take steps to measure and reverse it.  I do not wish to wait till the widowmaker clots too.

  • Dr. Davis

    11/22/2012 1:40:35 AM |

    Then, I fear, Jim, that the answers will not come from your doctor. Your best bet is to get out of the system and/or find someone within the system willing to work with you.

    In effect, your doctor is saying, "I have chosen to ignore the thousands of studies that demonstrate why simple cholesterol testing fails to fully characterize coronary risk in a substantial number of people. I therefore place the burden of proof on YOU."

    Imagine you take your car to the mechanic and ask why the engine isn't running. Instead of providing an answer, the mechanic says, "Hey, if you want your car fixed, then you tell me what you want done!" We would walk out in disgust. You should do the same with your doctor.

    YOU are not the problem. Your doctor is the problem.

  • Susan Brauer

    2/17/2013 3:25:45 AM |

    Can you supply a list of doctors who agree with your approach to heart disease.  I am trying to get my doctor to authorize a VAP test and they will not do it because they have never heard of it before.  It is so aggravating that I can't just get one done.  I live in Springfield, Illinois.