Fish Oils and their role in concussion recovery: Part 2

This is part 2 of a two part series on fish oils and their role in concussion recovery.

I'm joined by Dr. Michael Lewis who is an expert in the field of concussions and fish oils. 

In this episode we discuss we discuss more in depth about what you should know about fish oils.

Transcript

now I wanna start talking about fish oils. Now, one of the first brain health research studies in nutrition was looking at suicide and active duty military that you were involved with. Can you tell me about that? So as I was... Asking the original question, as anybody look at this, I knew I had to start I had to find out who knew anything about it. You know, I had to educate myself. And there weren't, like I said, only the neurosurgeon in West Virginia, Julian Bales, who is now up in Chicago. And, you know, some people might remember Alec Baldwin played him in the movie Concussion. He and I were the only ones really looking at omega-threes and things. specifically in brain injury, and still not a whole lot of people to this day are. So I had to look elsewhere. I had to find out who knows things about omega-threes in the brain in particular. So I got to know a psychiatrist at the NIH. He and I became really good friends. And I, you know, I was just learning as fast as I could from him. He had been doing twenty years of nutrition and particularly omega threes and psychiatric diseases. And so it's the brain. Right. So I can learn from him. And at one point we were out. I think he he asked me if we could just. If we could draw blood on people before they commit suicide, we could probably answer a lot of questions. I'm like, why didn't you tell me that before? That's easy. And he looked at me like I was crazy. How do you know who's going to commit suicide? The U.S. military, DOD, every time they draw blood on somebody, what's left over, they basically put it in a freezer and in the outskirts of Washington, D.C., and it's got all of DOD's data behind it. So I think now there's something like seventy five million specimens sitting in a freezer. And they've been doing this since around nineteen ninety two or so. And so so I you know, we put together a research study. We looked at one hundred well-documented suicides, one hundred suicides a year. for eight years after nine eleven because we wanted to look you know is there you know is there a component to wartime service with this and well in eight hundred well-matched controls and what i didn't realize and i found out later was we had eight hundred suicides well-documented suicides and i come to find out In that same time period, there were like thirty two hundred suicides of active duty military during that same time period. So but what that allowed us to I think actually made the study even more more valid is all the all the blood work had been drawn on those suicides within six months before they committed suicide. And so lipids, fats are really stable in the blood. So we felt very confident about that. And of course, we had tons of match controls to be able to choose from. And so what we found was a sixty two percent increased risk of suicide in those soldiers and sailors and Marines who had a DHA omega-three level of two percent or lower. So low omega. So let me put that in English. So low omega-three levels in the blood correlated to a sixty two percent increased risk of suicide, something that we could change literally for pennies a day with supplementation. And in fact, I said we had the DOD's data behind it, right? So we were able to look at who had been deployed, who had been seen for psychiatric reasons or mental health, sought mental health care. And none of those factors were anywhere near as important as literally just what were their omega-three levels in the blood. And that was the total omega-threes, not just like, well, EPA versus DHA. It was just a combined total omega-three level. Well, omega-three levels, I mean, all these were significant. So omega-three levels, but what we really focused in on was DHA levels, but omega-three levels as well. And interestingly enough, the average... Omega six to omega three ratio was twenty six to one out of balance. Omega sixes and omega threes are meant to be in balance. That's how nature designed us. And we as a society, a reflection of society, we were at twenty six to one out of balance of omega. Too many omega sixes to the amount of omega threes that we have in our blood. Yeah, so let's break this down a little bit, you know, because a lot of people are like, okay, what is this test, right? Like, can I get the test? Can my kid get the test? So I know there's different versions of this test out there, but, you know, what's one of the ones that you like for measuring omega levels and then even breaking down the ratios and kind of the distribution for the types of omega-three? Right. Well, the most... tests that have been done. So typically it's a finger prick type of test, drop a couple of drops on a filter paper and, and send it in. There's a couple of companies around the U S that do this. My favorite actually is out of Oslo, Norway. They've done over, I think now probably about one point six, one point seven million blood spot tests for Omega threes, a company that, um called zenzino z-i-n-z-i-n-o and their balance test and it's that fingerprint drop you know the filter paper stick it in the mail and you get results in two three weeks and what it's looking at is a number of different omegas and of different fats in the blood and the two most important numbers are your omega-six to three ratio, which is actually your EPA, I'm sorry, your arachidonic acid omega-six to the amount of EPA omega-three ratio. So let's just keep it as omega-six to three ratio. That's the most important number most people have no clue about. Most people know what their cholesterol is, right? Some people are going to know what their vitamin D levels are, which is really, really important in this whole talk as well. But most people have no clue what their omega six to three ratio is. And like I said, in the military suicide study, sixteen hundred patients, we had a ratio of twenty six to one. The second number that you can really get out of this is your omega-three index. It's the total percentage of your omega-threes, your EPA, your DHA, your ALA, all these combined, what percentage of all the fats, the fatty acids in the blood. So you should have an omega-six to three ratio of three to one or better. three to one, two to one, even one to one, which is how we were designed. So that's the most important number and easily the second most important number, or maybe just as important is that omega-three index, it should be eight percent or higher. So unfortunately, You know, when we said with the suicide study, we weren't looking at eight percent or anywhere near it. It was the total omega three index was around three and a half percent. And why is that important? Well, obviously for brain health, because that's what we're talking about, but also your cardiovascular risk. When you're at three to one or better or eight percent or higher, your cardiovascular risk goes down by almost fifty percent. And so it's something that we always talk about cholesterol, but nobody's talking about these omega threes and your risk factors. It's probably more important than knowing your cholesterol. Yeah, it's important when we talk about these numbers as well, you know, as I do one called Omega Check, you know, and the lab reference range kind of you've got to kind of ignore it. You know, whenever we're looking at a total omega three level of greater than eight percent, most labs are like five point five or above. They're like giving you two thumbs up gold stars and really on the omega six range. The three ratio, most of them are just like, they kind of almost consider anything normal. They're not looking at a three to one, a two to one. And that's, that's the other thing, you know? So for those that are going to ask a provider to get this test, like actually look at your values. Don't be like, oh, well they told me it was normal because what the lab considers normal and what's truly best for health are two different things. Well, and, you know, we could pick on anything. Let's pick on testosterone and men for a second, just because it's a pretty straightforward way to explain it. And, you know, there's some tests I say you've got to look in a horizontal way, like TSH for thyroid, where, you know, it's from zero point four to four and a half. Well, that's a huge log scale range where on that horizontal scale, you want to kind of be more in the middle, like around two. Right. So you want a much more narrow range. It's optimal, not just quote unquote normal. But let's you know, in the testosterone, I look at it more in the vertical way scale. And so you know, different labs, different values, but it's generally around a total testosterone of three hundred at the low end to eleven hundred or twelve hundred at the high end. And that's not a range. It's a three or four fold difference. And, you know, so It's a people want to call it a normal range, but it's not a normal range. It's the reference range. And what does that? So what's the definition? It's over the last ten thousand tests that were done by that lab. It's the mean plus or minus two standard deviations. That's all it is. They're nothing. So what? if you've seen studies you know decade after decade after decade the average testosterone level in a forty-year-old male let's just say has come down decade after decade after it's gotten lower and lower and lower so that reference range continues to change but that's has nothing to do with optimal correct kind of like and i'm happy to find that one what's that I said, I'm gonna have you define that one more time. Cause I really want people to hear that again, because people get so stuck on a lab range, but define once again, walk through how they come up with the reference range, because we need people to really see this from what the range is versus what kind of is reality. Well, it's not just that. It's really, I would argue, it's what's the quote-unquote normal range or the reference range compared to what is optimal. And I want to explain it in terms that most people can understand. If you're in high school and you're taking the SATs, do you want to be in the fifth percentile or the ninety-fifth percentile? Right. You know, you may get into Harvard or Yale or Stanford if you're in the ninety fifth percentile, but they're not even going to think about you in the fifth percentile. So, you know, optimal, maybe you can understand it in percentiles like that. Right. So we typically want people to be and depend on what we're measuring. But something like testosterone, we typically want to be seventy fifth to ninety fifth percentile. That's optimal. where you're going to feel good and where you should be. You know, you take a forty five, fifty year old man and they've got a testosterone of three or two and the doctor looks at it and doesn't see an L by it, you know, saying it's low and says, oh, you're normal. Well, OK, but is it optimal is the question you should be asking. So, again, it's determined by the lab over like the last ten thousand tests that You're looking at the mean plus or minus two standard deviations. So it's completely a statistical thing. It has nothing to do with are you normal? Are you optimal? Are you anything other than do you fall within two standard deviations? Yep, so ultimately there's a lot of sick people who are in there. They're skewing the values. It's just like a test score, right? You've got lots of people who don't do well. They're changing what the median number is. They're changing what the average is. And we could talk about this with so many labs, but with us focusing on omega-threes, we've talked about kind of the ratios of three, the six to three ratio, suicide, but what do omega-threes even do in the brain? Like why do we take specifically DHA? Like what's it doing? Well, and some people, you know i give a lot of talks around the the world and um and sometimes the sophisticated audiences will like well you know why do you even bother with epa um when we're talking about the brain like how do you discount epa and only focus on dha So the quick backstory on that, right, is omega-threes, they're carbon, you know, so ALA is eighteen carbons in length, EPA is twenty carbons in length, and DHA, twenty-two carbons in length. And why we call it omega-threes is from the end, the first double bond is three carbons in from the end. from the end so if you were to take one of those high school chemistry balls and sticks and and make a dha molecule with the double bond what you would see is it's a very flexible molecule whereas an omega-six the twenty carbon arachidonic acid which is the main one found in the brain it's got right that omega-six so the first double bond is six carbons in it's a very stiff molecule. And you would see that if you had a model. So it's very stiff. So let's look at red blood cells for a half a second. So just red blood cells floating around, you got EPA, DHA, you got arachidonic acid in there. And If you have way more arachidonic acid, you've got stiff molecules in the membrane of the red blood cell. Well, the red blood cells got to think about it going through the smallest of capillaries. And that red blood cells got to squish through those small capillaries. membrane, it's not going to do that very well. So it's just not going to happen. Whereas if you've got flexible molecules in the membrane, that's going to happen a lot easier. So, you know, that's just a structural component of it, whether, and that's also correlates to a stiff membrane is not going to allow the inflow and the outflow of the different types of things, whether it's calcium and potassium or toxins in and out of, of the memory, you know, you need a flexible membrane and it helps allow the essentially like the cell to breathe. and obviously no more important than in the brain. DHA is what's found typically in the membranes, whereas EPA is more of the downstream important in heart health. But the downstream effect from EPA helps relax blood vessels so that the blood can flow easier through there, whereas DHA is more in the membrane of cells, most concentrated actually in the retina and second in the brain. And the downstream effect, you know, there's constantly, you know, this constant turnover. And as the omega sixes and omega threes are released from the membrane, the downstream effects have two different things. Omega sixes are pro inflammatory. And omega-threes are anti-inflammatory, those downstream effects. And also the downstream effects of DHA, they've got things called resolvins and protectins. So the names kind of tell you what they do, right? And so that's really important in inflammation. So you've got the pro-inflammatory, and you got the resolving uh or you know it's a little misnomer to call it anti-inflammatory it's more resolving but we'll just keep it simple and call it the anti-inflammatory meant to be in balance right that one-to-one ratio but when we're twenty six to one pro-inflammatory to the anti-inflammatory, it's no longer a fair fight. The other workplace where it really has an effect in the blood cells arena, again, is the omega-six downstream effects are pro-clotting. Whereas omega-threes are pro-not clotting, right? Anti-clotting. And so it's meant to be balanced. So your blood needs to be able to clot, right? You have a damaged blood vessel, you cut yourself, you want your blood to clot. But if your blood clots too easily, that's... causes things like heart attacks and strokes, right? So obviously we want a good balance between pro and anti-clotting as well as pro and anti-inflammation. And I'll just kind of bigger picture thing. Muhammad Ali, right? Took a bunch of hits to the head as a young man, died of Parkinson's, much later in life, but it was sad to see how he aged. Was there a connection? I think most people would argue, yes. The question is, what's that connection? I would argue that connection is inflammation. and that the inflammation never quite gets resolved. And that's where we are with our food supply and where we're not providing the things to help resolve the inflammation. That's where we start talking about CTE with football players and others. It's this chronic inflammation that we continue to be exposed to that makes all the difference in the world. Yeah, absolutely. It's, I think it's the inflammation as well. You know, that's the biggest thing. And that's where some of this imaging in the future looks pretty intriguing because they can actually detect the inflammation that's still persisting and You know, there's even research that was done, University of Montana or Montana State, they looked at football players that were doing a blend of fish oil supplements before the season and throughout, and they saw less brain damage with subconcussive blows compared to those who didn't take any fish oils. They were looking at a market. Texas TCU. TCU. TCU, Texas Christian University, twenty fourteen football season. OK, they did this one there, too. Well, that was the one that that kind of started this whole process. Jonathan Oliver was the lead researcher. I was an advisor on that. And what they did was they started June first through the end of the football season, and they had everything from zero placebo. and different levels of omega threes, principally DHA. And what they found was that neurofilament light, a marker of inflammation, was decreased or blunted is a better way to put it with the omega-three levels uh with people with the players that were taking omega-threes versus the ones that were taking a placebo and so you know while it wasn't enough to show that it decreased concussions they actually had half the number of concussions that they historically would during a year but the numbers weren't big enough to be able to report that they were able to show that the neurofilament light uh was blunted with omega-three levels which is massive because neurofilament light which you know we don't have time to go into it but it's ultimately a marker of damage And so that's super important. And so when we're talking about preventing concussions as well as helping people recover, one of the first things we talked about is there's just not a lot of talk about nutrition. So we know the omega sixes are bad. What are some of the foods that people are eating that, you know, you're just like, look, parents, coaches, trainers, please just have your athletes stay away from the, you know, it's driving a lot of inflammation. inherently bad, they... we just consume too much of them. So they become bad just because of the abundance of it. And so you need omega-sixes to make a brain and keep a brain healthy. But again, it goes back to balance and you need that to be balanced with the omega-threes. So pre-industrial revolution, that ratio was really pretty close or around one to one. And we're talking about, you know, people that live nowhere near the ocean, didn't have access to seafood, and yet the ratios were still pretty good. Reason why? Because you're eating wild game and natural things from nature and, you know, Everything from, you know, in today's world, you think of say, you know, hunting wild deer type of thing, or free range chickens might be, you know, or grass fed beef. You know, once the industrial revolution came along, then that ratio started to change But then it really accelerated in the late sixties, early seventies with the Farm Bill. And how can we grow more calorically dense foods industrially? And the food that fit that the most was soybean. And so that rate, the amount of soybean consumed in the United States went up sixteen to twenty percent or not percent sixteen to twenty fold, like sixteen thousand percent. And you're like, well, but I don't eat soybean. Well, you think you don't, but you do. It's in everything. It's everything from the bottle of salad dressing. If you look, one of the first ingredients, soybean oil. But it's also what's fed to, you know, soy and corn are the principal animal feeds in the country. And it's what's fed to the cattle and to the chicken, to the pigs and so on. So we consume huge amounts of soybean, whether you know it or not. And partly because the omega-sixes are not only a stiff molecule, but they're shelf stable, right? So you could put a box of crackers out into the sun for three days, might be a little stale, but you could still eat them. You put a piece of fish, which is high in omega-threes, you can put it in the sun for an hour and you may not want to eat it. Right. Because the omega threes are unstable and they spoil quickly. So what do we do if we want to process foods and ship it around the world? You're going to process them with omega sixes because they're stable. So the processed foods are what's really bad. had an impact on our omega six to three ratio. So we've gone from one to one to five to one to twenty five to one over the last, you know, since World War Two, really. And so it's really about that ratio. What we need to do is we need to get back to eating more wild game. But so principally the biggest and best source of omega threes to offset those omega sixes is fresh caught seafood. Basically, salmon is about the most perfect food. The wild caught salmon is about as good as you can get, which nowadays we can ship it around the world and you can get access to it. And like I said, you know, fifty years ago, you couldn't get access to fresh salmon. So it was, you know, how did that change? It's important. So good wild caught seafood is our biggest source of omega-threes but also leafy green vegetables the spinaches and the dark green vegetables um you know we just got to get back to and you probably do this in your own practice right what am i really describing here a mediterranean diet right So if you want a word or two for somebody like, geez, I don't remember what he said, just remember this, Mediterranean diet. And that will tell you everything you need to know. It's the only diet, if you will, and it's not really a diet, it's a way of eating. It's the only diet that's ever been shown to actually be good for cognition. It's the only one that's ever been scientifically studied and shown. and so you think about what a mediterranean diet is it's eating closer to nature it's you know lean proteins more seafood fruits nudge vegetables what nature provides us not what man has processed and puts in your fast food bag when you go through the drive-thru yep absolutely you know it's getting rid of a lot of processed foods going more you know, like you said, healthy, fresh fish, wild caught, and not everyone's going to get everything they need from the fish or else, you know, their numbers are so skewed because of what they've been exposed to. And I know you've been around the fish oil industry for a long time. And people see all sorts of different stuff in the grocery stores. They see it on Amazon because fish oils, you know, they're being talked about a lot more in general and people are going and they're spending all sorts of money on it. But what should people know about what they're doing? What should they even be looking for so they can make sure they're getting what they hope they're actually getting? Well, unfortunately, you get what you pay for is as the old adage. Right. And so if you think you're getting a good deal because you're going to a big store and getting a gallon of fish oil for five dollars, you're probably not getting a high quality fish oil. I would argue in some ways any fish oil is better than none. But better and more fish oil, you know, omegas are better than some is one way to look at it. So, you know, you're right. I've been around the industry a long time. I know a lot about the manufacturing and a couple of things. So I'll say you go to your local drugstore and you get the generic brand of fish oil. It's a thousand milligram capsule and it has one hundred eighty milligrams. And this is the only important part. How much EPA and how much DHA are in that capsule? And so you got a thousand milligram capsule and you have a hundred and eighty milligrams of EPA and a hundred and twenty milligrams of DHA. Add them up. What do you get? You got three hundred milligrams of EPA, DHA or a hundred. We'll just call it omega threes in general. So you got a hundred. I'm sorry. Three hundred milligrams of omega threes. But it's a thousand milligram capsule. What's the other seven hundred milligrams? Oh, I don't know, because they don't tell you. Right. So you don't know what you're getting in that. And, you know, knowing a bit about the process, let me dispel one other myth. There's. I'm not going to say zero, but there is as close to zero percent chance of getting bad things in a fish oil as in terms of mercury, PCBs, heavy metals. Every fish oil on the market goes through a cleaning process. to clean those things out. A hundred percent of the fish oils go through that process. It's not a hundred percent exact, but it's, but so it's as close to zero as you can get of risk of getting. So if you hear don't take fish oil capsules, cause you'll get too much mercury. I call BS, it doesn't exist, it's not an issue, but it's quality. So the best products, if we're just talking about a capsule, the best products out there are gonna be, so if you think about it, about three hundred milligrams in a thousand milligram capsule, it's a thirty percent concentration is one way to look at it. The best products available on the market are actually in triglyceride form, which is you squeeze a fish, that's what you get. and ninety percent concentration well if you're gonna talk about what does it take to get a ninety percent concentration in a triglyceride form that takes some serious manufacturing and manufacturing know-how so it's going to be more expensive but the quality that you're going to get is exceptional and far better than your cheap generic brand that you get at your local pharmacy or drugstore So, I mean, I could go way into it far more if we had more time, but I'm going to leave it at that. You get what you pay for. Correct. You get what you pay for and don't get so distracted by the front label where they say you get one point five grams or one gram. Know what's on the back, as you've talked about, because you may not. You have to learn to read the labels. Yeah. What you're hoping, you know, and. I mentioned triglyceride form. And let me just say a couple of words really quick about that. Triglyceride form. You squeeze a fish, you get mostly triglyceride form. And that's really important. The manufacturing process, when you're going through that cleaning process, they break apart that triglyceride and they have to combine it with something like sodium needs chloride, you know, to stay stable. You need acid in the base, you know. So they combine it with an alcohol molecule. And that's called an ethyl ester now. And they're able to more easily separate out the good from the bad and get rid of the mercury and all that. But what the cheap ones do is they just put that in a capsule and sell it. It costs like nothing to make. And so you've got this ethyl ester. So if you're looking at a label in a bottle and it does not tell you it is specifically in triglyceride form, It's an ethyl ester form without a doubt. And you know, there's no exceptions to that, that I know of. And why do I bring this up? Because you eat fish and it's triglyceride form. Our body knows how to digest it. We have the enzymes to digest triglycerides. It's just part of natural food. And so we can easily digest triglycerides and But our body, ethyl esters are a new thing. It's only been around about two or three decades. Our bodies don't know how to digest ethyl esters. And so you're wasting your money anyway because so little of it actually gets through the intestine into our bloodstream because our bodies don't know how to digest the ethyl esters. So you're wasting your money anyway. Spend a little bit more money, get a good triglyceride form, and get one that's concentrated and even better for you. Yep. Absolutely great information, you know, and then with your book, When Brains Collide, where can people get that from if they want to? So I'm going to hold this up. I know I've got sort of that green screen. I'm going to hold it up over my face for a half a second so people can see it. Hopefully that comes through. Yep. So you got an idea what it looks like. When Brains Collide is available principally on Amazon. It's a just-in-time print. So you order one, they hit the print button, and off it goes. So you can find When Brains Collide on Amazon. And it's actually been out for eight years now. and continues to sell month after month because hopefully, really, people say, well, you should update it. I'm like, there's really not much to update because the message is still the same. So When Brains Collide, available on Amazon. Yeah. And then last thing I wanted to ask you, you know, and have you share with people is you've got a nonprofit, the Brain Health Education and Research Institute. Tell people about that really quick. You know, what's it about? Who's it for? And where can they learn about that? So when I retired from the military, thirteen years ago now, I started Brain Health Education Research Institute and education and research so i you know used it to be able to try to influence research but also as a forum to be able to educate people um and so brainhealtheducation.org or brain health education on facebook or brain health ed on twitter slash x um information out there. I'm constantly putting out educational information. Every day I get feeds on what's the latest news in brain trauma and omega-threes. And so I put out interesting articles all the time through principally through the Facebook. I used to send out a newsletter all the time. I'm starting to get back into that. But over the last few years I've started, there's been more and more of a need and people asking me for it. So we basically have started to, in addition to education, we're doing a little bit more direct care principally of veterans, but we're looking to expand beyond veterans into You know, there's so many concussions. There's millions of concussions a year. So there's a big need for help for not just for the information, but what do I do? And so we're we're we're transitioning into a more of a service organization, if you will. And so our sort of our service side, think of Brain Health Education Research Institute. in addition to the brainhealtheducation.org education side of things. Okay, awesome. Well, thank you for joining us today. This has been awesome talking about concussions, omegas, and just so much more to help parents and loved ones of those who've You know, had people in their family who've suffered a concussion or even individuals themselves who've had concussions and are trying to help, you know, in that acute phase, but also long term, keep their brain in the best spot possible. So thank you for joining me. I say, you know, when brains collide, just in case you're timid about, you know, thinking about getting it. The audience, the book is written for the soccer moms out there, really. So I say moms can change the world. And that's who I really wrote the book for. So, you know, think of it in those terms. It's not a textbook. It's written for the moms out there just trying to make a difference in their family. Awesome. Thank you.