The Truth about Saturated Fat, Omega-3 Fatty Acids and Total Mortality | Dr. Tom Brenna

24:53Dr. Gabrielle Lyon:And somehow that, they didn't know it was dangerous at the time. That's fair to say. And then that trans fat made it into the general American diet. Is that kind of what happened? That's kind of what happened, yeah. Because you start out saying in Europe it was whale oil and fish oil, but in the U.S., it would have been partially hydrogenated vegetable oil. Call it trans. That's what we call it these days, trans. So it would have been trans fat. And so the trans fats that would have been less expensive. And so if you say, well, if we don't know if there's anything wrong with it, it's not toxic.

25:37It tastes good. It makes wonderful pie crust. You're telling from a friend. I am extolling the culinary virtues of Crisco, the original stuff with trans fat hair. But do you know that it really is not a great thing for your health? I'll make one other point. We talk about these things like the world is a static place, like there's no other background. Those of us of a certain age remember when people were smoking two to four packs a day. Almost everybody in the 60s and 70s knew somebody who was a chain smoker. Lights one cigarette with the last one. And so think about what smoking is now known to do.

26:22And I scratch my head and I think, well, if I smoke four packs a day, maybe hydrogenated fat, who cares? Just making the point that it's a different world now. And the risks are different. So getting rid of smoking probably unmasked some risks. because smoking was not that unusual for people to have, particularly men, to have heart attacks in their 40s and 50s.

26:55Dr. Gabrielle Lyon:So what you're saying is, if I'm understanding you correctly, is that we created these dietary guidelines of, again, 10 % saturated fat. That's been maintained since what? 1980, probably, but it's probably 90 at least. But the number is basically picked out of a hat. There isn't some curve that somebody has made. Ah, there's a threshold. So the last I looked, which are not terrific numbers, it's ask people what they eat and see what they say. What did you eat yesterday? I don't remember. Remember? Exactly. Something. Yeah. Anyway. This is the problem with food frequency questionnaires is that, I don't know, RJ, what did you eat?

27:36Dr. Gabrielle Lyon:RJ, you probably don't even know that you had protein waffle pancakes. Well, a food frequency questionnaire asks you how many times you ate it in the last month. and a large fraction of people claim that they've eaten under 600 calories, which means they would be dead. So, yeah, anyway. So the rationale of the 10 % is based on cardiovascular disease risk reduction. From partially hydrogenated whale oil. That seems like a problem. I think it's a problem, too. And I really wish the ASN would look very carefully at the studies, as some of us have, and would really look carefully at what's saturated fat and what isn't.

28:22I actually don't think there is a lot of data on saturated fat. I don't think there is a lot of clean data on it. There is data on dairy. And over the years, the word saturated fat has been a code word for dairy. So you say, well, saturated fat. And then people say, oh, so what's saturated fat in? Ah, butter. Well, okay, yes, that's true. You've just figured that out. But that's where they were leading you when they said saturated fat. So, but what are the original data that people have looked at dairy and you don't see a great deal of, you just don't see risk here.

29:01Dr. Gabrielle Lyon:So as we frame up this new dietary guidelines, Again, the 10 % saturated fat has not changed since... Actually, I have something else for you. Oh, great. Yes. Okay, terrific. Let's see. It's an act that was passed unanimously in Congress and signed into law in January. Of this year? Of this year. It's something like the Whole Milk School Lunch Act, something like that. And that act authorizes the use of full-fat dairy in the schools. And it has a wonderful little line at the end. It says, saturated fat in whole-fat milk shall not be counted towards the 10%. In other words, Washington has taken saturated fat off budget.

30:07They do that sometimes with the budget over the years, and what they basically said is the school lunch won't count that. Well, all of a sudden there is no cap in school lunch, is there? Wait, so explain this to me differently so I understand.

30:23Dr. Gabrielle Lyon:So saturated fat is at 10 % for the dietary guidelines. Yes, that's right. Okay. And then when it comes to clusters or groups or schools, then the whole milk saturated fat doesn't count. In the school lunch program. In the school lunch program. Saturated fat that comes in as whole milk could be flavored, but it comes in as whole milk. It doesn't count towards the 10%. So you can have 10 % in everything else. and then as long as you're drinking milk, you can go any number you want. Explain to me how that works. Like, is that... So I have a hamburger. But I mean, like, is that a good thing that it doesn't count?

31:05Dr. Gabrielle Lyon:Is it sending confusing messages? I'm making the point that the 10 %... Is a made-up number. Well, it is a made-up number, but it may have been maintained, but it hasn't really been maintained everywhere. They've gotten around it in school lunch. I see. That's the point I'm making. I am pretty sure they didn't want to keep it. But the act that was signed by the president in January, I think it was around January 14th, the act that was signed by the president passed the Congress by unanimous consent. Everybody voted for it. Nobody voted against it, not a single person. So when is saturated fat not saturated fat?

31:47when it comes in as whole milk in the school lunch program.

31:51Dr. Gabrielle Lyon:That is confusing, right? So if you're thinking about, and here's the definition of saturated fat. Saturated fat is a fat found in animal products. Now this is, let's just go here for a second. Okay. Like fatty meats, beef, lamb, pork, and full fat dairy. As well as tropical oils and many processed baked goods, pastries, fried foods. I'm going to pause there. It also says it is typically solid at room temperature and should be limited in the diet. Okay, let's just pause. saturated fat is a type of fat found in animal products like fatty meats but from my understanding and from looking at the data almost 50 percent of the fat in say fatty meat like beef is monounsaturated there's a lot of monounsaturated in there yes that's right so now if we're thinking about science and this is the whole idea is that we're trying to to make the best decisions we can And this is information that I am reading.

32:48Dr. Gabrielle Lyon:And then it's saying that it increases the risk of heart disease and that we should recommend replacing saturated fat with unsaturated fat from olive oil, nuts and avocados. And then quickly underneath that, there's the American Heart Association that says limits saturated fat to less than 6 % of total calories. This is 2024. How do we reconcile all this? Wow. How much time you have? At least two hours. Well, may I ask who said that? Which one? All of it. Okay. Well, the first one comes up with a Google, and I did this actually on purpose. Okay. So this is what a person who is looking on the internet would come up with.

33:32Dr. Gabrielle Lyon:So this is put it in Google, use AI mode. Okay. AI mode says and gives this information. And this comes from, this is a university. I don't know if I'm going to say it. And then also the American Association. That's all fine. I just want to get an idea. And also I want to say one more thing, which I forgot to say in the beginning. All of your comments and opinions, they're all your own. They are not associated with any university. They're not associated with any government agency or HHS. So I'm going to. Everything I say is my opinion. That's right. Thank you very much for that. Anyway. Yes, that's correct.

34:04Right. So I see what you did there. What you said is, well, I'm going to Google it and see what comes up and hear all this stuff that's really confusing. And I would agree it's confusing and it is contradictory. And so if it's contradictory, I can't really explain it. I can only tell you what I think is right, which is where we're going. So I think the 10 percent limit is not justified. I've said that before. I think the 10 % limit chases us away from highly nutrient-dense foods and actually causes nutrients of concern.

34:40Dr. Gabrielle Lyon:Give me an example of what this would be. Would that be zinc, selenium, B12? Bingo. All that stuff. And we know that we can recover much of that by dairy, for instance. But if you're scared of cheese and milk and things like that, then you're going to stay away from it because you think it's going to give you heart disease. One of the things that really bugs me about this and I would query more in that Google inquiry is to get away from the cardiovascular story. because when we look carefully at whether saturated fat, defined however you like. I was going to ask you to define, okay. When we look at that in terms of total mortality, you don't see effects.

35:32If you don't see effects, why are we focusing on cardiovascular?

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37:14Dr. Gabrielle Lyon:Correct. The American Heart Association, again, I am on now. I've switched to a search engine that I use called Open Evidence. I have no relationship with them, but this is, you have to have a medical license to be able to look at this. And this scours for, you can put in criteria, but it's typically journals. So it's the New England Journal of Medicine. It's all academic, Journal of the American College of Cardiology, British Journal of Sports Medicine. So there are all these journals, which will then provide you with synthesized information. Every single thing here points to the connection between saturated fat and heart disease.

38:01And the concerning component is we are making broad generalizations that affect

38:07Dr. Gabrielle Lyon:our children, affect prisons, affect nursing homes, affect anyone that receives federal funding, and even more importantly, affect day-to-day decisions of moms like me. So what is the truth? No small task, but on saturated fat. So the American diet right now, to the best of our knowledge, is 11 % saturated fat. What, in the 80s it was 15 % saturated fat? Well, once again, if you count trans fat, which you shouldn't, but if you do, then maybe those numbers are right from the early days. So the point I am really making is that the evidence for saturated fat being related to heart disease is actually so messed up and conflated with trans fat that it's impossible to separate.

39:07But if you look carefully at foods that are high in saturated fat, you find out that those relationships are just not there. So I don't think the 10 % makes any sense at all. I don't think it's justified. And when folks talk about this, they gloss over that there's trans fat all over the place in these studies that they're citing. Okay, so let's see. I also want to bring it back to the idea that we are not just a heart. We have lots of other organs, the most important of which, in my opinion, is the brain.

39:51Dr. Gabrielle Lyon:Mine is muscle, and my husband, who's in neurology, is something else. I can probably find common ground with your husband. I'm sure I can find common ground with muscle too. But the thing about reproductive organs and the brain, they have a lot in common, actually. Mega 3s are a big deal. Before I move on, I just want to read something to you, okay? Okay. Because you're going to find this very exciting. So this is open evidence. And now this is from the Cochrane database of systematic reviews 2020. And I asked open evidence, what is the evidence of saturated fat and heart disease? Okay. And it said reducing saturated fat and replacing it with polyunsaturated fat reduces cardiovascular events by 17 to 30 % with effects comparable to statin therapy.

40:45Dr. Gabrielle Lyon:Why am I hammering this? One, I'm annoying and I'm sorry. And number two, this is the information that providers, clinicians are being given to then go out and put, quote, best practices in place. So I just, I want to say that. And to be fair, I'll read the next statement. So the first statement, 17 to 30 % reduction comparable to statin therapy by reducing your saturated fat intake. However, this blows my mind. However, the evidence shows a little to no effect on all cause mortality or cardiovascular mortality. And the benefit very, very substantially based on baseline cardiovascular risk. What are they like?

41:37Dr. Gabrielle Lyon:What? Well, well, you just got you just said it's related to cardiovascular events, but not to mortality. Did I get that right? Yeah. Okay. So one of the things folks notice... Comparable to statin therapy. Okay, fine. One of the things that folks notice is that when you talk about mortality, you have a very clean outcome because almost everybody can count bodies. However, when you assign events, you have to do a diagnosis. So is it a heart attack or is indigestion a really bad case? And so it doesn't make a lot of sense that there are more events than there is death. I'm with you. And so that is almost a smoking gun for there being biased.

42:35Now, I have another point that's very, very important, and that relates to what we just did on dietary guidelines. We talked about randomized trials as giving us the chance of identifying causal effects as opposed to prospective cohort trials, which ask people what they eat at one time and then see how many people get sick later. And that's just a natural kind of observational thing. But a randomized trial is only a truth teller if it is double-blinded, or as I prefer the way the ophthalmologists call it, double-masked. And none of these trials are the least bit blinded from the 20th century. They're not blinded.

43:25Everybody knows what group they're in. Everybody knows whether they are consuming the control or they're consuming vegetable oil or whatever it happens to be. You can design trials like that. And I have recently published a trial that's designed in such a way so that people didn't know what they were eating. But it is not easy and it is not cheap. And so people, most of those studies, they left people on their normal diets. They said, okay, you just eat whatever you're normally eating, which happens to be 50 grams of hydrogenated marine oil. And then we have these other people over here, and we're going to feed them all kinds of other things.

44:06We're going to feed them polyunsaturated fats and then vegetable oils or whatever it happens to be. And then we're going to blame all of the differences on saturated fat, which it sounds like they're all eating milk or something, and that's just not the case.

44:21Dr. Gabrielle Lyon:So as this translates to, so the question that you were designated to answer on these guidelines, what was that question? Well, it was about the relationship between saturated fat and cardiovascular mortality and the things that one usually looks at. And so one of the things that I, well, let's say re-verified for myself, is that the studies that are out there often lead with a statement that saturated fat causes more cardiovascular events. But then as you go through the paper, you find out, just kind of as a throwaway at the end, that there wasn't any difference in total mortality. Okay, well, if there's no difference in total mortality, isn't that what people care about, total mortality?

45:15Yeah. I think that's what people care about. And so we turned it around and we said, we're going to talk about total mortality first, and then we will talk about the various kinds of mortality, coronary heart disease, cardiovascular disease, mortality, and events, and look at those. And we found with a very high level of confidence that total mortality is not affected. and in the observational trials, which is really what there was.

45:48Dr. Gabrielle Lyon:In the other guidelines? Or this one? No, this is this one, because we did a randomized trial and we did prospective cohort trials. We looked at both. And in the prospective cohort trials, there was stroke as an outcome. And does it surprise people when these, that saturated fat, what we call saturated fat is protective against stroke. That's what it looks like. That's what the data say. Protective.

46:20So is this whole thing, what do you want to die of? I hope not. If total mortality is not affected, and even if you say heart disease is worse, but if total mortality isn't effective, then that means something else must benefit. most benefit.

46:37Dr. Gabrielle Lyon:You know, I've also seen, as we kind of wrap this piece up, it's fair to say that we don't know the number or percentage of saturated fat that would be detrimental, right? And then I want to take this one step further by talking about potentially the LDL conversation. So, but if we are, if we're just going to look at total mortality from cardiovascular disease, which is really the outcomes that people care about. There isn't, again, there isn't a strong relationship between the two. There's not a strong relationship, but I would even ask you, do people really care about total mortality due to cardiovascular disease or they care about total mortality?

47:21Dr. Gabrielle Lyon:They care about total mortality. I think they care about total mortality and the data say there's no effect on total mortality. Even if you accept what is called saturated fat, which I've just got finished explaining is not all saturated fat. So it's challenging because there are these guidelines, the dietary guidelines now make this recommendation, which now essentially weaponizes animal-based products because of the 10 % number or less. There's also another thing, and I'm not that well-versed in this, But I will raise the point that much of the work that's been done on red meat is not just red meat, it's red and processed meat.

48:06Well, is fresh red meat the same as processed meat? And if you throw in everything that's processed, is a nice roast or steak or hamburger? We really think that that's exactly the same as a very processed, and I don't want to pick on anything in general. specifically, but the cheapest, very processed kind of meat you can think of. Do we really want to put those things in the same category? I don't know why one would want to put those in the same category. I mean, they may well both be fine, but the red meat part, fresh red meat, I don't see a problem.

48:46Dr. Gabrielle Lyon:Does this lead us to this moment where what we can all agree is that we need more science behind what potentially we're defining saturated fat, what the actual implications are? We have to first have the folks who are saying that saturated fat is bad actually recognize that that is not what they've been talking about all these years. They've been talking about saturated fat plus partially hydrogenated oils. In other words, they've been talking about saturated fat plus trans. And the trans has been some of the worst trans that there is. When this data is, say, presented to these groups, again, this is not about a person or any of those entities, but what you're saying and looking at, if someone were to pull this up and to look at the science, the supplemental material, it's hard to not acknowledge that.

49:44People don't seem to have any trouble not acknowledging it.

49:47Dr. Gabrielle Lyon:So what do you, and this is, again, just a personal question. I don't want to spend so much time on that. Why? Do you think that there is, again, is the science questionable? Is what you're telling me perhaps, you know, maybe it's questionable or some other reason? Well, as scientists, we have to describe what we've done and we have to describe it with specificity. and when someone is calling something saturated fat and it's not saturated fat, I'm not sure how much further I have to go with that. I agree. I could go back and say, well, you're just trying to raise money or you're selling something or something like that.

50:31But I would prefer to just sort of say, look, you have to recognize that people are mischaracterizing what their data look like. They're mischaracterizing it. We need to look more carefully. And there are data out there that address this. I just mentioned it.

50:45Dr. Gabrielle Lyon:I mean, that's really important. And I think that you imagine that that's the next step. I mean, I think a lot of what the new administration is going to do or the current administration is it seems as if they're going to allocate funding to try to explore that more. So they say. Correct. They do say. Can we just touch on the LDL story? Okay. Okay. So reading again, what is available? And from my understanding, it's complicated. And for some people, let's say 20 % of the population has an LDL cholesterol over 160. Again, I'm just framing this up as to how one could intellectualize the statement that But if you reduce saturated fat, then you will lower your LDL cholesterol.

51:41Dr. Gabrielle Lyon:Oh, you will. You will, okay. And so this says replacing 5 % of energy from saturated fat with polyunsaturated fat, again, reduces mortality by 27%. Where? Not sure. Not in Japan. Not sure. But there is this relationship between saturated fat and lowering LDL cholesterol. My question is, at what percent of the population is that meaningful? And is that reduction, is it a linear reduction of LDL cholesterol with saturated fat to then have some kind of meaningful outcome for a mom like myself that wants to make sure my husband lives longer than me? Well, we understand a lot about the LDL story for the extreme cases.

52:32Dr. Gabrielle Lyon:So these are folks with the genetic mutation that causes their cholesterol levels to be sky high. So we have a pretty good idea how that works. The question I think that's really relevant is to what degree do reductions in LDL cholesterol at the moderate level below 160 really help us out? and I cannot get past looking at the Japanese data. Now, usually people shut you down by saying, well, there's hardly any Japanese who have high levels. Actually, there's 100 million Japanese, and so there are plenty of them that have higher levels. And if you look carefully, the relationship between cholesterol and heart disease is the opposite of what it is in the United States.

53:24It doesn't go up. It actually goes down a little bit, and those data are robust.

53:28Dr. Gabrielle Lyon:Okay, so I want to correct myself first, So I just pulled up my notes for this episode. The current average LDL in the U.S. is 111 grams per deciliter. Again, I'm sure someone can correct me, but this is what I found. Those who have an LDL above 130, that's around 25 % above 130. And above 160 is about 5%. 5 % above 160. Okay. Okay. Thanks. And so, again, as we frame it up, if saturated fat intake is down from 15%, let's say we pick that number from the 80s, then there should be an average drop in LDL to mirror this. Right. But one of the points that the Astra paper makes is that decreasing LDL doesn't always have a relationship with decreasing cardiovascular risk.

54:26So the question is whether one can make a Blinken statement about this kind of reduction and whether it makes any sense at all. And I think the answer is probably not. And what else to say? I can repeat myself by saying that we understand that sky-high cholesterol levels are a problem. We're also recognizing these days something we didn't recognize years ago, which is that triglycerides are a big deal also. And this is the other fat in the blood. and this is an independent risk factor as well.

55:10Dr. Gabrielle Lyon:How high? And I have those numbers, by the way. Well, if they're above 500 milligrams per deciliter, then I think they're candidates for... I'm going to call it a pseudopharmacological intervention. And when I call it pseudopharmacological, it's kind of a fish oil thing. And so... What does that mean? What do you mean? Here, I have some numbers for you. Okay, go ahead. Give me some numbers. Hit me. Hit me. People with elevated triglycerides above 200 are closer to 70%. 17%. 17%. So people with LDL above 160 are greater, are like between 5 % and 7 % of the population, which doesn't seem like that much.

55:52Right.

55:53Dr. Gabrielle Lyon:People with elevated triglycerides above 200 are closer to 17 % of the population. That's a higher number. And this is, from my perspective, a carbohydrate issue? Yes, I think it's a carbohydrate issue. And it may well be an insulin resistance issue as well. Okay. And you don't get numbers that high unless you're not eating much for omega-3s. Wait, so yeah. Omega-3s won't go that high. Omega-3s lower. I mean, we've known this since the 80s that omega-3s lower fish oil, essentially fish oil, lower triglycerides. Irrespective of carbohydrate intake? Pretty much. but they're going to basically lower it because they turn on the, they turn on the jeans that, that, that burn, burn fat is what they do.

56:36And so, uh, Sign me up.

56:38Dr. Gabrielle Lyon:Indeed. This episode is brought to you by Bond Charge. Now, my husband looked at me the other night and said, should I be scared? And honestly, fair. I was sitting in the dark with a glowing red mask strapped to my face. Um, I don't have time for a 5 million step skin routine. I just don't. but I do have 10 minutes while I'm answering emails or pretending to read before I pass out. The Bond Charge Red Light Face Mask uses red light and near infrared wavelengths to support skin health, which again, it's a great way to scare your husband. It's lightweight and it's portable. It doesn't feel heavy or uncomfortable.

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58:03Dr. Gabrielle Lyon:I'll switch that. I want to, again, close this out because, you know, there's the hearsay. There's the game of telephone. Like, oh, did you hear about this? You were literally there. Yeah, I was there. You were literally there. I got some great photos of you. Also have been contributing to the dietary guidelines for quite some time. 10 % saturated fat doesn't necessarily make sense. We don't have evidence from a mortality standpoint. You should hurry up and change that. I'm hoping you'll do that for the next one. And then also, consequently, the LDL cholesterol discussion still, while it might link back to the saturated fat, might not be the primary problem.

58:43I really don't think it is. And I would also reference for you that once upon a time, we were so very sure that it was HDL that protected you and LDL that was the problem. So good cholesterol, bad cholesterol. And the HDL stuff all fell apart with the pharmacological interventions in the 2000s. And everybody was scratching their head. Now, people are actually working on subclasses and do we really see reverse cholesterol transfer and those kinds of things. And that's fine. The point, however, is that these gross measures are just that. They're gross measures. There's other things going on.

59:23Dr. Gabrielle Lyon:So should we talk about another mistake? Sure. What mistake would you like? Pregnancy and avoiding fish. Oh, God. Yes, sir. What would you like to know? Well, this is really fun. I've been pregnant twice. It's not very fun. I'm not a huge fan of that. I just will say. Being pregnant? Yes. I had hyperemesis gravidome. Oh. My husband was active duty. I was alone in New York City throwing up like all day. Okay. It was terrible. So that wasn't fun. It wasn't fun. Okay. But I actually, it was one of the only periods of time I shifted away from reading about amino acids to reading about epigenetics, pregnancy, nutrition for pregnancy.

1:00:06And there's actually not a ton of data from a protein perspective, which I suppose makes sense, for pregnant women.

1:00:15Dr. Gabrielle Lyon:However, looking at some of the data around omega-3 fatty acids, children, now we're talking about something that could be really meaningful. You know that women are told, many women avoid fish while they're pregnant. Ready? I'm ready. Hit me. Hit me with your best shot. It was in roughly 1999 that an FDA commissioner was asked by a reporter, almost blindsided by a reporter, How come you're allowing women to be poisoned with all this mercury and tuna? And from the perspective, and there's some subtlety here, but we do have a few nerds in the audience. So it was in the 1980s and 90s that analytical chemists perfected ways of analyzing metal.

1:01:20So you could see de minimis, tiny little bits of metals. And so it wasn't very hard to see any kind of a metal in a natural product. And so if you looked in a tuna, you could see it because the chemistry was really very highly developed. It took longer to develop it for organic molecules than it does for elements. Anybody could see mercury in the 80s and 90s if they looked for it, but you wouldn't be able to see other small molecules. Not other small molecules. Like aluminum?

1:01:54Dr. Gabrielle Lyon:What are the other? Metals you could always see. Okay. In other words, the technology, you can't see microplastics. Then, the technology for analyzing metals was very well developed because it's actually, in a way, easier to measure metals than it is to measure organic molecules. When you measure metals, you blast the daylights out of everything and make a bunch of atoms, and then you detect the atoms. But if you try to do the same thing with organic molecules, you lose the organic molecules. So you have to be more nuanced and sophisticated and that kind of thing. Let me ask you this. Is it a mistake for pregnant women to avoid fish?

1:02:32Absolutely a mistake. No doubt. 100%. Since we'll call it the 21st century, we have been collecting data on the consumption of fish specifically in pregnant women and the mental development of their kids. And what we find is that compared to women who eat zero fish, women who eat a little fish, their kids almost always do better on almost all the tests that we look at. And it keeps going up, up, up, up, up, and then it plateaus. And it depends on, then it starts to depend on what fish you're eating. But we have gone up to 100 ounces a week. The recommendation is 12 ounces a week, at least from the government right now.

1:03:25We've looked at 100 ounces a week, 10 times more, of whatever they fish out of the sea in the Indian Ocean and the Seychelles Islands, for example. Even there, you don't even start to see it coming down again because, let's say, there's mercury. The mercury is entirely below any kind of a detectable harm level. You only get benefit. You don't get harm.

1:03:50Dr. Gabrielle Lyon:Whoa, whoa. I was expecting you to say only eat fish or tuna once a month. Is there a limit? So I really don't think there is a limit. I don't think the evidence shows there's any limit. There is a point where you plateau. You don't get any more benefit. But it's not like if you keep going, you're going to turn around. The people that eat the most fish in the world do not have kids who are mentally challenged. They just don't. And you will understand that we know what mental defects looks like. I always invoke iodine deficiency as being something that we know what that looks like. You see nothing like that.

1:04:38The kids just get smarter.

1:04:39Dr. Gabrielle Lyon:um so they're the components right so pregnancies is pregnancy that one time to build the brain like is that that's a critical component versus post-pregnancy into childhood we are putting DHA into our brain until we're about 20 years old so pre-pregnancy post-pregnancy one of the reasons why breastfeeding is so important beyond the immune stuff, behind the bonding stuff, and all that kind of thing, is that kids are getting omega-3, they're getting DHA in breast milk. In 2001, we got it put into infant formula for the first time in the United States anywhere, anyway, it was in other places, but not in the US.

1:05:32And no, the brain is remodeling consistently until at least age 20 and probably out to 25. So we are doing brain development all that time.

1:05:42Dr. Gabrielle Lyon:Do you think that it is that static? Because when you think about Alzheimer's and other cognitive problems, if one avenue of science shows that it could be helpful, it would make sense that DHA, and again, I want you to explain what that is, might mitigate some cognitive decline. Well, there's been a lot of hypotheses around that, and there has been some work in reduction in—or hypotheses looking at reduction in neurodegeneration towards the end of life. And the data are—I'm going to call it mixed. I'm going to eat fish until I'm in the ground. And so it isn't going to cure it. but certainly the underlying mechanisms, which we still have not identified, I'm working on some of that in other things I'm doing, but the underlying mechanisms, I'm quite convinced, are related to fatty acids and the extraordinarily high energy that we produce to run the brain, to run the retina, and the interaction between all that energy, which throws off reactive oxygen species, which then oxidize these highly oxidizable fats.

1:07:02Dr. Gabrielle Lyon:So DHA, can you frame us up what that is? The spectrum, there's omega-3, omega-6. DHA is an omega-3 fatty acid. It's actually, again, for the nerds in the audience, docosahexaenoic acid. You said it, I didn't. Docosah means 22, hexa means six. So it's got 22 carbons and six double bonds. And I like to call this the year of DHA because we've got two, and I ignored the 026, so that's 226. There we go. And at any rate, this is what we call an omega-3 fatty acid. The omega-3 part is a part of the structure of the molecule. So if you draw the molecule on a blackboard and then you name it according to organic chemistry, which you took, then you will see that the last double bond is three carbons in from the back end.

1:08:00If you go to omega-6 fatty acids, you'll find that the last double bond is six carbons in from the last carbon. Now, omega-3 and omega-6 are special because they are processed by the same enzymes in the body. And so when there is a big imbalance between the two, you start to suppress one against the other. And that's why a balance is actually quite important. What we have in the United States is a high amount of the omega-6 fatty acid and vegetable oils called linoleic acid. If you really want to read some nerdy stuff, you can look at the Dietary Guidelines Foundational Report, which is posted.

1:08:53And I think it's chapter five, which is a nice discussion of this stuff. There's lots of other stuff and there'll be things on the web that you can see about this. There is no question, none, zero, absolutely zero. So tell me how you really feel.

1:09:09Dr. Gabrielle Lyon:Oh, tell you how I really feel. Yeah, go with it, dude. Let me, for emphasis, start over. There is no question, absolutely zero, none, that omega-6 linoleic acid suppresses all the omega-3s. Metabolically everywhere. Wow. Period. Full stop. People say that's not the case. It is the case. It is always the case. No exceptions. Wow. And the outcome, so then a clinical outcome to that would be, or a metabolic outcome or a biomarker outcome would show higher amounts of... Well, I'm quite sure that it depends on genetics. And we've been working on those genetics. And you'll have me back for another one of those.

1:09:52Can't wait, anytime. But in vulnerable folks, the omega-6s in vegetable oils are actually enhancing a pro-inflammatory state. We're seeing a response to omega-3s pushing down colorectal polyps. We've published this already.

1:10:15Dr. Gabrielle Lyon:What is the dose? Two grams a day. Not very much. Not very much. And if you're of a certain genotype, it pushes down colorectal polyps at the end of a year by 50%. Is that good? Wow. It's published in the American Journal of Clinical Nutrition. Okay. So we'll pull that up. RJ, I'm going to make a note of that, pull that up. And then, so it's based on genetics. Obviously, someone could probably run those SNPs. Yes. It's actually more complicated. But it's actually, it's more and less complicated. It's an insertion deletion, which is sitting in the fatty acid desaturated gene cluster. Now I really lost everybody.

1:10:57Yeah, definitely. I was just thinking, are you popular at parties?

1:11:00Dr. Gabrielle Lyon:Okay. But there's no downside for someone who would be wanting or interested in taking omega-3 fatty acids. But you said it's the balance. The balance is what you need. The balance is what you need. You have to be balanced. And in the diets that we have now, we have an excess of omega-6. Now, the omega-6 folks will say, yes, but if you eat more vegetable oil that has more omega-6, it pushes down cholesterol. Well, it does, but we just got finished having that conversation about whether that actually benefits anything or not. And we always go back to the heart, but not the brain. So going back to the heart, meaning individuals are looking at LDL cholesterol or total cholesterol and saying, well, this reduces total cholesterol, but that might be irrelevant to the, if I'm understanding what you're saying.

1:11:55Yeah, you are actually, you have it, you have it correct. In fact, working on the omega-3, omega-6 story is what led many of us to start talking about saturated fats and start looking into that. Because if you say eat less omega-6, it's got to be replaced with something. And so what should you replace it with? Now, The best thing, I think, to replace it with is monounsaturate, so olive oil. Well, we now have avocado oil, but we're clear-cutting the Amazon to make avocados, avocado trees, and there isn't enough olive oil to supply more than a very small fraction of the demand in the United States.

1:12:35And so what I think we ought to be doing is what we learned how to do 20 years ago, which is to make effectively a kind of an olive oil, but we can do it with sunflowers and safflowers and peanuts because we've basically taught them how to make olive oil from this perspective. They're called hyaluronic oils. And there is a fundamental disagreement about what will happen with that.

1:13:07Dr. Gabrielle Lyon:Meaning will it be the same as the trans fats? Is that what the disagreement is? No, no, I don't think it will. I don't think the trans fats will be relevant here because the fatty acid profile in these high oleic oils is almost indistinguishable from olive oil. In fact, olive oil has a range depending on where you grow the olive trees, whether they're in the hot area of North Africa or they're in the cooler area in Tuscany, let's say. And there's more linoleic as you go north, and there's less as you go into the hotter regions, and so there's a range. And so these high oleic seed oils are within that range.

1:13:43Dr. Gabrielle Lyon:You know, that's fascinating. You're talking about essentially the food matrix, but in a different way, the compounds of the food. And if you were to say in an ideal world, would you say, I want you to have two grams of omega-3 fatty acids. I want you to have a component that is DHA, 200 milligrams. and I want you to have olive oil from Tuscany because it's up north, how would you think about getting granular for someone who wants to just say, you know what, I'm going to do a tablespoon of monounsaturated fat from olive oil and then I'm going to do three pills of omegas because that's going to give me two grams and then DHL.

1:14:29So the other thing to recognize is that when, as the, I just told you that omega-6 suppresses omega-3, if you push down the omega-6, you don't need as much omega-3. The omega-3 is actually more effective. We've never really calculated how effective, but, I mean, you can actually. Meaning if you push down. If you have high linoleic acid, you're creating a metabolic need for omega-3 in order to balance it. You need more of it. I would rather have a traditional diet. We didn't have these amounts of omega-6 in the diet before roughly the year 1900, maybe a little earlier than that, but it's about that.

1:15:08There's almost nowhere on the planet where we had these amounts of linoleic acid. There's some that was in northern China with rapeseed oil, but only a few hundred years ago. So this omega-3, this omega-6 business with high levels of linoleic acid has been an uncontrolled experiment that we conducted from the 1950s. And coming back here and saying, well, we don't want to do this new experiment by pushing it down. Well, no, the experiment was putting it so high.

1:15:37Dr. Gabrielle Lyon:I see. And the omega-6 would be things like corn, saffron, canola. I'm glad you asked me that question. So here's the problem. It has not been for 20 years that being able to say the name of the plant that an oil came from tells you what to eat. We can't, we can no longer do that. We can't say soybean oil because there's four different soybean oils that have been widely sold in the marketplace. There's at least three sunflower oils and they've all been intentionally bred to have different fatty acid profiles. So I can't just say... For what purpose? For the very purpose that I'm describing. Whoa.

1:16:22And the other reason is that the traditional oils, what we used to call the commodity oils 20 years ago... Yeah, I'm from Chicago.

1:16:32Dr. Gabrielle Lyon:So there's commodities and the options exchange. Yes, indeed. So how many hog bellies do you want? Anyway... These are jokes. We are collectively funny together. If you push down the amount of omega-6 in the oil, it increases the shelf life and the frying life. And so we've been frying potato chips, we, lathes, up in north of Dallas and everywhere else around, has been using these high oleic oils for years because the frying life is longer. There's fewer of these peroxides that get formed during the frying process. And so they like it a lot better. Now, I'm speaking for Lay's and they should hit me over the head because I don't know.

1:17:26I've never been set foot inside Lay's. But at any rate, I'm pretty sure that's what they've been doing. And that, I think, has made the products healthier. I mean, what I used to like to say is, you know, if chips make you fat, they have to make you sick, too. And I had Lay's potato chips the other day.

1:17:52Dr. Gabrielle Lyon:So busted. That's it. So for the omega-3 fatty acids, when someone, I know you don't see patients, but is there a good ratio? If there's a physician out there, again, we look at omega-3, omega-6 ratios. Many of our patients have higher omega-6s and there's a whole... Yes, they do. And so you're thinking of the omega-quant kind of omega-3. Yeah, you said omega-quant. Yeah, I think that what those folks have been using is a pretty good guide. So below four is bad and above eight is good as kind of the broad guidelines. Yes, I think there is, and I've watched that whole story develop since well before it started.

1:18:46I remember the discussions on it and one person running with it. And I'm very, in a manner of speaking, proud of him for running with it. That's very cool. And making it happen.

1:18:58Dr. Gabrielle Lyon:So there was one individual. Yes, that's right. And you can look on the website for Bill.

1:19:07And we had conversations about, well, we're measuring cholesterol. What the heck does that mean? If we could only measure omega-3 somehow, then we'll give people a little bit of control. And we think that'll have more control and be more important.

1:19:19Dr. Gabrielle Lyon:I pulled this number. It says more than, and I don't know if this is accurate. Sure. More than 95 % of people fall short of recommended DHA intake. Yeah, well, that's almost certainly true. But it depends on who's recommending it and what it should be recommended as. What about kids? How much? So, you know, I think about my two little kids. Yeah. We have little fish oils that we try to give them. You know, it's kind of hit or miss. But is that adequate? I know that you're going to say something is better than nothing. It is. But you talk about the food matrix. Yes. How much should they, in an ideal world where you're like, okay.

1:19:56Well, look, my grandkids just stuff salmon into their mouths. They absolutely love it.

1:20:07Dr. Gabrielle Lyon:So maybe we just have that. Okay. Well, I am kind of more of a Whole Foods guy, little W, little F, despite the fact the headquarters are over four blocks from my place. Oh, I see, I see. I get it. Okay. I'm more of a guy who thinks that the nutrient package is important. If you can't have fishing people, we've got allergies and this kind of stuff, right? And we can talk about what has caused that. We ought to be introducing foods. I think pediatricians are getting the idea they should be introducing everything very early on when the immune system is recognizing self and non-self. But at any rate, I get my, well, when she was three, I'd bring her over to Wegmans in Rochester.

1:21:02And she wants the salmon sushi. And then we sit down and she picks the salmon off the top, leaving the rice carcasses behind and just shoves the rest of it down her throat. And so she's taking in something like two weeks worth of fish and omega-3, maybe more than that, in that little thing. And she's giggling the whole time. She's gobbling it up.

1:21:32Dr. Gabrielle Lyon:I mean, but you guys got ahead of it. And, you know, my kids, they love salmon, but, you know, the other sardines, also good. Sardines. Absolutely. What about, I'd love for you to just touch on this. People will say, well, I'm getting my omega-3 from flax and chia, walnuts. Would you just speak to that just very quickly? Sure. So this is a little bit of an example that something is better than nothing. But the data say that these plant-based sources of omega-3 are not the same as the long-chain omega-3s. And I'm hesitant to call them animal sources because there are vegetarian sources. Naturally.

1:22:21Naturally, yes. It would be from the single-cell organisms from the ocean. So we call them algae oil. But there's other things like that. And I am well aware that there are vegetarians in the world. I won't say vegans, but I will say vegetarians. And even this is a nuanced thing, because if you decide you don't want to eat animals, but it's okay to eat dairy, for instance, that's great. If you start substituting high omega-6 oils for your dairy fat, that's when things really go off the rails because dairy fat is very low in omega-6 naturally. So you're getting the least suppression of the omega-3s if you eat dairy.

1:23:09If you start eating high omega-6 sunflower oil, you're suppressing the omega-3s. You're creating a metabolic demand. And when we do studies in animals, and there's lots of them out there, and I would just remind everybody that animal studies can be very well controlled. Human studies are the worst controlled studies that there are. Okay? So forgive me. I'm doing my science here. Okay? And so when people don't talk about well-controlled studies and they only rely on human studies, you can argue about things for seven decades like this that we're arguing about. But at any rate, when you feed those oils to pregnant animals, you can look at almost anything going on in the brains of the offspring and they are screwed up.

1:24:02Dr. Gabrielle Lyon:Not, I mean, I've never heard that as a technical term. Screwed up is a technical term. But you make a really good point. And to frame this up for people, people have been arguing about omega-3s, omega-6s. Should women, pregnant women eat fish? Should kids eat fish? Avoid it because of metals. And what I'm hearing you say is really two things. Number one, we got saturated fat wrong. Yes, we did. We really got that wrong. And number two, omega-3 fatty acids, DHA are necessary, amazing for brain development, important for pregnant women. And conversely, omega-6 is not just safe and neutral. We're just going overboard with it.

1:24:52That's all. The omega-6. You have to have some omega-6. And so when I have these conversations with people, sometimes they just go too far and they say omega-6 is terrible. No, no, it's not terrible. It's the balance. You need this much, and you really don't want to go above this much. It's really not that hard. I mean, a little is absolutely required. I mean, there was actually human studies from the early days, from 1961, where kids were put on omega-6 deficient diets. Babies were put on omega-6 deficient diets, and they knew they were omega-6 deficient, and they developed skin lesions, which were rapidly reversed when they put them back onto the omega-6.

1:25:32We can't do that anymore. It probably wasn't a great idea. But it served a purpose to at least answer a question way back then. And so you have to have some omega-6. It's just not so much.

1:25:47Dr. Gabrielle Lyon:Not as much. Just two final questions. The last one is a bit robust. there is a lot of discussion about ADHD, mood, omega-3 fatty acids. Is there real science behind the utilization of omega-3 fatty acids and improving ADHD? So I am told. Now, I know how to read this literature. I must say that I am not as up on the ADHD literature as I would like to be to answer you definitively. People I know who've been working on this say that there is something to it. But I'm not going to tell you that giving fish oil to kids with ADHD is going to solve the problem because I don't know that that to be the case.

1:26:39I don't think it'll make it worse.

1:26:41Dr. Gabrielle Lyon:I agree with you. I'm hopeful that it can help. It seems to help a lot of other things, maybe not ADHD. My last question. So beyond fish, mercury, saturated fat, nutrition policy information seems to really shape our thinking and it becomes extremely, I don't want to say misinterpreted, but accepted as truth when perhaps it's not? And this is just from my curiosity, which I'm sure that other people are thinking, is there something else also on the horizon that you're thinking, okay, this hasn't been developed enough yet and it's going to come out?

1:27:30Well, let me answer it this way. I think the story of precision nutrition, precision medicine, precision nutrition, is an undertold story. It is one that doesn't fit as well with the research paradigms that we have. You know, ask a huge number of people what they eat and then try to make correlations and that kind of stuff. But I think that we are going to have to get towards that. So when we have these conversations about one number for everybody, like in dietary guidelines, we need to be getting much more specific about that. We need to be able to say, here are life stage issues, pregnancy, lactation, brain development, and maintenance of brain health are all going to have demands that are different than that 50-year-old man that I was complaining about.

1:28:29And they are, as a matter of fact, there's just no question that they are. And then there are, I am quite sure, differences due to genetics. We really should tighten up our genetics when we look at these things. I am more or less a one-trick pony on my genetics because we identified something we think is actually a causal polymorphism that defines requirements. But I'm still working on that. And I think we have not incorporated that into our research the way we should and into our recommendations the way we should. A lot of genetics that is not an amino acid change, so that are really obvious changes, but a lot of the genetics we do is correlative or associated.

1:29:30The nerds have heard of genome-wide association studies, and the A association is a cleaned-up version of the word correlation. And we really need to move that needle towards things that will be causal insofar as that word is relevant in genetics. So I think we have a long way to go to do personalized nutrition. That's where I would like to see us move the whole thing forward beyond the general recommendations for everybody.

1:30:08Dr. Gabrielle Lyon:And I'm looking forward to our next visit. I'm sure that you'll have more to share and also with the genetics, but also the metabolomics of the genetics. Okay, well, metabolomics and lipidomics as a subset of that is something that is near and dear to my heart, in part because it is fundamentally a chemistry thing. And it is also something that has been devilishly difficult from a laboratory point of view. You always get correlations. You always get data. And as my advisor used to say, and not everything is an artifact, you hope.

1:30:58Dr. Gabrielle Lyon:Tom, Brenna, you are, I'm a huge fan. I think you do great science. You are a great human and just it is so wonderful to have scientists like you that don't mind teaching, are very personable and just willing to identify the science and also speak to it. Just thank you for all the work that you've done for all the years behind the scenes. Thank you. It's my pleasure. Thanks.