Omega-3s and brain health: what the science really says | Dr. Bill Harris & Prof. Sarah Berry

26:20So it's doing something across not just heart health. It's helping us stay alive and resilient longer. And if you choose to take supplements, is there evidence that if you take supplements, that that will improve my heart health? Yeah, they're right. That's, again, back to the UK Biobank. There have been several studies that just looked at fish oil supplement use. Yes, no. It's a very crude measure because we don't know how much they're taking, how frequently they're taking, what product they're taking, any of that stuff. It's just a yes, no. But the people who are taking omega-3 supplements in that UK biobank are lower risk for multiple kinds of heart outcomes.

27:00We've looked at stroke and we looked at blood levels of omega-3, which is much better than asking people if they take fish oil. Just look at their blood levels. And we find that the higher the blood level, the lower the risk for stroke, which contradicts that whole atrial fibrillation concern because the problem with AFib is increased risk of stroke. Well, even in the studies, the big studies with the pharmaceutical products, where they reported this, you know, 1 % or 2 % increase in risk for AFib, they had like 20 % reduced risk for stroke. So the omega-3s are still benefiting heart health in a wide variety of ways.

27:39Even in these people with, again, with high risk for heart disease who are taking high-dose pharmaceutical products, they're still getting a lot of good heart benefit. even if there is a small increased risk for AFib. So I think, Jonathan, the evidence is really clear that omega-3s beneficially impact heart health. I think it's really important to say as well for any skeptics out there, one fantastic thing about omega-3 is because we can't make it, it means that any increase in the blood we know is coming from what you're eating because people often say, oh, well, how do you know it's because it's what they're eating?

28:16So this is one fact that we can say, actually what's in the blood is coming from the food you're eating. And so I think where there's some really exciting new research though, is around brain health. And I think this is something, certainly when I was teaching, even up until a few years ago, a lot of what I was saying was, oh, we just don't know yet. And I know this is something you focused on more recently in your research. So it'd be great to understand a little bit about what the latest evidence says around omega-3 and brain health. Sure. And I'm sure when you do your lectures, you start with babies in the womb and the formation of the brain in the first place, which is very important because the brain has a lot of, one of the two omega-3s called DHA is part of the structure of the brain.

29:04And that's important from the very beginning in your eyes too. Actually, the eye is an extension of the brain and the level of omega-3 in the retina, the back of the eyes, is one of the highest in the whole body. So there's a real, it's there for a reason. It's always there for a reason. The omega-3 story in dementia has been growing over time. We know that when they do autopsies on people who died of dementia compared to controls who died of something else, those who had dementia have lower omega-3 levels in the brain. Okay, that's one piece of the story. We've seen that higher levels of omega-3 in the blood, higher omega-3 index, predicts a lower risk for developing Alzheimer's disease or all-cause dementia over time.

29:48So that's another important piece of it. If your B vitamin nutrition is good, then the omega-3s seem to help increase cognition, improve brain health, reduce risk for developing dementia. If your B vitamin levels are too low, actually, I'm talking about homocysteine, which is a particular molecule in the blood that responds to, that's kind of a barometer of how well your B vitamins are working. If that homocysteine level is high, the omega-3 effect goes away. So there's what we call an interaction here between those two nutrients. And so it's important to get good B vitamin nutrition, good omega-3 nutrition for brain health.

30:30But it's been difficult to show in the kind of randomized trial that we're all used to, you know, give somebody some omega-3 for three or four years and then another group not and then see who develops dementia. We haven't got time. Or either that or you pick people who are already so far down the road, you can't do anything about it. So at this point, the omega-3 and brain health connection is mostly, I think, based on these observational data, what we call epidemiology, more so than randomized trials, because haven't got that much randomized trial data yet. And what about in relation to mental health more generally?

31:06Yeah, mental health is right. We just got a paper accepted a couple of days ago on anxiety and depression as a function of omega-3 levels. And again, higher omega-3 levels are always linked with less current depression and anxiety and less risk for developing over time. I'll never forget the moment that everything shifted for me. I was at a public talk on nutrition, listening to a speaker explain that my gut had trillions of microbes in it and that these bugs shaped every aspect of my health. That speaker was Professor Tim Spector, one of the world's top 100 scientists, who became my co-founder here at Zoe.

31:43Nine years later, Zoe runs the world's largest gut health research study. And the conclusion is simple. Gut health is health. How you feel, your long-term health, and your digestion are all shaped by the state of your gut. As a listener to this show, you know how important it is to feed your good gut bugs. But I suspect that like me, you have a busy schedule. And often you feel you haven't given them all the different plants they crave. And that's exactly why we created Daily 30. It's a gut health supplement packed with over 30 plants that you sprinkle onto any meal. It tastes great, adds a satisfying crunch, and gives your gut the diversity it craves.

32:21Finally, a healthy habit that's easy to stick to. I should know. I take it every day. And because we're Zoe, we don't just guess. We test. We put our original Daily 30 formula through a randomized controlled trial, the gold standard of testing. The results blew us away and proved it supports your digestion, energy, and gut health. That trial helped us develop the formula we have today. Today, Daily 30 is a non-negotiable daily habit for me. So don't put your health off for the future. Go to zoe.com slash Daily 30 and try it today. And Bill, I think a lot of people listening will be really surprised the shift from heart health and dementia to anxiety and depression, because most of us were brought up with this idea that our mind and our bodies are separate and the first slide is really physical, but anxiety and depression, how could that be affected by how much salmon I ate?

33:17Do you understand at all what's going on there? No. Short answer. I can't tell you what's going on. I mean, some of the cells in the brain are kind of there to reduce inflammation, certain small part, not the big chunks of it, but there are certain cells that are, their job is to control inflammation. And the omega-3s can get into those cells and help reduce inflammatory signaling in the brain. And that's good. But at this point, we're just seeing associations between a high omega-3. That doesn't, you know, strictly speaking, and Sarah understands this very well, because you have an association doesn't mean you have a cause.

33:54Yeah. So this is what I'm fascinated by now listening to you. Have there been any supplement trials where they give people omega-3 supplements and see whether it reduces levels of depression, levels of anxiety, improves mood, happiness, those kind of things? Yeah, yeah, right. Should people who are not feeling happy, should people who are suffering from depression, in addition to whatever therapy they have, also be taking omega-3? I'd say yes is the answer to that. There have been studies, particularly in depression, for many years. and what they've discovered was somewhat surprising to most people because when you pool together a bunch of studies that were done to try to affect depressive symptoms, some of the supplements that were used in those studies are rich in DHA.

34:44Some of them are richer in EPA. They both have, all the supplements have both, but some are heavier EPA, heavier DHA. And the hypothesis has always been, well, pretty simple. the brain's got a lot of DHA, so give it DHA. So that ought to be the one. Well, it turns out that when they look at these studies, they say, well, interesting, the studies that have provide a supplement that's richer in EPA are the ones that seem to find a reduction in depressive symptoms, not the ones that have DHA. So again, a good hypothesis out the window, but based on observational research. And the theoretical explanation is that the EPA is more of an anti-inflammatory omega-3 than DHA.

35:30And that's something about getting more EPA. EPA doesn't really get into the flesh of your brain. It doesn't get incorporated, but it is in the blood circulation throughout your whole brain. And it can be made into some molecules that are anti-inflammatory that may help reduce risk for depression. So your recommendation to people who are suffering from an array of mental health issues would be, in addition to whatever therapy they have, to also try fish oil supplements but focusing on EPA-rich ones. Yeah. People always ask, is EPA better than DHA? And I always say they're both good. They're both in nature.

36:09They're always together in fish. We always eat them together. I think we should have all of them in a supplement. Maybe for depression, we have evidence that richer and EPA would be better. And that's because the anti-inflammatory effect of EPA rather than the structural effect of DHA has in our brain. So that when we're eating, let's say, a portion of fish, we've got two things happening. We've got an increase in DHA in our brain because of the structural components and then the EPA then helping with the inflammation. Yeah. And this is complicated because we know that giving more EPA and DHA will raise blood cell, omega-3 levels, omega-3 index.

36:48And from other studies, we know that you can increase the level of omega-3 in your liver, in your kidneys, in your heart, in your lung. But brain is not so easily moved. Just take an adult like you and me and start giving us omega-3 and DHA. We could take a biopsy of the brain. We would probably see that the DHA level is not going up. There is this blood-brain barrier that's very specific. And at this point, I don't think we can say that taking DHA is actually going to raise your brain tissue DHA levels. It's good for your brain health. It doesn't have to be because it became part of the meat of your brain.

37:32It could be doing other things in the brain that could be even just the blood vessels that go through, improving the circulation of the blood through the brain would be helpful without changing the composition of the brain. So I think that's still an area of active research is trying to figure out why when you give omega-3s, you don't really get a – you can see an increase in cerebral spinal fluid, which is the fluid that flows around the brain and spinal cord. And you can get more omega-3 in there. But actually, as part of the brain tissue, it doesn't seem to go up like it does in the liver. So is there a window of opportunity?

38:09Because I know we often talk about making sure during pregnancy you're getting enough because of how important it is for your baby, but also for young children. And I think a lot of parents, Jonathan, don't think about this. Is there a window of opportunity to make sure that you are a pregnant woman, but also your children are getting it to make sure there is enough DHA in the brain? Very simplistic question, I'm afraid. It's quite confusing. It's a great question, and it makes the most sense for pregnant women to be sure they're getting enough omega-3, particularly DHA, during pregnancy. Because all the omega-3 that your baby's getting is coming from mom, whether it's in utero or from breast milk.

38:46Optimizing the amount of omega-3 early in life, it makes the most sense to me. And really, brain development goes up until like 18 or 20 years of age, actually, right? Most of it is in that first thousand days of life where your brain is really put together. And that's the most important time to get the omega-3s. Get a good standing for the rest of your life. I'm not sure it will stay if you eat cheeseburgers the rest of your life. So my daughter is six. Are you saying at this point already it's sort of too late to change this DHA in her brain because of this barrier that you were describing? No, I wouldn't throw my hands up in despair.

39:22My grandkids and my kids back then, we made sure they have omega-3 all the time they're growing up. It's safe. We don't know for sure what it's doing all the time. We have good indications that higher levels are good across the lifespan. So why not do it? The risk is zero. Can I ask a clarification question? Because you were talking about EPA and DHA and saying that for depression, the EPA seemed to be more critical. before you're talking about your research around dementia. I think a mix is always best for overall health, above and below the neck. So I'm definitely sitting here thinking I need to make sure I get enough omega-3 in my diet.

40:04It feels like a very strong pitch from Bill with a lot of support here from you, Sarah. And just before we talk about the advice, I mean, the first question I have now is, well, I'd like to measure my own omega-3 levels because you've been talking about that. can I ask my doctor to measure my omega-3 index and see whether I'm at this magic 8 % level already? Yeah, your doctor will be a deer in the headlights. I was about to say, that'd be pretty cross in England if you asked them that. What's the omega-3 index? They don't know. They don't know. But yes, it can be done. This is where personalized nutrition, people taking their health in their own hands, I think is really important.

40:44In the UK particularly, it's very easy to get the omega-3 index done, but you just go online and order the test. They'll send you a little kit in the mail. You prick your finger, you drop a blood on it, put it in the mail, and in about a week, you get a report of your omega-3 index. We do actually measure this in our ZOE-PREDICT studies. So we have this big ZOE-PREDICT cohort. And in a subgroup of that 300 ,000 people, we have measurements of all of the different fatty acids. So not just the saturated mono and polyunsaturated, but the individual fatty acids, including the EPA, the DHA, the ALA.

41:22You have 300 ,000 people? We have 300 ,000 people in our Predict cohort. In all women? Which is, no, so they're about 65 % women, 35 % men, a huge proportion of peri and post-menopausal. And we just have this goldmine of data. It's mind-blowing as a scientist what we have. How many do you have blood on? We use a device called Tasso. And so we have that on all of them. And then on a subgroup of individuals, which is probably about 10 ,000 now, we have fatty acids who will be able to do the omega index. 10 ,000 is great. Yeah. But what's amazing with this cohort, we can start to really dig down into the kind of things that we've been talking about and the nuances that's so important in nutrition.

42:05Wow, that's fantastic. UK only? UK and US. And US. Oh, that's fantastic. I would like to talk about, okay, what do you do if you want to hit this magic 8 % number and you have a suspicion that you're in the 90 to 95 % of people you described who don't have that. So could you describe how someone could try and get there? Sure. I think the most important thing is to start with knowing where you're at. So getting a blood test to know your omega-3 index to begin with. That's your baseline. We did a study several years ago pooling data from 14 different other studies that we had done where we had measured omega-3 index before and after.

42:47And we were able to figure out how much omega-3 in additional you need to get EPA, DHA, in order to go from where you are now to 8%. And so we've reduced that down to a mathematical equation that's sort of buried in the website. And so if you come back as a 5 % or a 4%, 4 % would be not atypical. If you put that in the calculator, you're going to find that you need about 1 ,500 milligrams more a day of EPA and DHA together. That's a place to start. There's a lot of variability in how each individual responds to omega-3 intake. But on average, that's a great place to start. And you could eat salmon every day or you could start taking an omega-3 supplement.

43:32Red blood cells, which is where we measure the omega-3 index, you get a whole new crop of red blood cells every four months. And so now you can, after three and four months, you could do another test, see where you're at. We call it titration. You test, you intervene, and then you test again and see what the result was. And if you're where you want to be, keep doing it. If you're not, you need more. Bill, you've said quite a large amount, as in one serving every day. Something that I hear anecdotally a lot of people saying to me is, oh, but I'm worried about mercury. I've heard that if you have too much oily fish, it's going to give you mercury poisoning.

44:10And I believe it's actually preventing a lot of people from increasing their oily fish intake. I think it's really important to get some clarity on that. Very important. Mercury has gotten a much bigger concern than it really is. It's primarily a concern originally in pregnant women and young children. And back in the early 2000s, the Food and Drug Administration put out this warning about mercury in fish based on some, I think, very narrowly flawed research. And there's good evidence that that advice caused lots of pregnant women to say, I'm not going to eat any fish. even though there's only maybe four fish, swordfish, tilefish, king mackerel, shark, things that nobody eats anyway.

45:00Those are the ones that had high mercury and that was the warning in the United States in the FDA. Stay away from those fish. Well, women stay away from those fish anyway. I mean, salmon has virtually no mercury in it. Sardines, mackerel, herring, virtually no mercury. Those high omega-3, just the amount of omega-3 and the amount of mercury not related to each other. So unless it's those quite unusual fish, you're saying, don't worry. Don't worry about it. Absolutely. And for God's sake, don't avoid eating fish because you're worried about mercury. Salmon every day is a lot of salmon. I think I don't want to eat salmon every day.

45:39Okay. You can mix it up with sardines. Is that like to get my very most optimal? Do I really need to eat this every day? Right. I wanted to make the point that you don't have to take supplements to get to an 8%. You can do it with fish. I was just giving an example of salmon every day. You can eat salmon twice a week. You could eat maybe mackerel once a week, and you might get up to 8%. It just depends on you. It's very possible. But if you don't want to do that, supplements are a fine substitute for that. A serving of salmon once a week, maybe 1200 milligrams of EPA and DHA. Well, that's divided out by seven.

46:21That's about 200 milligrams a day. Well, that's twice the average American intake right there of omega-3 fatty, which is around 100, 150 milligrams is on average what Americans eat. So you double it or triple it by just eating an oily fish once a week. So it's a good thing to do. It's just not going to get you by and large to 8%. You're going to need to eat more than that. And that pushes you towards supplements, it sounds like realistically, if you're gonna stay at that, unless you are an Inuit or maybe some of the Japanese that you were describing about the level of fish intake. Just before we go onto supplements, I know that one of the questions we get a lot is about farmed fish.

47:03So not about mercury, but I think concerns actually about the overall health. And Sarah, you talk a lot about this, right? About thinking about the overall health of a food rather than just one element. and concerns that their farming might not be very healthy. 2010, 2012, there was a report that got a ton of press about not mercury in salmon, in farmed salmon, but PCBs, dioxins, other industrial organic chemicals that are not good for you. And this has set off alarms all over the world. And most of these fish that they, in this particular study, were from the Baltic Sea and the North Sea farming.

47:41And it turns out that the reason that those salmon that they were feeding had those levels was because the food, the oil that they got from other fish that they feed the salmon, because the salmon needed to be fed fish oil in order to get the omega-3s up. The fish oils that they were feeding them were not clean. They had those pollutants in them. So it was true, but the industry has cleaned it up tremendously. Our lab in Scotland is also an aquamarine lab, meaning they analyze fish carcasses for the industry. And there are very strict levels on PCBs, dioxins, and they're not there anymore. Now, salmon, which is kind of the classic farm fish, used to be back, say, 10, 20 years ago when fish oil wasn't so expensive.

48:30It's expensive now because people want supplements. There's a demand. So fish oil has gotten expensive. Salmon producers have been reducing the amount of fish oil in the feed and increasing the amount of plant oils in the feed, trying to balance cost and health and longevity and nutritional composition. So the omega-3 level has gone down in salmon. Now it's about the level of wild salmon. It used to be higher. It used to be you get more omega-3 per serving of farmed salmon than wild. Now they're about the same. So I don't have a problem with farmed salmon. It's still a great source of them. It's not as good a source as it was maybe 20 years ago, but that doesn't mean it's not a great source today.

49:13It still is. I think that it really nicely leads us on to another myth that I think is really important to cover briefly while you're here. And this is around the omega-6 to omega-3 ratio. And so one of the reasons people say, oh, farm fish isn't as good is because it's got, by being fattier, it's also got a higher amount of omega-6. I'd love to quickly get your perspective, if you can give me kind of top line views on the omega-6 to omega-3 ratio, because it's everywhere at the moment in relation to CEDAWs and so many other things. Yeah, and I think the omega-6 to omega-3 ratio is a useless metric for so many reasons.

49:51Number one, it assumes the omega-6 fatty acids are bad, and that's not true. Linoleic acid is what we're talking about. Linoleic is the primary omega-3 and omega-6 in seed oils and in our diet. And higher levels of linoleic acid in the blood are associated with lower risk for heart disease, for diabetes, for all-cause mortality. Everything is better with higher levels of the major omega-6. So the idea that it's bad is wrong. So there's no reason to have a ratio of something good to good. It doesn't make any sense. Secondly, you can have high levels of omega-6, high levels of omega-3 in a food, or you could have low levels of omega-6 and omega-3, and you have exactly the same ratio.

50:34If your ratio is wrong, the thing to do is not to reduce your omega-6, it's to increase your omega-3. So if you increase the denominator, the ratio gets smaller. That's okay. That's a reasonable response. But I think this dependence on the omega-6 and omega-3 ratio is way outdated. That's from the 80s. It should just be thrown in the trash can and ignored. We need to look at the amounts of fatty acids we're eating, not this ratio. Thank you. This is exactly what I say and why I get a lot of hate mail. I wonder if we can go back to thinking about how we can increase our omega-3 levels. You've talked about having oily fish.

51:11You've talked about supplements. I think something really important to cover is at what point should we be supplementing through our life course? Is it safe to give young children supplements? Should we be having more higher doses as we get older? I think, yes, it's safe to supplement children. Again, in that like 1 ,000 milligram a day, EPA, DHA, there's no question about that being healthy. From what age? It's hard to draw a line in the sand. If I could dictate, I'd say, from minus nine months through your life. I don't see any place where all of a sudden, now here is where you need it. Clearly, increasing your omega-3 levels is always going to help somewhat.

51:52And the earlier you do it, the better. Because these are what we call fat-soluble nutrients. So they stay in the body a lot longer than the water-soluble things like vitamin C, which kind of come and go. But the fat-soluble ones stay in longer. And the longer you feed omega-3s into your cells, the levels just go up, up, up, up. And Bill, can you overdose on omega-3? Not that we know of. It's kind of self-limiting. in a sense that people just can't eat that much fish. Again, the Japanese, who eat much more than we do, are healthier than we are. So we haven't seen it. The other issue that comes up is bleeding.

52:29And that was a concern, as you mentioned. You cut an Eskimo's finger back in the day, and it would bleed a lot. Or nosebleeds, you would have pictures of blood all over the place. And this scared people. And we did find in early studies that we were doing that you give high doses of omega-3, you will increase what's called the bleeding time. It increases, but it increases like aspirin increases it. Not outrageous, not hemorrhaging, not you're going to die from a nosebleed, none of that stuff. And then we've looked at other studies lately, or not lately, over the last several years, of people who are taking blood thinners already or taking aspirin and seeing that taking omega-3 on top of those does not increase the risk for anything that's clinically significant bleeding.

53:10And if I make this change and increase the amount that I'm taking, how long might it take for me to feel some of the effects of this optimal level of omega-3? Good question. And I'm not sure you can feel an effect of omega-3. The thing that we hear people, people are given omega-3s say to lower their blood triglyceride levels, for example. That's a pharmaceutical reason to take it. You don't feel a blood triglyceride level. You don't feel a high blood pressure. What you feel is achy joints. And this is the experience, anecdotal experience that we get is that people say, my shoulder just doesn't hurt anymore.

53:47My knees feel better now. So that is probably, you know, three, four, five months into taking omega-3s after your tissue levels go up. I worry about my brain health more than I worry about anything else. I've seen firsthand what can happen when the brain goes wrong, and it's a pretty horrible experience. If you know anyone who's also focused on keeping their brain healthy, why not share this episode with them right now? Give them facts from the world's leading expert, not some rumors they've heard on the internet. I'm sure they'll thank you. So I would love to switch to really clear, actionable advice now.

54:25I think we've had this brilliant description. I think lots of people listening are saying, oh, I'd like to eat more food that has his omega-3 in. Could you just very simply tell us what foods should be in that list? Well, there is an acronym. We talk about oily fish. SMASH is the acronym. S-M-A-S-H. So, salmon, mackerel. A stands for anchovies. I'm not sure anybody eats. Oh, I love anchovies. Except Sarah. Anchovies. S would be sardines and H is herring. So, those are the SMASH fish. And those are really very high omega, the highest omega-3. And is there anything other than oily fish that has higher levels of omega-3 and therefore is worth adding for that reason?

55:12Without being fortified with omega-3. You can feed chickens EPA and DHA, and in their eggs, you'll have more DHA. But that's not natural. It's because you're feeding it to them. Anything natural? Anything natural. No, we hear about microalgae, vegetarians or vegans who want no animal products. can take EPA and DHA as algal products. Scientists realized that the original source of omega-3 is certain kinds of microalgae, not seaweed. We're not talking about seaweed. These are single-celled organisms. So they find the exact species that makes EPA or DHA. They put them in a vat in the middle of Iowa, give them sugar and water and sunlight, and they will make EPA and DHA.

55:59And then they harvest lipids out of these and put them in capsules. And that is a perfectly good source of EPA and DHA that does not come from an animal. And if I understood rightly from what you're saying, that is actually sort of the original source of this EPA and DHA? That's where it all comes from on the planet. So when you're eating a fish, you're actually, it's eaten these little algae. You got it. It's inside it. Right, right, right. And these days, honestly, like most of the time I'm eating a fish, it's probably farmed. So you're describing it's sort of being taken and fed sort of manually to these fish.

56:32And then I'm eating them. Am I understanding that right? That's right. You're right. Exactly. I think it's really important, Jonathan, to clarify, again, thinking back to where we started at the beginning, that when Bill's talking about omega-3, he's specifically talking about the EPA and DHA sources, because I don't want people listening saying, oh, well, hold on, you can get these from flax seeds, from walnuts, et cetera, specifically the EPA and DHA. Yeah. And there's nothing wrong at all with these products that are rich in ALA, flaxseed oil, chia seeds, it's fine. They're good for your variety of other things.

57:06It's just not the substitute for fish oils. I think that's really the point. Don't expect that to meet all your omega-3 needs if you're going to do a plant-based diet. So can we maybe wrap up with supplementation? Because I think one of my takeaways from this is that for this sort of optimal level that you're talking about, it's actually quite hard to get there. So it feels like that does push you towards supplementation. So I guess my first question is, do you supplement yourself, Bill? Yes. Imagine that someone can't do the testing, so they don't know their own baseline. What would you advise?

57:40Yeah, I think not the pregnancy world, but the regular world, you would say I would aim for about 1 ,000 milligrams a day of EPA and DHA combined, roughly 50-50. It could be 40-60, 70-30, whatever, but both of them, 1 ,000 milligrams a day would be fairly typical of the average Japanese intake, at least historical. I mean, the Japanese are now becoming more westernized. The younger people are not eating following the traditional diets. But historically, the Japanese intake has been around a gram a day. That's a healthy target intake. You can do that with two or three pills a day, some supplements, one a day.

58:21And you just have to look on the back of the label of the product to see how much EPA and DHA is in there per capsule and then take enough to get a thousand a day, then I think that's a great start. And final question on this, supplements are not as well regulated as medicine in almost all countries. Might be a little worse here in the States, I think, than in some others. Is there any concern you might have as you think about these supplements? Is there any way to sort of judge that you're going to get what you're looking for? I mean, commonly, the more you spend, the higher the concentration per capsule and the cleaner it is.

59:02Not to imply that the ones that are fairly cheap are dirty. They're not. You might get more of a fishy burp from some of the cheaper products. The fishy taste doesn't come from the omega-3. It comes from other oil products, other breakdown products in there. If you get a fishy burp, it doesn't mean that the omega-3s are gone. The omega-3s are still there. I use a product that's got 700 milligrams of EPA and DHA per capsule. That's in a triglyceride form. I think that's important to get a triglyceride form and not an ethyl ester form, which is the drug form is an ethyl ester form, which is not as well absorbed.

59:39Not absorbed. It's not as well absorbed as the triglyceride, which is more of a natural form. I think the really big takeaway, Jonathan, from me listening to Bill on this is that any type of supplement is better than no supplement. Because you do see such big disparities in cost. And I would hate to think that someone thought, oh, I can only get this ridiculously expensive one. Yes, it might not be quite as pure, but it's still going to be beneficial in terms of health. So I think that's really important. Bill and Sarah, thank you so much for taking us through what was quite a tricky and complicated topic.

1:00:17I'm going to try and do a summary, and then I'm counting on you to correct me where I've got it wrong. So I start with the fact that fish oil is not a myth, which is surprising because almost everything I was taught about nutrition when I was growing up seems to have been reversed. But here we're saying there really is something like magical in it, omega-3, but specifically this EPA and DHA. And I think what I've understood, which I hadn't got before, is like omega-3 is sort of like a family, you described it. And within that, there are these different types. ALA is this one from plants, but the one that you're really excited about is EPA and DHA.

1:00:54It does some quite magical things. So although you said it does not lower cholesterol, that is a myth. It can improve your risk for heart disease. And now we have this new science suggesting it can lower your risk for dementia, but also really amazingly, it's linked to sort of less anxiety and depression. And you were saying that you think that might be linked to reducing inflammation in the brain, which is interesting because often on this podcast, we talk about research about which is looking at sort of the microbiome and gut health and the links to inflammation and other things. So it's just interesting to me to hear you say that.

1:01:25You have developed this thing called the omega-3 index, which actually basically tells me how much of this EPA and DHA is actually in my individual cells. The healthiest is like 8%. You said on average in America, someone has 5%. And for people who are vegans in the military, which I suspect does not have the best diet, you can get as low as three and a half percent. Right. And you can function in all of this. So it's not like you're gonna die by not having this, but you definitely see improvement as you go from average to optimal. You can't visit your doctor and get this measured, which is disappointing, but we will put a link in the show notes for how you can go and get yourself tested.

1:02:07Basically, if you wanna get this through food, then you have to go to these oily fish. And you said smash, so I think I wrote down salmon, mackerel, anchovies, sardines, herring, everything else is much, much lower. So it's not that there's none, but it's not going to really change this percentage in a big way. Yeah, lower, much, much is a little strong, just lower. You're allowed to add any foods here that you think are critical. And what I heard is there are plants that are high in ALA. That's definitely better than not having it, but it's really hard to turn that into this EPA and DHA. And hence these algae products, which sound very exciting to me because that's like the original source of this, right?

1:02:47So you're just eating the fish in order to get at the plant basically or the algae. So that sounds very exciting. We'll see whether we can find any links for that as well, where you can get the direct EPA and DHA. And therefore, Bill, you are supplementing yourself rather than just trying to solve it with food because you want to be at this optimal level. And the key thing I took away was aim for a thousand milligrams. It's going to be EPA and DHA combined roughly 50-50, but you weren't too worried about it being 60-40 or 70-30. Critically though, you can't just buy something that on the front says 1000 milligrams of fish oil.

1:03:21You need to turn it around and look on the back. And it sounds like you might find that those amounts of EPA and DHA might be quite a bit lower. So you need to do a little bit of calculation to make sure that you're not buying something that seems good on the front, but it's low on the back. And that is sort of what you do. And that would be your advice for someone who wants to get to the optimal basis. Right, right. Well done. Well done. When you think of a gut supplement, what comes to mind? Something you swallow and grimace at. I think the aftertaste is so horrible, it must be good for me. Or something you sprinkle, crunch and actually enjoy.

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