Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station. Today I'd like to talk about fish oil. Well, we all know a little bit about fish oil. We know that it's probably good for your heart, that it probably lowers triglycerides and probably reduces insulin resistance. It seems to reduce inflammation. There is some reported benefit for mood and we certainly know it's important for infant. Well, let's dive into the ocean of fish oil complexity just a little more. And I'll see if I can confuse you as much as I've been confused by myself. So when we look at fish oil, it's got two main components that are referred to as marine triglycerides. is pentatoic acid the other is tocosa hexaonic acid the first we'll refer to as epa because that's much easier to say and the second we'll refer to as dha and so when you look at your bottle or jar of fish oil tablets on the side it'll have epa and dha written on it well here we go These seem like good things to supplement with, although there's not a lot of data to support they're beneficial. And at low doses, there hasn't really been much to show it at all. In fact, there was a study in the last couple of years that showed no outcome benefit at all by supplementing with a gram of mixed EPA and DHA in intermediate risk individuals over the course of a number of years. I think a lot of us take it thinking it's probably going to be of benefit, but the data is not really robust. So where does the data fit in? Well, there are two major trials which convincingly and conclusively tell us that we can reduce event rate in high risk individuals. The trials are called the reduce it and jealous trials. And both of these trials have taken high-risk individuals, particularly though high-risk individuals with raised triglycerides, and they've given them purified EPA only. This is at like a pharmacological strength, about four grams a day or thereabouts. So more than we would normally take with our... supplementing of a couple of fish oil tablets most nights. So the eicosapentaic acid EPA purified in reduce it and jealous without question showed dramatic risk reduction event rates over and above best standard therapy which includes aspirin, blood pressure lowering and of course statin therapy. These were in people though with raised triglyceride levels and we'll come back to that in just a second. Interestingly though, similar trials using a combination of EPA and DHA have not shown clear outcome benefit for the supplemental group. So in a somewhat puzzling way, It would seem that for high-risk individuals with raised triglycerides, purified EPA, eicosapentaic acid, is beneficial. But the combination of EPA and DHA is yet to show any benefit. Well, does that mean that the benefit of EPA is negated by DHA? The answer is we don't know. What is important to add into this space, particularly if you've got some central adiposity, that means weight around the tummy, or particularly if you're heading towards diabetes, or particularly if your triglycerides are up, and even more so if you have significant coronary disease, is that when they've looked at raised triglycerides, then one of the most powerful things for reducing risk and other complications of prediabetes and diabetes has been the use of a fibrate agent now some of the people listening to this may already be on a fibrate phenofibrate for example also known as lipidil now lipidil or phenofibrate appears to have a remarkable role in reducing some of the microvascular that's the small vessel complications of diabetes Now, phenofibrate hasn't been shown to reduce mortality, but it does reduce events of stroke and heart attack. But really importantly, it seems to reduce progression of diabetic eye disease. So it reduces the chance of individuals with diabetes becoming blind, and it reduces the chance of amputation, particularly peripheral amputation of the feet, toes. Phenofibrate, very interesting in the diabetic group. So does that mean that triglyceride, which we're looking to treat with EPA and with phenofibrate, is that the marker of the underlying insulin and insulin resistance that is driving some of these inflammatory processes? Well, it probably is. What does all this mean for you who's listening to this? Well, eating fish remains a good thing to do. We're not sure about the EPA, DHA interaction within fish. No one's looked at that. Is there a role for supplementation? Hard to be sure. The reality is if you've got high-risk cardiovascular disease and raised triglycerides in a pre-diabetic or diabetic status, then there's no question that EPA... would be beneficial for you. And this is a conversation you should have with your caring GP or cardiologist. Further to that, if you've got raised triglycerides and diabetic, then phenofibrates, i.e. lipidyl, are an absolute must for preservation of peripheral microvascular circulation so you don't lose your toes and maintenance. and stabilisation of your retina so you don't go blind from your diabetes. Well, that's eucosapentaic acid and docosahexaonic acid, EPA and DHA, a nice confusing little summary that leaves me. thinking that we've got to watch out for raised triglycerides, we've got to think about prediabetes, we need to think about EPA, and there's pharmacological preparations available for that, and we have to think about phenofibrate or lipidil in the appropriate individual. I hope that's helpful. If you've got any queries or questions, as always, drop us a line at info at drWarrickbishop.com. If you've got any ideas for future podcasts, let me know. I'm always interested. Until next time, thank you for listening. Please feel free to share this and wishing you live as well as possible for as long as possible. Take care and bye for now. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
