Omega-3 Index More Predictive Than Cholesterol Levels

Omega-3 Index More Predictive Than Cholesterol Levels

Analysis by Dr. Joseph Mercola


  • Your omega-3 index has a greater impact on risk of heart disease than does your cholesterol level
  • Plant-based omega-3 ALA is converted in restricted amounts to EPA and DHA, but not in large enough amounts to support your brain and heart health
  • EPA and DHA improve blood pressure, reduce inflammation and help slow the progression of Alzheimer’s
  • The best sources of EPA and DHA are fatty fish such as herring, anchovies and wild-caught Alaskan salmon, as well as grass fed beef and dairy that have a nearly 1-to-1 ratio of omega-3 to 6

The ketogenic diet is beneficial for many people as it helps with weight control and management and offers protection against a number of health ailments. Approached incorrectly, however, it can actually be harmful.
In this short video Dr. Eric Berg warns, “The last thing you want to do is get the benefits of the ketogenic diet but then have deficiencies of omega-3 fatty acids.” If you’re following a standard ketogenic nutrition plan I recommend you focus on eating healthy fats and 1 gram of protein for every kilogram of body mass. You should also keep your net carbohydrates to not more than 10% of your daily calories.
However, if you’re not getting enough omega-3 fat it can be detrimental to your health. As Berg describes, your body uses fat for many reasons, including the lining and protection of cell membranes, the processing of fat soluble vitamins, the catalyzation of chemical reactions, and the production of hormones and bile. Without enough healthy fat, and the right kinds of fat, you may increase your risk for negative health conditions.
Omega-3 fats are one type of polyunsaturated fats (PUFAs) you must get from your food since your body doesn’t make them.1 The second type of PUFAs are omega-6 fats. Your body needs both in a balanced ratio for optimal health.
As the National Institutes of Health describes,2 “The three main omega-3 fatty acids are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). ALA is found mainly in plant oils such as flaxseed, soybean and canola oils. DHA and EPA are found in fish and other seafood.”

Omega-3 Fats Are Crucial to Heart Health

EPA, DHA and ALA each have unique functions. DHA is particularly important for your brain,3 as about 90 percent of the fat in your brain is DHA, while EPA appears to be of particular importance for heart health.4 ALA, found in plants, is the “parent fatty acid” and is used as a source of energy.
However, while some may be converted to EPA and DHA in the body, conversion to EPA is restricted and unreliable, and conversion to DHA is severely restricted.5 Making lifestyle changes, such as exercising, stopping smoking and improving your diet, have a significant impact on your heart health.
The authors of one study published in the New England Journal of Medicine6 analyzed the risk of a cardiovascular event while taking icosapent ethyl. The medication is a “highly purified eicosapentaenoic acid ethyl ester” that is “a synthetic derivative of omega-3 fatty acid.”7
The data8 were based on information gathered from 8,179 participants who were followed over a period of 4.9 years. The researchers identified end points of the study as death from a cardiac event, or a nonfatal heart attack or stroke.
The participants either had heart disease or risk factors for it and were taking statins. They were given either a placebo or 2 grams of icosapent ethyl twice a day. Those who took the medication had a significantly lower number of ischemic events than those taking the placebo.
Although the drug had previously been approved in 2012 for people with high triglycerides, in December 2019 the FDA approved it for use alongside statins.9 Its mechanism of action has not been completely identified, but the American Heart Association lists the following reasons natural omega-3 may have an impact on lowering the risk of heart disease:10
Lowers triglyceride levels and increases HDLs
Decreases platelet aggregation and prevents blockage of coronary artery
Lowers resting blood pressure
Increases compliance of arteries
Decreases atherosclerosis
Reduces inflammatory markers
Decreases risk of abnormal heart rhythms
As explained in a meta-analysis published in Circulation,11 scientists concluded there was a growing body of evidence that omega-3 fats can prevent sudden cardiac death by “modulating ion channels so as to stabilize the cardiomyocytes electrically.”

EPA and DHA Lowers Inflammation, Pain and Depression

EPA and DHA have been shown to improve blood pressure,12 reduce overall inflammation, reduce the effects of rheumatoid arthritis13 and depression14 and help to slow the progression of Alzheimer’s disease.15
Other conditions linked to inflammation that are positively affected by omega-3 fatty acids are Hashimoto’s disease and inflammatory bowel disease. Nutritionist Steph Lowe spoke with Starts at 60 about omega-3 fats, saying:16
“Fish oil is a natural alternative to non-steroidal anti-inflammatory drugs (NSAID), without the side effects but with the potential to reduce the inflammatory response and thereby reduces joint stiffness and pain.”

Your Body Needs Cholesterol for Vital Functions

For decades you’ve been told that high cholesterol levels will increase your risk for heart disease. In fact, some in the health community continue to stress your level of cholesterol as a biomarker for heart risk, when in fact it’s smarter to take a global view of cholesterol — how it affects your body and what you can do to reduce your risk of heart disease beyond the simple narrative which focuses on cholesterol as some kind of culprit.
Cholesterol is vital to your overall health, as it helps with the manufacturing of hormones and vitamin D. About 80% of the cholesterol in your body is made in your liver and intestines, while the rest has to come from your food.17
There are two categories of cholesterol: The first is high density lipoprotein (HDL), which many know as the “good” type that moves cholesterol out of your arteries.18
The second is low-density lipoprotein (LDL) or what many know as the “bad” type that may build up and form plaque in the arteries. The American Heart Association focuses on your total cholesterol number, which they recommend you keep at 150 milligrams per deciliter (mg/dL).19
In the 2015-2020 Dietary Guidelines for Americans, it’s noted that the Institute of Medicine recommends20 “… individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.” However, in the Scientific Report of the 2015 Dietary Guidelines Advisory Committee, it was acknowledged that “… cholesterol is not considered a nutrient of concern for overconsumption.”21
It’s troubling to know that the public hears one thing and something completely different is discussed at a medical advisory meeting.
Using cholesterol as a sole marker for the risk of heart disease is inaccurate because, like most things related to your body, its mechanisms are complex and interrelated. Increasing amounts of evidence show that people with higher levels of cholesterol live longer lives.22 As summarized by the authors of one study:
“Overall, an inverse trend is found between all-cause mortality and total (or low density lipoprotein [LDL]) cholesterol levels: mortality is highest in the lowest cholesterol group without exception … elderly people with the highest cholesterol levels have the highest survival rates irrespective of where they live in the world.”
While evaluating your heart disease risk, consider your fasting insulin and blood sugar levels, waist circumference and iron levels. I discuss the relationships of these factors to your heart health and the importance of differentiating the types of LDL in “Important Facts About Cholesterol and Heart Disease.”
There are a number of ways higher levels of cholesterol may have a protective effect on your health; these are discussed in “Higher Cholesterol is Associated With Longer Life.” Instead of looking at simple levels, there are two indicators that are important: your HDL/total cholesterol ratio and your triglyceride/HDL ratio.

Why Testing Your Omega-3 Level Is so Important

An omega-3 deficiency leaves you vulnerable to several chronic diseases and lifelong challenges. Optimizing your levels is truly a foundational strategy to attaining and maintaining good health. The best way to determine if you’re eating enough food with omega-3 is to get tested.
In fact, research23 supported by the National Institutes of Health suggests that an omega-3 test is a good predictor of overall health and all-cause mortality.24
Leaders of the study measured the omega-3 index in 2,500 participants; they found that those with the highest omega-3 index had lower risks of heart problems. The omega-3 Index is a measure of the amount of EPA and DHA in the membranes of your red blood cells (RBCs). As Berg mentioned, fat is a component of cell membranes.
Your index is expressed as a percent of your total RBC fatty acids. The omega-3 index has been validated as a stable, long-term marker of your omega-3 status, and it reflects your tissue levels of EPA and DHA. I just had my omega-3 index done last week from GrassrootsHealth and it was 11.1% and my 6:3 ratio was 2.7.
An omega-3 index over 8% is associated with the lowest risk of death from heart disease, while an index below 4% places you at the highest risk of heart disease-related mortality. Given its importance to your health, it is absolutely worth your time to complete the simple blood test required to determine your omega-3 index.
I firmly believe an omega-3 index test is one of the most important annual health screens that everyone needs. Please note I make no profit from these tests. I merely supply them as a convenience for my readers. It’s the same price whether you buy it from me or directly from GrassrootsHealth.25

Protect Your Heart and Brain With Animal-Based Omega-3

You can get all three types of omega-3 fats from your food, but EPA and DHA come mostly from fatty fish, seafood and grass fed beef and dairy products. Grass fed beef and dairy products, incidentally, offer a nearly 1-to-1 ratio of omega-3 to omega-6 fatty acids.26 Lowe points out the importance of where you source your fish:27
“As a nutritionist, my preference is always food, but one of the biggest challenges we face at the moment is that most of our oily fish is farmed and grain-fed.”
Your best sources of fatty fish are wild-caught Alaskan salmon, herring, mackerel and anchovies. The larger predatory fish, such as tuna, have much higher amounts of toxins such as mercury. As Berg stated in the video, steer clear of grain-finished beef as the omega-3 fatty acids are significantly reduced.
As I touched on above, it’s important to realize your body doesn’t convert enough plant-based omega-3 to meet your needs. This means that if you’re vegan, you must figure out a way to compensate for the lack of marine or grass fed animal products in your diet.
While the authors of some studies28 suggest that algae products may be an effective alternative, the only way to know if you’re on the right track is to test. If you are pregnant I urge you to check your vitamin D and omega-3 levels, as these two nutrients are vital for healthy fetal development and can dramatically reduce your risk of complications during pregnancy and delivery.
If your test results are low, and you are considering a supplement, compare the advantages and disadvantages of fish oil and krill oil as you’ll see in the infographic below. Krill are wild-caught and sustainable; krill oil is also more potent than fish oil and is less prone to oxidation.