What You Need To Know About Eating Fish And Taking Fish Oil

Coming up on this mini episode of the Doctor's Pharmacy.

Where it gets sticky with the Omega-3 supplements is when they start to do some of these randomized control trials around Omega-3 supplements. I think a lot of times they don't necessarily take into account who's eating fish and who's not eating fish and they throw the supplement on top of everything.

Hi, I'm Kaya Perowne, one of the producers of the Doctor's Pharmacy podcast. Fish and seafood is one of the best dietary sources of protein around. It's also chock full of nutrients like iodine, selenium, vitamins D and B12. But the biggest health benefit of fish comes from omega-3 fatty acids. Omega-3s lower our risk of cancer, type 2 diabetes, autoimmune disease, depression, and inflammation. They are essential for the functioning of every single cell in our bodies. But many of us do not consume enough of them. And there is so much confusion about supplementing with fish oil as well as what the best types of fish to eat are. Earlier this year, Dr. Hyman sat down with Paul Greenberg to talk about these issues. Paul is a bestselling author of Four Fish: American Catch and the Omega Principle.

What fish should we eat?

What fish should we eat? All right. So, I'm just to start, let's go to, you know, where we're already at, because I always find it's hard to move consumers away from things that they're familiar with. I'm always good with wild sockeye salmon, wild Alaskan sockeye salmon, wild Alaska pink salmon. I often say to people, what's one, you know, people ask, what's the one switch they could make that would be better for them and better for the environment? Number one change, swap in pink or sockeye canned salmon for your canned tuna.

Yes.

Because your canned tuna, as you probably know, is very high in mercury and the pink and the sockeye salmon is going to be much lower. The pink and the sockeye is also going to be higher in omega-3 fatty acids. And, you know, maybe the first couple of times you try it, you might find it a little strong. There is the whole issue that when you, the way they, it's really funny, have you ever been to an Alaskan cannery before? I mean, literally what they do is they take this fish and they go, bump, bump, bump, you know, cut, slices out of it and fit the slice literally right into the can and then goes into the cooker. And if you notice when you open up a can of salmon, they'll often be like the remnant of the backbone, but that will actually, with a fork, will dissolve. And it seems, you know, Americans are so squeamish. I mean, you live in the bones are a great source of calcium. Exactly. So it used to be that farm salmon were primarily, you know, a vector for bringing omega-3 fatty acids into our bodies. But now that you have soy and all these other kinds of agricultural additives to the feed, you're going to have more omega-6s. And as I think you've probably explored, omega-6s and omega-3s actually compete for space on the same enzymes. So that can then, you know, impact our ability to lengthen short-chain omega-3 fatty acids from vegetable sources. And it also possibly, and again, this is, you know, science that I think is very much on the edge. I'd be happy to hear your opinion on the whole thing. But there's some that say that omega-6 tends to lead us down the pathway of inflammation, whereas omega-3 is the balance.

It's the balance, right? We need both, but it's really the balance. We used to have 20 to 1, I mean, 4 or 5 to 1 omega-3 to omega-6. Now we have 20 to 1 up to 21. That's right.

Omega-6 to omega-3s in some people. That's right. Processed food. Right. And as you were saying, you would eat fish all the time in part because it's one way of locking in that good balance. If you made wild, oily fish, your primary protein, you'd probably have a pretty good balance. But if you start putting in farm salmon, if that's your go-to fish, then.

Your Omega-3s are not getting the bang for your buck.

You're still getting quite a few Omega-3s. Farm salmon has quite a lot of Omega-3s in it, but they're also going to be carrying Omega-6s to you as well. So besides salmon, what should we eat? Okay, so beyond salmon, I am a big fan of the anchovy. Yes, my wife hates them, I love them. Yeah, you know, it's like, you know, it's definitely a Mason-Dixon line in the kitchen. But so, you know, when you consider that the world's largest fishery, the Peruvian anchoveta, 99% of this huge fishery gets reduced and turned into salmon feed. And you consider that all of that is actually perfectly good human food. Yeah, it's the best. How can you- Low in mercury. Low in mercury.

Full of omega-3 fats.

Full of omega-3s. Yes, low in mercury. Because generally speaking, lower you are on the food chain, the lower your mercury. I like them. I do this sauce at home I call toucan sauce. It doesn't involve a bird, but it's two cans. One can of anchovies, one can of tomato sauce. I don't know about you, but I hate having open cans in the refrigerator. So what I do is I take the anchovy and I generally prefer to have anchovies that are packed in olive oil. In a glass. Glass would be great. And right, because you don't want to have, although the BPA thing I think we're somewhat past that, I don't know.

Meaning we've taken it out of the.

Cans or it's not a problem. More that we've taken it out of the cans. I don't know. I mean, I'm not up to speed on that. You may be more up to speed than me. Anyway, what I like to do is anchovy packed in olive oil. Drain the olive oil into your pot, mince up some garlic, then take the anchovies out, mince up the anchovies. Once the garlic has just fried for a little bit, stir in the anchovies until they dissolve. They melt. And they just melt. And then you take your entire can of tomatoes and you put that in. Now, like, Marcella Hazan on and all the Italian cooks will say, oh, two filets of anchovies. Nah, the whole freaking can. You know, it's a dollar fifty at Trader Joe's. Yeah, yeah. And you've got this amazing sauce that my son who doesn't like fish will totally scarf down a two-cans sauce.

Okay, well, I hope my wife doesn't listen to this podcast, but I make this incredible sauce and it's supposed to.

Have anchovies in it.

It's like pasta puttanesca. Yeah. And I'm not gonna tell her next time.

I'm just gonna do that trick and see if she likes it.

It can happen. It can happen. So let's talk about fish oil.

Yes.

Because you wrote a whole book about this. I did. The Omega Principle. I did. And as a doctor, I I think that omega-3 deficiency is a huge contributor to all sorts of problems my patients have. And over the years, I've tested thousands, tens of thousands of people for their levels of essential fatty acids, including omega-3 fats. And I found significant deficiencies among across a wide range of populations, especially vegans. I mean, they're like zero.

Yes, yes, yes.

And that affects mood, brain development. nervous function, regulates inflammation, heart health, brain health, dementia, depression, cancer. I mean, and yet so many of the studies that have come out that have been published recently have seemed to debunk the idea that omega-3 fats are beneficial for heart disease or cancer or anything else. So the population is left confused, as usual, by nutrition advice, because we're all told that fish is healthy. That if you eat fish, looking at the studies on fish, you will have better health outcomes, but then there's all this contradictory information that if you eat omega-3s from pills, it doesn't do anything. So what's the deal?

Where are we at? Okay, well first of all, let's just clear the air about fish. Fish is just great because it's a lot of protein per calorie, it's a lot of nutrients per calorie, and if you're eating fish for your, you know, often for dinner, you're not eating other bad stuff, right? So if you swap in fish for beef, I think generally speaking, you're going to be ahead of the game. That's just sort of my general opinion on this. You may differ from me.

I would qualify that saying in a perfect world, yes. Right, but in a world of factory farm meat and pristine fish, 100%. In a world of regeneratively raised grass-fed meat versus polluted ocean fish, I'm not so sure.

Right, right. Okay. Let's keep in mind what the average American is doing. The average American is having feedlot meat. And if they have a choice between, say, cheapish wild fish that it could pick up in the market versus that feedlot beef, I think they're ahead. So there's that. The Omega-3 question, I think, has a lot to do with what people have called the threshold effect. It's very true that if you go on a vegan diet that your omega-3 levels are just going to plummet. And, I know this personally because I actually have been experimenting with a vegan diet.

My body is a laboratory, but for the last- so, you have no omega-3s.

But no mercury now. Right, exactly. So, I went to OmegaQuant, which is one of the tests. Yes. Just like a finger prick test. And, I had below 5% blood, omega-3 blood lipid levels, which I would say you would qualify as being deficient, right? Yeah. Are you more depressed? That's a whole other story. But when I was eating fish every day, meanwhile, for three meals a day, my omega-3 blood lipid levels were 11-12%. Somebody said to me when they saw that, probably similar to those of a Sicilian fisherman circa 1890. That's of course. And then probably what we should have had maybe in Neolithic times. So in between vegan and fish every day though, I think that there's a compromise which is equivalent to about two portions of oily fish per week. And that if we do that, I think we'll probably hit that threshold of-.

A couple of cans of wild sardines.

A couple of cans of wild sardines, a couple of cans of wild salmon, I think we'll probably hit that threshold effect. Now, where it gets sticky with the omega-3 supplements is when they start to do some of these randomized control trials around omega-3 supplements, I think a lot of times they don't necessarily take into account who's eating fish and who's not eating fish, and they throw the supplement on top of everything. So like most recently, there was the VITAL study, which came out of Brigham and Women's Hospital. So, you know, in that case, they actually did keep track of who was a fishery, who wasn't. But across the whole spectrum, they showed pretty much a null effect when it came to coronary heart disease, right? You know, from five years of taking a gram of omega-3, Correct. Every single day for five years. So, pretty significant null result. I should qualify that by saying that when they took out strokes, they did show something of a degree of effect on heart attacks overall. That was my reading of this study.

Yeah, there's been other studies that have shown benefits for people who've had a heart attack, preventing secondary attacks like the JUPITER study and others.

But yeah. Yeah. But so anyway, when though you start looking, when they started separating out people who had a couple of portions of fish a week, from those who didn't, the people who didn't did show significant effect on cardiovascular disease.

So, the ones who didn't eat fish and took the fish oil supplements got better.

Right, because they crossed the threshold.

Well, that's why I say if you don't have a headache and aspirin doesn't do anything, right?

Correct.

It's like, well, if you have plenty of levels, high levels of omega-3 fats in your blood, you're not going to see an incremental benefit.

That's right.

If you have zero, you're going to see a significant benefit.

That's right.

Home for me is check. Check your Omega-3 levels. See what your ratios are. See if you have trans fat in your blood. If your Omega-6s are high, look at what's going on with your levels and then do something about it. Eat anchovies, mackerel. I call it the smash fish. Wild salmon, mackerel, anchovies, sardines, and herring.

Yep, I would throw mussels in there. Mussels, I love mussels. High in Omega-3 is super cheap, by the way. And also, did you know mussels have.

A carbon footprint lower than lentils. Navigating the world of fish can be complicated. There are several important factors we need to consider to get the highest health benefits from fish while also acting as good environmental stewards. Because larger fish are higher on the oceanic food chain, they accumulate more mercury, PCBs, and other toxins. That's why Dr. Hyman recommends what he calls smash fish: salmon, mackerel, anchovies, sardines, and herring. He always tells people that if you can fit the entire fish in your pan, it's probably a good choice. For most people, Dr. Hyman also recommends taking a high quality fish oil supplement. If you eat fish two to three times a week, you might not need a supplement. It's always best to get your levels checked with your doctor. To learn more about the most important things to think about when it comes to being a responsible fish and seafood consumer, I encourage you to listen to Dr. Hyman's full length interview with Paul Greenberg. If you enjoyed this mini episode of the Doctor's Pharmacy, please consider sharing it with a friend or leaving us a comment comment below. Thank you for tuning in.