averting arrhythmias with omega-3 fatty acids

ARRHYTHMIAS

BY WILLIAM DAVIS, MD

-ir

All too often, the first sign of hidden cardiovascular disease isthe last: sudden cardiac death. Many of these deaths are caused byabnormal heart rhythms, or arrhythmias.

Arrhythmias—some harmless, some life-threatening—affiictnearly 10 million Americans. While conventional medical treat-ments focus on invasive implantable devices and medications thatcarry serious side effects, compelling evidence shows that youcan arm yourself against dangerous heart rhythm disorders byoptimizing your oniega-3 fatty acid intake. > >

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AVERTING ARRHYTHMIAS WITH OMECA-3 FATTY ACIDS

Physicians Finally Recommend Fish OilIn the last two years, conventional medical prac-

titioners have increasingly embraced omega-3 fattyacids from fish oil for their heart-health benefits.

But just 30 years ago, had you suggested that fishoil could provide extraordinary benefits towards reduc-ing the risk of heart attack, help prevent or suppressabnormal heart rhythms, and even reduce the likeli-hood of death from heart disease more than any pre-scription drug known, you would have been laughedout of town.

But you would also have had the last laugh.For years, physicians have dismissed the value

of nutritional supplements, including omega-3 fattyacids from fish oil. This unwillingness to utilize fishoil has prevailed despite considerable scientific datadocumenting the flagrant health damage wreakedby omega-3 deficiency in Americans. Even after a1999 study showed that heart attack survivors whosupplemented with a modest amount of fish oileach day experienced significantly less cardiovascu-lar mortahty (30%) and sudden death (45%), manyphysicians failed to recommend omega-3 fatty acidsto their patients.'

Prescription Fish OilPracticing physicians remained reluctant to rec-

ommend fish oil until a pharmaceutical companydecided that it would commercialize omega-3 fattyacids as a prescription drug. Reliant Pharmaceuticalspushed its version of fish oil omega-3s throughhuman clinical trials, an expensive and laboriousprocess required for FDA approval as a pharmaceu-tical agent. In November 2004, the FDA approved fishoil as a prescription diug for the treatment of triglyc-éride levels of >500 mg/dL. (It is standard operating

procedure for pharmaceutical companies to obtaindrug approval for a single condition that is likely topass regulatory muster.) Of course, once the productreaches pharmacy shelves, it can be prescribed "offlabel" for other uses. The initial product name was

"Omacor®," but has recently been changed to Lovaza™due to confusion from a similar-sounding but unre-lated product.

Promptly following FDA approval, marketingefforts exploded. Practicing physicians receivedweekly visits, phone calls, and emails from eager salesrepresentatives, not to mention invitations to dinnersand "educational" conferences. Now, three years andplenty of marketing efforts later, your neighborhoodphysician is beginning to prescribe fish oil for hightriglycérides.

The appearance of fish oil as a pharmaceuticalagent has paved the path for large clinical trials tostudy its usefulness for treating a number of condi-tions. The larger sums that a drug manufacturer cancharge for a product (because "drugs" are paid forby the health insurance industry) bring in greaterrevenues sufficient to fund large clinical studies.

Among the emerging applications of omega-3sis the treatment or prevention of heart rhythm dis-orders, or arrhythmias. Since rhythm disorders arecomplex, the media has painted a confusing picture oftheir management with fish oil. Yet if we sift throughthe hype and media confusion, we will discover thatfish oil is emerging as a very powerful treatment forheart rhythm disorders. Although newer studies havefocused on the prescription form of omega-3s, fishoil is available to us without a prescription, just as ithas been for years. The good news is that fish oil mayrepresent the number one nutritional strategy for pro-tecting against dangerous abnormal heart rhythms.

62 I LIFE EXTENSION | JULY 2008

A Nationwide Deficiencyof Omega-3s

Before the late 1980s, the Ametican diet wasextremely high in saturated fats, which was linkedwith an elevated risk of cardiovascular disease.^In response, many arbiters of healthy eating, includ-ing the Surgeon General's office, the USDA, and even-tually even the FDA spoke out against fat intake inthe American diet. Thus was born the low-fat era.Not only did Americans receive an introductionto the concept of low-fat foods, but the foodmanufacturing industry spotted a new opportunityfor an entirely new range of products that exploitedthe low-fat concept: low-fat cookies, low-fatbreakfast cereals, low-fat lunch meats, and thousandsof others.

Along with the low-fat concept, the same agen-cies advocated a switch from saturated fats to poly-unsaturated fats, based on some evidence suggestingthat replacing saturated with polyunsaturated fatsreduced blood cholesterol levels, heart attack, andcancer.^ Polyunsaturated fats from corn, safflower,sunflower, and other sources thereby became deeplyentrenched in Americans' nutritional habits.

At the same time, a new trend was emerging inthe Midwestern farm belt. Traditional Americanfarms, in which livestock roamed and fed on grasses,were replaced with large-scale factory farms thatcould generate large amounts of low-cost meat.These factory farms kept animals confined to smallpens and fed them corn or industrialized food sub-stitute. While grass-fed beef contains a substantialamount of omega-3 fatty acids, factory farm-raisedbeef does not."* This trend di'ove down the cost ofmeat, but it also depleted the nation's meat sup-ply of omega-3 fatty acids. Now, most supermarketmeat is rich in omega-6 fatty acids, with the resul-tant gteater fat composition visible to the unaidedeye as "marbling."^

Thus, a confluence of events led to creating anexcess of omega-6 fatty acids and a depletion ofomega-3s in the American diet. Compared to thediet of a primitive human feeding on wild game, theaverage American diet based on factory farm-raisedlivestock contains less than 10% of its originalomega-3 fatty acid content."

The consequence of deep, long-term depletion ofomega-3 fatty acids from the American diet is a col-lection of inflammatoi7 diseases: cancer, high bloodpressure, mental illness, and heart disease.

Could the many cases of heart rhythm disordersafflicting humans today represent the end resultof decades of a diet lacking omega-3 fatty acids?Intiiguing evidence suggests that this may be the case.

Averting Arrhythmiawith Oniega-3 FattyAcids

• Heart arrhythmias are a leading cause of sud-den cardiac death. Abnormal heart rhythmshave traditionally been treated with prescrip-tion medications. However, these medicationshave dangerous side effects and may notdecrease overall mortality.

• Compelling evidence suggests that omega-3fatty acids from fish oil may prevent suddencardiac death, which is likely mediated throughrhythm-stabilizing effects. Individuals withlower levels of omega-3 fatty acid intake aremore likely to experience heart arrhythmias.

• The American diet is extremely low in omega-3fatty acids. The recent approval of a prescrip-tion form of omega-3 fatty acids has fueled aburst of interest in extending its uses, includingmanagement of abnormal heart rhythms. High-quality fish oil as a nutritional supplement isreadily accessible.

• Omega-3 fatty acids help stabilize heartrhythms through numerous mechanisms, andmay help prevent the common arrhythmia, atri-al fibrillation. Omega-3 fats may find usefulnesseven in people with dangerous heart rhythmsthat necessitate defibrillators.

• Fish oil supplements remain the best sourceof the omega-3 fatty acids, with alpha-linolenicacid a second choice,

)ULy2008 I LIFEECTENSION | 63

AVERTING ARRHYTHMIAS WITH OMEGA-3 FATTY ACIDS

Understanding Arrhythmiaswhat is that flip-flop feeling you get sometimes while

lying in bed or after a strong cup of coffee.̂ When isirregular or rapid heart rhythm just a passing, harmlessphenomenon, and when is it a harbinger of real trouble?

In truth, euerybody has some measure of irregularityof their heart beat and nobody's heart rhythm is perfectlyregular. Beat-to-beat variation, in fact, is a desirable fea-ture of heart rhythm that reflects health. The most physi-cally fit athletes, for instance, have the greatest degreeof heart rate variation. Lack of beat-to-beat variation cansuggest hidden dangers and potential for heart attackand even death. This cannot be easily measured on yourown, but can be assessed by electrocardiogram, or EKC.At some point, however, your heart's rhythm can vio-late its controls and exceed healthy limits of variabilityThis is arrhythmia. Actually a more accurate term wouldbe dysrhythmia. or disturbed rhythm, since arrhythmiameans "without rhythm," but arrhythmia is the morecommonly used term.

Like people, arrhythmias come in a variety of shapesand sizes. Some are benign and simply an annoyance(albeit a frightening one when your heart feels like it'sjumping or racing), while others are life-threatening.Your doctor can help determine vyhether you have an ar-rhythmia, and whether it is benign or a potential causefor concern.

Several clues can suggest that an arrhythmia may bepresent and that medical evaluation is necessary. For ex-ample, a heart rate that is too low (less than 50 beatsper minute) or too fast (more than 99 beats per minute)is unusual and should be evaluated by your doctor. Thesensation of palpitations; or that flip-flop feeling in yourchest, without feeling faint or losing consciousness; cansuggest that an arrhythmia is present. But palpitationsby themselves are exceptionally common and not neces-sarily rhythm-related. If you've passed out or felt faint,then you should have a physician evaluate whether youmay have an arrhythmia.

Omega-3 Fatty Acids from Fish OilAre Rhythm Stabilizing

Inexpensive, safe, and effective, the omega-3 fattyacids ft-om fish oil provide a stabilizing effect on heartrhythm function that no medication can provide.

The evidence showing that omega-3 fatty acidsstabihze heart rhythms dates back nearly 20 years tothe Diet and Reinfarction Trial (DART). Conducted byDr. Michael Burr at the University of Wales in 1989,the DART trial was the first randomized clinical trialdemonstrating the benefits of fish oil. Two thousandand thirty-three men with prior heart attacks partici-pated in the study. Those who were advised to eat fishtwice per week experienced a 29% drop in all-causemortality over the course of two years, compared withmen who did not receive this dietaiy advice. Dn Burrand colleagues reasoned that the modest quantity ofomega-3 fatty acids obtained by eating fish likely sup-pressed the generation of unstable electrical impuls-es from damaged heart muscle that can trigger fatalheart rhythms/

Another study of 360 patients with symptoms ofheart attack corroborated the DART findings, butused a higher dose of omega-3s obtained from fish oilcapsules. This study, which was conducted in India,showed that patients given omega-3 fatty acids at thedose of 1,080 mg per day of eicosapentaenoic acid

(EPA) and 720 mg per day of docosahexaenoic acid(DHA) totaling 1,800 mg per day suffered 48% less car-diac death and 76% less sudden cardiac death, as wellas a 54% reduction in dangerous heart rhythms.*•

Numerous experimental preparations have pro-vided a scientific basis for the rhythm-stabilizingeffect of omega-3s. These fatty acids affect myocardialmembranes, regulate heart muscle cell action poten-tials, and impact a wide variety of cellular-signalingmechanisms, which together help avert dangerousarrhythmias.^'" In contrast, the omega-6 fatty acidsfrom polyunsaturated vegetable oils, which are con-verted into arachidonic acid in the body, may increasethe potential for arrhythmias. Fish oil also reduces theblood-clotting protein, fibrinogen, and inhibits plate-let aggregation, both of which prevent blood clot for-mation on active, ruptured coronary plaque that couldcontribute to heart attack. Heart attack is notoriousfor destabilizing heart rhythm."

Taken over months, omega-3 fatty acids fromfish oil substantially reduce the frequency of abnor-mal irregular beats.'^'^ In the recent ATTICA Study,a detailed analysis of electrocardiograms (EKGs)showed that participants who consumed more than300 grams of fish per week (about 11 ounces, or twoto three small servings) showed shorter OT intervals, ameasure of heart rhythm stability. Thus, people eating


AVERTING ARRHYTHMIAS WITH OMEGA-3 FATTY ACIDS

fish showed less potential for unstable heart rhythmsby this measure.'''

But just how useful are the omega-3 fatty acids forreal-life suppression or prevention of abnormal heartrhythms?

Omega-3 Fatty Acids:Real-Life Applications

clinical studies now provide solid documentationthat omega-3 fatty acids reduce mortality from heartdisease and disorders of heart rhythm. This is in dra-matic contrast to prescription rhythm medication,which effectively normalizes heart rhythms but mayalso increase mortality dsk.'^

The Italian GISSI-Prevenzione trial persuasive-ly demonstrated fish oil's life-savmg benefits. Over11,000 subjects participated in this large trial thatfirmly established fish oil as a mainstay of heart dis-ease management. Participants took 1,000 mg of EPAand DHA, the omega-3 fatty acids of fish oil, or pla-cebo, with a resultant 30% reduction in cardiovas-cular mortality and 45% reduction in sudden deathamong those taking fish oil. The protective benefits(reduction in death) began as early as three monthsafter initiation of fish oil supplementation.' Similar,though even more profound, effects were suggest-ed by a Harvard study showing that men who hadhigher blood levels of oinega-3 fatty acids sufferedan 80% lower likelihood of sudden cardiac deathcompared with men who had low omega-3 bloodlevels.'^ Thus while prescription medications may

exert more potent effects on suppression of irregularheart beats, fish oil may have the upper hand in pro-viding life-saving benefits.

Substantial research suggests that omega-3 fattyacids may protect the cardiovascular system byincreasing heart rate variability. While abnormal anddangerous heart rhythms are often characterized byirregularity, there is also a modest modulation thatnormally occurs from heartbeat to heartbeat, ebbingand fiowing in waves that track respiratoiy (breathing)patterns. This sort of irregularity is actually desirableand healthy, refiecting heightened parasympatheticnervous system tone. Interestingly, omega-3 fattyacids increase this type of desirable heart rate varia-tion, which may help explain their ability to modulateheart rhythms. Omega-3 fats also reduce resting heartrate and improve heart rate recoveiy after exercise.'^

The rhythm-suppressing properties of fish oil are soeffective that some cardiologists now recommend thatpatients who have implanted defibrillators (to managelife-threatening heart rhythms) take fish oil to reducethe rhythm instability of the heart and reduce defibril-lator firings, which are very painful and frightening. Ina 2005 Harvard study, 402 survivors of heart attackswith implanted defibrillators were given a low dose offish oil or placebo. Fish oil supplementation produceda 38% reduction in painful defibrillator firings overthe course of 11 months.^"

Can fish oil prevent dangerous rhythms in peo-ple without known heart disease? The Physicians'Health Study provides the clearest perspective on


this intriguing question. Over 17 years of observation,participants who died from sudden cardiac death hadmuch lower blood levels of omega-3 fatty acids at thestart of the observation period than those who did not.Protective levels of omega-3 were obtained by just eat-ing one or more semngs of fish per week, yielding a52% reduction in the risk of sudden cardiac death,which was likely mediated by the decrease in fatalheart rhythms.^'

An intriguing but unanswered question is whetherfish oil suppresses the common arrhythmia known asatrial fibrillation. Atrial fibrillation plagues approxi-mately 10% of people over age 80 and is a frequentreason for hospitalization. Furthermore, atrial fibril-lation increases the risk of stroke by contributing toblood clot formation in the left atrium that fragmentsand is released into the circulation. Conventionalmedical treatment for atrial fibrillation is fraughtwith side effects and limited effectiveness, and bettertherapies are sorely needed.̂ ^ Fish oil has impressively

suppressed atrial fibrillation in experimental non-human preparations.^ The question is compelling: doestaking fish oil prevent this common arrhythmia?

Prevention of atrial fibrillation would be difficultin a broad population, as is any preventive strategy,since the rhythm develops in only a small percentageof people during the limited period of a study. A con-venient "laboratory" to study this question is providedby persons undergoing heart bypass surgery, sinceatrial fibrillation occurs in approximately one-third ofpatients following the operation. One such effort was arecent study of 160 patients given 2,000 mg per day ofEPA-DHA versus placebo, begun five days prior to sur-gery, which demonstrated that the occurrence of atri-al fibrillation plummeted from 33.3% in the placebogroup to 15.2% in the omega-3 group.'* Interestingly,the only other therapeutic agents that have beenshown to achieve a similar reduction in atiial fibril-lation after heart surgei*y have been the beta-blockerclass of antihypertensive drugs such as metoprolol.

Prescription Anti-Arrhythmia Medications:Playing with Fire

Thirty years ago, physicians diligently monitoredtheir patients' heart rhythms, selecting and prescrib-ing specific medications called anti-arrhythmia medica-tions, such as procainamide or amiodarone, accordingly.These medications were highly effective at reducing oreliminating irregular beats and rhythms.

It came as a surprise when several large clinical trialsin the 1980s reported that while heart anti-arrhythmiamedications reduced the quantity of "abnormal" heartbeats, they were associated with an increase in mortalityor death rates.'^

In 1995, Life Extension magazine exposed the FDA'sfailure to take lethal anti-arrhythmia drugs off the market,which at that time had already killed 50,000 Americans.

This startling discovery posed many questions forphysicians. When should abnormal rhythms be treated,and when should they be left alone? Is a reduction inrhythm irregularity a positive change—or potentially fa-tal? This drove home the lesson that simply suppressing ir-regular heart heats may not translate into better outcomes.

This finding ended the days of suppressing all ab-normal heart rhythms. Since then, investigators havelearned that not all rhythms need to be suppressed. Wealso learned that while rhythm medications do reduce

the number of excess beats, they are also potentially verydangerous.

Add to this the fact that many anti-arrhythmia medica-tions carry risks of side-effects outside of heart rhythm,some very serious. The agent procainamide, for instance,can cause a lupus-like syndrome, while amiodarone isclearly related tothyroid disorders and I iverdysfunction.'^'"Today, antiarrhythmic medications are reserved for dan-gerous and usually life-threatening rhythms.

The imperfections and pitfalls of anti-arrhythmiamedications led many cardiologists to embrace im-plantable defibrillators that deliver an internal shockto the patient's heart to terminate rhythms that poselife-threatening risk. These devices are expensive andrequire a surgical procedure for implantation.

Thus, while certain medications can suppress thenumber of irregular heart rhythms, they do not necessarilyextend life or reduce cardiovascular "events".

Your doctor or cardiologist can help you develop aplan to keep your heart in healthy rhythm. Fortunately,nutritional supplements like omega-3 fatty acids fromfish oil can play a preventive role even with seriousarrhythmias—and they do not have the undesirableaspects of anti-arrhythmia medications.



anti-arrhythmic medications Uke sotalol,^'' andthe anti-arrhythmic dixig, amiodarone.^^ All of thesedrugs carry side-effect risks. In contrast, the use ofomega-3 fatty acids was accomplished with virtuallyno side-effects.

Obtaining Omega-3 Fatty AcidsFish oil is the most concentrated source of the ome-

ga-3 fatty acids EPA and DHA. These fatty acids arepresent in cold-water fish such as wild salmon, halibut,and mackerel, as well as in fish oil supplements.

Existing data suggest that a dose of fish oil thatdelivers approximately 1,400-2,000 mg of EPA plus1,000-1,500 mg of DHA is likely to yield heart rhythmbenefits. This dose is similar to that used in the GISSI-Prevenzione trial that yielded a substantial reductionin cardiovascular events.

A secondai-y source of omega-3 fatty acids is alpha-linolenic acid (ALA) found in flaxseed, walnuts, andcanola oil. Less than 10% of the alpha-linolenic acidingested, however, is converted into active EPA orDHA, since much of it is simply burned for calories.These sources should be viewed as second choicesin your quest to obtain adequate levels of omega-3fatty acids necessary for optimal health. Nonetheless,emerging experiences are suggesting that alpha-linolenic acid may also reduce the likelihood ofdangerous rhythm disorders that result in suddencardiac death.^*

Since most of us are unable to obtain the necessaryquantity of omega-3 fatty acids thiough diet alone, fishoil capsules or liquids provide a convenient and read-ily available means of protecting against dangerousheart arrhythmias. If you use the medication warfarin(Coumadin'^), consult a physician before supplement-ing with fish oil.^'

ConclusionThe world of arrhythmias can be a confusing web

of complex issues, even for physicians and cardio-logists. The apparently straightforward strategy ofsuppressing abnormal heart beats with prescriptionmedication does not often improve outcome, as theexperience with heart rhythm diügs has shown us.

Chronic and severe deficiency of the omega-3 frac-tion of fats from the American diet may be a majorcausative factor behind cardiovascular disease, particu-larly life-threatening heart arrhythmias. Fish oil rich inomega-3 fatty acids may help treat the basic nutritionaldeficit that underlies many rhythm disordei^s.

Studies have shovm that people with lower levelsof omega-3 fatty acids are more prone to arrhythmiasand cardiovascular events. Researchers have alsodemonstrated that omega-3 fatty acid consumptionreduces such events. Supplementation with omega-3fatty acids can thus provide a useful, practical methodto prevent the development of several varieties of com-mon arrhythmias. •

IULY2008 I LIFE EXTENSION | 67

AVERTING ARRHYTHMIAS WITH OMEGA-3 FATTY ACiDS

If you have any questions on the scientificcontent of this article, please call a Life Extension

Health Advisor at 1-800-226-2370.

Dr. William Davis is an author and cardiologistpracticing in Milwaukee, Wisconsin, who focuses on

developing strategies for reversal of heart disease. He isauthor of the book, Track your Plaque: The only heart diseasepreventior) program that shows you how to use the new heartscans to detect, track, and control coronary plaque. He can be

contacted through wvkW.trackyourplaque.com.

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averting arrhythmias with omega-3 fatty acids

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