Do Omega-3s Lower Blood Pressure?

Written by Dr. Steve Chaney on . Posted in Food and Health, Issues, Supplements and Health

The Good News About Fish Oil

Author: Dr. Stephen Chaney

High Blood PressureHigh blood pressure or hypertension is a major problem in this country. Over 60% of Americans have high blood pressure. Only 47% of those with hypertension are adequately controlled. 20% of them don’t even know that they have high blood pressure.

In this case, ignorance is definitely not bliss. That’s because high blood pressure significantly increases the risk of stroke, heart attacks and congestive heart failure.

The causes of high blood pressure are many. Genetics, obesity, lack of exercise, sodium, alcohol, saturated fats and too few fresh fruits and vegetables all play a role. Age also plays a role. As we age, our blood vessels become less flexible and our blood pressure rises by about 0.6 mm Hg per year.

Medications can help, but many of them have significant side effects and often aren’t fully effective in controlling blood pressure. That’s why natural approaches are so important.

Because there are so many causes of hypertension, natural approaches for lowering your blood pressure are not simple. Natural approaches start with weight loss, restricting sodium intake, increasing physical activity, moderating alcohol intake and something called the DASH diet. In short, there is not just one simple change that you can make that will totally eliminate hypertension. It requires a complete lifestyle change.

That’s why the latest study on the effect of omega-3s on blood pressure is so exciting. If the headlines are true, adding omega-3s to your diet may be one of the most effective things you can do to lower your blood pressure naturally. So let’s examine the study to see if the headlines are accurate.

How Was The Study Designed?

This study (Miller et al, American Journal of Hypertension, doi:10.1093/ajh/hpu024) was a very large, well designed study. It is a meta-analysis of 70 randomized, placebo controlled clinical studies. Key characteristics of these studies were:

  • The mean study duration was 69 days. That means these beneficial effects occur relatively quickly.
  • The mean EPA + DHA dose was 3.8 g/day (range = 0.2 – 15 g/day). A wide range of doses was included.
  • The EPA & DHA came from all sources (seafood, EPA+DHA fortified foods, fish oil, algal oil, and purified ethyl esters. The source did not affect the outcome.
  • Olive oil was the most commonly used placebo, with omega-6 vegetable oils being used as placebos in a few studies. The choice of placebo did not affect the outcome.
  • None of the people in these studies were taking blood pressure lowering medications. That means these studies were specifically designed to see whether omega-3s lowered blood pressure, not whether they had any additional benefit for people already taking medications. This is important because if you only focus on groups who are already taking multiple medications, you tend to obscure the beneficial effects of omega-3s (see my recent Health Tip “Is Fish Oil Really Snake Oil?”)

Do Omega-3s lower Blood Pressure?

Fish OilThe authors of the study reported that:

  • Compared to placebo, EPA+DHA reduced systolic blood pressure (that’s the upper reading) by 1.52 mm Hg and diastolic blood pressure (that’s the lower reading) by 0.99 mm Hg.
  • When they looked at those participants who already had high blood pressure, the numbers were even more impressive – a 4.51 mm Hg decrease in systolic blood pressure and a 3.05 mm Hg decrease in diastolic blood pressure. That’s important because for each 2 mm Hg reduction in blood pressure there is a 6% decrease in stroke mortality, a 4% decrease in heart disease mortality, and a 3% decrease in total mortality.

More to the point, the authors of the study concluded that “A decrease of 4.51 mm Hg in systolic blood pressure among those with high blood pressure could help an individual avoid having to take medication to control blood pressure levels”.

  • When they looked at the study participants who had normal blood pressure the numbers were still significant – a 1.25 mm Hg decrease in systolic blood pressure and a 0.62 decrease in diastolic blood pressure. The authors pointed out that this could prevent, or at least delay, the age-related progression towards hypertension.
  • The effect of omega-3s on systolic blood pressure (4.51 mm Hg decrease) was comparable to the most successful lifestyle interventions – 3-10 mm Hg decrease for 10 pound weight loss, 4-9 mm Hg decrease for increased physical activity, 2-8 mm Hg decrease for sodium restriction, and 2-4 mm Hg for decreased alcohol consumption.
  • A dose of at least 1 gm/day of EPA+DHA was required for a significant decrease in systolic blood pressure, and a dose of over 2 gm/day was required for a significant decrease in both systolic and diastolic blood pressure

While this is a single study, it is consistent with a number of previous studies in this area. Based on the existing body of literature I would recommend omega-3s as part of a holistic approach for keeping your blood pressure under control.

The Bottom Line:

1)     A recent meta-analysis of 70 published clinical studies (AJH, doi: 10.1093/ajh/hpu024) has shown fairly convincingly that omega-3 fatty acids are effective at lowering blood pressure. Moreover, this study is consistent with a number of previous studies. The evidence appears to be strong enough for omega-3s to be considered as part of a holistic approach to keeping your blood pressure under control.

2)     If you already have high blood pressure, you should know that omega-3s caused blood pressure to decrease by 4.51 mm Hg in people like you. The authors of the study concluded that this decrease in blood pressure is large enough that some people may be able to avoid blood pressure medicines entirely. For others addition of omega-3s to their diet will likely allow their physicians to reduce the dose of medications required to keep their blood pressure under control – thus minimizing the side effects of the medications.

3)     If you already have slightly elevated blood pressure that has not yet progressed to clinical hypertension, you should know that omega-3s also give a modest decrease in blood pressure in people like you. The authors of the study concluded that this decrease was enough to prevent or delay the age-related onset of hypertension.

4)     The effect of omega-3s on reducing blood pressure is equivalent to the most successful lifestyle changes (weight loss, increased physical activity, sodium restriction and alcohol moderation). That doesn’t mean that you should pop fish oil pills and forget the other lifestyle changes. The idea is to combine as many of those lifestyle changes as possible so that you may never have to worry about high blood pressure again.

5)     You need at least 1 gm/day of EPA+DHA to reduce systolic blood pressure and more than 2 gm/day to reduce both systolic and diastolic blood pressure.

6)     Contrary to the hype you may have been reading elsewhere, the source of EPA+DHA didn’t matter. The only caveat is that many people really struggle with trying to get 1-2 gm/day of EPA+DHA from fish. It’s a bit too much of a good thing.

7)     Don’t think of hypertension as a “Do it yourself” project. Hypertension is a silent killer. It’s one of those diseases where the first symptom is often sudden death – or, even worse, a life that is no longer worth living. Work with your physician. Let them help you find the right balance between lifestyle changes (including omega-3s) and medications to keep your blood pressure under control.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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