International Heart Health: What the Japanese Can Teach Us About Fish Oil
The wonderfully varied dietary habits of people in different parts of the world can yield some useful lessons for us fast food, microwave-it-now, convenience store-obsessed Americans.
Rural Chinese experience 30% greater incidence of heart attacks (despite Colin Campbells' arguments to the contrary in The China Study) for unclear reasons. Or the Russian Federation, with five-fold─500%!─greater risk for heart attack than Americans.
How about the Japanese? The Japanese experience a third of the heart attacks of Americans, 30% less of all varieties of fatal cardiovascular events. In the American Heart Association's tabulation of heart attack and cardiovascular events from around the world, Japan sits way at the bottom of the list for least heart attacks─by a long stretch (better than Israel, France, and Switzerland, the three countries with somewhat greater risk). What is it about the Japanese that confers this extraordinary protection? Could it be sushi? Soy? It certainly isn't smoking, since Japanese smoke at twice the rate of Americans. They also drink more alcohol. Could it be their slender builds? (Japanese are far more slender than Americans, on average.)
How about fish? Or, more specifically, the omega-3 fatty acid content of their diet?
While there may be genetic and other cultural and lifestyle reasons behind the dramatically reduced cardiovascular risk in Japanese, it is undeniably at least partially due to the increased intake of omega-3 fatty acids from fish. Incidentally, the purported benefits of omega-3 fatty acids provide a vigorous counter-argument to the idea that all humans should be vegetarians.
If we were to take some lessons from the Japanese and their greater habitual intake of omega-3 fatty acids from fish, they might include:
- Rural and coastal Japanese are the sub-populations with the highest reliance on fish, about a quarter-pound a day. (Gives new meaning to the idea of a "Quarter Pounder," doesn't it?) This is at least five-times greater than the intake of an average American.
- Likewise, the blood level of omega-3s in the blood of the average Japanese is 5-fold higher than Americans.
- The average intake of omega-3s (EPA + DHA) among a broadly-selected population of Japanese is 850 mg per day (320 mg EPA; 520 mg DHA). Intake ranges from 300 mg per day all the way up to 3100 mg per day.
- Greater omega-3 intake (EPA + DHA) is associated with less carotid intimal-medial thickness, an index of body-wide atherosclerosis.
- Total fat intake (percent of calories) is presently nearly identical between Americans and Japanese. It's the proportion of fat calories from omega-3 that is greater, the proportion of omega-6 that is less in Japanese.
Even the fish-consuming Japanese obtain benefits by augmenting their intake of omega-3 fatty acids. In the JELIS Trial of 19,000 Japanese, supplementation with the single omega-3 fatty acid, EPA, 1800 mg per day (the equivalent of 10 capsules of 'standard' fish oil that contains 180 mg per day of EPA, 120 mg of DHA) significantly reduced heart attack even further.
The Japanese eat their fish in ways that we do not: As sashimi (raw, as with sushi in its various forms like Nigiri and Chirashi); fried in tempura; dried fish flakes sprinkled on about anything you can imagine (it's not as bad as it sounds; it's slightly salty); as a snack, as in dried cuttlefish (which you can purchase in packages as a portable, sweetened fish that you eat on-the-run; I know it sounds awful, but don't poke fun at it until you've tried it); in "soups" with soba noodles or udon. Fish also is commonly consumed with rice and soy sauce, as well as other soy-based foods, such as tofu, miso (soy bean paste), or natto.
If we accept the greater omega-3 fatty acid intake as the cause for their dramatically lower incidence of heart disease, then we might try to recreate their success by:
1) Eating more fish, but also adding an omega-3 fatty acid intake of at least 1000 mg per day, the threshold that yields measurable cardiovascular benefits. (In our program of coronary plaque reversal, we begin at 1200 mg EPA + DHA per day and go on up to 6000 mg EPA + DHA per day to treat certain abnormalities. Side-effects are virtually unheard of, outside of mild stomach upset.) I am sometimes puzzled by people who have heart disease, coronary plaque, or omega-3 responsive abnormalities like high triglycerides, who claim they take fish oil . . . one capsule a day! Don't be afraid of fish oil. It is no more dangerous than taking a tablespoon or two of olive oil, though it packs enormous health benefits.
2) Despite the fears over mercury and pesticide residues in fish, this seems to not have played out to be a real-life effect in the Japanese, who consume five-fold greater quantities of fish.
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