In a world of dietary extremes, from fashionable (and virtue signalling) veganism to the carnivore meat only fad (it’s an extreme elimination diet FYI), there is one tried and tested diet that is always worth using as a template for your nutrient intake: The Mediterranean diet.

It is a nutrient dense, whole food, sustainable and frankly relatively sensible way to eat and live.

Sure you need to tweak it to your personal situation, genetics (I have the gene for the coeliac disease so gluten for me is out) and lifestyle but as a general template, it’s pretty good as well as being tried and tested for quite a while now.

The omega 3 content from cold water fish has long been known to have positive benefits for heart health.

If fact omega 3 fish oil it is a multi-million pound business.

There have been plenty of epidemiological studies and RCT’s to back up the benefits of a long term intake of omega 3 for heart health.

But for a while now the results in studies have started to reduce and flat out look bad.

How can this be?

Before fish oil got really popular most people on a standard western diet were low in omega 3. Thus if you put them in a study and gave them omega 3, you had a chance to see what taking someone from deficient to sufficient can do for your heart long term.

Challenge is, most researchers are not clinicians, so they don’t actually measure the omega 3 levels of patients in studies before they enrol them.

They are asking a single question: does giving omega 3 reduce condition X.

But of course, if the patient is not low in omega 3 there isn’t going to be much benefit, thus the results look same between treatment and placebo group.

Thus the headline screams “omega 3 does not reduce condition X” or “omega 3 no better than placebo for condition X”.

Given the popularity of fish oil, the rates of deficiency are much lower than they were especially amongst the older more health conscious patients.

This is actually very common in modern research, many clinicians simply do not truly understand what they are researching from a clinical point of view. Plus there may well be a finance agenda, drug companies do not want patients reducing the risk of disease without the use of drugs, it’s not a good business model is it?

But in the case of omega 3 and heart health in research, there is also something else in play, everyone’s best selling favourite pain inducing, kidney failing, brain damaging drug……statins.

Not only do statins have very little if any effect in primary prevention

But they also appear to ironically increase the production on the omega 6 derivative arachidonic acid (AA).

Arachidonic acid is the precursor to the pro-inflammatory prostaglandin E2 (PGE2). The omega 3 cascade gives rise to the anti-inflammatory PGE3 from the EPA part of fish oil, plus EPA also slows the conversion of omega 6 cascade.

Quick Quiz: Why are prostaglandins called prostaglandins? answer at the end.

It is the balance between these two pathways that is one part of a healthy balance between pro and anti inflammatory mechanisms. But I will emphasise this is only one part of inflammation and not a priority at all for Chiropractors, you have much bigger fish to fry….…(couldn’t resist sorry).

If the aim of a study is to see if omega 3 fats reduce the risk of heart issues and part of the benefit is related to the omega 3-6 balance, then statins are going to ruin the effect.

They will increase long term inflammation and they also reduce potentially reduce the omega 3 conversion too.

Thus the effects on heart health from omega 3 fish is negated via the effects of statins.

I think the best bet for most patients is to try and eat a bespoke version of a Mediterranean diet, as fresh and whole as they can including oily fish.  The blend of fresh vegetables, fruit, nuts, seeds etc in a Mediterranean diet is full of antioxidants and this is critical when you are eating fish.

Omega 3 has delicate double bonds which is what makes them liquid at room temperature, and these are easily damaged by free radicals becoming a rancid fat.

Most of your patients have high levels of free radicals running riot in their tissues creating massive oxidative DAMAGE. This is, in reality, the speed at which we age (that’s why all the posh face creams have ANTI-oxidants in them).

In the case of omega 3, you especially need vitamin E as it is a fat-soluble vitamin that works as an anti-oxidant.

Putting the average patient on a high dose fish oil supplement with the same crappy diet is going to have little benefit in my experience, and could actually harm them by depleting them of vitamin E and then creating massive levels of pro-inflammatory, rancid omega 3 fats.


– Encourage your patients to eat a Mediterranean style diet that is fresh, whole, sustainable and time tested to maintain health.

– Send patients to the link below on statins and primary prevention, things are slowly changing, and GP’s are now starting to tell patients it might not be worth using them, but choose you audience wisely, some people don’t want to hear it

– Don’t pile your patients full of omega 3 fish just because they are in long term pain, I suspect we might be doing more harm than good.

– Quiz answer: They were first found in the prostate gland, hence prosta-gland-in.

And as always don’t waste those valuable adjustments,