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Ask Dr. Brad

Spring 2002

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Brad Lichtenstein, N.D.

Question: I have heard people talking about taking flaxseed oil and fish oil to help with triglyceride levels. Is there any benefit in taking these?

Answer: Flaxseed oil and fish oil are both fatty acids. In today's fat-conscious society, many people worry excessively about consuming fats in any form, regardless of the source. However, not all fats are created equal. Many of us have heard about the hazards of consuming excessive amounts of cholesterol, but most people do not realize that cholesterol comes only from animal products (dairy, eggs, chicken, and meat), the exception being fish. In order to understand the benefits of fatty acids, the differences between fats need to be addressed.

A triglyceride is the most commonly consumed form of dietary fat. When we talk about saturated fats, this term describes the number of hydrogen atoms attached to the triglyceride. A saturated fat has the maximum number of hydrogens attached to it, while an unsaturated fat has at least one hydrogen atom replaced by another molecule. Most animal fats, those fats that are solid or semi-solid at room temperature, are saturated fats, while most vegetable oils, those that are liquid at room temperature, are unsaturated. The standard American diet is excessively high in saturated fats, and approximately 70 to 90% of the population is deficient in essential fatty acids.

The body requires fats in order to survive. During digestion, a triglyceride is broken down into its components, 1 glycerol molecule and 3 fatty acid molecules. These fatty acid molecules are necessary in forming the important phospholipid membranes that surround every single cell of the body. How well a cell functions is partly determined by its phospholipid membrane, which is semi-permeable, allowing for exchange of nutrients in and out of the cell. The integrity of the membrane is determined in part, by the types of fat ingested. A diet high in saturated fat will lead to less fluid and less permeable membranes, while a diet high in unsaturated fats will improve the cell's integrity.

Furthermore, not all unsaturated fats are the same. The term omega fatty acids is used to describe unsaturated fats. Of particular importance here are the omega-3 and omega-6 fatty acids. Typical omega-6 fatty acids are evening primrose, black currant seed, and borage oil. Typical omega-3 fatty acids are fish and flaxseed oils. Literally hundreds of studies exist showing the benefits of omega-3 fatty acid supplementation. For instance, omega-3 fatty acids have demonstrated the ability to lower cholesterol and triglycerides, prevent heart attacks, lower blood pressure, decrease allergic reactions, improve skin conditions (eczema, dry skin, cracked nails), minimize arthritis symptoms, relieve the symptoms of multiple sclerosis, lower cancer risk, improve kidney function and aid in hormone synthesis.

Omega-3 fatty acid supplementation is helpful lowering both serum cholesterol and triglyceride levels. However, first we need to examine the reason that these levels might be too high. For those taking antiretroviral medication, elevated levels may be due to medication. Furthermore, levels of serum cholesterol and triglycerides in people taking antiretrovirals are higher than the levels seen in the general population who are deemed to have high lipid levels. At the moment, many mechanisms have been proposed, but the exact reasons for such an increase remain unclear. Regardless, omega-3 oils, whether from fish or flaxseeds, do confer some added protection. Although supplementation is useful, the first step is ensuring that your diet is low in animal products and high in foods with unsaturated fats and fiber. This would mean including more fish in the diet -- not fried, of course. In addition to lowering triglycerides, fish oil raises HDL (the good cholesterol) and reduces platelet aggregating factor, the stuff that makes platelets stick together, which leads to clot formation and subsequent atherosclerosis.

In choosing to supplement with omega-3 oils, I recommend flaxseed oil over fish oil. Cod liver oil, the most common fish oil used, has been known to contain high amounts of vitamin A. Too much vitamin can be harmful, especially for individuals with an already overactive liver (i.e., people on drug therapy). To be safe, try to consume no more than 10,000 to 50,000 IU of vitamin A per day. If your liver enzymes are elevated, it would be best to stay in the lower end of the range.

Finding flaxseed oil made from organic flaxseeds is relatively easy and safe. Flaxseed oil should be kept in the refrigerator and not used in cooking, as heating it will destroy its healing properties (i.e., denature its hydrogen bonds, making it a trans-fatty acid). I recommend simply swallowing 1 tablespoon once to twice a day with food. Flaxseed oil has a relatively benign taste. For those who are unable to swallow it alone, I recommend mixing in some other herbs to make a salad dressing, or putting it on top of oatmeal at breakfast. If none of these options appeal to you, you can find capsules of fish oil and flaxseed oil as well.

Dr. Brad Lichtenstein, N.D. is a licensed naturopathic physician in private practice specializing in HIV care, psychotherapy, meditation and yoga therapy. For the past four years, he was the supervising physician for the Immune Wellness Clinic at Bastyr University's Center for Natural Health, a specialty clinic for those living with HIV/AIDS. He can be reached at (206) 545-7133 or

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Perspective.
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