We all desire to have a clinical marker of our future state of wellness. It is my opinion that the AA/EPA ratio in the blood is the best marker of that elusive goal because it measures the level of cellular inflammation in the body.
Cellular inflammation is the type of inflammation that is below the perception of pain. What it does is to disrupt hormonal signaling at the cellular levels that leads to increased fat accumulation, acceleration of the development of chronic disease, and decreased physical performance. You can’t feel cellular inflammation, but you can measure it. The only way to measure cellular inflammation is by testing the ratio of two essential fatty acids (AA and EPA) in your blood.
The AA/EPA ratio is an indication of the levels of cellular inflammation in your body. High levels of cellular inflammation do not mean you have a disease state, but it does indicate that you are not as well as you could be. Your future state of wellness can be determined by the levels of cellular inflammation in the blood as shown below.
|AA/EPA Ranges||Cellular Inflammation||Future state of wellness|
|1.5 to 3||Low||Excellent|
|3 to 6||Moderate||Good|
|7 to 15||Elevated||Moderate|
|> than 15||High||Poor|
The higher your levels of cellular inflammation, the more likely the future development of chronic disease will be accelerated. A recent study from Italy has demonstrated that the AA/EPA ratio is always greater than 15 in patients with chronic diseases (1).
There are no drugs that can change the AA/EPA ratio. This is because AA/EPA ratio is a consequence of the diet. One method of lowering the AA/EPA ratio is to increase the intake of high-purity omega-3 fatty acid concentrates rich in EPA. This will increase the EPA content in the blood (2). This represents the fastest way to reduce the AA/EPA ratio. However, the best long-term method is to reduce the AA levels in the blood. This is best achieved by following a strict anti-inflammatory diet, such as the Zone diet (3-5). The Zone diet was designed to reduce elevated levels of both insulin and omega-6 fatty acids so that the production of AA is significantly reduced. The combination of an anti-inflammatory diet coupled with high-purity omega-3 concentrations represents the most powerful dietary approach to reach and maintain a low level of cellular inflammation for a lifetime.
A recent dose-response study in healthy women who had a high risk for potential breast cancer has provided supplementation guidelines for reduction of the AA/EPA ratio (5).
|Grams of EPA and DHA supplemented per day||AA/EPA Ratio|
This data indicates that a daily dosage of EPA and DHA of 2.5 grams was sufficient to bring the AA/EPA ratio into the desired range for excellent wellness for these healthy individuals. This level of EPA and DHA recommendation correlates well with an Italian study that demonstrated in patients with various chronic diseases having an elevated AA/EPA ratio (>15) lowered their elevated AA/EPA ratio to approximately 5 with daily supplementation of 2.5 grams of EPA and DHA (1). This is also indicative that a person with an existing chronic disease may need greater amounts of EPA and DHA to get them into an excellent wellness range compared to a healthy individual.
However, these are only general guidelines for daily EPA and DHA supplementation. The best indication of the amount of the amount of EPA and DHA required to optimize the AA/EPA ratio for an individual is best determined with blood testing every six to twelve months.
The JELIS study was one of the largest cardiovascular studies ever done using more than 18,000 subjects with elevated cholesterol levels. When these subjects were given high doses of EPA (1.8 grams of EPA per day), their average AA/EPA ratio decreased from 1.6 to 0.8. This reduction in the AA/EPA ratio was associated with an additional 19% reduction in cardiovascular events during the next four and half years (7).
Until there is more data, I do not believe it prudent to reduce the AA/EPA ratio to less than 1.5 even through significant cardiovascular benefits do occur at lower AA/EPA ratios in patients with elevated cholesterol levels as demonstrated in the JELIS study.