Healing Brains: How Omega-3s Can Prevent And Repair The Brain Dr. Michael Lewis

Lisa: Well, hi everyone, and welcome into Pushing the Limits. Your host Lisa Tamati here, and I am super excited. I have Colonel and Dr Michael Lewis to guest. Thank you so much for coming on, Dr Lewis. It's really fabulous to have you.

Dr Michael Lewis: Oh, it's my pleasure, Lisa. I'm great. Anything for my friends in New Zealand.

Lisa: Have you got some friends down here? Do you know anybody down?

Dr Michael Lewis: Actually, when I went to university, it was a requirement that the British exchange officer had to be a rugby coach, and we were fortunate to have an officer who had transferred from the New Zealand SAS to the British SAS and then 2 Para. He's either in London right now or on his farm down there outside of Wellington. So that was my introduction to New Zealanders, was literally through rugby.

Lisa: Oh, brilliant. Well, that is our national sport, so to speak. We're world famous for our All Blacks and ladies who play as well, and we've got a big history there. So that's a nice connection.

Lisa: Well, Dr Lewis, could you give us a bit of a brief background? Because today we're going to be diving into fish oil — but literally we're going to be diving into fish oil — and brain health. But before we go there, can you just give us a little bit of your amazing and incredible background before we get started?

Dr Michael Lewis: Well, like I said, at university — so I went to the US Military Academy at West Point, and its principal purpose is to develop officers for the Army. And went out and, I say, played Army for a few years and then decided to go to medical school. After some surgical training and then general practice for a little while, and then got into international infectious disease work, kind of all over the place, stationed in Southeast Asia for a while. And then by then Iraq and Afghanistan were going on, and I was brought back to the medical school, the military medical school in Bethesda, Maryland, across the street from the NIH. And now we've got Wounded Warriors everywhere, and I kind of put two and two together, came up with an odd number, and went to the head of research, said, "Is anybody looking at the use of omega-3s, like you would get from fish oil, to help our soldiers recover from traumatic brain injury?" And he thought about it — he didn't just blow me off like most doctors do — thought about it, and he said, "No, nobody's looking at that. Why don't you?" And so that was a career change, and that was 18 years ago, almost 18 years ago, and I've been on that trek ever since.

Lisa: Wow. Well, and to go from infectious diseases and being out in the wilderness and doing all those hard yards, to come back — and obviously in America you have so many veterans who are coming back with brain injuries of many types. And so this is a very hot topic, really, I should imagine, over there. And we have many brain injuries across, of course, all our sports, and rugby being one of those things, which is a great sport but does increase our risk. I've got a brother who's an ex-professional rugby player, and certainly he's dealing with the aftermath of repeated concussions throughout his career. And of course the soldiers who are exposed to blast trauma and lots of really difficult things.

Lisa: It's really imperative that we find ways — because, like, if you have a concussion now and you go to present to ED, they may do a CT scan, and if it's not like you're dying immediately, it's basically go home and rest, right? Go into a dark room for two weeks.

Dr Michael Lewis: My computer slid down on me there, so good. But yeah, no, you actually bring up a really good point, is that in the emergency room, they go to the emergency department and they may or may not do a CT scan. I think they're generally way overdone. But a CT scan is essentially a surgical tool. It is: is somebody bleeding, and do we have to rush them to the operating room for emergency surgery? And so that's really the main use for it. It doesn't tell you, outside of if there's a brain bleed, it doesn't tell you if there's an actual concussion. It's a probably misunderstood concept about concussions — you're never going to see, say, a typical sport-related concussion, even if somebody was unconscious, which is very rare actually, but even if they're knocked unconscious, it's really extremely rare that there's a brain bleed that requires emergency surgery.

Lisa: Yeah. And our recommendations haven't really changed in a thousand years. You know, go sit in a dark room and have some rest and you'll be right in a couple of weeks. And that paradigm, it's not true.

Dr Michael Lewis: Yeah, no, it's not. It's funny because I'm laughing because I was with a colleague from University of London. We were at a very small, invitation-only thing to look at the concept of fish oil and brain injury, and I said to her over a beer at the pub that night, I said, "It's frustrating, we're not doing anything different than we did 500 years ago." And she goes, "Well, that's not true at all, it's been at least a thousand years."

Lisa: So I laughed when you said that exactly, it's a thousand years of telling us the same things. And that's despite all the incredible advances we've made in medicine, that we're not doing anything proactive. We're also not doing anything in the preventative space, which is something that I'm a big advocate for — having on board the right nutrients and the right things, including fish oils, in order that if you are in a high-risk situation, so you're going to go and play rugby on Saturday, that you've got the nutrients on board in order to prevent the worst and to have the nutrients there should you need it. Would you agree with that one, that that would be a good approach?

Dr Michael Lewis: Lisa, there's a lot to unpack in those last couple of sentences, and we could spend the next couple of hours talking about it. Two big things. One is the idea — you mentioned go to the emergency department and go home and rest — and one thing that has finally started to change but it still has not gotten out around the world and where it should be, is that resting is actually not good for concussion. You need to be proactive, you need to be active. So the keywords should be: you need an active recovery, not a passive recovery.

Dr Michael Lewis: A quick story: a friend of mine who was the head of one of the major university — MD-PhD neurosurgeon, head of a major, major university concussion programme — and when I was kind of learning and reaching out to people to teach me, I said, "Well, what do you do with your athletes?" And he goes, "Well, when they have a concussion, I put them on a treadmill the next day and I make them run." And I kind of jokingly said, "Well, what if they have a headache?" And he goes, "Well, I give them a Motrin and tell them to keep running. They just get better that much quicker." And of course, caveat that with, you're not putting them back in a game. But that aerobic exercise, that blood flow to the brain, is an important aspect to help the recovery.

Dr Michael Lewis: So then I'll unpack the second part of what you just talked about briefly, is that being proactive as well, right, being in a preventive mode. And one of the things — and I've dealt with the US military, spent 30-plus years in the military, US military, retired quite a number of years ago now — but one of the things that I still shake my head about, and it's the same thing with professional sports and college sports, university sports, and so on, is we talk — you look at American football, for example — and we talk about getting better equipment and a better helmet and a better this and a better that, but nobody's talking about what can you do from the inside out. And the US military is just as guilty of that as anybody. And in fact, I had some very elite special operators tell me, "We've got an unlimited budget to buy anything to protect, like body armour, or to kill people, but it stops right at the mouth."

Lisa: Wow. Wow.

Dr Michael Lewis: We are not allowed to use money and all these unlimited funds to deal with nutrition, because that was a separate pot of money, a different colour of money, as they would call it. And it's like, we're not able to protect the most important thing that a special operator has, which is their brain. And well, and their body too. But it was amazing: anything to kill somebody, but not to protect your own brain.

Lisa: Yeah. And I've got a colleague down here who's actually gone through Dr Mark Gordon's training, and she's been trying to get into our rugby and get them to take some preventative supplements, just some very basic supplements, and they're not allowed. They're literally not allowed to take them. And she was looking at things like N-acetylcysteine and so on as well. And it's just like, no, no, no, they're not having it. And it's like, why are you not being preventative?

Dr Michael Lewis: So is it the team, or...?

Lisa: Not allowed. Not allowed. The union not allowing.

Dr Michael Lewis: Because I know I've got a friend who is a high-level nutritionist with the National Hockey League and professional teams in the National Hockey League, and her players take N-acetylcysteine before every game.

Lisa: Well, that's what we were hoping to do, yeah. Because N-acetylcysteine — I mean, fish oil, obviously we're going to dive into the deep deeps of fish oil — but N-acetylcysteine also very powerful as being proactive, having that on board, that glutathione, those antioxidants, to have on board before an injury happens so that you've got something ready to go. And N-acetylcysteine was one in particular that was not allowed.

Lisa: And I've listened to quite a few of your lectures and I'm just shaking my head at some of the stories and going, yeah, I've experienced the exact same thing, I've experienced the exact same thing. And it's really, really frustrating when you know you have something and you want to get this information out to the world and the world does not seem to be listening. And it's some pretty basic stuff too.

Dr Michael Lewis: So that same colleague, that same night, about the thousand-year remark, she said to me, she goes, "You're in the damnedest position I've ever seen. You've got something we know will work in people, but we've got to prove it in rats."

Lisa: Yeah, exactly, we've got to go back. And I love your approach. You have your Brain Health Education and Research Institute website — help me out there for the URL — where that's got all the research that's coming out. Because you're doing a top-down approach and a bottom-up approach: to educate via platforms like this, plus also get the studies done, because doctors want studies, they want to see the research, they want the data, they want the cold hard data.

Lisa: And something that I've been frustrated with, like my mother's case — it's an absolute miracle. We were actually just the day before yesterday with a neurosurgeon. She's got normal pressure hydrocephalus off the back of the aneurysm, the stroke, the brain cancer.

Lisa: The number of infections that she's had, blah blah blah, 24-odd concussions while she was learning to walk again, major vestibular problems — and I've managed to get on top of everything except the hydrocephalus, because it's water on the brain, and I haven't been able to get that. So we're looking into the possibility of a stent, after me saying for nine years, "She's got hydrocephalus, please can someone look at it."

Lisa: And finally I got to the new neurosurgeon just two days ago, and he said to me, when she walked in at 82, having known her history, having operated on her nine years ago — nine and a half — with the aneurysm, he didn't think she'd survive that. And then he operated three years ago when she had a massive brain tumour, and he didn't think she'd survive that. And he just said, "She's the strongest, most resilient, most incredible case I've ever seen." And I'm going, "Yeah, and nobody wants to know what I did."

Lisa: I've written a book actually called Relentless, how a mother and daughter defied the odds, and it's to empower the other people going through this, to listen to the story, to advocate, to fight — not that it's going to be an easy battle, by the way — but to not give up. Because we were told she's buggered, put her in an institution. They didn't think she'd survive the first few weeks, because she was in and out of coma as that biochemical cascade of inflammation sort of took over. She had vasospasms and all of that sort of thing happening, was in and out of coma. They did an amazing job, the surgeons, and put in a coiling to stop the bleed, etc. And then they realised, yep, she's going to survive, but massive, massive brain damage at age 74. Put her into an institution, nothing you can do. She didn't know who she was, she was like a baby.

Lisa: And in my desperation I started to research and study, and realised over the years — now I'm almost a decade into non-stop study — there is just nothing further from the truth. There's so much we can be doing that I didn't know to do at the beginning. We were mainlining glucose through feeding tubes and stuff like that. Oh my gosh, where was this discussion around ketones? Where was the right nutrition? Where was the fish oils? Where was all of these things? Hyperbaric oxygen — I run a clinic here down in New Zealand now with hyperbaric oxygen, because that was a cornerstone of her rehabilitation.

Lisa: And I'm so sad, because I could have implemented a lot of that stuff earlier if I had known. Hence why I do what I do, to educate as many people as I can, not only in brain health but across the board now. But all this information's out there, and in the clinic we're like 30 years behind, especially in New Zealand. We're an island in the Pacific with very small resources. And like the neurosurgeon said to me the other day — I said, "What about this procedure that I've read about in the States, and blah blah blah?" — "That ain't ever going to be here coming down here for the next 10 years, don't hold your breath." He said, "I'm frustrated too, I can't get the resources to do even the basics." So you need to understand that and be proactive, I think. What's your take on that?

Dr Michael Lewis: Well, it is — as you have alluded to, I've got twice as long as you being frustrated by the medical system. And I am an allopath, traditionally trained doctor. My father was a small-town general surgeon, my mother was a nurse. I went to medical school to be a surgeon. I have been stymied and frustrated for almost 20 years about this whole concept. And one of the more common things that I get is emails from around the world saying, "My mother, my brother, my uncle, my cousin is in a coma, can you talk to the doctors and tell them to do something?" And the problem is the doctors are entrenched in what they know.

Dr Michael Lewis: I think back to my medical school days — the thought of nutrition came up, it was, "write a consult for a nutritionist." Doctors didn't do nutrition. And everything that I've had to learn the last 20 years has been on my own, just like you. I may have had a little more medical background, and I've been able to do more from a medical point of view. And I always say that my patient number one is myself. I've had enough concussions, either from rugby or American football or jumping out of airplanes or whatever — I've had enough sporting-type concussions that I better take care of myself. And so when I come across something new, I'm patient number one, I try it on myself.

Lisa: Love it.

Dr Michael Lewis: I've got 18 years of experience of doing that, and so that's been really, really helpful. And one thing I'm always open with my patients about, I say, "There's so much we don't know, and if you come across something and you wonder if it might help or work, let me know. Because if I don't know anything about it, I'll either give you an opinion about it, or if I don't know anything about it, it gives me something to research so that I can learn, so that I can help the next patient." So your job as my patient is to help with the next patient, next patient, next patient.

Lisa: I absolutely adore that approach, and I operate the same way as a clinician now. My clients are always coming to me with some study, and I'm like, I'm overwhelmed with studies that I've got to get through or things that I've got to watch and do, but it provides me an unending education, because it's pushing me in this direction. And my clients have given me so much education that way, that I've been able to then pass on to the next person, exactly the same as what you're explaining.

Lisa: But that takes a humble attitude from the clinician, from the doctor, because you have to sometimes go back to the drawing board and relearn everything that you were taught, and it could be now wrong and outdated. And you have to have that humility to go, "Okay, maybe we got all that wrong, or maybe things have changed, or maybe we've progressed, and here's my new recommendations based on the science of today, what we know today." And of course, the medical knowledge — I heard someone say, I don't know whether this is correct, but every 72 days the knowledge is doubling now with the AI and the things that we have. So none of us are across it all.

Dr Michael Lewis: Nobody's across it all, except some of the things we really have got to get back to the basics on. And like I said, I wasn't taught anything about nutrition. Omega-3s — I kind of vaguely remember, if I were to look at a notebook that I probably don't have from back in medical school, it might be there somewhere buried in that. But it wasn't anything that was particularly put out there, and certainly taught or emphasised.

Lisa: So let's now, Dr Lewis, actually go and talk about fish oil and brain injuries. Omega-3s are an essential fatty acid, as is omega-6. And recently I just had Dr Stephanie Venn-Watson on, who works with C15. I don't know if you've come across her research — if you haven't, I'll be sending you some info.

Dr Michael Lewis: I haven't. But C15?

Lisa: C15, yeah. So this has been classed now as the third essential fatty acid. I'll probably silo that for a moment, because we want to talk about omega-3s and omega-6s first, but their research would be really, really interesting for you, so I will definitely send you some stuff to listen to and read.

Lisa: But omega-3s and omega-6s up until now have been the two essential fatty acids. We've got omega-3s that are more — I don't want to say anti-inflammatory, but they're more on that anti-inflammatory side of the equation, and omega-6 is more on that pro-inflammatory side. And we have a hell of a lot more omega-6s in our diet, and that's the problem. So the omega-6 to omega-3 ratio is the key factor here. Can you explain a little bit about that, and why is this skewed towards the omega-6s and so on?

Dr Michael Lewis: Absolutely. And forgive me if it takes the next two, three hours. So omega-6 and omega-3s — it's two things you've got to take into account: how many carbons in the length of the molecule, and where's the first double bond. So with omega-6, the first double bond is six carbons in, and the first double bond on omega-3 is three carbons in. And they are essential fatty acids. At the 18-carbon chain level they can get elongated to 20 and 22, and so that's part of the process.

Dr Michael Lewis: And omega-6s are not all bad and omega-3s are not all good, and some of the downstream effects. But really, nature designed our bodies — a thousand, 10,000 years ago, omega-6s and omega-3s were generally consumed in a one-to-one ratio. And the biggest reason for that is that the enzymes that are used to make and break the omega-3s and the omega-6s are exactly the same. To elongate them and put the double bonds in places, all those enzymes are exactly the same. And so that one-to-one ratio was how nature designed us.

Dr Michael Lewis: And 100, 120 years ago, with the Industrial Revolution, our food processing, things started to change. And then really, the biggest change, at least in the United States, was probably around the late 1960s, early 1970s with the advent of corporate farming. And what we saw was skyrocketing of the amount of soybean oil that is consumed per person across the board. And so soybean oil — well, you're like, "I don't need soybean oil." Well, yeah, you do, actually. And what I mean by that is soybeans are used to feed the animal which is then subsequently consumed. And so whether it's that you think you're eating healthier by eating chicken — well, it depends on what the chicken's being fed. Or even fish, and farm-raised fish, that gives a whole different meaning.

Dr Michael Lewis: So what's happened is we've become more and more skewed to the omega-6 side of things in our natural diet. And it's fat, so if you start to eat really, really healthy, it's still fat, and it takes months to years to really change that whole situation within our bodies. And so what I looked at was, how do we plus up the other side really quick? And so that's with omega-3 supplementation.

Dr Michael Lewis: But let me go back to a little bit of the chemistry on that for half a second. So omega-6 molecules, where that double bond starts, it's a very stiff molecule, stable. And it's very stable, and therefore that's the reason why we have so much soybean oil consumed — because of that stability, so we can process foods with it and ship it around the world. So I say you could put some crackers out in the sun for three days and they may be stale, but you could still eat them and be fine. You put a piece of fish out in the sun —

Dr Michael Lewis: — for an hour, you probably don't want to eat it. Because the omega-3s, because of where the double bonds are, it's a very flexible molecule, but it also makes it very susceptible to spoilage. And so we can't process foods with omega-3s and ship it around the world. So that gives you a little bit of an idea there.

Dr Michael Lewis: Some of the downstream effects of omega-6s, especially when you get to a 20-carbon chain length of arachidonic acid, are very pro-inflammatory. Whereas DGLA — I'm not even going to go into trying to say the name — but DGLA is an omega-6 and its downstream effects are actually anti-inflammatory. So it's not that sixes are bad. And omega-3s generally, pretty much, they have less inflammatory and some anti-inflammatory properties, so by that nature they're much better. And it really becomes this fight. That one-to-one omega-6 to omega-3 ratio has now, across the board in society, become 25 to one or worse. And so we have 25 omega-6 molecules for every one omega-3 molecule, and — remember, they're sharing the same enzymes — it's no longer a fair fight.

Dr Michael Lewis: And where do these molecules get taken up into? It's into the cell membrane. And the most concentrated place is actually the retina, second most concentrated is in the brain, and the third in the ovaries and testicles. So we could speak a little bit on that, but we'll let that one go. So when we become a little bit less — it's almost hard to say that you become deficient in omega-3s, because really you become way over-abundant in omega-6s. And it's that ratio that becomes important. So that's why if we do blood spot tests and things like that, we're not just looking — you know, you look at the amount of omega-6, omega-3s and the breakdown of the different ones — but really the most important number, most people don't know, is what is their omega-6 to omega-3 ratio. It has everything to do with brain health, heart health, immune health, and so on and so on.

Lisa: Wow. And yeah, I do fatty acid testing panels here, and very often when we get the panels back, that omega-6 to omega-3 ratio, omega-3 to 6 ratio, is very skewed. And what is the target that you're going after? If you're wanting to be healthy, what is the target of omega-3s to omega-6s that you would like to see in place?

Dr Michael Lewis: Well, one of the things that always confuses people is, are we talking omega-6 to 3 or are we talking 3 to 6? I generally keep the omega-6s on the numerator — well, even though it's a ratio, it's not a numerator, but on top — and omega-3s on the bottom. So when I talk about, for example, about 15 years ago I did a study of a couple thousand active duty US soldiers, and we determined that the omega-6 to omega-3 ratio was literally 26 to one.

Lisa: Wow, terrible.

Dr Michael Lewis: And I said one to one is what it should be, but a very good and reasonable, healthy target is actually 3 to 1 or better. So 3 to 1 from the omega-6 to omega-3 ratio is really the target that people should be shooting for.

Lisa: Okay, so that's what we're going for. And so the omega-3s have this double bond, so they're very easily oxidised and spoiled. So this comes to then the discussion around the quality of the fish oils that you're getting, right? And can we all go to the supermarket and get a $5 big box of fish oils? Why is that not a good idea, probably?

Dr Michael Lewis: Well, it's actually not — it's not what you think. A lot of people will say that that cheap fish oil is going to be contaminated with mercury and other heavy metals and PCBs and other things, and in fact that's not true at all. In fact, if you know the manufacturing process, it's really not even possible. And I can go into the manufacturing thing for about a minute, if you want me to.

Lisa: Yeah.

Dr Michael Lewis: But basically all fish oil that's on the market is cleaned of all those things. One of the issues is when you clean the fish oil the way it's — so I'll go on the manufacturing just really quick. The way it is cleaned is, generally you squeeze a fish and you get generally the triglyceride form, so it's got a glycerine backbone, and "tri" meaning you've got three branches off of that glycerine backbone. So they break that glycerine backbone and now you've got free fatty acids, which are very, very unstable. It's like having sodium without chloride. You need an acid and a base to keep it stable. So what they do is they attach it to an alcohol molecule, the free fatty acids, and that's now called an ethyl ester.

Dr Michael Lewis: I don't know about New Zealand, but I know in Australia you're not allowed to call that ethyl ester — I don't know who wants to keep calling me here — you're not allowed to call that ethyl ester fish oil, because it's actually no longer an oil. And so, at least that's what it was, and I'm assuming still is, in Australia.

Lisa: Yeah, not sure here.

Dr Michael Lewis: So what cheap companies do is they put it — it's a really caustic material, if you will — and so they put it into a gelatin capsule and stick it on the supermarket shelf for $5 a bucket, and it's really cheap. So that natural level that you get is generally about a third, what I call a 30% concentration. This is where the problem is. It's not in the potential for spoilage, it's not in the PCBs and mercury and stuff like that, it's the percentage of what you take. A thousand-milligram capsule has 180 milligrams of EPA and 120 milligrams of DHA, 300 milligrams of combined EPA and DHA. You add those two up, you've got 300 milligrams. What's the other 700 milligrams? I have no idea. We don't know.

Lisa: We don't know. They don't tell you. There's no analysis that shows what all that, 70% of what you're taking — we don't know what it is. And it's an ester, isn't it?

Dr Michael Lewis: It's an ester. And so even the pharmaceutical — at least what you can get hold of in the United States — is also in the ethyl ester form. The only difference is they concentrate the molecules so that it's a 70 to 90% concentration, and then they put it in a capsule and sell it to you for $30 a capsule, unnecessarily. And it's still cheap and it's still an ethyl ester.

Dr Michael Lewis: Now, there are a few good companies around the world that reverse that process, and they concentrate it and then they reverse it and they recombine it with the glycerine backbone. And now technology has come to where we can make up to a 90% concentration. So a couple of companies I know of, to throw out the numbers, have 1,250-milligram capsules — they're a little bit bigger capsules — but they have 600 milligrams of EPA and 400 milligrams of DHA. So a thousand milligrams of omega-3s in a 1,250 capsule. And that's a great concentration, but it costs a heck of a lot more, because it's also in a triglyceride form. And so you get what you pay for. And if you were to look at it dollar per milligram, or however you want to figure that out, you're far better off paying more for a good quality that's not going to upset your stomach and give you reflux and other problems as well.

Lisa: Because the ethyl ester — basically we don't have the enzymes, the body doesn't recognise it as an oil that we've seen for millions of years and digested. We haven't got the machinery to break it down, basically. When it's in the triglyceride or the phospholipid form, then we're able to break it down, and the concentration of that EPA and DHA — and that's also a really good point. So you want to be looking at the package, you want to see, if it doesn't say it's a triglyceride or a phospholipid, then it's an ethyl ester, and you probably want to go somewhere else.

Dr Michael Lewis: And people can reach out to me if they want to know some brands, because I don't like to talk about brands too much on the podcast. But there are good ones, and probably what's in your supermarket is probably not going to be the best option for you, and you're going to have to take a heck of a lot more.

Lisa: You generally have to go to either health food or prescription, or a clinic or pharmacy kind of thing. Is there a problem also with the oxidised — is it oxidised, the cheaper form?

Dr Michael Lewis: No, that's not an issue. It's not really an issue. I certainly wouldn't be sitting it out. It's why it comes in either a dark bottle, a glass bottle, or plastic, and they'd say keep it in a cool, dry place. And so yeah, if you had it outside the bottle sitting in the sun, it's going to oxidise, and it depends on the quality, but for the most part it's not usually going to be an issue in the time that the expiration date is.

Dr Michael Lewis: Now, it brings up an interesting thing. When they do that whole cleaning process, one of the things that they do is, they're so focused on EPA and DHA that they clean out all the other good things — the polyphenols and the other good antioxidants — and you don't get those. And so they typically will add in like vitamin E to try to keep it from oxidising.

Dr Michael Lewis: I just came across a new Norwegian company the last couple of months. It's funny, they reached out to me 11 years ago wanting to connect about a project, and we never connected for some reason. And then about three months ago they reached out a second time and said, "Hey, this is the project we're working on." And what they figured out is how to add in those good polyphenols and good things back into the fish oil. But they realised you couldn't do it with fish. And so what they do is they combine it with super high quality extra virgin olive oil. And so you get the polyphenols and the protective effects from the combination from the olive oil that helps protect the fish oil.

Lisa: Wow.

Dr Michael Lewis: And you get the benefits directly from extra virgin olive oil, as we know is also a good thing. So it's like 60% high quality fish oil, 40% olive oil.

Lisa: Oh wow, so that's a new technology. So is that Nordic Naturals or someone else?

Dr Michael Lewis: No, it's — Nordic Naturals is out of California, United States, although they've got a manufacturing plant in Norway. But this is a company out of Oslo named Zenzo, Z-E-N-Z-O.

Lisa: Okay, have a look at that one. New technology.

Dr Michael Lewis: They're just now coming into the US. 98% of their business is Europe and around the world. I'd be surprised if they're not in New Zealand.

Lisa: I'll have a look. I haven't come across them.

Dr Michael Lewis: They're just now — I can get you more information on that, but they're just now coming into the US. One of the other things they do is they combine it, they really urge you to do blood spot testing as part of it, because how do you know it's being effective if you're not testing? And so they've got one programme where they'll give you a test at the beginning, and after a couple of months they send you a second test so you can see how well you progressed.

Lisa: Wow, wow, really nifty little programme. Yeah, that's great.

Lisa: Because yeah, when the testing is not too expensive, getting before and after really helps you stay motivated, right? Because sometimes with supplements you don't know — you don't feel it necessarily, and that doesn't mean it's not working. It just means that, I don't know, I'm methylating right now a million billion times and I don't feel it. I don't feel that. But when something goes wrong, then I'll feel it. But people expect to take a supplement and feel like they've had a Red Bull or something, and that's not the case. That's not how it works. Try to get out of that instant mindset.

Dr Michael Lewis: There are some exceptions. There are some people who are really sensitive to things. I know, and I test them out on — I've got one of those as a good friend, and after I test something on myself, I test it on him, because he's very, very sensitive to things. He gives me great feedback.

Lisa: That's brilliant. So let's now talk — you've got a couple of cases that I did want to highlight that I've heard you talk about that were quite astounding and might give people some insights as to why you actually stumbled into this too. There was a young man, Bobby I believe his name was, in a car accident. Can you share that story?

Dr Michael Lewis: It was quite a while ago — was it Bobby? Was it Bobby? Now I can't remember. Yeah, 14 years ago, March 2010. And I was just still trying to figure out what was going on and which end was up. Like I said, I had to teach myself all these things. And I got a call one day — I'll give you the short version; the longer one is, how these things happen is just amazing. But I got a call one day: Bobby's been in an accident, would I talk to the father about putting him on fish oil like the survivor of the infamous coal mine accident, which had been about a year or so earlier — well, actually a couple of years earlier.

Dr Michael Lewis: And so there's one guy that survived, 23, 24, 25 years old, who out of 20-some guys, they all died except for this one, who was an inch away from death. And they did everything, from hyperbarics to dialysis, because of kidney and liver failure, massive heart attack from the methane gas poisoning and carbon monoxide poisoning. And they were left with a guy who was essentially brain dead, and they're like, well, now what do we do? And somebody had the idea, let's flood him with fish oil and see what happens. And the guy walked out of the hospital a couple of months later.

Dr Michael Lewis: So the call I got was, would Bobby benefit from this high-dose fish oil like the Sago Mine accident survivor did? And literally I was on it like, I don't know, it's never been tried before. And so the next thing you know, I talked to the father and I said — I didn't even know what to do or how much to give. I said, go to a Whole Foods grocery store down the street from the hospital where you are, and buy this product. How much to take? I just kind of made it up, just a wild guess.

Dr Michael Lewis: Bobby was dying basically. He was in the ICU and they were going to pull the plug. Fifteen millilitres twice a day. And yeah, he was in a bad car accident, [inaudible], and the parents were told, pull the plug, he has no chance of surviving. And so this was a couple of days afterwards and Bobby refused to die. And so the parents were desperate — what are we doing? And the doctors are saying there's nothing we can do, only time will heal his brain, we really think you should just pull the plug because nothing's going to help him.

Dr Michael Lewis: And so I convinced the neurosurgeon, you got nothing to lose, why don't you try the fish oil? And it was 15 millilitres twice a day, pushed down his feeding tube. And she said, all right, well, we got nothing to lose. And Bobby went to his high school graduation three months later.

Lisa: Amazing. That's an amazing story.

Dr Michael Lewis: Now, if that was 2010, so it's 14 years later, he's basically a stroke victim, right? He's got some one-sided weakness and slow, deliberate speech, but he's got a college degree now.

Lisa: Wow.

Dr Michael Lewis: He lives in an apartment and is dating and independent — almost as normal a life as you could expect.

Lisa: Wow, that's amazing. And they were just told, pull the plug, he has no chance of survival. My listeners know the story with my dad. He had sepsis — getting a little bit off topic — he had sepsis and they operated, he had an aortic aneurysm and then developed sepsis off the back of the operation. And I was aware of all the research around intravenous vitamin C, Dr Paul Marik who's done studies, and others, showing that the mortality rates drop like 50% if you can get early access to intravenous vitamin C.

Lisa: And I came with the research, desperate to save my dad, because they'd run out of options and they were telling us to take him off life support. And I was fighting, and I had to fight like 16 days against the Ethics Committee. And I say that with gritted teeth, because they didn't give a damn, to be honest with you, about the clinical research. They only cared about what were the legal ramifications if they gave them. And I said, I'll sign whatever you want me to sign, it's my full responsibility if something goes wrong, but he's dying.

Lisa: And then they said, well, vitamin C has been shown that it could damage his kidneys. I'm like, what part of "he's dying" did you not understand? Absolutely ridiculous arguments, in other words. And it took me 16 days of fighting. I finally found a legal loophole where my GP could come into the hospital and administer the vitamin C as his GP, and we got the first one in. But they would only do half of the dose that I was asking for, and it was meant to be every six hours, and the doctor could only come twice a day in between clinic. And then they played all sorts of games to make sure that when she was coming up, they'd call me out of the room, and, oh, there's no line available. And she says, what's that line for? And they said, well, that's for emergency. I'm like, what the freak is this? This is an emergency. And so there was all sorts of — so I'm very, very, very, very sceptical about these things.

Dr Michael Lewis: Yeah, I get emails, like I said, from around the world asking for help, and one of the biggest issues is doctors saying, you know, pull the plug, there's no chance of survival or any kind of meaningful recovery, so just let them go, let them die. But no, we can't give them fish oil because that might hurt them.

Lisa: Exactly.

Dr Michael Lewis: I don't — the disconnect there doesn't ever make any sense. It might hurt them, so you should just let him die.

Lisa: Yeah, exactly. Like, vitamin C is going to hurt his kidneys, we can't do that. And it basically comes down to their legal backsides being on the line. And that's why I want to get a law change where we have the right to try. When you're at the end of life and you've run out of options, you should have the right to try these experimental things. And vitamin C is not experimental, by the way — there's like 50,000 studies.

Dr Michael Lewis: I keep wondering, when did nutrition become experimental?

Lisa: Exactly.

Dr Michael Lewis: And people ask me just on a regular basis, how long should I take fish oil? And I'm like, how long do you plan on eating?

Lisa: Yeah, exactly. Because this gets back to the other thing — Omega-3s make up, I heard, correct me if I'm wrong, 30% of the brain?

Dr Michael Lewis: The brain fat is Omega-3 — the fat of the brain is about 30% Omega-3s. So the brain's made of fat. It's why we got the term "fat head" and other things, right? And probably the three most important fats, I would argue, are cholesterol, Omega-6s and Omega-3s. And so we need all three, and you can't build a brain without them. In fact, Omega-3s are so important that a mother will give up her own store of Omega-3s from her own brain to help the foetus develop. We talk about calcium, right? Everybody knows about calcium, you've got to make sure for the baby, for the bones. And also in the breast milk, the mother will give up her own Omega-3. So pregnant women really need to be consuming more Omega-3s.

Lisa: It should be absolutely standard for every obstetrician. And what happens when you don't, when you have —

Dr Michael Lewis: I mean, this has been shown over and over and over and over again. In fact, the study I alluded to with the US military showed that low DHA, low Omega-3 levels correlated to a 62% increased risk of suicide. Talk about mental health.

Lisa: Wow.

Dr Michael Lewis: So when you have low Omega-3 levels, you're more susceptible to mental health issues. Has anybody ever heard of postpartum depression, right? So if you've got low Omega-3s and you're giving up Omega-3s because you're pregnant, you're giving them to your foetus to grow a brain.

Lisa: Yeah.

Dr Michael Lewis: So we don't think of these things. It's like we can't get from A to B to C to D, it's too complicated. And so it's just really, really frustrating, because part of the reason why I hesitated to even start asking these questions was, to me, not being a neurologist, not being a neurosurgeon, being an outsider, I just thought — I couldn't believe these things weren't being done or talked about. I put two and two together, I came up with an odd number, and I'm like, what do you mean nobody's asking these questions? It seems really obvious to me. And now almost 20 years later, I'm still asking the same questions, and it still seems even more obvious to me, and yet it's not anywhere near mainstream.

Lisa: And if you think you're an outsider, wait till someone like me, who comes from an athletic background and doesn't have a medical background initially — then you're really an outsider and pushing the proverbial uphill when you're trying to get change. And that's why I go through these forums, because I just bring in the experts and let them talk, because I've done the research. I know the things, I know the people that should be getting a voice, and I share it that way, or I write a book about it. So I've written a few books.

Lisa: It just baffles me. It's the same with cancer. My mum had the CNS lymphoma, an aggressive form of cancer in the brain, and this was just three years ago, and given weeks to live, nothing she could do. And there's nothing further from the truth. And now I've written a book called What Your Oncologist Isn't Telling You, and it's all 21 interviews with the world's leading metabolic approach to cancer people, and sharing that information — not my information, just what I did and what they

Lisa: do and what the science is saying, and giving people both sides of the equation. Here's the side with the chemo, the surgery, the radiation, and here's the side with the metabolic, the hyperbaric, the intravenous vitamin C, the peptides, all the rest of it. You make a fully informed decision now, and good luck fighting the oncology, because they will not accept any of this other stuff, and that's the hard part, right? But at least they've got that information in front of them and they can make the choices to the best of their ability. But we definitely need change.

Lisa: Without going off on a tangent, because I do want to stick to the omega-3s — with the DHA and EPA, these are the constituents, the types of omega-3s. Can you explain the differences between the DHA and the EPA? Because we hear those terms, but we may not understand them.

Dr Michael Lewis: Right, without throwing out the long chemical names. So 18 carbons is ALA, and that gets elongated and desaturated to EPA, and then that further gets elongated and desaturated to DHA. So from 18 to 20 to 22 carbons in length. And so ALA, which you get from leafy green vegetables, flax seed and walnuts and other healthy things — absolutely great things to eat — but EPA and DHA are generally derived from animal meat, and particularly most concentrated in seafood.

Dr Michael Lewis: But you have to look at that process. You're swimming uphill because of the omega-6 situation, but the typical conversion from 18 to 20 to 22 carbons in length — ALA you consume all day long, and only somewhere between less than one and maybe as much as two or three or 4% will ever get made into DHA and found in the brain. They've done radio-label studies to show it over and over again. In fact, one study was like 0.04% ever gets — you know, a radio-labelled ALA, consume it, and only 0.04% was found in the brain.

Dr Michael Lewis: So what are the differences? We consume EPA and DHA — seafood is your best source of it, and that's why we call it a fish oil supplement. It's not meant to be a replacement, or we wouldn't call it — it is a supplement. You should be eating seafood on a regular basis, salmon being probably the highest, and there's different types of salmon and this and the other, but the thick of it is just seafood, EPA and DHA.

Dr Michael Lewis: So EPA is generally the downstream effects. They get incorporated into the cells, and when they're released from the cell membrane they have downstream effects, and the EPA is generally the heart-healthy one. It helps keep our blood from clotting — it's like an aspirin type of thing, keeps our blood from clotting — and is relatively anti-inflammatory, counter to that of the omega-6s. The downstream effects of arachidonic acid, omega-6, is to help the blood clot. Well, clearly that needs to be a balance, but inflammation is also meant to be a balance. You twist your ankle, you need to be repaired. You have a rough rugby game and you're just sore all over — that's all inflammation, and we need it.

Lisa: Yeah, so we need inflammation.

Dr Michael Lewis: I always say inflammation is life. You've got to have it. Even the person that's not playing rugby, you're bombarded all day, 24/7, by the radiation from the sun and radiation from the earth. You're breathing — if you live in a city in particular — you're breathing not-so-clean air. All these things are constantly bombarding our bodies, and we need sleep to recover and repair that, but we need to be able to handle that with the anti-inflammatories. That radiation from the sun's causing microscopic inflammation, and we need to resolve that inflammation. So EPA is really the heart-healthy one for that.

Dr Michael Lewis: DHA is what then gets incorporated into the cell membranes. As I said earlier, the three most concentrated places are the retina in the back of the eye, the brain — about 30% of the brain fat is omega-3s, DHA in particular — very little EPA found in the brain, but it may be that it gets consumed so quickly that we can't find it. But we'll focus on DHA. So EPA, best way to remember, EPA is the heart-healthy one, DHA is the brain-healthy one. But we also know that EPA is really important for mental health — in fact, probably more important for mental health than DHA.

Dr Michael Lewis: So people say, well, with a brain injury you only need DHA. Well, no, I would argue — I kind of take the approach, whatever your beliefs are, I just say God put them both here. It's not for me to argue with God. So I think both are important, but for different reasons. You need to deal with inflammation in the brain, but you also need the downstream effects of DHA, and they have some interesting names, like resolvins and protectins.

Lisa: Yes.

Dr Michael Lewis: And so those downstream effects, when the DHA is released from the cell membrane, resolvins and protectins — it kind of tells you what they do and why. They resolve inflammation, and so they help resolve inflammation and protect the brain.

Dr Michael Lewis: But it gets so much more complicated — the interaction with our endogenous cannabinoid system, for example, which gets way complicated. All our fatty acids act in one way or another through our cannabinoid system. And so arachidonic acid, for example, gets broken down into something called arachidonoyl ethanolamide, which is more known as anandamide — a very short half-life molecule. It gets made, and what we now know is it causes a runner's high. So that endorphin rush, as we used to call it, is actually anandamide from arachidonic acid.

Lisa: Wow.

Dr Michael Lewis: Well, on the DHA side, it gets made into something called docosahexaenoyl ethanolamide, or something that's a little easier to remember or say, synaptamide. So DHA gets made into this synaptamide, which helps make longer, branchier synapses and more synapses in the brain. And so this is all through the cannabinoid system, and it gets really complicated. And it's not just the ethanolamides — the serotonin, the dopamines, and on and on and on, how arachidonic acid and DHA and EPA and all the C15s, all of these get made into these different things that we're just now scratching the surface to try to understand. One of them, for example, from palmitic acid, which nobody talks about —

Lisa: Palmitoylethanolamide. I take that.

Dr Michael Lewis: Yeah, yeah, and that's a cannabinoid activator, CB1 and CB2.

Lisa: Cannabinoid, right?

Dr Michael Lewis: Right, and it comes from plants, and we can take that and it helps with pain and other things. So yeah, if you're a biochemistry nerd you can get into this for years, all day long.

Lisa: It's way over my head anyway. Actually, it has thrown up a whole lot of questions for me, so bear with me. When you say the retina has high concentrations of the DHA, does DHA go into the retina, so would that support eye health?

Dr Michael Lewis: Yeah.

Lisa: Okay. That's a good question. And then the depression study, the suicide study — you did a study of veterans, I believe it was 800 veterans who committed —

Dr Michael Lewis: Active duty.

Lisa: Sorry, who had committed suicide, and then your controls, and what you found was very low levels of omega-3s, correct? So there is a strong connection perhaps with the suicide, depression, mental health side of that equation. And then when you mentioned the cannabinoid — so the PEA, I am a fan of that. I take that for digestive health, but also for the pain reduction, and I have it in my mum's protocol.

Dr Michael Lewis: Yeah, and there's another one called PDC — pentadecanoylcarnitine — that is a downstream metabolite of the C15 that I mentioned earlier, and that's a full-acting cannabinoid activator as well, the CB1 and the CB2. I probably butchered that science, but —

Lisa: The cannabinoid system — so we think of it in relation to marijuana. Everyone sort of knows it in relation to marijuana. That's where it got the name, it got the name. But it's actually not just marijuana that does that, and it has lots of positive sides to it, doesn't it, the cannabinoid receptors? Can you elaborate on how maybe the fish oils are sort of downstream metabolites of this?

Dr Michael Lewis: Absolutely. So just really quick, the reason why it's called the cannabinoid system was because the Israeli researcher back in the 60s — for whatever reason, he just passed away last year, I believe — but for whatever reason, he set out to figure out what's the chemical structure of THC. And once he figured that out, he's like, just had one of those moments, I guess, and they're like, well, wait a minute, THC, how does that interact with the brain and cause somebody to have euphoria? And so he figured out — either he or somebody figured out — okay, there's these receptors that the THC interacts with that cause you to get high. So that's how it got named cannabinoid receptors. And so the first one was CB1, type one, in the brain, and eventually figured out there's CB2 receptors that are more associated with our immune system. And then what we now know is there's hundreds of different types of cannabinoid receptors, like I talked about — the serotonin receptors and the dopamine receptors and the ethanolamide receptors, and so on and so on. So we now know that the cannabinoid system actually is the most complex, most abundant receptor system in the entire human body.

Lisa: Wow.

Dr Michael Lewis: And you think about it, 50 years ago we didn't really know about it. And so here's an interesting thing. I talked about anandamide, arachidonoyl ethanolamide — that interacts, and its principal action is to interact with the CB1 type receptors found with nerve tissues, obviously the brain. But if you look at the chemical structure of arachidonoyl ethanolamide and THC, they look nothing alike. And so, wait a minute, we went from THC to figure out that there's these CB1 receptors — and why do we have CB1 receptors? Not for THC. Turns out it's for synaptamide, right? And so how's that all mixed together?

Dr Michael Lewis: The only way I can really best explain it is like putting your hand in a glove. So arachidonoyl ethanolamide, anandamide, is like putting your fingers into the five finger holes of a glove. THC is like trying to put your fist into a glove.

Lisa: Wow.

Dr Michael Lewis: It'll go into the glove, but it's not a real good fit.

Lisa: Yep.

Dr Michael Lewis: And that's — but it's enough to cause that euphoria.

Lisa: Wow.

Dr Michael Lewis: And so you bring up CBD, right, cannabidiol, the counter to THC but also found in the cannabis plant. The reason why CBD works is it kind of hits the side of the glove and knocks your fist out of the glove, knocks the THC off the receptors. So that's one of the multiple ways that it all works. And again, it gets really complicated really fast. Some of it I understand, some of it I can explain, some of it goes right over my head.

Lisa: Yeah, and we really are scratching the surface. Just to go back, I will send you the interview that I did with Dr Stephanie Venn-Watson and the C15 story and cellular fragility syndrome — I hope I got that right. The C15 particularly has some special things about it, and you'd probably understand more than I do if you listen to it. But I did want to put that on your radar, because apparently this is quite a

Lisa: ...something that you might want to add into the protocols that could help with the whole fish oil story. And that's exactly actually what I'm doing with my mum's protocol. I have fatty15, I have the fish oils now on your dosing recommendation that you have on your website — which is not personalised medical advice, anyone listening, but there are some things there that you can read. I've got her on the high dose.

Lisa: I did want to ask you, because people are going to ask: is that going to thin the blood too much? What about people that are on warfarin or other blood thinners, aspirin? So Mum is on three capsules of 1,000 combined DHA and EPA three times a day, so that's nine capsules a day, and I've been doing that now for the last couple of weeks, along with the fatty15 that she's on as well, and a third one called plasmalogens, which I'll talk about. Have you come across plasmalogens before?

Dr Michael Lewis: That one's a new one. I'm a little bit familiar with the fatty15.

Lisa: Okay, well, I'm quite excited to be able to share those two with you, because I think they're actually very interesting and could add to this whole story.

Dr Michael Lewis: I've had a number of people point me in the direction of fatty15 in the last six months.

Lisa: Well, there you go. Maybe serendipity. It's very interesting, and it's again newish research, and there's a lot more work to be done. It came from the Navy dolphin pods that they were working with, and finding that certain ones had much more age-related diseases — non-alcoholic fatty liver disease, Alzheimer's, dolphins get Alzheimer's, metabolic disorders — in the dolphins that were not fed candlefish. So candlefish are very, very, very high in fish oils, right, very fatty fish. And so when they changed it, because the candlefish stocks were dwindling, they changed the diet of these Navy dolphins, who live much longer with the Navy than they do in the wild, but they were getting all these age-related diseases. And then they found when they swapped them back onto the candlefish that these diseases diminished, and they did a whole lot of studies on that.

Lisa: And then Dr Stephanie reached out to, I think it was Dr Jeff Schwimmer, who is non-alcoholic fatty liver disease, and said, hey, our dolphins are getting NAFLD and we've been able to reverse it with the C15. And I'm probably butchering the story, but anyway, he goes, they can't be having the same disease, send me some tissue samples. He looks at the tissue samples and says, yeah, we're good to go, this is the exact same disease and exact same thing. And so then they became aware of the C15 connection for non-alcoholic fatty liver, and then they've gone on to do other research in other areas. And again, it's in the membrane. This is basically the brain of the cell, is the membrane. If the membranes have good fats and good things, then you're going to be a lot better off than if you're having shitty deep-fried foods and things like that, or the stuff that we've been talking about. So yeah, just to put that on your radar, could be an extra good addition to what you're doing, or an area of research.

Lisa: And the third one was — there's a Dr Dayan Goodenowe, so G-O-O-D-E-N-O-W-E. I've interviewed Dr Goodenowe, and he works with one of my mentors, so I know quite a lot about him and his work. He's written a book called Breaking Alzheimer's, and this is the plasmalogen story. So plasmalogens are again produced in the cell, in the peroxisome I believe — listen to Dr Goodenowe in case I get stuff wrong — but we make a lot of plasmalogens. There's a lot in breast milk, our babies get a lot, it helps with brain development. And these are very good at putting out fires. So if you have a virus, if you have immune activation, if you have anything like that, our body sacrifices plasmalogens to put out the inflammation, to put out the fire. If you don't refill your lake with more plasmalogens, then you're going to have issues.

Lisa: So my brain, as a lay person in this world of fat, is going, this is the greatest combination on the planet, isn't it? High-dose fish oils with fatty15 and plasmalogens. And there's two types, there's Glia and there's Neuro. Glia is more for the myelin sheath, remyelinating the neurons, and then the plasmalogen that's called Neuro increases the connectivity at the synapse, so you have a bit stronger transmission. So he's done lots of research in Alzheimer's, in cognitive decline, in cancer, helping in the aftermath of a kill phase in cancer to stop the cancer spreading, autism. So yeah, very, very interesting research.

Lisa: And I have all three of those in Mum's protocol. And as a neurosurgeon said the day before yesterday, I've never seen anybody's brain be as good as hers for what it's gone through. She's got some disabilities, mostly balance-related issues, but, you know. So I don't know, I'm doing a lot of things with her, so it could be any number of things, but we're doing something right. I just wanted to put those two on your radar, because they're quite fascinating research, and anything that we can do in this realm to improve that whole brain health and people that are having repeated brain injuries through sports or blast trauma, all of these should be on your radar to go and do some more deep diving into it. Did that make any sense? I've probably...

Dr Michael Lewis: No, absolutely, it made total sense.

Lisa: Well, I have the privileged position of having interviewed hundreds of amazing scientists in their areas of specialty, and while my knowledge is surface level, sometimes you get to connect dots, because you have a general education, and sometimes you make some interesting connections that could possibly lead somewhere. I don't know, but it could be an interesting combination to be looking at.

Lisa: But coming back to the omega-3 story, so dosing schedules — what are you recommending for your average healthy person who doesn't have a brain injury? What should they be consuming on a day-to-day basis?

Dr Michael Lewis: I would say the easiest, broad, general way to approach it, without saying anything about brand or quality or anything like that, is whatever bottle you pick up at the store, there's going to be a recommended dose, typically two capsules for example. But there'll be typically a recommended dose, and really, if the average person takes twice that, you're probably going to be doing okay. You're going to be doing better than most people who aren't taking anything. So generally that's the most broad way of approaching it that I can think of — whatever you take, twice the recommended dose. Whether it's twice a day or four capsules in the morning, whatever is easier for you. But that's the easiest approach, without even going into the quality, the quantity and everything else. So hopefully that helps.

Lisa: Yeah. And if you've got a brain injury, or you're dealing with cognitive decline of some way, shape or form, or you've got somebody in the ICU who's just had a car accident, what sort of things?

Dr Michael Lewis: Different things, yeah.

Lisa: Okay, so step me through what your reasoning would be, without this being personal medical advice, obviously.

Dr Michael Lewis: No, absolutely. The broad approach, the way I look at it, is in your everyday, not-in-a-coma, walking, talking person, the approach that I take is everybody is relatively deficient in omega-3s. It's not so much a deficiency in omega-3s, but that there's so much omega-6s. So again, you could try to decrease the sixes all day long, but it's going to take months to years to really make a difference — and can you really make a difference? So I look at the other side of the equation: how do we up the omega-3s? And you really want to start feeling better in six months, or maybe a little bit quicker.

Dr Michael Lewis: And so I start people on a loading dose. I don't build up, I start high. Or not — I don't believe it's high, but I'll start a loading dose, with the goal of coming down to a recommended dose, or depending on the quality of the supplement, maybe twice the recommended dose. So I'm going to go four to five to six to even nine times higher than the recommended dose as a loading dose for at least a week, if not a month, depending on the situation, and then try to come down. Because A, it's going to make you go broke by spending that much money on fish oil, but B, the bigger amounts that you take, there is the slight potential risk — although it's never been shown in any clinical trial — of bleeding issues. But theoretically it can, and those are only at the really, really, really high levels. I never recommend levels that should cause anybody to have an issue.

Dr Michael Lewis: I'll back up for half a second. You did sort of ask or bring up the idea of blood thinners, things like that.

Lisa: Yes.

Dr Michael Lewis: So my big question — I kind of take the opposite approach. "The doctor won't let me take fish oil because I'm on a blood thinner or something." How about, why don't you decrease the amount of the blood thinner to adjust for the fish oil? Because one of those is helping the brain and one of them isn't.

Lisa: Yeah, exactly.

Dr Michael Lewis: And so maybe you should decrease the blood thinner to adjust for any blood thinning that you're getting from the fish oil, because that's what's helping the brain. But that doesn't always win the argument.

Lisa: No, that's not... it's not a drug, and that's not logical.

Dr Michael Lewis: So hopefully it makes sense. Without giving any kind of specific amounts, I do a loading dose and then try to come down. And that loading dose, depending on the concentration and quality of the fish oil, can be anywhere from multiple times higher. So like the one brand that I typically use, the recommended dose is two capsules a day; I have people take nine a day, three a day, spread it out over the day.

Dr Michael Lewis: This new liquid fish oil that's combined with the olive oil, I'm finding is so much better absorbed. I haven't been using it long enough to really work out how much a typical dose is — it's about 10 mls — and I'm thinking 15 mls twice a day would probably be a pretty good loading dose, and then get down to once a day. So it just depends on the quality. And like I said, I'm really excited about this Zinzino product, because of adding the polyphenols in through the olive oil to go with the fish oil. The synergy between the two of them seems to really be making a much bigger difference.

Lisa: Well, it's a bit like a Mediterranean diet, isn't it, with fish and some polyphenol vegetables, if you think about it.

Dr Michael Lewis: One of my good friends calls it a Mediterranean diet in a bottle.

Lisa: Wow. Yeah, it makes a whole lot of sense to me, because polyphenols have all of their benefits as well, and you put those together — and nature has done that, right? Every time you look at nature...

Dr Michael Lewis: And it has combined — what we've had in our food, it's developed to work together. I've been asking probably 10 years, why don't companies put astaxanthin back into the fish oil? I mean, it's getting lost with the cleaning process, why don't they put it back in? Well, it turned out it would take a lot more fish, and the technology is just not there. What you have to do to isolate the astaxanthin — and then this company figured out, oh, we don't have to do it from fish, and it doesn't have to be astaxanthin, and we can get some really good stuff out of extra virgin olive oil.

Lisa: Yeah. I mean, I take astaxanthin on top of the polyphenols on top of the fish oil, so I must be ready.

Dr Michael Lewis: You're well covered, because astaxanthin's one of my favourite things.

Lisa: Probably take — you and I probably take way too many things.

Dr Michael Lewis: And I'm always figuring out not only how do I decrease my stuff, but because we can get access to things that people don't always have access to, so I'm always trying to figure out how to decrease the amount of what I'm asking people to purchase and to take.

Lisa: That's a very good point. It's very easy to get carried away when you're a biohacker and you're experimenting and you're fascinated, and you read all this incredible research on each of these things, and you think, I've got to have that.

Dr Michael Lewis: That's right.

Lisa: And that one, and that one, and then you go broke in the process, which is a definite risk factor. But there is — it is exciting times, because all of these things, we are understanding them more, and things that have derived from food. Because our food supply isn't what it used to be. Our chickens are fed soy, and unless you're in New Zealand where you've got grass-fed beef — but if you're overseas, maybe not, and you're not getting your omega-3s that way. And there's a whole lot of problems with our food chain, so I do think that we need to be supplementing.

Dr Michael Lewis: Can I throw something out just really quick? If I could, one thing about food. I don't want to say plead with people, but to beg people not to do whatever — but I'll just kind of throw it out as a blanket thing: stay away from farmed fish.

Lisa: That's a very good point.

Dr Michael Lewis: A lot of good things, yes, you're getting protein, and yes, you're going to get some of this and some of that, but honestly, if you've got a choice...

Lisa: Some people don't have a choice. I mean, our supermarkets don't have, like, salmon, which I love, right? I want salmon. We can only get farmed salmon, unless we get the tinned salmon. What's your take on the tinned stuff?

Dr Michael Lewis: Yeah, so if you have a choice between fresh caught Pacific Northwest or Pacific salmon versus farmed salmon — if you have a choice, and you can afford it, because it becomes a price thing as well — definitely stay away from farmed fish if you can. And if it's a choice between farmed fish and no fish, then farmed fish is great. But they have antibiotics and they have bad food practices and things like that, so we're not getting the omega-3s like we think we're getting when we have a farmed fish. Sure, you're getting the protein, because it's meat. You're getting way too — you're getting a lot more fat, and you're not getting the astaxanthin.

Dr Michael Lewis: If you just pick on salmon for half a second, at least here in the United States, farmed fish and fresh caught salmon sitting next to each other at the butcher, it's just a world of difference. I just totally blanked on the type of salmon — not coho, but — anyway, it's a beautiful nice pink colour, which is the astaxanthin. Then you look at the farmed fish and it's got big white marbling through, and that's fat, and it's not nearly as pink. But if you actually read the label, they're adding red dye. They're actually adding red dye to try to make it look like it's pink.

Lisa: Oh, I thought they put astaxanthin back in.

Dr Michael Lewis: No, they're not putting astaxanthin, they're putting red dye to make it look like it's good.

Lisa: Okay, so that's how bad it can be.

Dr Michael Lewis: Right. Tilapia from China would be the thing I'd avoid more than anything.

Lisa: Tilapia.

Dr Michael Lewis: Tilapia. Farm-raised tilapia, particularly from China, is going to have all kinds of bad things in it.

Lisa: Super good advice.

Dr Michael Lewis: Everything from the plastics to the antibiotics to whatever.

Lisa: Yeah, and unfortunately, fish in general out of the sea — mercury and things like that. What's your take on, like, smaller fish?

Dr Michael Lewis: Smaller fish are certainly more preferable, and that's why I say a fish oil supplement is a supplement, it's not a replacement. But a very good friend of mine did a very detailed analysis looking at the IQ points, and the IQ points that we lose by eating a big amount of fish, or the IQ points of a mother and their offspring, is measured like maybe half an IQ point because of the potential risk of heavy metals. But the loss of IQ points by not eating fish is measured by like five to 10 points of IQ, or not gained by not eating fish. So we only tend to look at the bad side, right? What are the heavy metals doing to us? But we're not looking at the potential loss of not having the nutrition.

Lisa: Yeah. And you can do things like — I tend to take chlorella with fish, so that if there is mercury in that fish, hopefully it's sucking up a bit of that mercury with the chlorella, which apparently can help with detoxing that, and certainly has its own good value in itself. So no harm, no foul, right? But it could help with getting rid of some of that mercury.

Dr Michael Lewis: Or other binders too that you can work on, because we definitely don't want mercury in there.

Lisa: Yeah. Oh, that's super good advice. Look, Dr Lewis, you've been absolutely amazing. I'm so grateful for having this time with you in your busy schedule. And I hope I can stay connected, and I would love to get you to come and talk. I've just started up a group of doctors and allied health professionals down in New Zealand to start to study and learn from people like yourself, and I'd love to maybe have you come and present on there at some point, just to share. I'm trying to educate from the...

Dr Michael Lewis: Absolutely, yeah. I'd prefer to do it in person.

Lisa: Well, that would be even better, wouldn't it? That's my long-term goal, is to have a big conference down here, but I've got to take one step at a time. And then definitely I'd love to have you on the speaker list. That would be amazing. It's a beautiful country, it's worth coming to have a visit. But thank you so much for the hard work you do, and I know it's a grind to try to get this information out there, but it is having a massive impact. You've written the book, When Brains Collide. Can you tell us where can people get more education from you, sign up to any newsletters or anything that you do to help you get the word out there, all of that good stuff?

Dr Michael Lewis: Yeah. I'm a little bit in the process of changing things. I'm terrible at marketing.

Lisa: We're all learning that one.

Dr Michael Lewis: You can get the book, When Brains Collide, through Amazon, all around the world, certainly.

Lisa: And I loved it.

Dr Michael Lewis: You go to whenbrainscollide.com, but right now some hacker has messed up the whole website, so I can't figure out how to just go to Amazon.

Lisa: That's where I got it, I know. So just go to Amazon, get When Brains Collide, you can get it anywhere in the world.

Dr Michael Lewis: And so when I retired from the military, I started a small nonprofit called the Brain Health Education and Research Institute, and the website for that is brainhealtheducation.org. And I will make an outrageous plug for this new product that I have come across, Zinzino — Z-I-N-Z-I-N-O dot com. And if you go in there, I really would say they've got the two things I highly recommend to anybody. What it's called is the balance test. It's a finger stick, you do it at home, put it in the post in the mail, and a couple of weeks or so you get the results back by email. So balance test before and down the line, and then their balance oil is the combination of fish oil and olive oil. And if you go in to order anything, they ask you for the distributor — if you look me up by name, you should be able to find it, or if you put out my email, however people... But the other thing is, you and I can talk about this after this.

Lisa: Yeah, let's do that.

Dr Michael Lewis: That you can have a little bit more direct access.

Lisa: That sounds absolutely marvellous. All right, thank you, Dr Lewis, for your time today. You're making a massive impact in the world, so please keep up the good, amazing work.

Dr Michael Lewis: Yeah, it's an uphill battle, swimming upstream for sure, but let's keep doing it.

Lisa: Just like those salmon.

Dr Michael Lewis: That's right, exactly.