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Biomedical Odyssey

Life at the Johns Hopkins School of Medicine

salmon, avocado, flax seed and other examples of fatty acids

Omega-3 Fatty Acids May Lower the Risk of Fatal Heart Attacks by More Than 10 Percent

The human body synthesizes most of the fats it needs. However, there are certain fats — called essential fatty acids — which are required for its function and that the body is unable to make from scratch. Humans instead must depend on food consumption for these fatty acids, which are called essential fatty acids and include omega-3s. Omega-3 fatty acids are a type of fatty acid with a specific chemical structure and consist mainly of eicosapentaenoic acid and docosahexaenoic acid — found in seafood, such as tuna and salmon — and α-linoleic acid — found in several kinds of nuts.

Omega-3s play an important role in brain function and normal development, and deficiencies have been linked to poor memory, disorders of the liver and kidneys, impaired immune function, depression and fatigue. Consumption of omega-3 fatty acids has been associated with a reduced risk of developing atherosclerosis, heart disease, stroke, Alzheimer’s disease, dementia, asthma and joint pain. However, while several studies have reported significant benefits associated with omega-3 consumption, others’ results were inconclusive. Explanations for these inconsistencies include small sample sizes, as well as self-reported consumption of omega-3s via questionnaires and surveys from study participants, which are not necessarily reliable methods of measuring intake.

This is where the Fatty Acids and Outcomes Research Consortium (FORCE), led by Dariush Mozaffarian at Tufts University, comes into play. In a recent study published in JAMA Internal Medicine, the consortium provided the largest data set to date assessing the purported benefits of omega-3 consumption. The authors pooled data from 19 groups with over 45,000 participants from 16 different countries. Instead of relying on self-reported estimates or questionnaires to measure intake, the researchers used direct blood and tissue measurements of omega-3 fatty acids to provide an unbiased analysis of the heart-healthy benefits of omega-3s.

Did you know: 1 in 4 deaths in the U.S. is a result of heart disease?The study, which is the most comprehensive of its kind thus far, found that participants with higher circulating blood levels of omega-3 fatty acids had, on average, a nearly 10 percent lower risk of a fatal heart attack, as compared to participants whose levels were lower by one standard deviation. The authors also found that the higher the omega-3 levels, the lower the risk of heart disease, with participants with the highest blood level of omega-3s having the greatest reduction in risk, of more than 25 percent. These effects held true irrespective of age, sex and race, suggesting that anyone can enjoy the benefits of adding omega-3s to their diet.

Given that one in four of all deaths in the United States is due to heart disease, a 25 percent reduction in risk could translate to significant numbers. However, the authors caution that because their study focused only on the consumption of omega-3s from natural plant and seafood sources, their results do not make claims that fish oil supplements will have the same beneficial effect. FORCE will also provide future opportunities to study the relationship between fatty acid biomarkers and other health outcomes besides heart health. Now that the link between omega-3 consumption and prevention of fatal heart disease has been more firmly established, the authors are beginning to look into other measurements of health in the hopes of better understanding the relationship between omega-3s and the risk of developing diseases such as diabetes, obesity and various types of cancers.

Source: Del Gobbo, L.C.; and Mozaffarian, D., et al. ω-3 Polyunsaturated fatty acid biomarkers and coronary heart disease. Pooling project of 19 cohort studies. JAMA Intern Med. 2016;176(8);1-13. doi: 10.1001/jamainternmed.2016.2925. Published online June 27, 2016.

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Reminders in Medicine: Patient Care Impacts Medical Training

Years of carrying a massive backpack full of books to make it here — to OR2 of the Weinberg Building at The Johns Hopkins Hospital — had given me terrible lower back pain at the ripe old age of 23. My goal was to focus on the procedure, but my back throbbed, and my sleep-deprived mind kept wandering. The sound of a phone ringing suddenly jolted me from my daze: “Pathology reporting on frozen section of iliac lymph nodes. Metastatic cancer.”

The air in the room changed, but the operation continued. “This lady is going to die,” said the attending matter-of-factly. It would have been easy to misinterpret her statement as cold, but I had witnessed this particular surgeon stay until 10 p.m. for her patients, visit with each of them during rounds and fight to get them appointments with specialists, so the weight of her words hit harder than most.

My problems were so small compared to those of this patient. When I saw her in the preop area just hours earlier, she looked dazed, as if she had been through so much already and had fully surrendered herself to the whims of the medical system. She knew she had cancer, but this surgery would tell her how much. Just before the surgeons wheeled her back, her family gathered around her to sing a lament. The words were beautiful, and when I saw her open her eyes afterward, I noticed that they had a little more life in them.

This is medicine.

I have only been on my third-year clinical rotations a for few months, but time and time again, I am reminded of how lucky I am. When I look out of the hospital windows at 5 a.m., the misery of my sleep deprivation is often broken by awe at the fact that I am here, at the Johns Hopkins University School of Medicine - my dream school. When those patients walk through the door, the ones that the medical system has given up on, with the hope that we at Johns Hopkins Medicine can care for them, I am reminded what an honor it is to serve them. And finally, when I am splashed with a sudden wave of reality that I am in the presence of someone who will soon die and that I have been given the chance to be with them now, in their last few months or days, I am reminded of the privilege I have been given to make these people feel better in any way, whether I am their surgeon or simply the person holding their hand while their epidural is placed.

Practicing medicine is a roller coaster. When you are feeling your worst, overwhelmed by exhaustion or sadness, or on the days when you simply feel that you are not good enough, your patients will always remind you that you are lucky enough to be yourself, lucky enough to be alive and healthy, lucky enough to be given the opportunity to serve others, and that this is what makes you good enough for them.

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model of a human heart

The Anatomy of Being Human

It’s 6 a.m., and my alarm goes off. Groggily, I continue to press snooze for the next hour, until I realize I won’t be able to enjoy a breakfast that’s not a granola bar if I sleep any longer.

It’s been six weeks since I started at the Johns Hopkins University School of Medicine as a first-year medical student, but time passes oddly in medical school. With the fast-paced atmosphere, sometimes I feel like I’ve only been here a few days, and at other times, a full year. At the moment, we are nearly finished with our Human Anatomy course, which is notorious for its rigor and intensity, but also the immense thrill and exploratory nature.

Class starts promptly at 8 a.m., but today I frantically arrive at 8:02 a.m., quickly settling into my chair to learn about the ventral roots of the spinal cord. Following the lecture, I head up to the anatomy lab and mentally prepare for the day’s dissection of the human heart.

Dissection of a cadaver is an overwhelming experience. It’s an immense privilege to be able to explore the human body in a hands-on setting, but it can also be jarring to face the reality of death and the passing of a human life. Today’s dissection is a particularly profound reminder of this. When my lab group and I remove the heart from our cadaver, we take a moment to pause and offer our deepest gratitude to the donor and her family, who gave us this incredible privilege for the purpose of our medical careers. Seeing an actual human heart for the first time takes my breath away — to imagine that this same heart beat throughout every single second, throughout every single memory of person’s lifetime — it was truly a special moment.

Dissection is easily my favorite part of the anatomy course. I came to medical school with a strong background in engineering and became interested in pursuing surgery as a specialty because of the many parallels between the two fields. However, dissection lab has given me an unexpected but enriched view of anatomical biology through the constant juxtaposition of science and humanism it forces us to face each day. The privilege of dissection reminds us that the heart isn’t just an organ, but also a physical representation of billions of seconds of another human’s life, their memories, relationships, fears. It teaches us that the hand isn’t simply the distal portion of an upper limb but once served as a source of warmth and comfort for loved ones, a hand that once held a child, a book, maybe a scalpel like my own. Even early in my medical education, I’m already grateful for this deeper perspective.

As the Human Anatomy course comes to an end, I often reflect back on my time in medical school so far. Although I’ve only been at Johns Hopkins for six weeks, it’s already been a unique and exciting journey, as each day brings something challenging and fresh. Constantly experiencing the multiple facets within medicine is what makes this educational pathway so special, and I can’t wait to see what the next four years will bring.

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