Dr. Pineda and several internists, who have expressed their opinions in press and TV interviews, agree that the cause of bangungot, a.k.a. sudden unexpected nocturnal death syndrome (SUNDS), is cardiac arrhythmia. Cardiac arrhythmia, like ventricular fibrillation, is characterized by a wildly irregular heart rhythm that stops the normal blood flow to the heart muscles, resulting in ischemic cardiac dysrhythmia. This results in sudden cardiac death.
Sudden cardiac death (SCD), as a result of ventricular fibrillation, occurs within one hour after the onset of the malignant irregular heart rhythm. Fifty percent of the individuals have no previous history of heart disease.
SCD can occur not only among Asians but in non-Asian countries as well. The American Heart Association reports that more than 250,000 SCDs occur in the US every year. Similar reports have also come from Australia and the United Kingdom. It appears that men are more predisposed.
Based largely on previous epidemiologic observations, inhabitants of countries with a high consumption of fish like the Greenland Eskimos, have a low death rate from coronary artery disease. These have led to an intensive research on the role of fish oil in preventing heart disease.
Fish oil coming particularly from cold deep-sea water like salmon, tuna, cod, etc. contains the long-chain polyunsaturated fatty acids, EPA (eicosapentaenoic acid) and the longer unsaturated chain DHA (decosahexaenoic acid). Both belong to the omega 3 long-chain polyunsaturated fatty acids. EPA and DHA are derived from one of the essential fatty acids, alpha-linolenic acid (ALA), which is present in our normal diet. However, several enzymatic steps must take place before ALA is converted to EPA and finally to DHA.
DHA is the main component of the phospholipid which makes up the cell membranes, from the neurons of the brain to the cardiac membranes. Since it is highly unsaturated, it facilitates the normal flow of electrical discharges, ionic fluxes and neurotransmitter signals. How DHA affects membrane excitability, resulting in anti-arrhythmic effects, is the subject of several ongoing studies. It involves the normal movement in the ion channels of the heart.
In a review article by Charnock published in the Asia Pacific Journal of Clinical Nutrition, the author concluded that based on these studies, the evidence suggests that "it may be the DHA, rather than the EPA component of fish oils, which is the biologically active fatty acid responsible for the reduction in susceptibility to developing ventricular fibrillation" which causes sudden cardiac death. EPA is also a source of inflammatory mediators which may have unwanted physiologic effects.
While fish oil is a rich source of both DHA and EPA, there are other sources like eggs, organ meats, etc. Unfortunately, they also contain the "bad cholesterol." A natural source preformed DHA is human breast milk. It is in fact the DHA in breast milk that is one of the factors that contribute to a higher IQ among exclusively breast-fed infants.
A pure source of DHA derived from the fish food microalgae was developed by Martek Bioscience, USA using a patented technology. This vegetarian source of DHA carries the brand name Neuromins which comes in gel capsule and is locally available at Mercury Drug outlets. It has been certified as safe and is even added to improve infant formulas. Other available commercial brands are marketed as omega-3 capsules which contain both DHA and EPA derived from fish oil found in health food shops.
According to one large prospective study by Albert, et. al published in JAMA, a consumption of fish at least once a week was associated with a significantly reduced risk of sudden cardiac death in men.
So to all the healthy young men who will be spending a boys’ night out drinking moderately, include tuna panga, fish kinilaw or inihaw or even sardinas de lata, preferably in olive oil, in your pulutan. Your heart will love you for it!