| Recent Clinical Studies
on Fish Oils
In a previous newsletter (The Importance
of Pharmaceutical Grade Marine Lipids 01:02:2003), I stressed
that one of the most significant developments in nutritional medicine
is the recent introduction of truly pharmaceutical grade fish oils.
Over 600 clinical studies now exist that show the benefits of the
omega-3 fatty acids EPA and DHA. In this newsletter I want to highlight
three recent double-blind clinical trials that once again reinforce
the importance of the long-chain omega-3 fatty acids in good health
and modern medicine. The studies that I chose to review in this
issue center around the importance of omega-3 fatty acids to proper
brain function and development.
Omega-3 Fatty Acids and the Brain
If you have come to one of my lectures, undoubtedly you have heard
me say that your brain is literally a vat of fat - so don't be upset
when people call you a "fat head." Let them know, however,
that your brain is likely functioning better than theirs because
you are getting enough of the right fats. The type of fat that you
consume in your diet and through supplementation determines the
type of fat that you have in your brain. And, the type of fat that
you have in your brain goes a long way in determining how well your
brain functions.
The importance of omega-3 fatty acids to brain function relates
to their role in the phospholipid composition of nerve cell membranes.
While it is thought the cell is programmed to selectively incorporate
the different fatty acids it needs to maintain optimal function,
the lack of essential fatty acids (particularly the omega-3 oils)
and excess of in saturated fats, margarine, cholesterol, and animal
fatty acids leads to the formation of cell membranes which are much
less fluid than normal.
A relative deficiency of essential fatty acids in cellular membranes
substantially impairs cell membrane function. Since the basic function
of the cell membrane is to serve as a selective barrier that regulates
the passage of molecules into and out of the cell, a disturbance
of structure or function disrupts homeostasis. Because the brain
is the richest source of phospholipids in the human body and proper
nerve cell function is critically dependent on proper membrane fluidity,
alterations in membrane fluidity impacts behavior, mood, and mental
function. Studies have shown that the physical properties, including
fluidity, of brain cell membranes directly influences neurotransmitter
synthesis, signal transmission, uptake of serotonin and other neurotransmitters,
neurotransmitter binding, and the activity of key enzymes that break
down neurotransmitters like serotonin, epinephrine, dopamine, and
norepinephrine. All of these factors have been implicated in depression,
attention deficit disorder, and other psychological disturbances.
Fish Oils Effective in Major Depression
Fish oils concentrated for EPA and DHA have been shown to have
positive effects for patients with schizophrenia in several studies
as well as in bipolar disorder (manic depression). Given the central
role that these omega-3 fatty acids play in brain chemistry and
nerve cell function, a double-blind study was conducted to evaluate
their role in depression. Previous studies have shown quite convincingly
that patients with depression have significantly low EPA and DHA
in cell tissue contents (red blood cell membrane, plasma, etc.)
and presumably their brain. This fact alone is probably reason enough
to supplement with a pharmaceutical grade fish oil. However, now
there is even more evidence. In the recent study, 28 patients with
major depression were given a hefty dosage of omega-3 fatty acids
(4.4 g EPA/2.2 g DHA) or placebo, on the top of their usual treatment,
for 8 weeks. Evaluation of the subject with the Hamilton Rating
Scale for Depression showed that those taking the fish oils a significantly
decreased score compared to those in the placebo group (P < 0.001).
These results are quite exciting and suggested that continued use
may produce even greater benefit as there was a continued downward
trend with time on the symptoms of depression.
Reference: Su KP, Huang SY, Chiu
CC, Shen WW. Omega-3 fatty acids in major depressive disorder.
A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol
2003;13:267-71.
Fish Oils in Borderline Personality Disorder
This next study is one that I am particularly excited about. It
showed fish oil supplementation to be very effective in improving
borderline personality disorder (BPD). If you are not familiar with
this term, it is used to describe a pervasive pattern of instability
of interpersonal relationships, self-image, and mood, and marked
impulsivity beginning by early adulthood. Some of the major indicators
of BPD include the following:
- Relationships with others are intense but stormy and unstable
with marked shifts of feelings and difficulties in maintaining
intimate, close connections.
- Frantic efforts to avoid real or imagined abandonment.
- Markedly and persistently unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self-damaging
(e.g., spending, sex, substance abuse, reckless driving, binge
eating).
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior
- Tremendous mood swings.
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger
(e.g., frequent displays of temper, constant anger, recurrent
physical fights).
- Transient, stress-related paranoia.
In the study, only EPA was used. I view that as a shortcoming given
the importance of DHA to brain function. Nonetheless, in the study
30 women with BPD were given either 1 g of EPA or a placebo for
8 weeks. Detailed analyses using sophisticated measures found EPA
to be superior to placebo in diminishing aggression as well as the
severity of depressive symptoms. The authors of the study went so
far as to conclude that EPA may be a safe and effective form of
primary therapy for women with moderately severe borderline personality
disorder.
The significance of this study is profound given that an estimated
6 million people in the United States are believed to suffer from
symptoms of BPD. All told, this disorder touches an estimated 36
million lives counting spouses and children. If pharmaceutical grade
fish oil can help BPD (and I believe that it does), it would be
a godsend to many.
Reference: Zanarini MC, Frankenburg
FR. Omega-3 fatty acid treatment of women with borderline personality
disorder: a double-blind, placebo-controlled pilot study. Am J
Psychiatry. 2003;160(1):167-9.
Can Fish Oils Make Kids Smarter?
EPA and DHA are critical for proper brain development - especially
during the fetal and infant stage. In particular, there is a growth
spurt in the human brain of the fetus during the last trimester
of pregnancy and the first few months after birth that is characterized
by a large increase in the cerebral content of DHA. This fact makes
insuring adequate intake of DHA during pregnancy and breastfeeding
absolutely essential. On a side note, do not rely on flax seed oil
for accomplishing this goal as detailed research has shown that
the capacity for elongation and desaturation of alpha-linolenic
acid (18:3 n-3) to DHA is inadequate in both the mother and in the
fetus and the newborn.
Did you know that breastfed infants are smarter and have higher
IQs than formula fed infants? According to a large amount of research
it is true and the availability of DHA to the developing brain is
one of the key reasons. Just recently the FDA has allowed manufacturers
of infant formulas to fortify their products with DHA.
A recent study tested the hypothesis that supplementing the maternal
diet during pregnancy and lactation with DHA and EPA could benefit
the fetus and the newborn infant by demonstrating greater cognitive
function. In the study, a total of 341 pregnant women were supplemented
with either omega-3 fatty acids (1200 mg DHA, 800 mg EPA) or corn
oil from 18 weeks of pregnancy through completion of lactation,
and the children were examined at 4 years of age with an intelligence
test. All of the children evaluated had been breastfed exclusively
for the first three months. Results indicated that the group getting
the DHA and EPA did in fact score considerable higher on the Mental
Processing Composite of the K-ABC at 4 years of age as compared
with children whose mothers had taken corn oil.
Think about the ramifications of helping children get a head start
in life by making sure that their brains have all of the important
nutrients and building blocks it needs to develop properly - including
DHA. Sadly, low levels of DHA during fetal and infant brain development
may be one of the critical reasons why we are seeing so many children
of psychoactive drugs for attention deficit disorder, depression,
obsessive compulsive disorder, and other psychological illnesses.
Reference: Helland IB, Smith L,
Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with
very-long-chain n-3 fatty acids during pregnancy and lactation
augments children's IQ at 4 years of age. Pediatrics 2003;111:e39-44.
Choose the Right Product
I have stressed the importance of using a pharmaceutical grade
fish oil in previous newsletter. In order to represent itself as
pharmaceutical grade a fish oil product must possess the following
characteristics:
- It must be manufactured in a certified GMP facility approved
for pharmaceutical products.
- It must be manufactured according to pharmaceutical standards
that include quality control steps to insure the product is virtually
free from lipid peroxides, heavy metals, environmental contaminants,
and other harmful compounds.
- It must provide at least a 60% concentration of the most active
long-chain omega-3 fatty acids (EPA and DHA).
- The ratio of omega-3 fatty acids to arachidonic acid must be
greater than 50:1
- It must contain the optimal amount of natural vitamin E as
a preservative.
The bottom line is that I recommend, RxOmega-3 Factors from Natural
Factors. It is one of the few fish oil products that truly is a
pharmaceutical grade product. Each capsule provides 400 mg of EPA
and 200 mg of DHA - the exact ratio used in so many of the clinical
studies.
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