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.

---

Michael T. Murray, N.D., is widely regarded as one of world's leading authorities on natural medicine. A prolific author, Dr. Murray has written over 20 books on health and nutrition including the best-selling Encyclopedia of Natural Medicine and his latest book The Encyclopedia of Healing Foods. Dr. Murray is also Director of Product Development and Education for Natural Factors one of the leading manufacturers of natural products.