For many years, baby formula manufacturers have been fortifying and reformulating their products in an effort to produce variations that are ‘equal’ to that of natural breast milk. Formula milk now comes in 3 forms: ready-made, concentrate and powder. Each has its advantages and disadvantages and these generally condense down to convenience and cost. Baby formulas are derived from either cow’s milk or soybean, and are fortified with iron and Vitamin D (which can be lacking in breast milk) and contain a form of sugar called lactose (although lactose free varieties are available). Different brands will generally contain different levels of sugar and protein and some will be fortified with docosahexaenoic acid (DHA) and arachidonic acid (AA), long chain omega fatty acids that are vital for normal growth and development.

The ongoing debate associated with the benefits of breastfeeding over that of bottle feeding centres, in part, on observational findings that link breast milk to higher scores on cognitive tests. These scores are related to head size; it has therefore been hypothesised that breast milk mediates cognitive effects by promoting brain development, particularly that of white matter growth. The two most abundant long-chain polyunsaturated fatty acids in the brain are DHA and AA, where they have a functional and structural role in infant development. DHA is concentrated in the prefrontal cortex of the brain, an area important for association and short-term memory, and in some retinal cells. Concentrations of these fatty acids in human breast milk are relatively consistent during the first year of life, and studies have shown that breast-fed infants have a greater mean weight percentage of DHA and a greater proportion of DHA in their red blood cells and brain cortex than formula-fed infants. Furthermore, cortex DHA in breast-fed infants increases with age, probably due to the length of feeding.

However, human milk is also rich in EPA, another long chain omega-3 that, whilst present in white and gray matter at relatively low levels when compared with DHA, actually plays an important and significant role in myelination and brain function. EPA also plays an important immunomodulatory role by expressing potent virucidal activity, thereby reducing the risk of mother-to-child transmission of infections.

Given the importance that EPA plays in the structure and stabilisation of nerves and brain function as well as its predominant role in the immune system, it is surprising to me that formula milk development has not progressed to include this fatty acid. The rational for this is that EPA competes with AA and that this may cause displacement of AA within membranes. However the research behind individual physiological roles of each fatty acid has developed immensely in the last few years alone and given the presence of EPA within breast milk would suggest to me that there is a role in the development and welfare of the infant. The importance of DHA and AA for brain development is certainly acknowledged by milk formulation companies who have begun in the last few years to add these important fats to their milk products. The Expert Panel recommended that the maximum concentration of AA be 0.6% of total fatty acids, that the maximum concentration of DHA in preterm infant formulas be 0.35% of total fatty acids, and that the maximum concentration of EPA be 30% of the concentration of DHA.

However, commonly available formulas such as Cow & Gate and SMA only include AA and DHA and therefore the only source of EPA for the newborn baby is via its mother’s breast milk, so fully supporting the concept that breast really is best.

Le Huërou-Luron I, Blat S, Boudry G. (2010) Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects. Nutr Res Rev. 23:23-36.

Puri BK, Stannard JP. (2006). The essentiality of eicosapentaenoic acid in breast milk during human lactation: implications to formula milk manufacturers. AGRO FOOD IND HI TEC. 17:7-8.

There are huge ethical concerns over the long-term health consequences that arise from such procedures as cloning, and consequences that we should really have learn from past errors in playing God in the food chain. Take transfats for example. The hydrogenation process by which trans fats are formed was first discovered around the turn of the 20th century, and so with it was born the first man-made fat to join the food supply. American kitchens were the first to introduce partially hydrogenated vegetable oil in 1911 with a product called Crisco®. The incorporation of transfats in to many food products soon became popular with consumers and food manufacturers because they acted as a preservative, giving foods a longer shelf life but also giving foods a more appealing taste and texture. The devastating effects of these fats are now abundantly clear, with links to cardiovascular disease and metabolic syndrome, and consequently we are now desperate to deplete these fats completely from our diets. So it seems we have learnt very little from past mistakes.

Cloning is one form of genetic manipulation to suit a dietary ‘need’; another is the genetic modification of plants to produce genetically modified (GM) end products. This process isolates and modifies genes, usually so that they function better, before inserting into a new species. The end result is to develop an organism that expresses a novel trait that is not normally associated with that species. GM foods first hit the market in the early 1990s and were restricted to transgenic plant products such as soybean, corn, canola, and cotton seed oil. The objections that are raised against GM foods include possible safety issues, ecological and economic concerns – all of which are still prominent and, consequently, use of GM in the food chain is still of great concern.

Another such potential use of a GM plant species is to genetically modify plants to produce essential omega-3 fatty acids that are usually only associated with fish and fish oils. The drive behind such a process is an attempt to increase omega-3 in human diets without adding pressure to fish stocks. If successful, the resulting plants are aimed at feed for farm animals, and for incorporation into the food chain through direct inclusion in food products as an indirect way of increasing our omega-3 levels. Consequently, the consumer may be completely unaware of such processes, and that GM products are even being incorporated into every day food products. Whilst GM omega-3 may not be the next trans fat, and that it is hoped that the heath positive benefits outweigh any heath negative attributes, we do not know at this point the long term heath consequences of such actions.

I would like to have the choice to make up my mind and not have to actively seek out foods that are free from GM. Would you?

There is increasing scientific focus on the mechanisms that occur within the body and brain of depressed patients. Indeed, it is becoming much clearer that inflammation significantly contributes to the cause and progress of depression, and that this triggers a myriad of processes that all contribute to the symptoms associated with the condition. It is difficult to comprehend that inflammation can trigger depression, because it is generally thought of as a response to injury or irritation that is characterised by physical processes such as pain and swelling.

However, inflammation need not be physical or obvious, and inflammatory processes and brain-immune interactions are now known to be involved in the development of major depression. Inflammation is certainly suggested to contribute to the dysfunction of biological systems involved in the production of important neurotransmitters (brain hormones) such as serotonin and noradrenalin. Indeed, increased levels of inflammatory products called cytokines (produced by immune cells, and involved in relaying messages between cells) have consistently been reported in patients with depression. Pro-inflammatory cytokines have many physiological functions but, significantly, have been reported to modulate central nervous system functions including a process called neurogenesis, which is simply the method by which nerve cells are generated. Excessive inflammation, and the production of cytokines amongst other things, causes a series of processes that ultimately damage neurones leading to their death. When cells within the brain die, this causes atrophy, or shrinking, by which there is loss of brain gray matter. Structural brain changes detected by a process called MRI scanning in depressed patients have been reported in several brain regions.

However, there appears to be hope offered through supplementing with fish oil. EPA is an omega-3 fatty acid known to help the symptoms of depression and reduce levels of inflammatory cytokines, whilst producing beneficial anti-inflammatory products. There is increasing scientific interest in the ability of EPA to prevent neuronal cell death and therefore reduce or prevent gray matter loss. Much of the pioneering work has focused on the role of EPA in Huntington’s disease with extremely promising results. Given the evidence that omega-3 fatty acids are beneficial for conditions in which there is reduced gray matter atrophy, such as Huntington’s disease, supplementing with ethyl-EPA may have further positive benefits on gray matter volume in individuals with depression, and further studies to support this hypothesis are certainly warranted.

Puri BK, Bydder GM, Manku MS, Clarke A, Waldman AD, Beckmann CF. (2008)
Reduction in cerebral atrophy associated with ethyl-eicosapentaenoic acid treatment in patients with Huntington’s disease. J Int Med Res. 36: 896-905.

Song C, Wang H. Cytokines mediated inflammation and decreased neurogenesis in animal models of depression.Prog Neuropsychopharmacol Biol Psychiatry. 2010 [Epub ahead of print]

Indeed, several studies have highlighted that abnormal cell membrane fatty acid composition is related to risk and incidence of major depression, and that supplementation with omega-3, and specifically with EPA, appears to normalize fatty acid levels and reduce the symptoms associated with this condition. However different studies can report different findings, and whilst several studies may appear to give varied and often conflicting results, performing a meta-analysis gives an indication of general findings by ‘pooling’ the data from several studies to give an overall picture and therefore adding clarity to a concept.

A recent meta-analysis of 14 studies comparing the levels of polyunsaturated fatty acids between depressive patients and control subjects found that omega-3 polyunsaturated fatty acid levels were significantly lower in those individuals suffering from depression (Lin et al, 2010). Because the primary sources of these long-chain omega-3 fats are fish and shellfish, it is not surprising that those individuals with the highest consumption are the least likely to suffer from depression (Suominen-Taipale et al, 2010). Treating people who suffer with depression using fish oils is therefore a viable method for alleviating symptoms whilst restoring omega-3 levels. Given that low levels of omega-3 are also associated with increased risk of cardiovascular disease, as well as several other chronic disorders and conditions, the overall health benefits of raising omega-3 levels reach out much further as a nutritional approach to improving health.

Encouragingly, improvements in depressive symptoms can be seen as quickly as 8 weeks after commencing treatment. Indeed, a group of Montreal researchers have recently confirmed that taking omega 3 fish oil supplements, at doses higher than that normally consumed in an average diet, is superior to placebo in treating symptoms and that results can be observed within a two month time period (Lespérance et al, 2010). The results of this particular study also confirm EPA to be the predominant active ingredient responsible for the benefits of omega-3.

A meta-analysis of 28 trials investigating as to whether either EPA or docosahexanoeic acid (DHA) or both are responsible for the reported benefits showed that those trials in which EPA was the predominant or only fatty acid used, gave the most significant findings. Furthermore, it was suggested that the effects of 1g daily of EPA could be enhanced and prolonged by the addition of gamma-linolenic acid (GLA), an omega-6 fatty acid found in evening primrose oil (Martins 2009). Given that 1 in 4 individuals will suffer from depression at some point in their life, it is encouraging to know that there is a safe and natural way not only to treat depression but also as a method that could reduce the possibility of developing the condition in the first place.

Suominen-Taipale AL, Partonen T, Turunen AW, Männistö S, Jula A, Verkasalo PK.Fish consumption and omega-3 polyunsaturated Fatty acids in relation to depressive episodes: a cross-sectional analysis. PLoS One. 2010 May 7;5:e10530.

The human brain is a complex organ that controls our senses, our movements, receives information, analyses information, and stores this information as memories. Dementia, simply put, means ‘deprived of the mind’ and, contrary to what many of us consider an acceptable part of growing old, memory loss and dementia are not a natural part of the ageing process. Scientists are now suggesting that the omega-3 EPA, found in fish oil, can help. Like any organ, the brain needs nurturing, and if we provide our brain with the correct nutrients then we can help to ensure the function of our brain remains at its most efficient.

For those of you interested in finding out more about how EPA helps preventing memory loss, offering help for Alzheimer’s sufferers, the full article is available here: EPA fish oil and its role in Alzheimer’s disease risk

So why is it that pharmaceutical drugs, with such well documented findings in terms of their negative health effects, continue to be prescribed? It certainly appears that they are offered as a ‘quick fix’ regardless of the long term consequences. Originally discovered in the 1950s, anti-psychotics were found to block receptors in the dopamine pathway and used quite successfully in the treatment of schizophrenia and bi-polar disorder before being introduced as treatment for dementia where their actions serve as nothing other than “chemical restraints”. It seems shameful that pharmaceutical companies can benefit in such situations whilst nutraceutical companies struggle to get clearance for health claims from the Medicines and Healthcare products Regulatory Agency (MHRA). This government agency is responsible for ensuring that medicines and medical devices work and are acceptably safe, and consistently rejects claims for many well-known safe and commonly used nutritional products.

The benefits of fish oil and the role of long-chain fatty acids in brain chemistry and in dementia are generally accepted but not endorsed. Ironically the side effects of consuming fish oils include only relatively minor complications (gastrointestinal upset, nausea, headaches) when compared with the potentially very serious sides effects of some pharmaceutical products. Given that long-chain fatty acids are involved in the dopamine pathway influencing dopamine concentration, number of vesicles and D2 receptors, and have been beneficial in studies where the dopamine pathway is known to be involved such as schizophrenia and attention deficit hyperactivity disorder (ADHD), would it not be prudent to suggest a role of fatty acids as a regular or add-on treatment in individuals with dementia? The recent positive findings of the role of eicosapentaenoic acid EPA in reducing cerebral atrophy in Huntington’s disease is certainly indicative that non-pharmaceutical products need to be investigated and that their role in dementia, not only in the treatment but in the prevention of the condition, is sadly underrated at the expense of the patient.

Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu LM, Jacoby R; DART-AD investigators. (2009) The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol. 2009 8:151-7.

Puri BK, Bydder GM, Manku MS, Clarke A, Waldman AD, Beckmann CF. (2008) Reduction in cerebral atrophy associated with ethyl-eicosapentaenoic acid treatment in patients with Huntington’s disease. J Int Med Res. 36:896-905

The Glycemic Index

The brain needs energy supplied at an even rate in order to function optimally. Sudden peaks in blood sugar will adversely affect behaviour, anxiety, depression, and fatigue, so it is particularly important for people with depression to keep their blood glucose levels even. Although commonly known for its diabetes and weight loss benefits, the glycemic index (most commonly referred to as GI index), which ranks carbohydrates according to their effect on blood glucose levels, is a good guide to informing us which foods to include as part of a healthy diet, and indeed which foods to limit.

While all carbohydrate foods are eventually broken down into glucose, quick-release simple carbohydrates (such as high sugar foods, glucose and fructose) are broken down more quickly into glucose than complex carbohydrates (such as wholemeal grains), releasing glucose rapidly into the bloodstream. Repeated ‘spikes’ of glucose can decrease insulin sensitivity, increasing the risk of type 2 diabetes, as well as promoting oxidative stress in the veins and arteries – a cause of coronary heart disease. After the highs come the energy-sapping blood sugar lows and, frequently, strong urges to reach for another sugary carbohydrate snack to perk us up. Indeed individuals who suffer from atypical depression (a subtype of depression) often overeat and report an almost irresistible craving for carbohydrates.

White sugar and other refined carbohydrates, such as those found in processed white bread and white pasta, white rice and most convenience foods, supply few nutrients to the body but use up important B vitamins, which are essential for our nervous and immune systems, as well as healthy digestion. Avoiding refined foods and sugar, as well as consuming foods with a low GI value, will help to keep blood sugar levels even. Perhaps a more accurate reference guide to prevent blood sugar spikes is the Glycemic Load(GL) ranking system, which is based on a food’s GI value and average portion size. For example, whilst an apple is not low GI, it has a low GL and will barely influence blood sugar levels.

Micronutrient deficiencies

It is extemely common for depression sufferers to have low levels of B vitamins and essential minerals such as zinc, selenium and magnesium. These water-soluble vitamins and minerals must be consumed daily to avoid depletion. Deficiency can, in turn, hinder the body’s ability to utilise specific omega-3 fatty acids, which are known to lift our mood by elevating serotonin and regulating levels of this important neurotransmitter.

EPA, a long-chain omega-3 fatty acid found in fish oil, not only influences serotonin and dopamine in the brain, but is also converted to powerful anti-inlammatories via a series of enzyme-mediated steps. It is these enzymes that rely on the presence of B vitamins and essential minerals in order to function, without which the body’s production of natural anti-inflammatories is minimal, and can even result in the production of inflammatory substances. Combining a good nutritional vitamin and mineral supplement with 1 gram EPA daily (or 4 capsules Vegepa) can help to balance serotonin levels and alleviate the symptoms of depression.

Carbohydrate cravings are also linked with low levels of chromium, which helps to regulate blood sugar levels and reduce cravings. This is because for blood sugar to provide energy, it must be escorted into each of our cells where the energy conversion takes place. Insulin then ‘unlocks’ the cell, allowing glucose to pass in. But there is a missing link. Insulin doesn’t work properly unless biologically active chromium is present as a cofactor (much like a catalyst).

With many modern food processing methods, up to 80% of chromium is lost – particularly with whole wheat and raw sugar when they are processed to white flour and refined sugar. If we regularly opt for these refined foods over their healthy wholegrain relatives, chromium levels within the body can easily become depleted.

Whilst it is likely a low priority during episodes of low mood to concentrate on our eating habits, following a few general guidelines can help to restore healthy brain chemistry and minimise sugar-induced mood swings.

- Avoid processed foods.

- Keep red meat to a minimum or eat organic (red meat is high in inflammatory omega-6 unless animals are fed on natural grass).

- Drink plenty of water, as the brain needs to be hydrated to function at its best.

– Don’t forget your ‘five a day’. Make sure you get plenty of vitamins and minerals by eating a wide variety of fresh fruit and vegetables. If you eat them raw they’ll supply even more nutrients.

– Eat two portions of oily fish weekly to top up on omega-3, containing the natural antidepressant EPA, or take 2 capsules of Vegepa morning and night.

If you found this article interesting, you might like to read more about anti depression foods.

Our understanding of the significant health benefits associated with fish oil supplementation has come a long, long way since scientists’ original discovery, back in the 1950s, that cod liver oil was a rich source of fatty acids. Researchers have since then progressed far beyond the basic understanding that fish oil is a promoter of general good health, and moved onto the next phase of innovation – investigating which particular elements within this oil are biologically active and whether a physical deficiency in this bioactive element results in some degree of physical deterioration. Indeed, fish oil contains two major fatty acids EPA and DHA and it is only really in recent years that these important fatty acids have been investigated individually rather than dumping them in the same boat with the generic label of omega-3.

DHA is the most abundant omega-3 fatty acid in cell membranes, present in all organs and most abundant in the brain and retina. In contrast, EPA is present in minute quantities. It could be easily assumed that DHA is the more dominant of the two fatty acids and put all of our focus here. However whilst DHA has a primarily structural role, EPA plays an important functional role. In actual fact whist EPA and DHA are both considered to be important regulators of immunity, platelet aggregation and inflammation, their influencing bi-products arise from very different pathways and it is therefore not surprising that their mechanism of action will differ.

So what is my problem with the latest headline? Well what’s very misleading with this is the loose use of the word “fish”. The study didn’t even have a vague whiff of fish about it but was conducted using a DHA supplement and a dummy placebo. The importance of this is that the information put forward to eager ears gives the impression that all that mackerel eating is a waste of time. But hear me out. This study took but one of the major fatty acids associated with fish oil, showed no benefit, but happily used the word fish to summarise the findings. If we recall, fish oil contains two important fatty acids, DHA and EPA. It is becoming increasingly clear that the marked differences between the effects of EPA and DHA mean that we can no longer generalise the effects of ‘fish oil’ as a reservoir of omega-3. EPA not only plays a major role in cell signalling but also contributes to the compaction and stabilisation of neurones. Indeed previous studies have shown that high plasma EPA concentration may decrease the risk of dementia and that EPA can actually reduce the atrophy associated with the shrinking brain. I’m not objecting to their findings that DHA is not the fatty acid which plays a role in dementia, rather it’s the fact that the message implies that it we should now question or even rule out the protective role of fish altogether. But when we dig deeper and unravel the scientific evidence and put that on our plates to eat, we see that things are a little more convoluted than we initially thought – well, if you read the recent headlines, that is. Just because the bigwigs are now telling us that DHA won’t save our brains (this week at least) it doesn’t mean that we should now disregard our efforts to include fish as part of our diets in our bid to prevent age-related mental decline. I, for one, shall be continuing to get my twice weekly portions in and I hope you will too. Do remember that once again, it’s not black or white, to fish or not to fish.

So far so good, until I open up the paper to page two where I am met with the words “although side effects are rare, they can include muscle pain and damage to the liver and kidneys.” I guess this is what infuriates me. With the majority of pharmaceuticals there will be the downside list of side effects or contraindications that steal some of the glamour from a treatment programme. Take NSAIDs, for example; these are common over-the-counter anti-inflammatory drugs, like Ibubrofen.

Whilst one of the most common over-the-counter drugs and used by millions, NSAIDs are associated with several side effects, of which many are probably not known by the common user. Whilst the frequency of side effects varies among NSAIDs, the most common side effects are nausea, vomiting, diarrhoea, constipation, rash, dizziness and headache (interesting that we often take them when we have a headache!). NSAIDs may also cause fluid retention, leading to oedema. The most serious side effects are kidney failure, liver failure, ulcers, an increased risk of heart attack and prolonged bleeding after an injury or surgery.

So why is it that if there is a natural alternative which we can take for both of these drugs and without the associated side effects, that we are not advised? Let me speak firstly about cholesterol. In the 1970s Danish researchers discovered that in spite of their high-cholesterol, high-fat, diet Greenland Eskimos had an astonishingly low incidence of cardiovascular disease (as well as arthritis and other chronic inflammatory diseases). When analysing blood samples it was discovered that they had low levels of LDL (bad cholesterol) and low levels of VLDL (triglyceride), but high levels of HDL (good cholesterol). It appeared that their high intake of omega-3 was responsible for this low risk of heart disease. Since this research emerged, much focus has been centred on the role of omega-3 fatty acids and, more recently, specifically the role of EPA in lowering cholesterol levels. EPA reduces cholesterol production by inhibiting the activity of another enzyme called acyl-CoA but without the side effects associated with statins. EPA also acts as an anti-inflammatory in a similar mechanism to that of NSAIDs, but again without the side effects. So my message today is to boost your EPA levels on a long-term basis and you may well lower the possibilities of having to resort to pharmaceuticals with all sorts of side effects.

Increase your fish intake and adopt a more Eskimo-like diet! For those who don’t like fish, you can opt for a high-EPA supplement. Purified fish oils actually are a useful alternative to oily fish consumption and, unlike most oily fish, are contamination-free.

Our nervous system acts very similarly to an electrical cable; with the nerve’s ‘impulse’ adopting the role of the electrical wire itself, and the ‘myelin sheath’ (the ‘skin’ of the nerve), mimicking the insulation surrounding the wire. If the wire becomes damaged, then the nerve signal will not travel efficiently along the wire, nor will it transmit the intended messages as instantaneously. This delay results inevitably in the ‘classic’ symptoms of neuropathy; namely; tingling, numbness, ‘burning’ and pain.

A causative link has been drawn between neuropathy and deficiencies of long-chain polyunsaturated fatty acids within the body. Indeed, insulin itself plays a pivotal role in the metabolism of EFAs (essential fatty acids), by alerting the genes necessary for enzyme-conversion to begin the process of converting short-chain fatty acids into a bio-available (i.e. usable by the body) long-chain fatty acid.

Where insulin is absent, or enzyme-activity impeded, the enzymes needed to create specific fatty acids cannot be produced and a deficiency results. Of the myelin layer which protects our vulnerable nerves, an estimated 75 % is composed exclusively of EFA’s (these are termed ‘essential’ because the body cannot generate them independently, but must instead source them externally from the diet). Depletion of this fatty, insulatory layer, leads to severe nerve damage (Neuropathy).

Nutrition, as all Diabetics are painfully aware, is central to the manufacture of insulin and for creating the right ‘biological environment’ to encourage enzyme conversions to take place. By boosting or supplementing our dietary levels of long-chain fatty acids we can essentially sidestep the risk that the enzyme-mediated conversions will fail to progress past the initial hurdle.

Fatty acid supplementation nourishes the myelin sheath, and prevents further degeneration of inter-cellular communication; it reduces the risk of developing Neuropathy, and actually reinvigorates nerve endings to overcome numbness and the likelihood of eventual tissue loss. However, EPA, a specific omega-3 fatty acid found in fish oil that appears to have significant beneficial effects on diabetic neuropathy and serum lipids as well as other diabetic complications such as nephropathy (kidney damage) and macroangiopathy (damage to the blood vessels). EPA plays a role in the compaction, stabilization, and maintenance of myelin sheaths by regulating the production of proteolipid protein or PLP. PLP is literally the ‘glue’ that hold in place the sheets of protective fats that cover the nerve axon. Loss of PLP is associated with many conditions that have nerve damage including Multiple sclerosis, Alzheimer’s disease and Huntington chorea.

OmegaForce is a patented formulation of omega-3 and 6 long-chain fatty acids with a multitude of health-enhancing properties, including anti-inflammatory and pain-relieving actions. For more information on the relationship between EPA deficiency and the pathogenesis of Diabetic Neuropathy, please go to www.igennus.com