E-EPA reduces inflammation in recurrent depression

Approximately 40–50% of people who experience depression suffer from more than one episode and are therefore categorised as experiencing the recurrent type of this disorder.   Identifying predictors for recurrence in these patients is important for a better understanding of its course and for providing opportunities to improve preventive interventions (1).

The link between diet and depression is one that is gaining considerable interest and it has recently been hypothesised that an unhealthy dietary pattern, one that is low in vegetables, fruits, whole grains and fish, and high in refined grains, fast food, meat and sugar, leads to chronic inflammation which, in turn, could raise the risk for depression and depressive disorders (2).  The products of an inflammatory response, known as cytokines, are produced by a specific type of dietary fat known as the omega−3 and omega-6 polyunsaturated fatty acids.  Importantly, cytokines produced by the omega-6 fatty acid AA are considered pro-inflammatory whilst those from omega-3 EPA are anti-inflammatory.   These polyunsaturated fats are present in our cell membranes where they have important structural and functional roles. The ratio of AA to EPA in the diet therefore influences the composition of cells which, in turn, influences the regulation of inflammation within the body and brain.

Depression is associated with low intake of fish (rich in omega-3), low EPA levels and an imbalance between omega−3 and omega-6 polyunsaturated fatty acids, leading to increased levels of pro-inflammatory products that are linked to many of the somatic symptoms linked to depression, such as gastrointestinal disturbances, complaints of chronic pain, fatigue, and/or other unexplained medical illness3.  Pro-inflammatory cytokines are also known to reduce the availability of the amino acid tryptophan – needed for the production of the mood-enhancing neurotransmitter, serotonin.  Serotonin production and lowered omega-3 fatty acid status are related to dysregulation of the serotonin pathway that is related to mood and cognitive dysfunction in depression.

Low levels of omega-3, and specifically deficiencies in EPA, are consistently observed in patients with depression and recurrent depression.  However, many supplementation studies have given rise to conflicting results and it appears that the efficacy of a ‘fish-oil’ intervention in treating depression is dictated by the EPA content of the oil.  Only oils containing pure EPA appear to offer consistent therapeutic effects on symptoms, with a 1g daily dose of EPA over a period of 3 months providing break-through benefits for depression sufferers (4,5,6).  Whilst there are several hypotheses about the success of pure EPA supplements over conventional oils – which has been shown to be as effective as Prozac in its therapeutic effects (7), – it is believed that just 2 capsules daily of E-EPA 90 (= 1g) may reduce depressive symptoms, in part via regulation of the key components of the inflammatory cascade that are known to affect the production of serotonin (8).

E-EPA 90 is the purest ethyl-EPA concentrate available without prescription, suitable for counteracting omega-3 deficiencies and restoring a healthy omega-6 to omega-3 ratio. This product provides the ideal loading dose for three months, prior to a ‘maintenance’ dose of  Vegepa E-EPA 70, which combines the benefits of 70% ethyl-EPA concentrate extracted from marine anchovy oil with GLA and triterpene antioxidants from organic evening primrose oil.  This unique formulation is designed to balance and maintain healthy omega-3 and omega-6 levels, making it the ideal follow-on treatment once a healthy omega-6 to omega-3 ratio has been restored by the therapeutic actions of E-EPA 90.

1.  Lok A, Assies J, Koeter MW, Bockting CL, Wouters LF, Mocking RJ, Schene AH. (2012) Sustained medically unexplained physical symptoms in euthymic patients with recurrent depression: predictive value for recurrence and associations with omega 3- and 6 fatty acids and 5-HTTLPR? J Affect Disord. 136:604-11.

2. Ekmekcioglu C. (2012) Are proinflammatory cytokines involved in an increased risk for depression by unhealthy diets? Med Hypotheses. 78:337-40.

3.  Hoffmire CABlock RCThevenet-Morrison Kvan Wijngaarden E. (2012) Associations between omega-3 poly-unsaturated fatty acids from fish consumption and severity of depressive symptoms: An analysis of the 2005-2008 National Health and Nutrition Examination Survey.  Prostaglandins Leukot Essent Fatty Acids. [Epub ahead of print]

4.  Martins JG, Bentsen H, Puri BK. (2012) Eicosapentaenoic acid appears to be the key omega-3 fatty acid component associated with efficacy in major depressive disorder: a critique of Bloch and Hannestad and updated meta-analysis. Mol Psychiatry. 2012 Apr

5.  Sublette ME, Ellis SP, Geant AL, Mann JJ. (2011) Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry. 72:1577-84.

6.  Martins JG. (2009) EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 28:525-42. Review.

7.  Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, Peet M. (2008) Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry. 42:192-8.

8.  Jazayeri S, Keshavarz SA, Tehrani-Doost M, Djalali M, Hosseini M, Amini H, Chamari M, Djazayery A. (2010) Effects of eicosapentaenoic acid and fluoxetine on plasma cortisol, serum interleukin-1beta and interleukin-6 concentrations in patients with major depressive disorder. Psychiatry Res. 178:112-5.


Echium seed oil superior to algae EPA/DHA for vegetarian heart health

Within the UK, dietary intakes of long chain omega-3 fatty acids are well below current recommended levels for optimal cardiovascular health.   Whilst adequate intake of the long chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acids (DHA) can be achieved by eating fatty fish at least 1–2 times per week, (equivalent to 250–500mg/d of EPA and DHA) the majority of us fail to achieve such intake.   The cardiovascular health properties of fish oil are attributed to its enrichment in EPA and DHA but for vegetarians and vegans, for whom marine sources of omega-3 are not an option, sourcing effective amounts of omega-3 can be challenging.

Many vegetarians and vegans turn to algae sources of preformed EPA and DHA;  when it comes to heart health, however, it seems that algae oil may not be the best option.  The majority of algae oils are high in DHA with little or no EPA content.  Several studies have recently shown that oils that are high in DHA can increase the amount of LDL or ‘bad’ cholesterol within our blood and that, as such, pure EPA oils may fair significantly better when attempting to lower both triglyceride and cholesterol levels (Bays et al, 2011). When LDL cholesterol levels are too high, the LDL lipoprotein can stick to the lining of the blood vessels and in time can lead to atherosclerosis – the development of sticky plaques that can build up and obstruct the normal blood flow   In contrast, another type of cholesterol HDL lipoprotein ’scours’ the walls of blood vessels, removing excess cholesterol.  What is becoming clear is that whilst EPA and DHA lower triglyceride levels (high triglycerides can lead to type II diabetes and raise the risk of heart disease), only EPA increases good HDL cholesterol and lowers bad LDL cholesterol.  Ideally, vegetarians and vegans who are seeking to supplement with omega-3 for optimal heart health should therefore seek oils containing EPA but which are free from DHA.  Flaxseed oil contains significant amounts of alpha-linolenic acid (ALA), the precursor to EPA.  Our ability to modify and convert ALA to EPA, however, is significantly restricted with less than 8% of ALA metabolised to EPA.

In contrast, echium seed oil, unlike flaxseed or algae oil has the potential to significantly reduce plasma triglyceride and cholesterol levels, and the risk of atherosclerosis (Forrest et al, 2011). Echium oil, derived from the seeds of Echium plantagineum, contains 12–14% of total fatty acids as stearidonic acid (SDA) the immediate product of ALA and the direct precursor to EPA.  Recent findings suggest that even a low daily intake of SDA, easily achievable through dietary means, has the potential to raise tissue membrane levels of EPA (Krul et al, 2011).

Echium seed oil is, not surprisingly, generating a lot of interest as a ‘fish-oil alternative’ for vegetarians and vegans.  Offering known benefits for health and the cardiovascular system, echium seed oil, with its unique fatty acid composition, offers a myriad of health benefits (Whelan et al, 2011; Chilton et al, 2008) making it a superior choice of omega-3 for those who choose not to consume fish or fish oils.

1. Bays HE, Ballantyne CM, Kastelein JJ, Isaacsohn JL, Braeckman RA, Soni PN. Eicosapentaenoic acid ethyl ester (AMR101) therapy in patients with very high triglyceride levels (from the Multi-center, plAcebo-controlled, Randomized, double-blINd, 12-week study with an open-label Extension [MARINE] trial). Am J Cardiol 2011;108(5):682-90.

2. Forrest LM, Boudyguina E, Wilson MD, Parks JS. Echium oil reduces atherosclerosis in apoB100-only LDLrKO mice. Atherosclerosis 2011.

3. Krul ES, Lemke SL, Mukherjea R, Taylor ML, Goldstein DA, Su H, et al. Effects of duration of treatment and dosage of eicosapentaenoic acid and stearidonic acid on red blood cell eicosapentaenoic acid content. Prostaglandins Leukot Essent Fatty Acids 2011.

4. Whelan J. Dietary stearidonic acid is a long chain (n-3) polyunsaturated fatty acid with potential health benefits. J Nutr 2009;139(1):5-10.

5. Chilton FH, Rudel LL, Parks JS, Arm JP, Seeds MC. Mechanisms by which botanical lipids affect inflammatory disorders. Am J Clin Nutr 2008;87(2):498S-503S.




Controlling cholesterol: why statins may not be the answer.

Statins, also known as HMG-CoA reductase inhibitors, work by preventing the pathway to cholesterol production and are generally prescribed for individuals who are at high risk of heart attack or stroke. It seems that, even in healthy people, these drugs can cut the risk of heart attack by around 30%. Good news, you’d think, considering more than six million adults in the UK currently use them to help control cholesterol levels.

However, it would appear that the story is not quite so black and white; it wasn’t too long ago that I commented on a Daily Mail story highlighting the worrying side effects associated with the use of statins for reducing cholesterol. Not only do statins come with side effects that include muscle pain and damage to the liver and kidneys, it is becoming apparent that they may also cause memory loss and depression.

Strange, then, that these drugs are so commonly prescribed when there are natural ways of keeping cholesterol levels in check. Given the overwhelming evidence for the protective role that long-chain omega-3s play in cardiovascular health, it amazes me that this information is not passed on more readily by GPs to their patients. With the huge costs to the NHS for treating cardiovascular disease in secondary care, wouldn’t it be more cost efficient to educate people on preventative methods?

Omega-3 fatty acids not only reduce cholesterol, but can lower triglyceride levels, blood pressure, improve blood flow and reduce the risk of arrhythmia (the abnormal heartbeat that can increase risk of heart failure). Whilst eating oily fish is a good way of increasing omega-3 levels for heart health, supplementation with purified oils is a convenient way of achieving the therapeutic doses needed (which are often as much as 2-4g) to treat specific conditions such as hypercholesterolaemia (very high cholesterol) or hypertriglyceridaemia (very high trigycerides).

The type of fat in our diets needs to be addressed. Dietary fat plays a huge role in the development of cardiovascular disease. Our increased intake of junk food and heavily processed foods means that we consume amounts of saturated and trans fats that are detrimental to our health and these limited food choices are becoming normal for the next generation, as parents are making fewer food choices for their children. Making relatively simple dietary changes can have profound effects on our health and the habits we adopt now will be reflected in those we pass to our children. Choosing fat wisely, moderating saturated fat intake and increasing polyunsaturated fat at an early age may well help our own and our children’s passage to good health long-term, without the risk of side effects from prescribed drugs.

Nutrition and the Toxic Patient

cropped-IMG_7188-1.jpgThe general population is increasingly being exposed to a variety of “toxic” substances and, as a result, our environmentally polluted world is causing a myriad of health problems.   Whilst we generally understand the concept of toxins that come from external sources- for example, car fumes, tobacco smoke, drugs, dental fillings, environmental pollution, etc., we are less aware of the endogenous toxins that we encounter daily.  These toxins include those generated from viral and bacterial sources within the body, or toxins that are created by the body itself due to its own metabolism.

Long-term exposure to toxins, a decreased ability to metabolise toxins and therefore neutralise them within the liver, or simply an inability to clear toxins from the body can result in toxic overload that can contribute to the many symptoms associated with ME/CFS/fibromyalgia.

The symptoms of toxic overload, such as fatigue, dizziness and nausea, headaches, brain fog, and so on, are frequently misdiagnosed and pharmaceuticals prescribed, which may exacerbate symptoms and the patient enters a vicious cycle of treatment that has little or no benefit in alleviating symptoms.

So what does the toxic patient do?  It is not possible to remove ourselves from all exposures to toxins, but what we can do is to provide the best possible protection from the effect these toxins have on our health.  We have a complex internal system, involving multiple enzyme families that act, within the liver, to modify and detoxify agents from external sources, as well as those created internally – as a product of digestion, for example.

These enzymes depend on many dietary nutrients including essential vitamins, essential minerals, proteins and essential fats.   Deficiencies of any of these nutrients can contribute not only to the disruption of this important detoxification system, but to all physiological and biochemical pathways that contribute to normal functioning of the cells, tissues and organs that make up the human body.  It is no wonder that diet is so important to our overall health.

By modifying our diet we can therefore protect the organs and systems involved in detoxifying and eliminating toxins and manipulate the endogenous systems that protect the body from the effects of toxins.

Broadly, the ME/CFS/fibromyalgia diet should comprise simple, healthy and unadulterated foods that nourish the body and provide the raw nutrients needed to ensure detoxification pathways are provided with the key co-factors to perform optimally.  ‘Junk’ foods, and foods that are processed and highly refined (such as white sugar and flour) should all be eliminated, as they offer little nutritional value and are most likely to trigger symptoms, as well as being high in artificial additives and chemicals.  Eating a good variety of foods that incorporate organic products will help to eliminate pesticides and other toxins, whilst increasing essential vitamins, minerals, proteins and important fats such as omega-3s.  It is also important to eat small portions at regular intervals to ensure that the body’s nutritional requirements are continuously met.

A very important element of the diet relates to the types of fat that we eat, which can have a significant effect on how we feel. Saturated fats and trans fats, found in animal products and processed foods, have a negative effect on our health. In contrast, polyunsaturated fats (omega-6 and omega-3) have a major positive effect on our health because they are converted in the body to powerful hormone-like substances called ‘eicosanoids’. It is these eicosanoids that regulate physiological functions, with major roles in cardiovascular health, inflammation, immunity and mood.

Consuming a diet that is balanced in these types of fat can help to ensure that our bodies work most efficiently, right down to the cellular level. Consuming too much omega-6 fatty acids, however, can have negative effects. Omega-6s are found in plant oils such as vegetable oil and corn oil, or non-organic meat (these animals are fed on grains rich in omega-6), and while omega-6 fats are essential for good health, too much can result in the over-production of eicosanoids, triggering pain-processing pathways and increasing production of inflammatory products, as well as over-stimulating the immune system.

In contrast, omega-3 fatty acids (specifically those found in oily fish) have the opposite effect.  Generally, Western diets are high in omega-6 and low in omega-3.  Increasing omega-3 fatty acids, especially one known as EPA (eicosapentaenoic acid) and found in oily fish, can help reduce the production of specific proteins which trigger pain and inflammation, at the same time stimulating the production of neurotransmitters – brain chemicals involved in electrical signalling, mood and sleep.

Unfortunately, however, it’s not as simple as merely increasing fish intake. The polluted state of our oceans means that the benefits of consuming fish, as a rich source of omega-3, may be offset by the presence of contaminants, such as methylmercury (MeHg), dioxins, polychlorinated biphenyls (PCBs), and should be limited to twice weekly.   Highly purified omega-3 oils such as Vegepa – a product of choice for many practitioners – offer a safe and convenient method of increasing EPA levels without the risk of consuming hazardous contaminants – a consequence which can be associated with eating too much fish.

Incorporating organic fruit and vegetable produce into the diet, where possible, will also help to ensure that contaminants such as pesticides, herbicides and fertilizers are avoided.  Organic produce is also much higher in important vitamins and minerals – micronutrients that are essential in every biochemical pathway in the body.  Organic meat is also lower in omega-6, higher in omega-3 and, importantly, is free of the steroids and hormones associated with intensive farming methods.

Sugar is also an important element in the ME/CFS/fibromyalgia diet, since the brain and body need energy supplied at an even rate in order to function optimally. Sudden peaks, followed by troughs, in blood sugar can result in low energy and fatigue. The glycaemic index (GI) ranks carbohydrates according to their effect on blood glucose levels and is a good guide to informing us which foods to include as part of a healthy diet, and indeed which foods to limit. White sugar and other refined (simple) carbohydrates have a high GI value, and can be found in processed white bread and white pasta, white rice and most convenience foods. Avoiding these simple carbohydrates and consuming foods with a low GI value, will help to keep blood sugar levels even, and help to stabilise mood too. Good low GI foods include high fibre cereals, whole grain products, beans, pulses, brown rice, whole wheat pasta, fruit and vegetables. Not only are these foods far better for stabilising our blood sugar levels, but these foods also tend to be high in fibre, as well as vitamins and minerals which are needed for good immune function and maintaining energy levels.

Choice of protein is also key when considering the FM diet, since it is needed by the body for growth and repair, and our requirements increase when our body is in a hypercatabolic state (such as fighting infection, during illness, inflammation etc). Ensuring that we get the right amount and type of protein is extremely important for people with M.E./CFS/fibromyalgia.  Amino acids, which are the building blocks of protein, are essential for our health; animal produce is actually the best source of protein as it contains all eight essential amino acids. But we shouldn’t forget that organic meat far outweighs non-organic for nutritional value.  It’s sensible to avoid eating too much red meat, and fish is an excellent source of protein, as well as omega-3 good fats. Fish is low in saturated fat and particularly rich in arginine and glutamine – amino acids known to have a regulatory role in both cardiovascular health and immunity. Remember, though – due to contamination issues, fish should be limited to twice weekly, and smaller, short-lived species tend to be safer to eat than larger, long-lived fish such as tuna.  Vegetarians, on the other hand, need to eat a good combination of cereals and pulses to ensure that all the essential amino acids are included in the diet.  A great plant source of all 8 essential amino acids is quinoa, which can be sprouted or treated in the same way as couscous or rice.

To summarise, these simple guidelines will help people with M.E./CFS/ fibromyalgia to gradually modify their diet towards greater well-being, and a body that is stronger and more resilient to the obstacles it faces with M.E./CFS/fibromyalgia:

Eat small meals and try to eat regularly throughout the day


  • Complex carbohydrates (whole grain/wholemeal)
  • Organic ‘5-a day’
  • Fibre
  • Healthy plant fats – replace vegetable oil/corn oil with olive oil
  • Fish up to twice weekly – a good source of omega-3 fatty acids
  • Omega-3 EPA purified Vegepa capsules
  • Lean animal protein and vegetable protein
  • 8 glasses of purified water/day


  • Junk food and fast food
  • Trans fats
  • Too much saturated fat
  • Processed and refined food (white sugar, white flour, white pasta, white rice)
  • Too much alcohol and caffeine
  • Artificial ingredients, additives, and chemicals

As well as the above plan for eating well, avoiding stress is also important in managing symptoms.  Try to take regular exercise, outdoor walks, perhaps join a support group and spend time with close friends or family – sharing experiences and advice can all help.

Mercury, genes and the link with Alzheimer’s disease

cropped-IMG_7188-1.jpgMethyl mercury, a pollutant produced by various industrial activities, is a potent neurotoxin that has now caused serious contamination issues within our oceans. As a fat soluble molecule, methyl mercury enters the food chain and accumulates in the flesh of the fish that then may end up in our supermarkets. Consuming larger, longer living fish on a regular basis is now known to pose a serious health hazard, especially for children and pregnant women who are consequently advised to limit (or even avoid) the intake of some species such as fresh tuna or marlin.

The accumulation of mercury within the body can have profound long-term effects on the nervous system, and has been linked to a variety of conditions including Alzheimer’s disease where it is believed to play a part in nerve cell death. Lipoproteins, such as high density lipoprotein (HDL) and low density lipoprotein (LDL), are combinations of lipids (fat) and proteins that function to transport fat around via the blood, a function that is generally associated with cholesterol, and therefore cardiovascular health. However, approximately 1 in 7 people carry a gene that causes their body to produce a particular lipoprotein called apoE4, known to play a significant role in the development of Alzheimer’s disease. Those who inherit the apoE4 gene from one parent are three times more likely than average to develop Alzheimer’s disease, with those who inherit the gene from both parents having a tenfold risk of developing the disease (Donix et al, 2010). There are multiple hypotheses as to why those carrying the apoE4 gene are more likely to develop Alzheimer’s than those who carry the apoE3 or apoE2 genes; one such hypothesis regards the role that these lipoproteins play in mercury transport within the body, as mercury accumulation in the brain hasbeen linked to the progression of Alzheimer’s. Like all proteins, apolipoprotein is made of chains of amino acids. Cysteine is of particular relevance, as this amino acid contains sulphur, a member of a class of substances called ‘mercaptans,’ the Latin name for “mercury capture.” Because apoE2, the protective form of apoE, contains two cysteine amino acids, it is particularly efficient at removing mercury from the system. In contrast, apoE3 has only one cysteine, and apoE4 none, making it the most ineffective at removing excess mercury from the body.

Given that fish oils are thought to offer protection against neuronal death and therefore the onset of dementia, it seems that ingesting them in high doses may negate any beneficial therapeutic effects unless they are highly purified to ensure all heavy metals are removed. The growing omega-3 market means there are more products of differing qualities and strengths, and the processes used to isolate and purify oils can also differ quite significantly. It would certainly be advisable to choose fish oil supplements that have been purified under pharmaceutical grade conditions to ensure the product not only offers the best possible health benefits, but can also guarantee to be contaminant free.


Dórea JG. Environmental contaminants as biomarkers of fish intake: a case for hair mercury concentrations. Eur J Clin Nutr. 2010 Sep 1. [Epub ahead of print]

Albert I, Villeret G, Paris A, Verger P. Integrating variability in half-lives and dietary intakes to predict mercury concentration in hair. Regul Toxicol Pharmacol. 2010 Aug 27. [Epub ahead of print]

Why breast really is best

Breastfeeding is both natural and safe, giving your baby the best possible start in life. When born, infants have no gut faecal flora (healthy gut bacteria), microbes that play an important role in immune defence. The initial milk produced when breastfeeding is known as colostrum, and is high in a specific antibody (IgA) that plays a vital role in mucosal immunity. By coating the lining of the gastrointestinal tract, IgA helps to protect the newborn until its own gut flora is established, and its own immune system is functioning optimally. Breastfeeding also allows mother and baby to form a unique bond, both physically and emotionally. Ideally, women should breastfeed in order to allow their child to obtain the benefits that colostrum offer, one that is not provided by formula milk. In fact, the Department of Health actually recommends exclusive breastfeeding for the first 6 months of life, and this can continue to benefit the baby along with solid foods for many months after.
However, choosing to bottle feed rather than breast feed is not always simply for reasons of convenience. Indeed, not all mothers are able to breast feed. Such examples are: babies born prematurely, or women who are HIV positive or who are undergoing chemotherapy. Furthermore, women taking specific medications, either prescription or over-the-counter, are often advised against breastfeeding. It is important therefore that formula milk offers the best possible benefits for the newborn. The preferred food for premature infants is fortified human milk, either from the infant’s own mother or from milk ‘banks’. However, the number of surviving children born prematurely has increased substantially over the last two decades and this increase in survival rates is, in part due, to the progess that has developed in enteral nutrition and the development of formulas specifically designed for premature infants. The goal in supplying to these infants is to achieve growth that is similar to foetal growth but that is coupled with satisfactory functional development. Currently the maximum concentration of AA in preterm infant formulas is 0.6% of total fatty acids, DHA is 0.35% of total fatty acids, and the maximum concentration of EPA is no more than 30% of the concentration of DHA.

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.

Common false impression – getting sufficient quantities of omega-3 from fortified foods

The media may be saturated with the message that omega-3s are good for us, but it seems that there is still a lack of knowledge over what omega-3 is, and what exactly we are consuming when we eat foods that are fortified with omega-3. In the latest omega-3 report – 2010 US Consumers’ Choice: Omega-3 Nutrient Products – dairy products and beverages fortified with omega-3 are the two categories that have seen the highest sales increase over the past two years in the omega-3 market. Other foods commonly fortified are bread and spreads. Consumers, it seems, are influenced mainly by what they see on the television and what they read on the internet.

What consumers really need to understand is that not all omega-3s are created equal, particularly when it comes to such things as heart health and brain function. In fact, it is well established that dietary omega-3 polyunsaturated fatty acids are involved in health promotion and disease prevention, but specifically and uniquely those omega-3s that are derived from fish. It is these omega-3s and these omega-3s only that are needed for proper growth and development in foetuses, infants and children, and for the regulation of immune function, inflammatory function and cardiovascular regulation at all ages.

The difficulty with adding marine derived omega-3s to everyday food items is that these long chain fatty acids are prone to rancidity when exposed to air, raising issues with both taste and the product’s shelf life. However, fortifying food items with the short chain omega-3 alpha-linolenic acid (ALA) derived from plants does not pose with the same problems, as ALA is significantly more stable than the long chain fatty acids eicosapentaenoic acid (EPA) and docosahexanoeic acid (DHA). However, whilst ALA is an omega-3 fatty acid, is does not offer the same health benefits as that of EPA or DHA, as it is simply a precursor to these longer chain fats. Indeed, consumed sources of ALA (such as flaxseeds and hemp seeds) must be physically modified before offering any significant health benefits, a process that is extremely inefficient in humans. In fact, the conversion of ALA to EPA and DHA is consistently low in most people; less than 8% of ALA is metabolised to EPA and only between 0.02% and 4% is metabolised to DHA. Although there is currently no Recommended Daily Allowance (RDA) for omega-3 fats in the UK, the government do suggest a daily intake of 450mg a day for adults and 200mg for children. However, these figures are specifically for long chain omega-3s. Consumers may still be under the false impression that they’re getting sufficient quantities of omega-3 simply by using a fortified spread or breads when the reality is that many fortified foods often contain fairly insignificant levels of omega-3, or are fortified with short chain ALA, and they would need to eat huge amounts to achieve any significant health benefits.

So if you are under the impression that you are boosting your intake of beneficial fats as you place your ‘omega-3 laced’ loaf of bread into your trolley, you may have to think again. Make sure you read the label as this will give a clear indication as to the source, and if it doesn’t state EPA or DHA then you might want to head for the fish counter. The alternative is, of course, to supplement your diet with a quality fish oil (I recommend omega 3 fish oil Vegepa) and, if you really are not a fish lover, try supplementing with echium oil; Echiomega may not be a fish oil but it’s certainly superior to other plant sources of omega-3.

Man’s best friend and more?

Last week saw a rather unusual story in the headlines in which a jack Russell took it upon itself to remove an infected toe from his sleeping owner. Jerry Douthett, a 48-year-old musician from Rockford, USA, had been out drinking, and on returning home had fallen into a deeper than usual sleep. He awoke, some hours later, to find the sheets of his bed blood soaked, and on further investigation, found the big toe that had been infected for several weeks, but for which he had not sought medical attention, had disappeared. It turned out that Kiko, the family dog, had detected the infection and chewed the toe to the point that is was completely removed. Whilst the story had a an edge of humour to it, it came to light that Mr Douthett had in fact been suffering from type II diabetes, a condition he was unaware of, but for which he is now is being treated. Some of the long term damaging effects of diabetes are to the blood vessels and nerves that supply the limbs. Neuropathy is the direct damage of nerves and results in gradual loss of sensation and, if the skin is damaged, can result in infection, as experienced first hand by Mr Douthett. Unfortunately, many people have type II diabetes for years without knowing it, simply because any early symptoms can be vague and may not cause undue concern, or seem important at the time. Symptoms, amongst others include feeling thirsty all the time, frequent urination, unexplained tiredness and unexplained weight loss, muscle wasting and frequent infections, or slow-healing sores. It is important, therefore, to be aware of these symptoms and visit your GP if you have any concerns. Catching diabetes early is a key factor to managing the condition successfully. In Mr Douthett’s case he had his dog’s ability to smell his infection to thank, as it has enabled him to now regulate his glucose levels and hopefully avoid any further losses!

A dogs’ ability to detect infection is not surprising, given their acute sense of smell, believed to be around 100,000 times more acute than that of humans. The distinct olfactory gift that is associated with the canine species has, in fact, led scientists to conduct small-scale studies of dogs’ ability to detect the chemical markers of cancer, specifically melanoma, with extremely promising results. Much of the research in this area is based on the theory that a disease causes subtle chemical changes in the body, or alterations in metabolism, which in turn releases a different smell or chemical marker to which dogs can be trained to recognise. Whilst the concept that dogs may be used as a cancer diagnostic tool is doubtful, their use in heath care is certainly of significance. Indeed, their use as guide dogs and hearing dogs is now advancing to their use to warn their owners of epileptic seizures, low blood sugar and heart attacks to name but a few. So they really are man’s best friend!

Why being depressed can make your brain shrink!

For many sufferers, depression brings on many kinds of emotions and feelings including anxiety, guilt and shame, so it’s not surprising that many people fail to seek help. Often, many of the feelings that are associated with depression are, in part, caused by a general lack of understanding of the condition, not only by the sufferer, but by family members, friends, employers and colleagues. And yet the majority of people will experience some psychological problems during their lives. In fact very few people will go through life without experiencing some form of mental trauma of some description. But what is it that goes on in your head when you are feeling depressed?

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]

Omega 3 and depression

IMG_0650There is growing evidence for the role of omega3 fish oil, not only in the etiology of major depression, but also as a treatment method. Given the numerous and undesirable side effects associated with conventional pharmaceutical treatments it is no wonder that many individuals actively seek natural alternatives, and the pure EPA fish oil (eicosapentaenoic acid – EPA) may just be what the doctor ordered.

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.


Lespérance F, Frasure-Smith N, St-André E, Turecki G, Lespérance P, Wisniewski SR. The Efficacy of Omega-3 Supplementation for Major Depression: A Randomized Controlled Trial. J Clin Psychiatry 10.4088/JCP.10m05966blu

Lin PY, Huang SY, Su KP. A Meta-Analytic Review of Polyunsaturated Fatty Acid Compositions in Patients with Depression. Biol Psychiatry. 2010 May 7. [Epub ahead of print]

Martins JG EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009 28:525-42.

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.

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