Irritable bowel syndrome, serotonin levels and the role of diet

Irritable bowel syndrome (IBS) is becoming an increasingly common gut disorder in which the sufferer typically experiences: abdominal pain, cramping, bloating, excess wind, diarrhoea, and/or constipation, or an alternating combination of the two. Whilst the severities of these symptoms vary considerably between individuals, IBS has a profound effect on the sufferer’s quality of life. Many of the day to day activities that the majority of us take for granted can pose much more of challenge when you have IBS. You no longer simple take your body for granted, with careful forward planning essential in order to cope with the unpleasant, and often, embarrassing symptoms. Understanding IBS and what triggers the variety of symptoms is paramount to developing coping strategies.

It is thought that people with IBS have an abnormal gastrocolic response. This is the physiological reflex that controls the movements of the gastrointestinal tract (GI tract). Simply put, this mechanism controls the movement (peristalsis) that pushes food through and out of the gut. In IBS, simply eating or drinking can cause an over reaction of this process resulting in painful cramps, often resulting in diarrhoea.

Whilst the action of eating causes an increase in gut mobility, eating large meals seems to cause excessive cramping and bouts of diarrhoea, so a key tip is to try to eat small amounts and to try to eat regularly. Many people with IBS also find there are specific dietary triggers that can result in discomfort and bowel dysfunction. Knowing what foods to include, and what foods to avoid, can make a dramatic impact on regulating or avoiding specific symptoms.

Several gut peptides (types of protein), and neuropeptides are involved in the control of the gastrocolic reflex, of which serotonin is one such example. Serotonin, a neurotransmitter peptide, is generally known for its role in the regulation of mood, appetite, sleep, and some cognitive functions including memory and learning. However approximately 80% of the serotonin is actually produced in the body by the enterochromaffin cells found in the gut lining. The function of serotonin within the gut is to control muscle contractions, thereby functioning to maintain the movement of the intestines. Importantly however, many IBS sufferers can directly link stress to the onset of symptoms and it appears that there may, in some cases, be a link between serotonin, stress and IBS.

During a stressful experience there is a complex set of interactions between the hypothalamus (a part of the brain), the pituitary gland (also part of the brain) and the adrenal glands (at the top of each kidney). Several types of neurotransmitters are involved in this system, collectively known as the HPA-axis, which is thought to be dysfunctional in individuals with several conditions including fibromyalgia, chronic fatigue syndrome and depression to which IBS is often linked. Sufferers of these conditions can have numerous abnormalities in their hormonal, metabolic and brain-chemical activity including levels of serotonin. Dysregulation of the serotonin system has been found in individuals with IBS, with low levels associated with constipation, and high levels with diarrhoea (Sikander et al, 2009).

The link between stress, diet and IBS means that suffers can help reduce symptoms not only by modifying their diet, but also from reducing tension and stress through simple relaxation techniques such as: meditation, yoga and the Alexander Technique. Certainly living with IBS is far from pleasant, but with the right diet and learning how to manage stress, there is no reason why IBS should not be controllable. Let you control your IBS and not your IBS control you!

FOODS TO INCREASE FOODS TO AVOID
Carbohydrates
Complex carbohydrates, also known as starchy foods, are broken down slowly in the body to produce energy and are much kinder to the GI tract. This includes foods such as rice, oats and barley as well cooked vegetables.
Carbohydrates
Avoid foods high in fast releasing sugars such as unrefined grains, confectionary, cakes and biscuits. Avoid raw vegetables, salads and raw fruit.
Fats
Increasing omega-3 from oily fish (mackerel, sardines, pilchards, salmon) or through supplements can help alleviate inflammation and calm the guts. Try including evening primrose oil as a source of GLA, an anti-inflammatory omega-6 fatty acid
Fats
Avoid saturated fats from red meat and dairy food and fried food as these are classic triggers that exacerbate the symptoms of IBS
Protein
Lean chicken, pork, turkey and fish can supply good animal protein.
Protein
Avoid protein from red meat.
Fibre
Soluble fibre absorbs excess fluids forming a gel which bulks out faeces and can therefore help to reduce diarrhoea. By bulking out faeces, soluble fibre keeps the muscles of the GI tract gently stretched thus giving them something to grip on during a peristaltic motion and helps to avoid painful spasms. This in turn can help relieve constipation by softening and pushing through any impacted faecal matter.
Fibre
Insoluble fibre (bran, raw fibrous vegetables, salad greens, unpeeled fruits) can trigger painful gastrointestinal spasms
Fluids
Drink plenty of fluid to avoid constipation. The following teas can help eliminate gas and bloating but also can relax the intestine smooth muscle: peppermint, fennel, ginger and chamomile.
Fluids
Coffee, tea (even decaffeinated) and alcohol are powerful GI tract irritants, and can have the same effects as fats and insoluble fibres. Also avoid sugary carbonated drinks or drinks containing the sweeteners sorbitol or xylitol.
Probiotics
Available as dietary supplements and foods such as yogurt, with most products containing one of two types of bacteria – Lactobacillus or Bifidobacterium. Probiotics are often combined with prebiotics to form synbiotics. Prebiotics are simply non-digestible food ingredients that selectively stimulate the growth and activity of beneficial microorganisms already in the colon.

Sikander A, Rana SV, Prasad KK. (2009) Role of serotonin in gastrointestinal motility and irritable bowel syndrome. Clin Chim Acta. 403:47-55.

Low-carbohydrate diet – The Atkins diet

The Atkins diet has caused quite a debate with regards to its use and safety ever since Dr. Atkins launched his ‘Diet Revolution’ in 1972. So what’s wrong with it exactly? For starters, the diet totally excludes all carbohydrates, which are actually an absolutely vital component of our diet. By excluding them, the body must rely on protein and fat, not only as a source of energy, but also for vital nutrients and macronutrients. Therefore, by completely depleting the body of carbohydrate we also decrease our intake of many essential vitamins and minerals as well as fibre and another important type of carbohydrate called ‘non-starch polysaccharide’ which is absolutely essential for normal gut function.

In addition, high intake of fat, especially saturated fat derived from animal products, can increase both lipid and cholesterol levels, both of which are know to increase the risk of developing heart disease. By combining a high fat diet with one that is low in fibre results in a diet that carries an even stronger risk of developing heart disease. Furthermore, consuming too much protein is known to put strain on the kidneys, which can result in possible renal injury. Because the body cannot store protein, once the body’s needs are met, any excess must then be removed. This excess protein is converted by the liver into compounds, like urea, which are finally eliminated through the kidneys as part of urine. High protein intake also causes loss of calcium from the bones into the blood with corresponding implications on bone health.
High protein diet.gifGenerally, whilst the immediate positive benefit attributed to the Atkins diet is quick and relatively easy weight loss, the long-term consequences on cardiac, renal, bone and liver health must be all be taken into consideration. However, the ‘new’ version of the Atkins diet differs from its older counterpart in that rather than excluding carbohydrate completely, after a certain amount of weeks (depending on weight loss targets), carbohydrate is slowly reintroduced. The diet then continues, but as a ‘low-carbohydrate’ diet.

On the whole, this would appear to be a better option to restricting carbohydrate completely. However, it’s still a diet that is very low in fruit, vegetables and fibre, so in terms of digestive health, it’s not in keeping with fibre and ‘complex’ carbohydrate recommendations. Complex carbohydrates are important because they are broken down into glucose slowly, therefore providing a gradual steady stream of energy throughout the day. Eating a diet that has plenty of complex carbohydrate can help reduce the chances of developing type II diabetes for example.

The simple truth is that anyone carrying too much weight has most likely consumed more calories than they should have for some period of time. Whilst you can lose weight on anything that helps you to eat less, it does not mean it’s good for you. If you want to lose weight you need to look the amount of energy you put into your body and compare it to the amount of energy you burn. Men need approximately 2500 Kcal daily and women 2000 Kcal daily. So what do we need these calories for? Our daily calorie intake can be divided into the 3 following areas: firstly, basal metabolic rate (BMR) is the minimum amount of energy needed for our bodies to function on a daily basis and includes things like our heart beating and our breathing. Secondly is something called diet induced thermogenesis (DIT) which is the energy used when we digest our food. Finally, we need energy for physical activity, to move and to exercise and the more active a person is, the more energy they use.

Consuming more calories than we need will simply make the body store them as fat for ‘later use’. With our chaotic modern lifestyles, many of us exercise much less than we should, driving places rather than walking, with many of us having office jobs that require little, if no physical activity. The down side of all this is that sedentary individuals are much more likely to be overweight than active ones. All in all, it’s pretty easy in today’s world to pile on the pounds. Fad diets simply target vulnerable individuals who want a quick fix, and whilst the Atkins may deliver in regards to weight loss, the long-term consequences for our health may outweigh the short-term benefits. If you are really keen to shed those pounds, think about easy changes you can make to you life style and try being more active as well as adjusting what you eat to your level of activity. You simply don’t need as much energy to sit on the sofa watching television as you would playing sport for example. Being active also has numerous other benefits for our stress levels, not to mention its release of ‘happy hormones’.

Depression and self help, where do you turn for the answers?

General practice is the formal point of entry into the mental health care system, and GPs act as the ‘gatekeepers’, playing a central role in this help-seeking process. A good GP is therefore central to ensuring that individuals receive the best and most appropriate mental health care possible. It is also important to remember that pharmaceutical intervention is not necessarily the key to all treatments – diet, as well as alternative therapies, can be key players in recovery.

Whilst many forms of depression can be easily treated in primary care, many people chose not to undertake, or are certainly reluctant to begin, the journey that takes them on this route of self-help. There is such a high prevalence of mental health problems and disorders that develop in adolescence and early adulthood, yet young people in particular are the least likely to seek professional help. It seems that the stigma that is associated with mental health issues plays a significant role in the choices that people make. Individuals are also less likely to ask for help if they are experiencing suicidal thoughts and depressive symptoms, hold negative attitudes toward seeking help or have had negative past experiences with help offered. Furthermore, the belief that they should be able to sort out their own mental health problems on their own plays a strong inhibitory role when it comes to asking for help. On the other hand, people are more likely to seek help through talking to their family and friends, since this helps with expressing their feelings without fear of prejudice. If they have some knowledge about mental health issues and the relevant sources of help, they are more likely to seek help. Thus, internet-based information is now a routine source of knowledge for mental health issues and can provide key information. There is so much information on the internet on self-help and advice for people with depression that it can quite overwhelming!

For this reason, I’ve formulated a nice easy to read info pack that people can download, read online or print and take away. It covers depression facts and various treatments including conventional treatments, dietary changes that are known to help, as well as alternative treatments to pharmaceutical drugs. Download my depression help pack now.

Middle age and hot sweats, oh joy!

I was invited out to a dinner party a few weeks ago, joining a group of friends that I had known for many years but some of whom I had not seen for some time. By the time we had finished desert and were sipping our coffees the conversation turned from general catch up to a subject that seems to involve some degree of doom and gloom.

The subject was the ugly word ‘menopause’ (to which I still shudder slightly) and seemed to be on the minds of many of my dinner comrades. Whilst we all still proclaimed to be of healthy ‘child-bearing’ age it seemed that the menopause was in fact the next major event to look forward to in most of our lives (bar the daughter of my friend Shelly who, at the age of 24, found the whole conversation quite amusing).

So why the long faces? Well simply put, the menopause can be a rather unpleasant experience for many women. When the ovaries cease to produce eggs, oestrogen levels drop, the normal menstrual cycle is disrupted and the whole package results in a number of generally unpleasant symptoms. I have only one friend that I know of who is currently at this stage of her life, and as we were chatting her face lit up like a cartoon creation that had eaten chillies unwittingly. You could almost see the smoke leaving her ears as she panted like a small dog that had been left out in the sun without any water. After a few minutes her ruddy cheeks returned to normal and she muttered the words “sorry, hot flush”. Oh, what a joy to look forward to! Thereafter the subject was focused on who would and who wouldn’t turn to HRT (hormone replacement therapy). Whilst HRT is by far the most effective therapy, it seems that many people are turning to natural methods to alleviate the symptoms of menopause, for fear of side effects. So, what is out there exactly?

First let us consider the phytoestrogens (isoflavones: genistein and daidzein) found in red clover and products such as soya flour, soya milk, and tofu, which have a wide range of heath positive benefits. The interest in phytoestrogens has developed because of the epidemiological evidence that women whose diets are rich in these compounds, such as women in Japan and Asia, appear to have a much lower incidence of “Western diseases” such as heart disease, osteoporosis, and cancers of the breast, colon, and womb. Women in these countries also do not appear to suffer the same way with hot flushes and sweats as we do in the western world. Another beneficial plant is black cohosh from the buttercup family, which grows in eastern and central areas of the United States. Black cohosh was used by Native Americans as a traditional folk remedy for womens’ health conditions, such as menstrual cramps and hot flashes, arthritis and muscle pain. Whilst some people may not be familiar with the benefits associated with black cohosh, they are likely to be aware of the general association between menopausal as well as premenstrual syndrome (PMS) and evening primrose oil.

Evening Primrose oil is a plant oil that contains gamma-linolenic acid (GLA), an omega-6 fatty acid. GLA is involved in the metabolism of hormone-like substances called prostaglandins that regulate pain and inflammation in the body and can help with both the hot flushes and mood swings associated with menopause. Whilst all of the above are relatively well known alternatives to HRT, ethyl-eicosapentaenoic acid (E-EPA), an omega-3 fatty acid found in fish oil, has recently been shown to be an effective method for reducing hot flushes.

Results from the first double-blind, placebo-controlled randomized clinical trial of E-EPA published last year found that E-EPA was more effective than the placebo in reducing hot flushes, with a 55% average reduction in symptoms in these women (Lucas et al, 2009). EPA, like GLA, is the precursor to a family of anti-inflammatory prostaglandins and works, therefore, in a similar way to that of GLA. Combining these two anti-inflammatory products in one product such as Vegepa certainly offersa unique method of managing menopausal symptoms, either on its own or in combination with other approaches.

Lucas M, Asselin G, Mérette C, Poulin MJ, Dodin S. (2009) Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Menopause 16:357-66.

EPA fish oil and its role in Alzheimer’s disease risk

I have recently written an article on EPA fish oil and its role in Alzheimer’s disease, as there are currently around 700,000 people in the UK with dementia (it is believed that these figures are set to rise to one million in the next 10 years because of the ageing population) and new research adds to the weight of evidence that suggests that people who regularly include fish as part of their diet have a lower risk of developing dementia and, in particular, Alzheimer’s disease.

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

Omega 3s and Fatty Liver Disease

Whilst most people in the UK are familiar with alcohol-related liver disease as a result of heavy drinking, which is on the rise, many of us are unaware of the problems associated with another form of liver disease, non-alcoholic fatty liver disease (NAFLD) – also known as non-alcoholic steatohepatitis (NASH). A recent review of four human studies by a group based at the University of Edinburgh found that long-chain omega-3 fatty acids not only improve liver health and function, but also increase insulin sensitivity in people suffering from fatty liver disease.

I’ve recently published an article on Omega 3s and fatty liver disease and the study led by Dr Gail Masterton and I would be very interested to hear your feed back!

Use of anti-psychotics in dementia patients leads to premature death

Currently there are around 700,000 people in the UK with dementia and it is believed that these figures are set to rise to one million in the next 10 years because of the ageing population. The National Institute of Health and Clinical Excellence (NICE) guidance is that people with dementia should only be offered antipsychotic drugs if they are severely distressed or there is an immediate risk of harm to the person or others. However the use of sedatives in dementia has repeatedly been condemned due to the increasing evidence that the use of such drugs in dementia patients significantly increases their risk of death. One such study published earlier this year followed 165 patients with Alzheimer’s disease living in care homes in Oxfordshire, Tyneside, London and Edinburgh. Patients who were already taking anti-psychotics either continued on their treatment, or given a dummy pill for a year and then followed up over a period of three years. After two years, 46% of patients who had been treated with anti-psychotics were alive compared with 71% on the placebo. Three years after the start of the study, fewer than a third of people on anti-psychotics were alive compared to nearly two-thirds taking the placebo (Ballard et al, 2009). A recent review ordered by the Department of Health outlines the over prescription of antipsychotic drugs to treat aggression and agitation in people with dementia and contrary to NICE guidance. The review authored by Professor S. Banerjee goes as far as suggesting that up to two thirds of those individuals with dementia receiving anti-psychotic drugs are prescribed them unnecessarily.

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 mood food connection

Each year on 10th October, the Mental Health Foundation marks the day by raising awareness about mental health and well-being. Whilst we would probably all consider ourselves as reasonably tolerant and open minded, there is still quite a significant stigma about depression. If we haven’t experienced depression directly, it’s highly probable that we know someone, perhaps a friend, relative or workmate, who suffers. Mental Health Statistics report that 1 in 4 British adults experience at least one diagnosable mental health problem in any one year and 1 in 6 of us experiences this at any given time. In 2001 the World Health Organisation (WHO) estimated that approximately 450 million people worldwide have a mental health problem, of which 154 million are affected by depression.One of the major side effects of depression is that the way we think about food changes and this can influence how we eat – both the types of food and how often. Because food can directly influence our mood, our diet is even more fundamental when we’re feeling low.

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.

One capsule of omega-3 for a healthy happy heart?

Another juicy head line this week. This time it’s the Daily Express reporting the findings of a study led by Dr Carl Lavie and published in the Journal of the American College of Cardiology. The outcome of the study suggests that eating oily fish can help ensure a long life, as it slashes the risk of heart failure by a third and as a result of these findings there is a push for everyone in Britain to be taking omega-3 (about time too). So we are told that people with existing heart problems should take at least 800 to 1,000mg of omega 3 each day – the amount found in three to four 3oz portions of oily fish a week. The news story then goes on to quote that half that amount of fish would provide enough omega-3 for healthy people – so 400-500mg, “the equivalent of one supplement capsule”.

So I can now hear the thunder of feet rushing down to Holland and Barrett a bid to snap up their EPA 1000mg fish oil capsules. This has to be good value for money surely? Firstly, they come in a tub so big that it nearly take up the whole basket leaving very little space for your ginseng and dried apricots (but you do get change from a tenner). Secondly, the pot clearly states “EPA 1000mg” so it’s all good – isn’t it? Well no! This is where the public get misled and some what confused (and I get annoyed). My first point that I feel needs clarification is the statement – “equivalent of one supplement capsule.” This is confusing and misleading. Firstly capsules mostly come in two sizes, 500mg and 1000mg (like our H&B example above). Secondly there is a huge variation in the quality of supplements. Generic fish oil (including Mr Holland and Mr Barrett’s “EPA 1000mg”) is simply oil that has been extracted from the flesh of fish and filtered but not molecularly distilled or concentrated. These types of supplements are cheap and tend to be easy to spot on the shelves, generally containing 180mg EPA and 120mg DHA per 1000mg of fish oil. Indeed, a far cry from the boastings of “EPA 1000mg” (which actually refers to the size of the capsule and not the EPA content!).

In order to achieve anything close to the 400-500mg of omega-3 through consuming just one supplement capsule, then we need to be looking at pharmaceutical grade products. These oils undergo rigorous molecular distillation and can achieve as much as a 70% concentrated blend of active ingredients (namely EPA and/or DHA). Molecular distillation not only concentrates these fatty acids but also ensures that the oil is free from contamination and from vitamin A. Because of the processes involved and the amount of active ingredients in each capsule, the price goes up, but then you are paying for a quality product. Even then, a 70% oil falls short of achieving the concept of ‘one capsule is enough’. Not all supplements are the same and cheaper products will not give the benefits that the article suggests. EPA and DHA compete for the sn-2 site of phospholipids, and therefore the ratio of EPA to DHA within any supplement becomes important in influencing which fatty acid is the most active in any preparation. My second point…

This goes back to my “black or white” theory. Fatty acid metabolism and the role that these fats play in cardiovascular health is intensely complicated and it is no wonder that the public can find tabloid information confusing. EPA and DHA have very different mechanisms of action and therefore to generalise the effects of ‘omega-3’ as a whole is over-simplifying the issue. Indeed, many studies are now taking DHA and placing it gently to one side in order to focus on the activities of EPA. Whilst yesterday’s news is interesting it’s far, in fact, from novel, which is partly why I roll my eyes. In regards to taking an EPA-only product, a good line of support for the role of EPA in cardiovascular health for this comes from the Japan Eicosapentaenoic acid (EPA) Lipid Intervention Study (JELIS trial) which was the first large-scale, prospective, randomized trial of a combined treatment with a statin and EPA for the prevention of major coronary events. These studies take highly purified preparations in doses of around 2g daily to obtain the results that are subsequently published in major journals. This information, it seems to me, is then portrayed to the public via a game of Chinese whispers, with the resulting message being generally down played. The article furthers exemplifies my point that there is a general need for the public to be aware of the variation in the quality and dosage of omega-3 supplements.

DHA, Fish and Alzheimer’s: Press Misinformation

The general public are reliant on the media for their most recent update on “what to eat and what not to eat” and so it’s terribly important that studies are reported objectively and fairly – and, of course, that we are given the whole picture. It is not a very new concept that eating fish such as salmon, sardines and mackerel may offer an element of protection against developing dementia and indeed the media has reported on a number of studies showing that people who consume a significant amount of oily fish or fish oil are less likely to develop Alzheimer’s disease. This week’s headline, “Fish may not be Alzheimer’s answer” suggests, however, that Alzheimer’s patients may not benefit from eating fish, despite this “brain food” reputation.

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.

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