1.Types of fat.
2.What is omega-3 fish oil.
3. Why the intake of omega-3 has dropped by 80%.
4.Omega-3 in pregnancy and childhood.
5. Molecular structure.
6. How it helped some of my patients.
7 Conditions where omega-3 may help
8 Dosages.
9 Conclusions and recommendations.
1. TYPES OF FAT
Fats are a mixture of fatty acids.
1.Saturated fatty acids (SFAs) such as beef fat are solid at room temperature.
2.Monounsaturated fatty acids (MUFAs) such as olive oil have one kink or bend.They
are liquid at room temperature but solid when refrigerated.
3.Polyunsaturated fatty acids (PUFAs) like fish oil or flax seed oil have two or more
kinks.It is this unique feature that allows them to perform their useful functions in the
body. They remain liquid even when refrigerated,because the molecules cannot pack
together.Two PUFAs,omega-3 and omega-6 are essential fatty acids (EFAs).They
must come from our food as we cannot synthesise them ourselves.
2.WHAT IS OMEGA-3 FISH OIL.
Sixty percent of the brain is fatty tissue and about eight percent is omega-3 fatty
acids.Omega-3 has an important role as structural membrane lipids particularly in the
nerve tissue,in the retina and as precurors to eicosanoids which are highly reactive
substances such as prostaglandins and leukotienes that act locally to influence a wide
range of functions in cells and tissues.We should be getting it from our diet but we
don`t get enough.Fish oil is the best source while oily fish such as mackerel or salmon
is good too. Other sources favoured by some experts include flaxseed oil,wheat germ
and walnuts.
Omega-6 is found in meat and vegetables (and particularly vegetable oil) and is in
abundant supply in our diet.In the world where the human race originated (?Rift
valley of Kenya) it seems intake of omega-3 and omega-6 were similar but American
figures show over 10 times as much omega-6 as omega-3 is consumed nowadays. Have a look at www.abc.net.au/catalyst/stories/s1241479.htm That site contains a film strip from a university research centre in Australia, which suggests that this imbalance may be a significant cause of obesity.
The FDA reckons that 3g omega-3 daily is safe although I note that Eskimos eat 18g daily
without any problem.The current daily intake in North America is 130 mg per day.You can read about fish itself as well as fish oil in the Irish Fishery Board booklet "Nutritional Aspects of Fish" which is available at www.bim.ie/uploads/text_content/docs/553Nutritional%20Aspects%20of%20Fish.pdf
3.WHY THE INTAKE OF OMEGA-3 HAS DROPPED BY 80%
This has happened in the western world in the past century and so most of us seem to
be deficient in it.There are at least five factors that may have contributed to this
drop and this diet change may be partly responsible for our escalating depression and
suicide rates:
1. Mothers have stopped breast-feeding to a great extent.American figures show the
fat in breast milk contains 1.9% omega-3 while cow`s milk there is 1.0%.
2.Mothers stopped giving their children cod liver oil,a good source of omega-3.
3.The Catholic Church ended the Friday fast which meant that many Catholics who
traditionally ate fish at least once a week stopped doing so.
4.The recent use of low-fat milk reduces the amount of omega-3 eaten.
5.The use of margarine and other spreads instead of butter usually result in less
omega-3 and more,perhaps too much,omega-6 being consumed. Irish and New
Zealand dairy products,which are based on grass and not grain have a small amount
of omega-3 -mostly alpha linolenic acid -which is still invaluable.
4.OMEGA-3 IN PREGNANCY AND CHILDHOOD
During pregnancy the mother gives the foetus some of her own low stocks of
omega-3,particularly in the third trimester.This leaves her vulnerable to pre-eclampsia
and eclampsia and for post-natal depression. This can be a psychotic episode and the
first manifestation of bipolar disorder.The duration of pregnancy is a few days longer
in women with a high level of omega-3. A child born with low omega-3 gradually
runs down his stores and it is at a very low level by the late teens.Even in childhood
those who are given adequate amounts of omega-3 have a slightly reduced blood
pressure compared to those who do not get fish oil .They also appear to be slightly
ahead developmentally.Recent research suggests that there is a lesser response to allergens such as cats or house dust mites where the diet is high in omega-3 in pregnancy.Eczema is likely to be less severe too in those babies.There is some suggestion that much mental illness is due to a
deficiency of omega-3.It is interesting to note that in Iceland bipolar disorder affects
only 0.2% of the population as against 6.5% in Germany where not much fish is
consumed.The incidence of schizophrenia is the same in both countries. However it
seems to run a much more devastating course in the more developed countries than in
the third world where omega-3 is got in e.g. breast feeding and from wild game.
5.STRUCTURE
Fatty acids are molecules built up of carbon chains of different length.Omega-3 has
the first double bond at the third carbon atom and the omega-6 has it at the
sixth,starting from the methyl end.The main omega-3s (or n-3s) are alpha-linolenic
acid-18:3, EPA -eicosapentaenoic acid,20:5 and DHA-docosahaexanoic acid,22:6.The
figures 18,20 and 22 are the number of carbon atoms while the 3,5 and 6 indicate the
number of double bonds. These double bonds make the fatty acids very flexible but
also very sensitive to oxygen (oxidation).DHA seems to be particularly important in
pregnancy and in early childhood and EPA later in life.DHA is also found to be low in bipolar disorder and in Alzheimer. DHA is sometimes referred to
as the brain`s hardware while EPA is the software.A suitable product for pregnancy is Mumomega and for a newborn baby is Mumomega Infancy-see details on www.equazen.com.
Many people use flax-seed oil as their omega-3 of choice.There is strong evidence
that the conversion in the body of the alpha -linolenic acid in this oil into the
longer-chained EPA and DHA is quite small,except in pregnancy. People of northern European and Celtic origin are among the worst with rates as low as 1% in males and perhaps 10% in pregnant women. Stoll favours
taking fish oil as the one of choice as then the EPA and DHA are provided fully
formed.
6. HOW IT HELPED SOME OF MY PATIENTS
My own experience of omega-3 started by in May 1999.I read in the Archives of
General Psychiatry an article by Professor Andrew Stoll of Harvard on bipolar
disorder.He had found in a small trial that he got a good response by adding omega-3
fish oil to the standard medication.I had a 29-year old woman with this condition but
it was her OCD that really distressed her.She was obsessed with the idea that she had
HIV although her risks were minimal and her tests were negative.Her
lithium,olanzapine and 80mg fluoxetine daily still left her with a very poor quality of
life.I suggested that she should try Stoll`s figure of 9.6g of omega-3 fish oil daily.In a
few days the tortured phone calls she frequently made to me ceased and the OCD did
not bother her much any more.Three other things occurred-she slept very well,her
anxiety level dropped greatly and she stopped smoking.She remained quite well for
the following three years with a relapse of her OCD only when she went off the fish
oil.
Having seen this result I read all I could find on the subject and decided that it might
be worth trying in other patients where the current medication did not offer
satisfactory relief.The Irish Medicines Board does not regard omega-3 as a drug but
a food so that no prescription was needed and I advised the patients to try fish oil
which they could buy cheaply in a supermarket.I then tried it on five others with OCD
and 3 of them got good relief.Another woman had OCD and agoraphobia and within a
week she could wash her hands normally,change her baby`s nappy and could leave
the house by herself.She also felt clean for the first time since she was sexually
abused at 13.She stopped taking the thioridazine prescribed in the clinic but remained on clomipramine.Six months later she remained well and had her first job.Three
schizophrenic patients got a good benefit from adding omega-3.One told me had had
never felt fully well from the time of his first breakdown until he added fish oil to his
olanzapine 20mg.He got a full-time job within a short time,having been part-time up
to then.Another case was that of a 36-year old schizophrenic who had never worked
and was on olanzapine 15mg.I added omega-3 and within a few weeks he got a job -3
hours every evening. A few weeks later he added a 9 hours per day job as an assistant
to a roofer so he was working then from 9am to 9pm.He practically stopped drinking
and also stopped spending his money on betting.He was able to go to the Canaries for a holiday.Alas after eight months he stopped his medication,was admitted to hospital
and I have not seen him since.His brother told me he was back to square one. Nowadays I now do blood,hair and urine tests on patients with schizophrenia (also for bipolar disorder,depression and to a certain extent for OCD) and send them for analysis to a specialist nutrition lab in London.I like the ideas of the Pfeiffer Center in Chicago(www.hriptc.org) which uses amino acids, minerals,vitamins and fatty acids while the patients continue on their regular medication as a rule and my treatment regime is based to a significant extent on their model.
THERE IS ONE GROUP OF PEOPLE WHO DO NOT BENEFIT MUCH FROM TAKING EXTRA OMEGA-3.THEY HAVE A SHORTAGE OF ARACHIDONIC ACID (AN OMEGA-6 FATTY ACID) INSTEAD. THEY SUFFER FROM A CONDITION CALLED PYROLURIA AND MAY DEVELOP SCHIZOPHRENIA UNDER EXTREME STRESS ESPECIALLY IF PROLONGED. A BREAKDOWN UNDER SEVERE STRESS SHOULD MAKE ONE THINK OF PYROLURIA AS A LIKELY CAUSE. 27% OF THOSE WITH SCHIZOPHRENIA ARE PYROLURICS AND MOST OF THEM COULD RECOVER AND LIVE A NORMAL LIFE WITH PROPER NUTRITIONAL TREATMENT-IT IS THE EASIEST FORM OF SCHIZOPHRENIA TO TREAT. THEY HAVE A SEVERE DEFICIENCY OF ZINC AND IN 75% OF CASES A LOW B6 TOO. THEY TEND TO BE OF SMALL STATURE,TO SKIP BREAKFAST,TO BE NIGHT PEOPLE,TO LACK DREAM RECALL EXCEPT PERHAPS FOR NIGHTMARES. THEY ARE OFTEN THE FAIREST SKINNED IN THEIR FAMILY.THEY OFTEN HAVE BAD TEMPERS,ARE EXTREMELY ANXIOUS,AND SUFFER SOCIAL ISOLATION.THEY ARE SENSITIVE TO SUNLIGHT AND OFTEN WEAR SUNGLASSES. LOUD NOISES AND BRIGHT LIGHTS OFTEN BOTHER THEM. THEY HAVE DRY SKIN AND ABNORMAL FAT DISTRIBUTION,BEING FAT IN THE ABDOMEN BUT NOT IN THE NECK OR ARMS. THEY MAY HAVE GREAT MOOD CHANGES EVEN IN A SINGLE DAY.NOTE THAT THEY ARE QUITE OFTEN DIAGNOSED AS RAPID-CYCLING BIPOLAR. THEY LIKE SPICY OR SALTY FOODS.THEIR SHORT-TERM MEMORY IS OFTEN POOR AND NOT AS GOOD AS THEIR LONG-TERM MEMORY.THEIR READING ABILITY AS CHILDREN IS OFTEN POOR -THEY ARE OFTEN DIAGNOSED AS DYSLEXIC-AND THEY RARELY READ BOOKS.GENERALLY THEY DO NOT DO WELL IN SCHOOL UNLESS THEY HAVE FOR EXAMPLE AN ELEMENT OF OCD WHICH MAY PUSH THEM FORWARDS.INTERESTINLY I HAVE SEEN 2 FEMALE LAWYERS WITH THIS CONDITION (PYROLURIA) SO THEY ARE NOT ALL SLOW IN SCHOOL. WITH THIS CONDITION.FEMALES MAY HAVE AMENORRHOEA, LOW LIBIDO OR OTHER MENSTRUAL PROBLEMS .I HAVE ONE FEMALE PATIENT WHO IS NOW WELL BUT SHE NEEDS VIAGRA OR CIALIS TO HAVE ANY LIBIDO. MALES OFTEN HAVE SEXUAL PROBLEMS TOO-ESPECIALLY IMPOTENCE- AND NOTE THAT ZINC IS A COMPONENT OF SPERM.THE URINE TEST FOR ELEVATED KRYPTOPYRROLES CAN BE DONE IN ONLY A FEW LABS. I ALSO DO TESTS FOR PLASMA ZINC,SERUM COPPER,VITAMIN B6 LEVEL (EGOT ACTIVATION OF B6 IS THE ONE TO DO), AND CAERULOPLAMIN. I SEND URINE SPECIMENS FOR KRYPTOPYRROLES TO BIOLAB LABORATORY IN LONDON IN A SPECIAL CONTAINER AND OVERNIGHT.NOTE THAT KRYPTOPYRROLE RETURNS TO NORMAL IN SCHIZOPHRENIA WHEN THE TREATMENT IS SUCCESSFUL AS A RULE. TREATMENT (IN ADDITION TO THEIR REGULAR MEDICATION) IS ZINC, B6 (INCLUDING THE P5P FORM OF B6) AND PRIMROSE OIL.VIT C,E,MANGANESE AND OTHER ANTIOXIDANTS MAY HELP TOO.I RECOMMEND A OMEGA3 HERE ONLY WHERE I HAVE DONE A TEST FOR ESSENTIAL FATTY ACIDS AND IT SHOWS A LOW LEVEL OF OMEGA-3. PATIENTS WITH SCHIZOPHRENIA USUALLY NEED LESS ANTIPSYCHOTICS AND THOSE WITH ONLY DEPRESSION MAY BE ABLE TO COME OFF ANTIDEPRESSANTS WITHOUT RELAPSING AFTER A FEW MONTH`S TREATMENT. IF SOMEBODY HAS SEVERAL OF THESE SYMPTOMS CONSIDER THE POSSIBILITY OF PYROLURIA/KRYPTOPYRROLE DISORDER.YOU MAY KNOW A SCHIZOPHRENIC OR BIPOLAR OR DEPRESSED PATIENT AND IF SO CONSIDER ASKING ABOUT THE ABOVE SYMPTOMS AS MOST PSYCHIATRISTS DO NOT KNOW ANYTHING ABOUT PYLORURIA. YOU MAY BE RESPONSIBLE FOR RETURNING SOMEBODY TO A PERFECTLY NORMAL LIFE SO PLEASE BE ON THE LOOKOUT AS THE TREATMENT IS QUITE GOOD.If there are no facilities for doing the tests but the history is strongly suggestive of this condition it might be worthwhile going to a healthfood shop and taking 30 mg zinc twice daily , a maximum of 400mg daily of vitamin B6 -(if necessary take enough to bring about dream recall) plus 50mg of the P5P version of B6, 1000mg daily of evening primrose oil ,1000 mg Vitamin C twice daily,manganese 30mg daily vitamin E 400units twice daily and omega-3 fish oil 1g daily. Try this combination for 2 or 3 months and see if it starts to work-it often improves patients in a week or two.If there is a problem with sensation in the feet due to the high level of B6 change to the P5P version of B6 at one tenth the level of B6 being taken up to then or reduce the B6 dose.This condition often mimics rapid cycling bipolar disorder too and the results are similar.A small number of patients need the P5P version of B6 so if the diagnosis is obvious or the kryptopyrrole test is positive then add 50mg of the P5P version of B6 after a month if the response is poor if the patient is not on it already.I myself do not take patients off antipsychotics but I do notice that typically the psychiarist reduces the level of antipsychotics prescribed. In Feb 2006 I had the privilege of listening to Dr William Walsh Ph.D. talking about nutrition in mental health,including pyroluria,at a meeting for doctors in Sydney. I added a great deal of his views at the pages on "Alternative Mental Health " in another part of this site. I also attended the lecture on Pyroluria (Kryptopyrrole Disorder ) by Woody McGinnis M.D. whose views on the subject are available at www.alternativementalhealth.com/articles/pyroluria.htm . Note that if you cannot get a kryptopyrrole test done a reasonable alternative is to get plasma zinc and B6 done locally and use that to make a tentative diagnosis of pyroluria if appropriate.Sometimes only the zinc is very low and even then taking the treatment for pyroluria may work. I myself test patients for kryptopyrroles,zinc, egot activation of B6 and evening primrose oil among others.Note that you may get a negative kryptopyrrole result if the patient is on antipsychotics even though he or she has pyroluria.Sometimes very high doses of zinc are needed to normailse the plasme zinc level-50 to 200mg daily.Any adult on more than 50mg elemental zinc needs blood tests from time to time to make sure the plasma level is not too high. You can read some personal experiences of pyroluria at http://brain.hastypastry.net/forums/showthread.php?t=9626&goto=newpost
Other types of schizophrenia benefit from omega3.Let us look at the major types as they are not being adequately treated in most cases at present by conventional medication! As they recover with proper nutrition they will become drowsy as a rule and the amount of amount of antipsychotics can be reduced,sometimes to as little as a quarter of the current level. I do not reduce the antipsychotics myself but look with interest as the psychiatrist does it.
The main type of schizophrenia is called paranoid although from the nutritional point of view a more useful term is histapenia. 45% of schizophrenics have it.With a combination of nutrition and medication over 80% of these can make a decent recovery.How do you recognise them?Please read this as again you may be able to advise somebody with schizophrenia that treatment does exist. They tend to be anxious or very anxious although they may not appear so because they are filled to the gills with powerful medication that sedates them.They tend to move around a lot. They suffer from severe depression. They usually have auditory hallucinations.They may suffer from religiosity-an overwhelming religious attachment. Grandiosity is common too. They may have non-bizarre delusions where for example they may think that they have the solution to some of the world`s problems.The brain chemistry shows low histamine.They are overmethylated, are not low in serotonin,have high copper and they have very high noradrenaline and adrenaline. High copper tends to convert noradrenaline to adrenaline-the fight or flight drug. (Note that depressed patients given SSRI medication may get a bad reaction and even commit suicide as the combination pushes up the serotonin too high). Blood tests are done to confirm the diagnosis
,Treatment is vitamins in association with their regular medication.: Niacin or niacinamide,zinc , B12 and folic are the main treatment and B6,C and E are also added.Recent additions are DMAE and metallothionen promotion therapy-available from www.hriptc.org by prescription. 2g daily of EPA (part of omega-3) is useful. Dr Abram Hoffer discovered the value of niacinamide in this condition some 50 years ago and if a patient agrees to take only one nutrient in associaiton with their medication then niacinamide 1-2g three times daily is useful.
After about 4-6 weeks they start to get better although full recovery can take over 8 months.Not everybody recovers but most do. Paranoia is the last symptom to go as a rule.The level of psychotropics (usually atypical antipsychotics) is gradually reduced as they become drowsy -this occurs as they become well.However they are left on a small amount of medication to prevent relapse.
Another type of schizophrenia is histadelia or high histamine -they are undermethylated,they are very low in serotonin and often suffer from really severe depression.That type is difficult to treat. 18% of schizophrenics have it.One of the reasons they do not respond so well is that they do not take their medication-they just do not like intervention or interference in their lives.even before they become ill.They may suffer from severe often bizarre delusions e.g.seeing little men coming out of their abdomens or thinking the FBI is on their trail.Religiosity is common too-they may go out on the road naked with a bible.80% have OCD tendencies.They tend to be sociallyisolated..High internal anxiety is a feature although they appear catatonic.Phobias are common.They are genetically low in serotonin,dopamine and noradrenaline.They are low in ceruloplasmin.Recovery is slow if it occurs at all.Those who do well take about 6 months to get good results.Delusions take 6-12 months to go,that is if they ever go.Treatment involves adding L -methionine,calcium,magnesium,SAMe,zinc and methallothionein promotion.I use fish oil in these patients too,typically around 3-5 g daily but it may need 10g or more for those who have OCD too. SSRIs are useful for the severe depression here.
Gluten Intolerance appears to be the cause of 4% of psychosis cases.It is due to incomplete breakdown of gluten proteins in the intestine.Did you know that short peptides have opiate qualities? Treatment involves dietary avoidance of wheat,oats,barley and rye.
The above views mainly come from the Pfeiffer Center in Chicago,USA. A Canadian psychiatrist,Dr Abram Hoffer,discovered some 50 years ago that nutrition could help schizophrenia greatly and his book Ortholecular Treatment of Schizophrenia costs only four dollars from www.amazon.com. This is the regime he recommends and he claims up to 90% do well on it. I have found that his treatment works well in histapenic patients-niacinanide being the key element of his therepy.They should not come off their regular medication -merely add the following daily:
Niacin 3-6g in divided doses after meals.Some who fail on this dose may take higher doses after a few months.Niacinamide is an alternative where flushing in present with niacin.In my own pracice I use almost exclusively niacinamide as flusing is too much of a problem for many patients.
B6 up to 1,000mg daily
3g vitamin C,sometimes more
Zinc 50mg.
Selenium 200-600microgrammes.
Chelated manganese 30mg
Essential fatty acids-omega3 . No figure given but 2g EPA would be recommended by some authors, mostly based on the work of Peet and Horrobin in Britain.. Fish oil capsules are usually 1,000mg of which 180mg is EPA and 120mg DHA so one would need about 11 of these daily!
I do not routinely use the Hoffer regime on my patients but try to be more specific in what individuals need based on blood,urine and hair tests. Where it is not possible to do the tests then try his regime.Dr Hoffer retired in 2005 from practice at age 86 after a lifetime of high achievement and helping thousands of patients.
In bipolar disorder quite a few psychiatrists are using omega-3 nowadays but it is still used by only a small minority.The dose given is usually 5-10g daily initially,a few take over 10g and some get by on as low as 3g after a while. There are other natural treatments for bipolar too-see www.alternativementalhealth.com/articles/altbipolar.htm
7. CONDITIONS IN WHICH OMEGA-3 AND OTHERN NUTRIENTS MAY BE USEFUL. This section will take me some considerable time to put together but I am starting off with ALZHEIMERS DISEASE. This is a condition that affects one in 20 over 65 and one in 5 of those over 80.In the Dec 2004 edition of American Journal of Clinical Nutrition an article reviewed the evidence for omega-3 fish oil in regard to its possible effect on preventing or postponing the onset of this condition.The conclusion was that in a group of 300 Scottish people studied in 1947 when they were 11 and reviewed recently that the IQ of fish oil consumers was 13% higher.In other tests to identify signs of dementia the fish oil users did 6% better.Prof. Walter Whalley of Aberdeen University said that the evidence was that fish oil slows the ageing of the brain by reducing inflammation.The ageing of the brain is being slowed down by a year or two.That is a useful bonus for the individuals as well as for the health services as it will help to keep many out of nursing homes for one or two years more and they may succumb to something else in the meantime.An ongoing project at the Pfeiffer Center in Chicago (www.hriptc.org) is showing significant improvement in a small group using their metallothionein promotion therapy.I myself have recently stared to use this type of treatment. See details on my Alzheimer`s page.
BIPOLAR DISORDER/SCHIZOPHRENIA
I came across an interesting article in Nutrition Journal which covers a great deal of information on these two conditions with lots of references to other publications. It is avalable in full on www.nutritionj.com/content/4/1/6
The Oct 05 edition of American Journal of Clinical Nuterition shows that dry eye syndrome (DES) is about 20% less common in those with an adequate supply of fish oil in their diet. A low level of omega-6 is helpful too.
I found the slides and lecture notes on this very topic on the web in September 2006. It may be heavy going in places to get through all the slides but it is a splendid piece of work in my opinion. The site is www.lipidsonline.org/slides/slide01.cfm?tk=42&dpg=1
