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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
October 1, 2011

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Drug Disposal National Take-back Day Scheduled
Predicting Adult Obesity: Keep It Simple
A Yogurt of the Future as an Anxiety Treatment?
Increased Coffee Consumption Linked to Lower Depression Risk in Women
Treating Cardiovascular Risk Factors Can Improve Sexual Function in Men with ED
How Clinicians Talk About Kids' Weight Matters to Parents
The Numbers: Employer-Sponsored Health Insurance Costs Rise Sharply in U.S.
Cytisine a Possible Cheaper Approach to Smoking Cessation
Adolescent Female Athletes Lack Awareness of Link Between Menses and Bone Health
See for Yourself: Amenorrhea Means Thinner Bones
Even High Doses of Saw Palmetto Do Not Reduce Lower Urinary Tract Symptoms
Migraine, Pregnancy, and Blood Pressure
Yogurt & Co. May Reduce a Pregnancy Risk
Omega-3 Trial Finds Mood & Brain Benefits

MM: Mark Drugs in Roselle and Deerfield offer a FREE Drug Take Back service every day! Just contact either of our stores for more details.
Drug Disposal National Take-back Day Scheduled
     The DEA has scheduled another National Prescription Drug Take-back Day on Saturday, October 29, 2011, from 10:00 am to 2:00 pm to provide a procedure for individuals to dispose of unwanted and unused prescription drugs.
     The DEA, in conjunction with state and local law enforcement agencies throughout the U.S., conducted National Prescription Drug Take-back Days on Saturday, September 25, 2010 and April 25, 2011. Nearly 4,000 state and local law enforcement agencies throughout the nation participated in these events, collecting more than 309 tons of medications
     Four days after last fall's Take-back Day, Congress passed legislation amending the Controlled Substances Act to allow the DEA to develop a process for people to safely dispose of their prescription drugs. DEA immediately began developing this process after the President signed the Safe and Secure Drug Disposal Act of 2010 on October 12. Until that process is complete, however, DEA will continue to hold Take-back Days every six months.
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J Clin Endocrinol Metab 2011 Jul 21
Predicting Adult Obesity: Keep It Simple
Adding inflammatory or genetic risk factors to measures of child BMI, maternal BMI, and family income did not enhance prediction of adult obesity.
     Childhood obesity and parental body-mass index (BMI) predict adult obesity, but whether risk factors such as markers of inflammation or genetic polymorphisms improve predictive models is unknown. To examine childhood environmental and genetic risk factors for adult obesity, investigators in Finland followed 2119 participants (age range at enrollment, 3–18 years; mean age, 11 years) for 27 years in a population-based longitudinal study.
     The following childhood factors were directly and significantly associated with adult obesity: childhood BMI, maternal and paternal BMIs, birth weight, insulin level, systolic blood pressure, C-reactive protein (CRP) level, aggression-prone negative emotionality, and polymorphisms near three obesity-related genes. Family income, parental educational levels, and HDL cholesterol level were inversely associated with adult obesity. As early as age 3, a multivariate prediction model containing childhood BMI, family income, and maternal BMI (paternal BMI was excluded because of missing data) was highly predictive of adult BMI. Adding CRP values or the presence of as many as three single nucleotide polymorphisms associated with BMI only marginally improved the model's predictive ability.
     Comment: With the rapid pace of advances in diagnostic laboratory medicine and genetics, overlooking basic aspects of clinical medicine can be tempting. This large longitudinal study indicates that — at least for identifying children and adolescents at risk for adult obesity — nonlaboratory risk factors that can easily be obtained in our offices are every bit as good as and much less expensive than laboratory studies. The finding that low socioeconomic status is inversely related to risk for adult obesity has important policy implications for targeting preventive measures.
Alain Joffe, MD, MPH, FAAP Published in Journal Watch Pediatrics and Adolescent Medicine August 31, 2011
     Citation(s):Juonala M et al. Childhood environmental and genetic predictors of adulthood obesity: The Cardiovascular Risk in Young Finns study. J Clin Endocrinol Metab 2011 Jul 21; [e-pub ahead of print]. (http://dx.doi.org/10.1210/jc.2011-1243)
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MM: This information supports one more use and justification for daily use of probiotics. It also brings out the question, could the preponderance of social anxiety that is described in the literature have a dysbiosis component?
Proc Natl Acad Sci U S A 2011 Aug 29
A Yogurt of the Future as an Anxiety Treatment?
In mice, a Lactobacillus strain reduces anxiety via vagus nerve mechanisms that affect brain GABAergic systems.
     Over the past few years, research in rodents has revealed the existence of a "microbiota–gut–brain axis," through which microbial actions are mediated through vagal afferent nerves to affect functional bowel disorders, hypothalamic–pituitary–adrenal axis stress responses, and anxiety behaviors. Now, researchers from two laboratories using slightly different protocols report on their examination of the possible effects of the probiotic bacterium Lactobacillus rhamnosus (JB-1) on GABAergic brain systems and on stress responses, anxiety- and depression-like behaviors in relation to vagal nerve functioning.
     Animals received broth with or without L. rhamnosus (JB-1). Chronic administration of L. rhamnosus (JB-1) in healthy mice differentially affected the messenger RNA expression of several GABAA and GABAB receptor subtypes in the prefrontal cortex, amygdala, and hippocampus, among other areas. L. rhamnosus (JB-1) administration was also associated with reduced corticosterone levels in stressed mice and with reduced fear behaviors in several stress tests (e.g., open maze and forced swimming tests). L. rhamnosus (JB-1) did not have these effects in animals that underwent vagotomy, indicating the microbiota–gut–brain pathway.
     Comment: That these findings have already been replicated supports their veracity. Molecular and neurophysiological mechanisms by which this bacterial strain affects vagal afferents remain to be worked out. Because the gut–neural effects of Lactobacillus are strain-dependent, they cannot be generalized to other Lactobacillus strains, such as those found in yogurt cultures available in supermarkets. Clinical trials are being planned.
Joel Yager, MD Published in Journal Watch Psychiatry September 26, 2011
     Citation(s):Bravo JA et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci U S A 2011 Aug 29; [e-pub ahead of print]. (http://dx.doi.org/10.1073/pnas.1102999108)
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Increased Coffee Consumption Linked to Lower Depression Risk in Women
The more caffeinated coffee women drink, the less likely they are to develop depression, according to a prospective study in the Archives of Internal Medicine.
     Some 50,000 Nurses' Health Study participants without depressive symptoms at baseline were followed for roughly 10 years. During that time, about 5% reported physician-diagnosed depression.
     Overall, as self-reported caffeinated coffee consumption increased, the risk for depression decreased. In particular, compared with women who drank 1 cup or less a week, those drinking 2 to 3 cups a day had a 15% lower relative risk for depression, and those drinking 4 or more cups a day had a 20% lower risk. No link was seen between other sources of caffeine and depression, or between decaffeinated coffee and depression.
     An editorialist says that the while these and other data may provide reassurance that coffee drinking has "no glaringly deleterious health consequences ... it seems premature to recommend coffee consumption."
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Treating Cardiovascular Risk Factors Can Improve Sexual Function in
Men with ED

     Using lifestyle modification or drug therapy to treat cardiovascular risk factors can ameliorate erectile dysfunction, according to a meta-analysis in the Archives of Internal Medicine.
     The meta-analysis included four randomized trials that looked at the effects of lifestyle modification (e.g., weight loss, exercise) and two trials that examined the impact of atorvastatin on CV risk factors and erectile dysfunction. Some 740 men were included, and follow-up ranged from 2 to 24 months.
     Overall, reducing CV risk factors with either lifestyle changes or statin therapy was associated with statistically significant improvements in sexual function. The benefits persisted even when patients were also using phosphodiesterase type 5 inhibitors (e.g., sildenafil).
     The researchers write: "Erectile dysfunction detection in the primary health clinic may provide an opportunity for early adoption of a healthy lifestyle to improve the overall health of men."
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How Clinicians Talk About Kids' Weight Matters to Parents
     Clinicians' choice of words when discussing children's weight with parents can have a substantial impact on parents and their decisions about what to do next, according to a Pediatrics study.
      Some 450 parents with children between the ages of 2 and 18 were asked to imagine a clinical visit during which their child was found to be significantly overweight. The parents were then asked to rate the desirability of terms that a clinician might use to discuss the problem.
     Overall, parents much preferred "weight," "unhealthy weight," and "high BMI" over terms such as "obese," "extremely obese," and "fat." In particular, they considered "chubby," "obese," "extremely obese," and "fat" to be stigmatizing. And in motivating children to lose weight, they preferred terms including "unhealthy weight," "weight problem," and "overweight."
     Asked what their reaction would be to stigmatizing words, a third of the parents said they would consider looking for a new doctor.
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The Numbers: Employer-Sponsored Health Insurance Costs Rise Sharply in U.S.
     The average annual premium for family coverage in employer-sponsored health insurance plans is at $15,073 — a 9% increase over 2010 — the New York Times reports.
     The reasons for the increase are unknown, but the Times says some analysts suspect that insurance companies are raising their prices before new rules, anticipated to take effect next year, would force them to justify increases above 10%.
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Cytisine a Possible Cheaper Approach to Smoking Cessation
Cytisine, a partial nicotine agonist extracted from acacia seeds, sustains smoking cessation better than placebo, according to a New England Journal of Medicine study.
     Researchers randomized 740 smokers to 25 days' treatment with cytisine or matching placebo. The primary outcome, biochemically confirmed smoking cessation at 1 year, was 8.4% with cytisine and 2.4% with placebo.
     Gastrointestinal side effects — stomachache, dry mouth, dyspepsia, and nausea — occurred more often with cytisine.
     The authors conclude that cytisine's low cost (about $15 for a course of therapy) "may make it an attractive treatment option for smokers in low-income and middle-income countries."
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J Pediatr Adolesc Gynecol 2011 Oct; 24:311
Adolescent Female Athletes Lack Awareness of Link Between Menses and Bone Health
Most female high-school track athletes incorrectly answered questions about bone loss and its connection to menstrual irregularity.
     Menstrual irregularity is a risk factor for suboptimal bone development in adolescents. To determine if female high-school track athletes — a group at high risk for oligomenorrhea and amenorrhea — are aware of this connection, investigators surveyed 150 track athletes from five public high schools in Houston. Athletes who took hormonal contraceptives or were premenarchal were excluded.
     Among the 95 athletes (mean age, 16 years) who completed the survey, 16 were amenorrheic and 16 were oligomenorrheic (33%), and the rest were eumenorrheic. About 90% of the athletes answered incorrectly or did not know the answer to five of six questions about consequences of bone loss and the link to menstrual irregularity (e.g., "Skipping my period is my body's way of saying I'm training too hard" or "I'm not old enough to have weak bones"); only 50% recognized that skipping their periods was abnormal. About 30% to 50% of athletes responded that they did not know or agreed with attitudes about missed periods such as "If I have my period I need to train harder" or "Skipping my period is a sign of success at running." Menstrual irregularity was associated with lower knowledge scores.
     Comment: If these results are representative of the knowledge and attitudes of high-school track athletes nationwide, pediatricians — especially those who work with schools or serve as team physicians — have work to do to educate these young women about the importance of regular menses for bone health. An excellent free source of information on this topic specifically written for adolescents is available on The Children's Hospital of Boston Center for Young Women's Health website.
Alain Joffe, MD, MPH, FAAP Published in Journal Watch Pediatrics and Adolescent Medicine September 28, 2011
     Citation(s): Feldmann JM et al. Female adolescent athletes' awareness of the connection between menstrual status and bone health.
J Pediatr Adolesc Gynecol 2011 Oct; 24:311.
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J Clin Endocrinol Metab 2011 Aug 3
See for Yourself: Amenorrhea Means Thinner Bones
Amenorrheic athletes had impaired bone microarchitecture compared with eumenorrheic athletes and nonathletic controls.
     Bone microarchitecture might be a more sensitive measure of bone health than bone-mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA) scan. For example, adolescents with anorexia nervosa have abnormalities in bone microarchitecture even when BMD is similar to that in normal-weight controls. Investigators used high-resolution peripheral quantitative computed tomography (HRpQCT) to evaluate bone microarchitecture in amenorrheic athletes — a population at risk for abnormalities in bone health. They compared bone microarchitecture in 16 amenorrheic athletes (absence of periods for ≥3 months within a period of oligomenorrhea for ≥6 months or absence of menarche at age ≥16 years), 18 eumenorrheic athletes (≥9 periods in the previous 12 months), and 16 nonathletes. All athletes participated in regular endurance training for at least 6 months before enrollment.
     Bone age, body-mass index, lean body mass, and vitamin D and calcium levels were similar in the three groups. Mean serum estradiol level was lowest in amenorrheic athletes and was significantly lower than levels in nonathletes. HRpQCT measurement of weight-bearing tibia indicated that both groups of athletes had greater total and trabecular area and cortical perimeter, but amenorrheic athletes had the lowest total tibia density and trabecular number and density and the greatest trabecular separation. Measurement of non–weight-bearing radius showed that amenorrheic athletes had lower total density and cortical area than the other two groups. In regression models that controlled for menarchal age, bone age, and lean mass, group assignment accounted for 18% to 24% of the variability in tibial trabecular number and separation.
     Comment: A picture is worth a thousand words — if you have access to this article, you can see (thanks to HRpQCT) what DXA scans can only display numerically: Amenorrhea in athletes is associated with suboptimal bone health. Athletic activity is associated with an overall increase in weight-bearing bone, but amenorrhea attenuates the effects, resulting in impaired microarchitecture. Given the paucity of data that combined hormonal contraceptives prevent or reverse bony abnormalities associated with amenorrhea, we must emphasize to adolescent athletes that consuming adequate calories and maintaining weight sufficient to support a eumenorrheic state is critical to bone health.
Alain Joffe, MD, MPH, FAAP Published in Journal Watch Pediatrics and Adolescent Medicine September 28, 2011
     Citation(s):Ackerman KE et al. Bone microarchitecture is impaired in adolescent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls. J Clin Endocrinol Metab 2011 Aug 3; [e-pub ahead of print]
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Even High Doses of Saw Palmetto Do Not Reduce Lower Urinary
Tract Symptoms

     High doses of saw palmetto extract are no more effective than placebo in improving urinary tract symptoms attributed to benign prostatic hyperplasia, according to a JAMA study.
     Some 370 men with lower urinary tract symptoms were randomized to increasing doses of saw palmetto or placebo for 72 weeks. Men in the saw palmetto group began with the widely used, 320-mg daily dose, and then increased to a double dose at 24 weeks and a triple dose at 48 weeks.
     Although there were small improvements in urinary symptoms in both groups during the study, there were no significant differences between the groups.
     The authors note that their findings concur with those from the 2006 STEP trial, in which the standard dose of saw palmetto proved no better than placebo for benign prostatic hyperplasia.
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Headache 2011 Jul 28
Migraine, Pregnancy, and Blood Pressure
Migraine was associated with slightly higher blood pressures during pregnancy; obese migraineurs were at highest risk for preeclampsia.
     Migraineurs have excess risk for hypertensive disorders of pregnancy. In a prospective study, researchers assessed blood pressure (BP) by trimester and its effect on risk for gestational hypertension and preeclampsia in 3373 women who sought prenatal care at two clinics in Washington state.
     About 17% of participants self-reported histories of physician-diagnosed migraines, and migraineurs were more likely to be obese than were nonmigraineurs (11% vs. 7%; P=0.021). Mean systolic BPs were modestly higher during all trimesters in migraineurs than in nonmigraineurs; mean diastolic BPs were slightly higher during the first and third trimesters. Overall, 7% of participants received diagnoses of either gestational hypertension or preeclampsia, but migraine was associated significantly only with excess risk for preeclampsia (adjusted odds ratio, 1.5). Using lean nonmigraineurs as a reference, risk for preeclampsia in migraineurs was strongly associated with prepregnancy obesity (lean migraineurs: AOR, 1.2; obese nonmigraineurs: AOR, 2.7; obese migraineurs: AOR, 6.1).
     Comment: Women who did not have physician-diagnosed migraine were excluded from this large, observational study; therefore, cases of mild or infrequent migraines might have been missed. The authors also did not address migraine with aura, which carries a higher stroke risk than does common migraine and which probably is associated with more vascular risks. Finally, the postpartum period (which has attendant risks for obstetric and neurological complications) was not studied. Overall, these results support the idea that vascular function is altered during pregnancy in women (especially obese women) with histories of migraine, and suggest that migraine should be included among risk factors for hypertensive disorders of pregnancy.
Autumn Klein, MD, PhD Published in Journal Watch Women's Health September 22, 2011
     Citation(s):Williams MA et al. Trimester-specific blood pressure levels and hypertensive disorders among pregnant migraineurs. Headache 2011 Jul 28; [e-pub ahead of print]. (http://dx.doi.org/10.1111/j.1526-4610.2011.01961.x)
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September 26, 2011
Yogurt & Co. May Reduce a Pregnancy Risk
     A famous – and deeply disturbing – episode of television’s ER, titled “Love's Labor Lost”, dramatized a rare but deadly pregnancy danger called preeclampsia. Preeclampsia (pree-eh-clamp-see-ah) affects up to eight percent of first-time mothers in the U.S., and remains a leading cause of mother-and-baby mortality and infant health problems worldwide.  
This potentially deadly condition features a serious rise in blood pressure, leaking of protein into urine, headaches, and swelling of the hands, feet, and face.

Preeclampsia: Dangerous but treatable
Typically, preeclampsia occurs in middle to late pregnancy, though it can occur earlier (For more about the warning signs, visit thePreeclampsia Foundation). Fortunately, the condition is readily detectable and treatable, and almost all mothers with preeclampsia will do fine and deliver healthy babies if they follow a prescribed regimen of rest and medication. The causes of preeclampsia remain unclear, although suspects include poor nutrition, high body fat, immune deficiencies, inflammation, and insufficient blood flow to the uterus, with ethnicity and heredity playing possible roles.
     Earlier research – including some by the Norwegian team behind today’s study – raised hopes that anti-inflammatory antioxidants in foods might be preventive (Brantsaeter AL et al. 2009) … but these hopes have not so far panned out (Triche EW et al. 2008; Rumbold A et al. 2008; Klebanoff MA et al. 2009). However, vitamin D deficiency may be a risk factor, as we reported two years ago … see “Pregnancy Danger May be Deterred by Vitamin D and Omega-3s”. Now, an epidemiological study from Norway suggests that diets rich in yogurt, kefir, and other cultured dairy foods may help prevent preeclampsia.

Norwegian study links yogurt and company to reduced risk
     Researchers from the Norwegian Institute of Public Health analyzed data collected from 33,399 women participating in the Norwegian Mother and Child Cohort Study (Brantsæter AL et al. 2011). Their intake of cultured milk products containing friendly, “probiotic” lactobacilli bacteria was determined using a diet questionnaire, while their status with regard to a diagnosis of preeclampsia was determined using the Norwegian Medical Birth Registry. The scientists’ analysis found that a daily intake of at least 140 milliliters (4.7 ounces) of any cultured, probiotic milk product was associated with a 20 percent reduced risk of preeclampsia. The deterrent effects were greater for severe preeclampsia, with daily and weekly intakes of probiotic products associated with 39 percent and 25 percent reductions in risk, respectively. As the Norwegian team concluded, “These results suggest that regular consumption of milk-based probiotics could be associated with lower risk of preeclampsia in primiparous women.”

(“Primiparous” means women who are pregnant for the first time.)

Why would yogurt and company deter preeclampsia?
     The Norwegian researchers believe that probiotic dairy foods may confer protection in two ways:
• System-wide anti-inflammatory effects
• Beneficial effects on cells surrounding the embryo (placental trophoblasts)

The Norwegians put it this way: “… probiotics might specifically ‘target’ and modify the type of inflammation underlying severe preeclampsia.” (Brantsæter AL et al. 2011). They called for randomized controlled trials to test foods containing different probiotic bacterial strains.

Sources: Brantsaeter AL, Myhre R, Haugen M, Myking S, Sengpiel V, Magnus P, Jacobsson B, Meltzer HM. Intake of probiotic food and risk of preeclampsia in primiparous women: the norwegian mother and child cohort study. Am J Epidemiol. 2011 Oct 1;174(7):807-15. Epub 2011 Aug 5. Brantsaeter AL, Haugen M, Samuelsen SO, Torjusen H, Trogstad L, Alexander J, Magnus P, Meltzer HM. A dietary pattern characterized by high intake of vegetables, fruits, and vegetable oils is associated with reduced risk of preeclampsia in nulliparous pregnant Norwegian women. J Nutr. 2009 Jun;139(6):1162-8. Epub 2009 Apr 15. Grill S, Rusterholz C, Zanetti-Dällenbach R, Tercanli S, Holzgreve W, Hahn S, Lapaire O. Potential markers of preeclampsia--a review. Reprod Biol Endocrinol. 2009 Jul 14;7:70. Review. Habon T, Kesmarky G, Toth K. Omega-3 fatty acids improve haemodynamic and haemorheologic parameters and lipid profiles in patients with cardiovascular diseases. Eur Heart J. 2002 Jan;23(1):89. Haugen M, Brantsaeter AL, Trogstad L, Alexander J, Roth C, Magnus P, Meltzer HM. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology. 2009 Sept Vol20, Issue 5, Pages 720-726. [pub med] Klebanoff MA, Zhang J, Zhang C, Levine RJ. Maternal serum theobromine and the development of preeclampsia. Epidemiology. 2009 Sep;20(5):727-32. Mahomed K, Williams MA, King IB, Mudzamiri S, Woelk GB. Erythrocyte omega-3, omega-6 and trans fatty acids in relation to risk of preeclampsia among women delivering at Harare Maternity Hospital, Zimbabwe. Physiol Res. 2007;56(1):37-50. Epub 2006 Feb 23. Olsen SF, Secher NJ. A possible preventive effect of low-dose fish oil on early delivery and pre-eclampsia: indications from a 50-year-old controlled trial. Br J Nutr. 1990;64:599-609. Qiu C, Sanchez SE, Larrabure G, David R, Bralley JA, Williams MA. Erythrocyte omega-3 and omega-6 polyunsaturated fatty acids and preeclampsia risk in Peruvian women.Arch Gynecol Obstet. 2006 May;274(2):97-103. Epub 2006 Mar 7. Rumbold A, Duley L, Crowther CA, Haslam RR. Antioxidants for preventing pre-eclampsia. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004227. Review. Triche EW, Grosso LM, Belanger K, Darefsky AS, Benowitz NL, Bracken MB. Chocolate consumption in pregnancy and reduced likelihood of preeclampsia. Epidemiology. 2008 May;19(3):459-64. Williams MA, Zingheim RW, King IB, Zebelman AM. Omega-3 fatty acids in maternal erythrocytes and risk of preeclampsia. Epidemiology. 1995 May;6(3):232-7.
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Article from Vital Choices Newsletter
September 26, 2011
Omega-3 Trial Finds Mood & Brain Benefits
Clinical trial in people with mild cognitive impairment detected different benefits in older people given omega-3 DHA or omega-3 EPA; Omega-6 fats showed no benefit
by Craig Weatherby
     Can omega-3 fatty acids from fish oil help prevent or alleviate depression? A small but lengthy clinical trial from Australia adds positive evidence to a mixed picture … and it also revealed differences in the brain-mood effects of omega-3 EPA and omega-3 DHA. Back in 2006, an expert panel of the American Psychiatric Association expressed this positive but qualified opinion of the anti-depression promise of omega-3s from fish:
“[Omega-3] EPA and DHA appear to have negligible risks and some potential benefit in major depressive disorder and bipolar disorder …” (Freeman MP et al. 2006)

    Since then, several more clinical trials of omega-3s have been conducted, with mixed results, suggesting that the efficacy of fish oil depends on factors such as a person’s degree of depression, genetic profile, overall diet, and the doses and forms of omega-3s (i.e., EPA, DHA, or a combination) he or she consumes.For example, a person’s intake of omega-6 fatty acids – which, in the U.S. is generally very excessive – appears to affect their vulnerability to depression.

     High intakes of omega-6 fats blunt the impact of dietary omega-3s, because omega-6s compete with omega-3s for absorption into cell membranes ... see “Omega Ratio” Matters to Mood”. The Aussie study we summarize today was conducted in people 65 or older who’d been diagnosed with mild cognitive impairment (MCI). Evidence suggests that fish-source omega-3s may ease or deter some forms of depression and delay the slide from cognitive decline to dementia as we age. These twin effects of fish oil may be linked, because depression typically raises the risk that a person with MCI will develop dementia. Before we look at the new trial, it’ll be helpful to quickly recap the differences between the two omega-3s found in fish oil and human cells.

DHA and EPA: Omega-3s with distinct but complementary characters
     Fish oil contains two key omega-3s – DHA and EPA – which serve different but overlapping purposes in the human body. Generally speaking, DHA is essential to brain and eye functions, while EPA is essential to immune functions, especially inflammation … but there is significant overlap between the two. Omega-3 DHA and EPA are both essential to ending inflammation after it’s no longer needed to help heal an injury or infection (Calder PC 2009), while omega-3 EPA appears particularly important to mood support and some other aspects of mental health (Martins JG 2009). Most prior studies have suggested that EPA is the more important fish-source omega-3 in terms of mood support, and this one affirms that idea. But the outcomes of the new clinical trial suggest that DHA may help keep people verbally fluent as they age.

Trial paints positive but varied picture of omega-3s’ mood potential
     The new trial was led by Natalie Sinn, Ph.D., with whom we became familiar as an author of studies regarding omega-3s’ potential for aiding kids with attention deficit disorders (Sinn N et al. 2011). (See “New Findings Support Omega-3s’ Ability to Aid Kids with Attention Disorders”.) Dr. Sinn and colleagues from the University of South Australia and the Queensland University of Technology recruited 50 people aged 65 years or older to participate in a small but well-designed (double-blind, randomized, controlled) six-month-long trial. The trial participants were assigned to one of three groups of roughly equal size, each of which took a different supplement daily for six months:

     Compared with the group receiving omega-6 LA, those who took the EPA-rich fish oil had higher (better) scores on the Geriatric Depression Scale. In contrast, no mood advantage was detected in the DHA fish oil group. However, the DHA fish oil group displayed improvements in verbal fluency, compared with the group taking the omega-6 LA supplements.

The Australian team made three key points (Sinn N et al. 2011):

     We couldn’t agree more. Given the mixed efficacy of anti-depressant drugs, and their adverse side effects, Congress should rapidly fund more research on omega-3s for mood health.

Sources: Calder PC. Polyunsaturated fatty acids and inflammatory processes: New twists in an old tale. Biochimie. 2009 Jun;91(6):791-5. Review. 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 Oct;28(5):525-42. Review. Rogers PJ, Appleton KM, Kessler D, Peters TJ, Gunnell D, Hayward RC, Heatherley SV, Christian LM, McNaughton SA, Ness AR. No effect of n-3 long-chain polyunsaturated fatty acid (EPA and DHA) supplementation on depressed mood and cognitive function: a randomised controlled trial. Br J Nutr. 2008 Feb;99(2):421-31. Epub 2007 Oct 24. Sinn N, Milte CM, Street SJ, Buckley JD, Coates AM, Petkov J, Howe PR. Effects of n-3 fatty acids, EPA v. DHA, on depressive symptoms, quality of life, memory and executive function in older adults with mild cognitive impairment: a 6-month randomised controlled trial. Br J Nutr. 2011 Sep 20:1-12. [Epub ahead of print] van de Rest O, Geleijnse JM, Kok FJ, van Staveren WA, Hoefnagels WH, Beekman AT, de Groot LC. Effect of fish-oil supplementation on mental well-being in older subjects: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2008 Sep;88(3):706-13. van de Rest O, Geleijnse JM, Kok FJ, van Staveren WA, Olderikkert MG, Beekman AT, de Groot LC. Effect of fish oil supplementation on quality of life in a general population of older Dutch subjects: a randomized, double-blind, placebo-controlled trial. J Am Geriatr Soc. 2009 Aug;57(8):1481-6. Epub 2009 Jun 22.

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