EPA vs. DHA

[Guest guest]

Dina,

To get you started. Keep in mind, this is a brand-new field. No

one knows if nutritional requirements for the brain are different for people

with schizophrenia, bipolar disorder, etc., or if these disorders reflect

nutritional deficiencies that resolve with adequate nutrition, or if neurons

that degenerated before the disease was diagnosed are lost for good or can be

recovered--or to what extent such recovery could be achieved.

Given the fact that issues such as schizophrenia and bipolar

disorder can be extremely dangerous when not managed, it is very important NOT

to extrapolate dietary recommendations that work well in healthy individuals and

try to apply them to those who have these problems.

I believe that what will eventually fall out of this is that while

some people can get along without fish, others may absolutely need it. It may

also be that since these diseases also have a degenerative component, that

whether or not a vegetarian DHA source will provide enough DHA and EPA for

healthy brain function will depend on how advanced the problem is when it is

initially identified. Which is why, though I am mostly vegetarian myself, I do

my best to not let that bias interfere with what is best for people asking for

help.

Monika

Schizophr Res. 2001 Apr 30;49(3):243-51.

Two double-blind placebo-controlled pilot studies of eicosapentaenoic acid

in the treatment of schizophrenia.

Peet M, Brind J, Ramchand CN, Shah S, Vankar GK.

Academic Department of Psychiatry, Northern General Hospital, The Longley

Centre, Norwood Grange Drive, S5 7JT, Sheffield, UK. m.peet@...

Evidence that the metabolism of phospholipids and polyunsaturated fatty

acids (PUFA) is abnormal in schizophrenia provided the rationale for

intervention studies using PUFA supplementation. An initial open label study

indicating efficacy for n-3 PUFA in schizophrenia led to two small double-blind

pilot studies. The first study was designed to distinguish between the possible

effects of two different n-3 PUFA: eicosapentaenoic acid (EPA) and docohexaenoic

acid (DHA). Forty-five schizophrenic patients on stable antipsychotic medication

who were still symptomatic were treated with either EPA, DHA or placebo for 3

months. Improvement on EPA measured by the Positive and Negative Syndrome Scale

(PANSS) was statistically superior to both DHA and placebo using changes in

percentage scores on the total PANSS. EPA was significantly superior to DHA for

positive symptoms using ANOVA for repeated measures. In the second

placebo-controlled study, EPA was used as a sole treatment, though the use of

antipsychotic drugs was still permitted if this was clinically imperative. By

the end of the study, all 12 patients on placebo, but only eight out of 14

patients on EPA, were taking antipsychotic drugs. Despite this, patients taking

EPA had significantly lower scores on the PANSS rating scale by the end of the

study. It is concluded that EPA may represent a new treatment approach to

schizophrenia, and this requires investigation by large-scale placebo-controlled

trials.

Nutr Neurosci. 2004 Apr;7(2):91-9.

Effects of fish oil on the central nervous system: a new potential

antidepressant?

Naliwaiko K, Araujo RL, da Fonseca RV, Castilho JC, tini R, Bellissimo MI,

Oliveira BH, s EF, Curi R, Fernandes LC, Ferraz AC.

Laboratorio de Fisiologia e Farmacologia do Sistema Nervoso Central,

Departamento de Fisiologia e Farmacologia, Universidade Federal do Parana,

81.531-990 Curitiba, PR, Brazil.

In the last 100 years major depression has increased worldwide. In this study we

provided coconut fat (CF, rich in saturated fatty acids) or fish oil (FO, rich

in n-3 polyunsaturated fatty acids) to female rats throughout pregnancy and

lactation and then to their offspring post-weaning and examined lipid brain

profile and the possible effect of FO as antidepressant agent in the offspring

in adulthood (F1). Rats were submitted to forced swimming test, elevated plus

maze, water maze and open field. Peroxidation rate in the cerebral cortex

and hippocampus were measured. Docosahexaenoic acid (DHA) concentration in dam's

milk, eicosapentaenoic acid (EPA) and DHA concentration in hippocampus and

cerebral cortex from F1 rats FO supplemented increased significantly when

compared to control © and CF rats. Arachidonic acid/EPA ratio in the cerebral

cortex and hippocampus decreased in rats submitted to forced swimming test.

Peroxidation rate were not different between the groups. Immobility time in the

forced swimming test in FO group was reduced (p < 0.01) when compared to C and

CF rats. We conclude that lifelong intake of FO was able to induce an

antidepressant effect with EPA and DHA concentration increased in the cerebral

cortex and hippocampus.

Annu Rev Nutr. 2004;24:597-615. Related Articles, Links

Dietary n-6 and n-3 fatty acid balance and cardiovascular health.

Wijendran V, KC.

Biomedical Research Lab, Brandeis University, Waltham, Massachusetts

02254, USA. vwijen@...

Epidemiological and clinical studies have established that the n-6 fatty acid,

linoleic acid (LA), and the n-3 fatty acids, linolenic acid (LNA),

eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) collectively protect

against coronary heart disease (CHD). LA is the major dietary fatty acid

regulating low-density lipoprotein (LDL)-C metabolism by downregulating LDL-C

production and enhancing its clearance. Further, the available mass of LA is a

critical factor determining the hyperlipemic effects of other dietary fat

components, such as saturated and trans fatty acids, as well as cholesterol. By

contrast, n-3 fatty acids, especially EPA and DHA, are potent antiarryhthmic

agents. EPA and DHA also improve vascular endothelial function and help lower

blood pressure, platelet sensitivity, and the serum triglyceride level. The

distinct functions of these two families make the balance between dietary n-6

and n-3 fatty acids an important consideration influencing cardiovascular

health. Based on published literature describing practical dietary intakes, we

suggest that consumption of ~6% en LA, 0.75% en LNA, and 0.25% en EPA + DHA

represents adequate and achievable intakes for most healthy adults. This

corresponds to an n-6/n-3 ratio of ~6:1. However, the absolute mass of essential

fatty acids consumed, rather than their n-6/n-3 ratio, should be the first

consideration when contemplating lifelong dietary habits affecting

cardiovascular benefit from their intake.

Am J Clin Nutr. 2004 May;79(5):765-73. Related Articles, Links

Differential eicosapentaenoic acid elevations and altered cardiovascular disease

risk factor responses after supplementation with docosahexaenoic acid in

postmenopausal women receiving and not receiving hormone replacement therapy.

Stark KD, Holub BJ.

Department of Human Biology and Nutritional Sciences, University of Guelph,

Guelph, Ontario, Canada N1G 2W1.

BACKGROUND: Dietary docosahexaenoic acid (DHA) has triacylglycerol-lowering

potential and undergoes in vivo retroconversion to eicosapentaenoic acid (EPA)

in humans. Hormone replacement therapy (HRT) influences circulating lipid

concentrations and fatty acid metabolism. DHA supplementation has not been

studied in postmenopausal women. OBJECTIVE: We studied the effects of

supplementation with DHA (free of EPA) on the resulting elevation in EPA and on

selected cardiovascular disease risk factors in postmenopausal women. DESIGN:

Women receiving (n = 18) and not receiving (n = 14) HRT completed a randomized,

double-blind, placebo-controlled crossover trial with a DHA supplement (2.8 g

DHA/d). A washout period of > or =6 wk divided the two 28-d intervention

periods. Fasting blood samples were collected for analysis. RESULTS: In all

women, DHA supplementation was associated with significant changes (P < 0.05),

including 20% lower serum triacylglycerol concentrations, 8% higher

HDL-cholesterol concentrations, a 28% lower overall ratio of serum

triacylglycerol to HDL cholesterol, and a 7% decrease in resting heart rate. DHA

supplementation resulted in a 45% lower net increase (P = 0.02) in EPA and a 42%

lower (P = 0.0028) estimated percentage retroconversion of DHA to EPA

[DeltaEPA/(DeltaEPA + DeltaDHA) x 100] in women receiving than in those not

receiving HRT. CONCLUSION: With DHA supplementation, the accumulation of EPA in

serum phospholipids is significantly attenuated in postmenopausal women

receiving HRT compared with that in women not receiving HRT. DHA supplementation

can also favorably influence selected cardiovascular disease risk factors in

postmenopausal women.

P R Health Sci J. 2004 Jun;23(2):107-13. Related Articles, Links

Erythrocyte membrane fatty acid composition in cancer patients.

Mikirova N, Riordan HD, JA, Wong K, Miranda-Massari JR, MJ.

Center for the Improvement of Human Functioning International, Inc., 3100 N.

Hillside Avenue, Wichita, Kansas, 67219, USA.

Essential fatty acids (EFA) have an important role in complex metabolic

reactions. The metabolism of essential polyunsaturated fatty acids (PUFA)

appears to be one of the critical targets in the complex metabolic stages that

lead to, or are associated with cancer. The goal of our research was to analyze

the erythrocyte specific types of membrane fatty acid content, level and

distribution in cancer patients as compared to non-cancer patients. Changes in

fatty acid composition may affect different aspects of cell structure and

function, including proliferation. Analyses of RBCs membrane fatty acids were

performed for 255 patients with different types of cancer (breast, prostate,

liver, pancreas, colon, and lung), 2,800 non-cancer patients and 34 healthy

volunteers. Our research study demonstrated a lower level of stearic acid and an

increased content of oleic acid in RBC of cancer patients in comparison with

control and non-cancer patients. According to the results of this investigation,

the ratio of Eicosa pentaenoic acid (EPA) and Decosa hexaenoic acid (DHA) to

Alpha-linolenic acid (ALA) may be useful to estimate PUFA imbalances in cancer

patients. EPA and DHA acid may be recommended as supplementation and in addition

to current therapy during cancer treatment.

Prostaglandins Leukot Essent Fatty Acids. 2003 Dec;69(6):477-85. Related

Articles, Links

Eicosapentaenoic acid in the treatment of schizophrenia and depression:

rationale and preliminary double-blind clinical trial results.

Peet M.

Swallownest Court Hospital, Aughton Road, Sheffield S26 4TH, UK.

malcolmpeet@...

It has been hypothesised that polyunsaturated fatty acids (PUFA) play an

important role in the aetiology of schizophrenia and depression. Evidence

supporting this hypothesis for schizophrenia includes abnormal brain

phospholipid turnover shown by 31P Magnetic Resonance Spectroscopy, increased

levels of phospholipase A2, reduced niacin skin flush response, abnormal

electroretinogram, and reduced cell membrane levels of n-3 and n-6 PUFA. In

depression, there is strong epidemiological evidence that fish consumption

reduces risk of becoming depressed and evidence that cell membrane levels of n-3

PUFA are reduced. Four out of five placebo-controlled double- blind trials of

eicosapentaenoic acid (EPA) in the treatment of schizophrenia have given

positive findings. In depression, two placebo-controlled trials have shown a

strong therapeutic effect of ethyl-EPA added to existing medication. The mode of

action of EPA is currently not known, but recent evidence suggests that

arachidonic acid (AA) if of particular importance in schizophrenia and that

clinical improvement in schizophrenic patients using EPA treatment correlates

with changes in AA.

CNS Drugs. 2003;17(15):1081-91. Related Articles, Links

Clinical potential of omega-3 fatty acids in the treatment of schizophrenia.

Emsley R, Oosthuizen P, van Rensburg SJ.

Department of Psychiatry, Faculty of Health Sciences, University of

Stellenbosch, Tygerberg 7505, Cape Town, South Africa. rae@...

The phospholipids in the neuronal membranes of the brain are rich in highly

unsaturated essential fatty acids (EFAs). It has been hypothesised that

abnormalities of phospholipid metabolism are present in patients with

schizophrenia and that the EFAs omega-3 polyunsaturated fatty acids, and

eicosapentaenoic acid (EPA) in particular, may have a role in treating this

illness. Considerable preclinical and clinical evidence provides support for

this proposal. An epidemiological study reported a better outcome for patients

with schizophrenia in countries where the diet is rich in unsaturated fatty

acids. Evidence of abnormalities of EFAs has been found in erythrocyte membranes

and cultured skin fibroblasts of patients with schizophrenia, and abnormal

retinal function and niacin skin flush tests (markers of omega-3 polyunsaturated

fatty acid depletion) have also been reported. Case reports and an open-label

clinical trial reported efficacy for EPA in schizophrenia. Four randomised,

controlled trials of EPA versus placebo as supplemental medication have now been

reported. Two of these trials showed significant benefit with EPA on the

positive and negative symptom scale total scores, whereas the other two did not

show any effects on this primary efficacy measure. One study also reported a

beneficial effect on dyskinesia. In the only published trial in which EPA was

used as monotherapy versus placebo in schizophrenia, some evidence was found to

suggest antipsychotic activity. Taken together, there is considerable evidence

to suggest abnormalities of EFAs in cell membranes of patients with

schizophrenia, and there is preliminary evidence that EPA is an effective

adjunct to antipsychotics.