Safely using eicosapentaenoic acid (fish oil) for schizophrenia

Fish oil, primarily eicosapentaenoic acid (EPA) is gaining popularity as a natural treatment for schizophrenia. (Before I continue, just want to say I have to be very careful with this post because I don't want to encourage anyone who needs to be on antipsychotics to read that I'm saying to discontinue them--I AM NOT!)

Because of this popularity, a prominent group of schizophrenia researchers in the UK decided to evaluate whether or not therapeutic doses of EPA produced any safety issues for its users. They divided 84 individuals with schizophrenia into two groups; one group received 2 grams EPA per day along with their antipsychotic, the other received a placebo along with their medication.

Those individuals receiving EPA experienced a trend toward decreased total cholesterol and HDL. Weight tended to increase. And their bleeding time increased, meaning it took longer for their blood to clot when they cut themselves.

Here are some thoughts to take away from this study.

1. 2 grams daily of EPA is a very high dose. Most over the counter capsules have about 10% of that amount. This was a very specific protocol unlikely to be randomly adopted by the average person.

2. If you have ever had any issues with blood clotting, or are on any type of medication that affects clotting time, such as Coumadin, it is very important to work with your prescribing physician in order to coordinate appropriate dosages of medications and supplements.

3. I'm not working with critically ill schizophrenics on an outpatient basis, so I have the liberty of starting low and upping doses to evaluate for tolerance. I tend to work with a mixture of dietary fats and fish oils and not use such a specific, directed protocol. I feel much safer with that. But I am always on the lookout for the kinds of reactions that this study produced.

4. What is not known is whether or not all the subjects were on the same antipsychotic, or for how long before starting this study. Each antipsychotic has a slightly different effect on lipids, weight, and hormones, and that information would likely affect the results that were reported.

Overall, I'd say the most important finding in this study was the effect of super-high doses of EPA on clotting time. Because EPA has been getting more attention for its potential in treating bipolar disorder and schizophrenia, it is showing up more and more as a single supplement rather than as a component of fish oil. There is a tendency to use the "more is better" approach and to assume that if it's natural, and it's over the counter, it's safe. That may or may not be true with EPA, and it should be used judiciously.

Emsley R, Niehaus DJ, Oosthuizen PP, Koen L, Ascott-Evans B, Chiliza B, van Rensburg SJ, Smit RM. Safety of the omega-3 fatty acid, eicosapentaenoic acid (EPA) in psychiatric patients: Results from a randomized, placebo-controlled trial. Psychiatry Res. 2008 Dec 15;161(3):284-91. Epub 2008 Oct 29.

Another "because" to put on my long list of reasons to eat hummous

All of my clients know that of all the foods on the famous internet glycemic index list, hummous is the one that scores the most favorable. It's got garbanzo beans, a great high protein/carb combo food, olive oil, a healthy fat...and in many cases, tahini, which is also packed with health potential.

Tahini is a paste made from sesame seeds, and sesame seeds contain a compound called sesamin. Sesamin has been found to help take vegetarian omega-3's and convert them into the omega-3's more commonly associated with fish oil. This conversion almost always exists to some degree, but nutritionists have always questioned whether the conversion is efficient enough to provide adequate DHA and EPA for human needs.

One interesting disclaimer I should add here...this conversion was tested in salmon as a potential way to increase the DHA content of salmon. The process has yet to be proven in humans. Even so, it doesn't seem like it would hurt to add a little bit of sesame seed to your own program. It's when sesame OIL is extracted from seeds and used in large quantities that you can override the benefits with potential disadvantages.

I don't know if I'm ready to say if you eat hummous you can stop eating fish, but I can say that hummous definitely helps to improve your omega-3 balance, and it's certainly a most tasty way of doing it!

For some more ideas on how to get more sesame seeds onto your plate, check out one of my favorite websites, World's Healthiest Foods.

Trattner S, Ruyter B, Ostbye TK, Gjøen T, Zlabek V, Kamal-Eldin A, Pickova J. Sesamin Increases Alpha-Linolenic Acid Conversion to Docosahexaenoic Acid in Atlantic Salmon (Salmo salar L.) Hepatocytes: Role of Altered Gene Expression. Lipids. 2008 Nov;43(11):999-1008. Epub 2008 Sep 11.

Which came first, the high glucose or the depression?

There are reams of references in the National Library of Medicine database reporting on what happens to blood glucose in the presence of numerous psychotropic medications. It seems that group wisdom points to the repeated finding that glucose can elevate as a result of some medication options.

Now, a group of researchers has shown that glucose changes can actually change how serotonin receptors work.

In the short term (several hours), elevated glucose decreased serotonin uptake.

In the long term (4 to 6 months), elevated glucose increased serotonin uptake.

It wasn't the attraction of the receptor to the molecule that was the problem. It was the activity of the receptor itself.

Which has me wondering a few things.

1. What is the point of giving a medication that increases the number of serotonin molecules when the limiting issue is about a completely different issue--whether or not the serotonin receptors are actively engaging with those molecules? You can put a million molecules out there, but if they can't get the attention of the receptors, seems like a moot strategy.

2. Seems like a setup for a vicious cycle--meds, higher glucose, more depression, more meds...yadayadayada. That is, when doctors don't let a medication sit and "brew" in the system long enough to see how it's really going to work. That's not what I see. Physicians often have very short attention spans and tend to stop one medication and start another one, frantically looking for the "fix". Looks like you truly have to let a med settle in for 4 to 6 months before making any decisions about its effectiveness.

3. Maybe we should be looking more closely at this interaction and trying to understand exactly why glucose metabolism and serotonin transport are so closely related? Nature made our brains that way for a reason. Sometimes throwing a medication at the problem we can see keeps us from seeing and understanding the problem we need to see.

I still think anyone who is diagnosed with depression should automatically get a referral to a mental health-specializing dietitian. There are a myriad of things that can be added to a treatment plan that can often keep this from even being something we have to discuss.

Gonçalves P, Araújo JR, Martel F. The effect of high glucose on SERT, the human plasmalemmal serotonin transporter. Nutr Neurosci. 2008 Dec;11(6):244-50.

And I thought I was happy after eating at Delhi Palace because the food was so good!

Turmeric is a spice commonly used in Indian cooking that is gaining attention for its health properties. Curcumin, the ingredient in turmeric that provides its yellow color, is thought to be a very powerful antioxidant and anticancer agent.

In Alzheimer's patients, not only can it prevent the accumulation of destructive beta-amyloid proteins, but it is thought to even break up already existing plaques (when I saw this, it made me wonder if this is why the oldest man in the world always seems to be living in some small Indian village.)

Now it's looking like curcumin may also have antidepressant properties. When tested on rats, it had activities mimicking that found in three different categories of antidepressants--monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and dopamine reuptake inhibitors. Specific medications it was compared to included fluoxetine (Prozac), venlafaxine (Effexor), and bupropion (Wellbutrin).

When rats were already on medication, curcumin seemed to enhance the activity of the medication. Which has me thinking that psychiatrists should be handing out coupons to the closest Indian restaurant along with their medication scripts.

It appears that curcumin absorption is better in the presence of piperidine, a component of black pepper. Curry powder, readily available in most grocery stores, is a combination of coriander, cumin, black pepper, white pepper, turmeric and chillies). Not a bad item to keep stocked in your mental health cooking arsenal.

If you like to cook, Indian food is fun and easy. To get you started, here's a link to some curry recipes. Be sure you cook with olive or canola oil to get the best brain bang for your buck.

Kulkarni SK, Bhutani MK, Bishnoi M. Antidepressant activity of curcumin: involvement of serotonin and dopamine system. Psychopharmacology (Berl). 2008 Dec;201(3):435-42. Epub 2008 Sep 3.

Yang, F; Lim GP; Begum AN; Ubeda OJ; Simmons MR; Ambegaokar SS; Chen PP; Kayed R; Glabe CG; Frautschy SA; Cole GM (February 2005). Curcumin inhibits formation of amyloid beta oligomers and fibrils, binds plaques, and reduces amyloid in vivo. Journal of Biological Chemistry (American Society for Biochemistry and Molecular Biology) 280 (7): 5892–901.

Information for aviation professionals

If any of you know anyone who is a flight attendant or a pilot, I wanted to let you know I've launched a new endeavor to address their specific needs. In all the years I've done my work, this profession consistently stands out as one at great risk for health issues...and when mental health issues hit they can end an aviator's career.

My partner in this business and I want to provide ideas and support to help lengthen some of those careers and enrich the lives of those who sacrifice much so we can get where we need to. We'll be covering everything from eating well to conquering sleep disorders to stress management.

If you are interested, or know someone who might be, please check us out!

N-acetyl-L-cysteine: use with hope, use with caution

N-acetyl-L-cysteine is an up and coming supplement, which is gaining popularity among body builders. What's interesting is that it's also showing promise as a natural antidepressant.

It makes sense that it would work for both, since NAC is an antioxidant. In the case of exercise, it helps to repair the damage created in the process of metabolizing energy to fuel the exercise. When it comes to depression, it helps to slow down the oxidative process that has been destroying neurons.

Other potential mental health issues it is showing promise for include: bipolar disorder, schizophrenia, and obsessive-compulsive disorder. It may also help with polycystic ovary syndrome, another issue I specialize in treating.

NAC is to be treated with respect, however. In mice, in large doses it has been found to increase blood pressure in the lungs and right ventricle of the heart, creating symptoms similar to what is seen in animals subjected to an oxygen-deprived environment for 3 weeks.

While this supplement may have some very useful potential, it is important to work with a professional who knows how to dose it in order to maximize your benefit from it without putting yourself at risk. The guy at the corner bodybuilding store, who makes more money, the more you use, is likely not this person. A registered dietitian with specific training ins sports nutrition is your better bet.

Ferreira FF, Biojone C, Joca SR, Guimarães FS. Antidepressant-like effects of N-acetyl-L-cysteine in rats. Behav Pharmacol. 2008 Oct;19(7):747-50

Zinc KO's Prozac in the fight against depression

Zinc is an essential mineral that can cause depression when it is deficient. In a recent study, scientists produced depression in a population of rats by creating a zinc deficiency. They went one step further and tried to reverse the depression with an antidepressant. Turns out, the rats did not respond to the medication.

Makes me wonder about another relationship. The fact that medical schools often give as little as one hour of nutrition to medical students in a four year curriculum. Could that be why, the first thing physicians think of when a patient is depressed, is to use the therapy on which semester-long courses are created, rather than to recommend something mentioned in passing in that long lost hour?

If you want to do something about your own zinc intake, remember that the highest levels of the best absorbed kind of zinc is found in protein-based choices such as beef, lamb, pork, crabmeat, turkey, chicken, lobster, clams and salmon. If you're vegan, your best bets are milk and cheese, yeast, peanuts, beans, and wholegrain cereals, brown rice, whole wheat bread, potato and yogurt.

Interestingly, pumpkin seeds are a great source of zinc. I keep running across pumpkin seeds for a lot of different pieces I'm writing these days. They just might be one of those foods you should never let yourself run out of. Trail mix, anyone?

Tassabehji NM, Corniola RS, Alshingiti A, Levenson CW. Zinc deficiency induces depression-like symptoms in adult rats. Physiol Behav. 2008 Oct 20;95(3):365-9. Epub 2008 Jul 3.