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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Joe Bloe on February 22, 2007, at 1:39:54
WEDNESDAY, Feb. 14 (HealthDay News) -- There's no evidence that omega-3 fatty acids on their own fight depression and only limited evidence that they're effective against depression when used in combination with antidepressant drugs, according to new research.
Previous studies had suggested an association between omega-3 levels and behavior and mood disorders, including depression, according to background information in the review article, published in the journal Drug and Therapeutics Bulletin. [To see their independence claim, see http://www.dtb.org.uk/dtb/do/independence/independence.html]
Omega-3 fatty acids play a role in chemical signaling in the brain, and also help regulate blood vessel activity and immune system function linked to the central nervous system. Oily fish, nuts, seeds, and leafy green vegetables are the main dietary sources of omega-3, which is also available in dietary supplements that contain fish oil.
The review authors analyzed published studies on the clinical effectiveness of omega-3 in people with depression.
Along with their conclusion that omega-3 has little or no effect on depression, the authors said there is evidence that fish oil supplements contain environmental toxins, which may be especially concentrated in supplements made from fish livers.
This means that people should not exceed the maximum recommended doses of these supplements, the authors said. They also noted that pregnant women should take only low doses of fish oil supplements, which contain vitamin A. High levels of vitamin A can harm a developing fetus.
Posted by Declan on February 22, 2007, at 18:07:04
In reply to Little Evidence Omega-3 Fights Depression: Study, posted by Joe Bloe on February 22, 2007, at 1:39:54
I don't mean to be cynical, but any idea who funded it?
Posted by laima on February 22, 2007, at 18:32:31
In reply to Re: Little Evidence Omega-3 Fights Depression: Study » Joe Bloe, posted by Declan on February 22, 2007, at 18:07:04
I was going to say, when I think to the times I've done better, they tend to be times I've used fish oil. It's not a quick-fix of course. Perhaps that's what's confused this study?
Posted by laima on February 22, 2007, at 18:34:10
In reply to Re: Little Evidence Omega-3 Fights Depression: Study, posted by laima on February 22, 2007, at 18:32:31
...and I'd like to add, as for avoiding toxins, a reputable brand is one way to start.
Posted by Joe Bloe on February 22, 2007, at 21:42:01
In reply to Re: Little Evidence Omega-3 Fights Depression: Study » Joe Bloe, posted by Declan on February 22, 2007, at 18:07:04
This is their objectivity claim: "True to this objective, DTB has always been wholly independent of the pharmaceutical industry, Government and regulatory authorities. We are also free of advertising and every other form of commercial sponsorship."
Hmm... I dunno. Omega 3s (in the form of high quality brand - cannot remember which anymore - 6,000 mgs fish oil/day) did not work for me as monotherapy for MDD/BPII (?) - in fact it was a pretty terrible experience, and my pdoc thought I was crazy for even trying. But I do think as a supplement for my existing regimen, it has been a little effective. I have heard from friends that it has helped them quite a bit, and that they usually only notice the extent upon terminating its use.
On Remedyfind, fish oil is rated higher than many pharmaceuticals by individuals, although it might be that the expectations and the side effect profiles are lower.
Posted by dessbee on February 23, 2007, at 4:58:43
In reply to Re: Little Evidence Omega-3 Fights Depression: Stu, posted by Joe Bloe on February 22, 2007, at 21:42:01
Fishoil is not a total cure, but a nice friend to have.
6 gram is a high dose
What side effects did you experience? insomnia?
Posted by circusboy on February 23, 2007, at 9:03:56
In reply to Little Evidence Omega-3 Fights Depression: Study, posted by Joe Bloe on February 22, 2007, at 1:39:54
> Along with their conclusion that omega-3 has little or no effect on depression, the authors said there is evidence that fish oil supplements contain environmental toxins, which may be especially concentrated in supplements made from fish livers.
>
I was under the impression, (esp. from some of Larry Hoover's older posts), that toxins weren't a large concern with standard fish oil supplements. Heavy metals, at least, bind to protein, not fat.> This means that people should not exceed the maximum recommended doses of these supplements, the authors said. They also noted that pregnant women should take only low doses of fish oil supplements, which contain vitamin A. High levels of vitamin A can harm a developing fetus.
>
This claim is also misleading. Maybe (if we're continuing with the cynical theme) even disingenuous. Most people who take fish oil aren't being force-fed cod liver oil from a large tin spoon in an English orphanage... they're taking purified gelatin capsules that contain only fats. There's no appreciable vitamin A content that I'm aware of in these. Correct me if I'm wrong.-cb
Posted by Joe Bloe on February 23, 2007, at 13:11:35
In reply to Re: Little Evidence Omega-3 Fights Depression: Stu » Joe Bloe, posted by dessbee on February 23, 2007, at 4:58:43
Just to be clear: I was (and recently started again) taking 6 grams of total fish oil - so that's 6/1000 mg standard (180 epa/120 dha) capsules a day, not 6 grams of total EPA/DHA.
I am under the impression that this is a standard or even below standard dose for therapeutic effects for mdd, add, etc etc., but I could be mistaken.
No real side effects to speak of, but it's hard to say what is from what anymore!
Posted by Joe Bloe on February 23, 2007, at 13:16:16
In reply to Re: Little Evidence Omega-3 Fights Depression: Stu, posted by circusboy on February 23, 2007, at 9:03:56
Interestingly enough, my pdoc highly recommends the omega 3s as a supplement - he even admitted to taking them himself. But he also warned about the toxins in some of the cheaper brands. He said to buy quality brands that claim to purify any toxins out of the oil. He said something about a double or triple purifying process that the better brands use.
Posted by linkadge on February 24, 2007, at 8:57:39
In reply to Re: Toxins and Omega 3s - warning from pdoc, posted by Joe Bloe on February 23, 2007, at 13:16:16
It is true, its not a quick fix. I don't know if omega-3 would offer the quick illicit-drug like effects of most prescriptions, but I have noticed improvements after longer term supplementation.
So I know know if the design of traditional antidepressant trials would fully capture the benifit of omega-3.I would have to look at the studies which were analyzed to look for things like duration of length etc.
I think it really all depends on the particular view. I mean, one can compile data for prescription antidepressants that makes them look like miracle cures or one can compile data on prescription antidepressants that makes them look like sugar pills.
The timing seems a little questionable too. Everbody is attacking the efficacy of prescription drugs, it only seems natural that somebody would attempt to attack the efficacy alternative treatments. I wouldn't be suprised if there were alternative motives.
Linkadge
Posted by linkadge on February 24, 2007, at 9:02:01
In reply to Re: Toxins and Omega 3s - warning from pdoc, posted by linkadge on February 24, 2007, at 8:57:39
Another thing too, is that while the authors of this study may not have held bias, does not mean that the studies the were analyzing were not biased.
For instance, one could could not review the trials of SJW without encountering bias.
Linkadge
Posted by Larry Hoover on February 25, 2007, at 18:19:39
In reply to Little Evidence Omega-3 Fights Depression: Study, posted by Joe Bloe on February 22, 2007, at 1:39:54
> Along with their conclusion that omega-3 has little or no effect on depression, the authors said there is evidence that fish oil supplements contain environmental toxins, which may be especially concentrated in supplements made from fish livers.
>
> This means that people should not exceed the maximum recommended doses of these supplements, the authors said. They also noted that pregnant women should take only low doses of fish oil supplements, which contain vitamin A. High levels of vitamin A can harm a developing fetus.Hogwash. That's my reaction to this article. I'd like to see the actual published version, but I can't yet find it. Anyway....
I'm an environmental toxicologist, and these toxicants that were inferred are the dioxins, PCBs, PCDDs, and similar cyclic hydrocarbons. They are fat-soluble, so they do partition into fatty tissues, or oils. The thing is, recent studies have shown that fish and fish oil are no more contaminated than meat or dairy. Belgian and Norwegian studies have those three groups at about 30% each as dietary sources, with the rest made up by grain products. In Egypt, 90% of these toxicants are dairy-sourced. I don't hear anyone saying butter is contaminated (or beef), do I?
Any risk-benefit analysis I've ever read has concluded that fish oil intake is better for you than the effect of trying to avoid the contaminants it contains. And I agree with them. However, that's not to say that spending a little more and getting a certified pure product isn't worth the money. Peace of mind is priceless. The findings of toxic substances at these ppt (part per trillion) levels is really a result of better instrumentation. Twenty years ago, these toxins were undetectable. Do what you can to reduce the burden, but don't lose any sleep over it.
I've grabbed a couple of recent abstracts to make two points. The first is that fish oil is almost totally accepted as an augmentative treatment strategy in mood disorders. Look at the names of the authors, below. Second point: Whole fish is better for you than is fish oil, even at equivalent fatty acid intake levels. For unexplained reasons, the fat from whole fish is better absorbed. It's possible (but unproven) that my admonishment to take fish oil with your fattiest meal of the day might minimize that poor uptake, but I'm just speculating.
Best,
LarJ Clin Psychiatry. 2006 Dec;67(12):1954-67.
Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry.
Freeman MP, Hibbeln JR, Wisner KL, Davis JM, Mischoulon D, Peet M, Keck PE Jr, Marangell LB, Richardson AJ, Lake J, Stoll AL.
Women's Mental Health Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson 85724-5002, USA. marlenef@email.arizona.eduOBJECTIVE: To determine if the available data support the use of omega-3 essential fatty acids (EFA) for clinical use in the prevention and/or treatment of psychiatric disorders. PARTICIPANTS: The authors of this article were invited participants in the Omega-3 Fatty Acids Subcommittee, assembled by the Committee on Research on Psychiatric Treatments of the American Psychiatric Association (APA). EVIDENCE: Published literature and data presented at scientific meetings were reviewed. Specific disorders reviewed included major depressive disorder, bipolar disorder, schizophrenia, dementia, borderline personality disorder and impulsivity, and attention-deficit/hyperactivity disorder. Meta-analyses were conducted in major depressive and bipolar disorders and schizophrenia, as sufficient data were available to conduct such analyses in these areas of interest. CONSENSUS PROCESS: The subcommittee prepared the manuscript, which was reviewed and approved by the following APA committees: the Committee on Research on Psychiatric Treatments, the Council on Research, and the Joint Reference Committee. CONCLUSIONS: The preponderance of epidemiologic and tissue compositional studies supports a protective effect of omega-3 EFA intake, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in mood disorders. Meta-analyses of randomized controlled trials demonstrate a statistically significant benefit in unipolar and bipolar depression (p = .02). The results were highly heterogeneous, indicating that it is important to examine the characteristics of each individual study to note the differences in design and execution. There is less evidence of benefit in schizophrenia. EPA and DHA appear to have negligible risks and some potential benefit in major depressive disorder and bipolar disorder, but results remain inconclusive in most areas of interest in psychiatry. Treatment recommendations and directions for future research are described. Health benefits of omega-3 EFA may be especially important in patients with psychiatric disorders, due to high prevalence rates of smoking and obesity and the metabolic side effects of some psychotropic medications.
Lipids. 2006 Dec;41(12):1109-14.
Enhanced incorporation of n-3 fatty acids from fish compared with fish oils.
Elvevoll EO, Barstad H, Breimo ES, Brox J, Eilertsen KE, Lund T, Olsen JO, Osterud B.
Norwegian College of Fishery Science, Department of Marine Biotechnology, University of Tromso, Norway. edel.elvevoll@nfh.uit.noThis work was undertaken to study the impact of the source of n-3 FA on their incorporation in serum, on blood lipid composition, and on cellular activation. A clinical trial comprising 71 volunteers, divided into five groups, was performed. Three groups were given 400 g smoked salmon (n = 14), cooked salmon (n = 15), or cooked cod (n = 13) per week for 8 wk. A fourth group was given 15 mL/d of cod liver oil (CLO) (n = 15), and a fifth group served as control (n = 14) without supplementation. The serum content of EPA and DHA before and after intervention revealed a higher rise in EPA and DHA in the cooked salmon group (129% rise in EPA and 45% rise in DHA) as compared with CLO (106 and 25%, respectively) despite an intake of EPA and DHA in the CLO group of 3.0 g/d compared with 1.2 g/d in the cooked salmon group. No significant changes were observed in blood lipids, fibrinogen, fibrinolysis, or lipopolysaccharide (LPS)-induced tissue factor (TF) activity, tumor necrosis factor-alpha (TNFalpha), interleukin-8 (IL-8), leukotriene B4 (LTB4), and thromboxane B2 (TxB2) in whole blood. EPA and DHA were negatively correlated with LPS-induced TNFalpha, IL-8, LTB4, TxB2, and TF in whole blood. In conclusion, fish consumption is more effective in increasing serum EPA and DHA than supplementing the diet with fish oil. Since the n-3 FA are predominantly in TAG in fish as well as CLO, it is suggested that the larger uptake from fish than CLO is due to differences in physiochemical structure of the lipids.
Posted by Joe Bloe on February 25, 2007, at 19:46:25
In reply to Re: Little Evidence Omega-3 Fights Depression: Study » Joe Bloe, posted by Larry Hoover on February 25, 2007, at 18:19:39
Great explanation and abstracts, thanks Larry.
Assuming you take a daily fish oil supplement, what form of fish oil and in what amount do you take?
Posted by Larry Hoover on March 1, 2007, at 10:42:46
In reply to Little Evidence Omega-3 Fights Depression: Study, posted by Joe Bloe on February 22, 2007, at 1:39:54
For some reason, the BMJ site that hosted the original article has been down ever since the day I first saw the lay press article, posted by JB. However, today the page opened, and here's a link to the original text: http://press.psprings.co.uk/dtb/February/dtbfeb.pdf
I'm comforted to note that the study I posted in refutation of what I took to be a slam on fish oil was a central part of the scholarly article.
I think it's an interesting exercise to contrast exact quotations from the two pieces of work, the academic press and the lay press versions.
Lay press:
"Along with their conclusion that omega-3 has little or no effect on depression..."Original, academic press:
"CONCLUSION:
Despite observational evidence linking depression with reduced intake of long-chain omega-3 fatty acids, there is no convincing basis for using these nutrients as a sole treatment for the condition. There is limited evidence suggesting that long-chain omega-3 fatty acid supplements might help to relieve depression when given in addition to existing antidepressant medication."I don't know about you, but I get entirely different messages from the two 'conclusions'.
As I said, the Freeman et al article was a central point in this review article, and I quote further from the latter:
"One meta-analysis (ref 4) combined all the studies involving adults with unipolar or bipolar depression reported above,(refs 16-24) in which omega-3 fatty acids were used to augment existing treatments or as monotherapy. Best-case and worst-case analyses were carried out, and omega-3 fatty acids were found to produce a statistical improvement compared to placebo under both scenarios (best-case p=0.02, worst-case p=0.03)."The lay press article also confounded the distinction between fish liver oils and fish body oils, and the implications for pregnancy. But, enough analysis. The problem is, the lay press article is the one that went around the world, and was read by most people.
Lar
Posted by Larry Hoover on March 1, 2007, at 11:05:27
In reply to Re: Evidence Omega-3 Fights Depression, posted by Joe Bloe on February 25, 2007, at 19:46:25
> Great explanation and abstracts, thanks Larry.
>
> Assuming you take a daily fish oil supplement, what form of fish oil and in what amount do you take?I use salmon oil, and the cheapest I can find. I'm satisfied that the industry has adopted Good Manufacturing Practises, and that toxin burdens are reduced in so far as it is practical to do so. http://tinyurl.com/43qjy I also eat a fair amount of fish. I've never tried high-EPA oils, so I have no idea of their effect on me.
Fish and/or fish oil confer resiliency on me. Considering how hard it is to measure such a construct, short-term supplementation trials would almost certainly fail to detect the subtle character of this trait.
It's also important to recognize that oxidative stress has a role to play in PUFA metabolism, so antioxidants should be increased simultaneously with increased PUFA intake. That would be the inter-related core group of mixed tocopherol vitamin E, vitamin C, and alphalipoic acid, along with selenium and zinc.
Lar
Posted by jed on March 8, 2007, at 17:20:16
In reply to Re: Evidence Omega-3 Fights Depression » Joe Bloe, posted by Larry Hoover on March 1, 2007, at 11:05:27
I'm currently taking Omacor for bipolar disorder. It is the Omega-3 pharmaceutical, made by Reliant Pharmaceuticals, Inc. It doesn't seem to help depression but it might be a bit of a mood stabilizer... I think it is helping my hair, so I suppose that's something! (That is, the hair that is not falling out due to the Lamictal...)
Does anyone know anything about Omacor? Here's their blurb:
"By prescribing OMACOR, your doctor is giving you a concentrated and reliable omega-3. Each OMACOR capsule contains 90% omega-3 acids (84% EPA/DHA*). OMACOR is naturally derived and manufactured through a unique, patented process that creates a highly concentrated, highly purified prescription medicine. The unique manufacturing process for OMACOR helps to eliminate worries about mercury and other pollution from the environment."
Just because they say we needn't worry about pollutants doesn't mean we're truly safe...
I'm interested in any opinions or knowledge about Omacor, especially about possible toxins.
Posted by Joe Bloe on March 8, 2007, at 22:00:40
In reply to Re: Evidence Omega-3, Omacor?, posted by jed on March 8, 2007, at 17:20:16
Did your pdoc prescribe Omacor for Bipolar? If your pdoc did, that's pretty cool. Wasn't it designed to treat high blood pressure or cholesterol or something?I would assume it is genuinely pretty pure, probably as high-grade as it comes.
How much lamictal do you take with it?
Posted by jed on March 10, 2007, at 0:44:11
In reply to Re: Evidence Omega-3, Omacor?, posted by Joe Bloe on March 8, 2007, at 22:00:40
>
> Did your pdoc prescribe Omacor for Bipolar? If your pdoc did, that's pretty cool. Wasn't it designed to treat high blood pressure or cholesterol or something?
>
> I would assume it is genuinely pretty pure, probably as high-grade as it comes.
>
> How much lamictal do you take with it?Yes, my pdoc prescribes it for bipolar disorder, at my request. You're right, it is FDA approved for heart conditions. It lowers triglycerides, that's all I know.
Because I am distrustful of the pharmaceutical industry, I worry about toxins, that maybe they get a fish oil supply that has extra poison, super concentrated! ...but I'll bet you're right, it is probably quite pure.
I take 100mg of Lamictal a day, and two Omacor, which comes to almost 2 grams of Omega 3. I've tried to increase the Omacor, but it seems to give me insomnia. I have recently added phosphatidylcholine to the mix, since I heard it is good to take with fish oil (don't know if it's true) and also that it has possible mood stabilization effects.
Yes, I am lucky to have a pdoc who listens to me and is willing to try new things. She'll go out on a bit of limb if it will help me get relief. She has seen me work so very hard over the years, and after a while, she realized I will do whatever I can to get better and that my ideas are as good as anyone's. I am really grateful.
Posted by LOOPS on March 15, 2007, at 9:45:42
In reply to Re: Evidence Omega-3, Omacor?, posted by jed on March 10, 2007, at 0:44:11
I've recently been taking fish oil again for a leg injury, but I am wondering if the reason the oil alone isn't as good as 'the real thing' is because fish contains high amounts of other things very useful for depression like taurine and magnesium and B vitamins, and goodness knows what else we haven't discovered yet.
Loops
Posted by jed on March 18, 2007, at 14:48:50
In reply to Re: Evidence Omega-3, Omacor?, posted by LOOPS on March 15, 2007, at 9:45:42
> I've recently been taking fish oil again for a leg injury, but I am wondering if the reason the oil alone isn't as good as 'the real thing' is because fish contains high amounts of other things very useful for depression like taurine and magnesium and B vitamins, and goodness knows what else we haven't discovered yet.
>
> LoopsThat's got to be true. Nothing like a real food source. It's just so hard to get those mega doses with the whole food!
Posted by LOOPS on March 19, 2007, at 8:02:43
In reply to Re: Evidence Omega-3 » LOOPS, posted by jed on March 18, 2007, at 14:48:50
Yes that's what I thought but actually you'd be amazed at how much n-3 is in, say, salted mackerel for instance. Per 100g there is over 5g - yes, that's 5 GRAMS of omega-3 - for only a single serving, and you get all the different types of n-3 that seem to be missing from the capsules -
http://www.nutritiondata.com/facts-C00001-01c220q.html
Salmon has around 2.5g of n-3 per 100g. 100g isn't a lot of fish. That's 8 of 300mg fish oil capsules to equal, and you don't get the Mg or the taurine (around 100mg Mg per 100g - not bad). Unfortunately I don't know how much taurine is in 100g of salmon - can't seem to find data on this anywhere.
On a side note, did you know that lard has a huge amount of vitamin D in it? If I remember correctly nearly 3000IU per 100g. Yeah not many people are going to eat 100g of lard (apart from me and those rendered crispies) but it makes me think how people used to cook in lard and now cook with vegetable oil and miss out on the extra D.
Loops
Posted by jed on June 5, 2007, at 20:25:35
In reply to Re: Evidence Omega-3, Omacor?, posted by jed on March 10, 2007, at 0:44:11
I just found out that Omacor has a mystery ingredient other than omega 3 fatty acids. Its action is to "inhibit certain liver enzymes." Omega 3's don't do that, and I don't want my liver enzymes "inhibited," so I stopped taking it. I should have figured that a pharmaceutical company wouldn't concentrate something natural without throwing something funny in...
Posted by Iansf on June 27, 2007, at 1:02:06
In reply to Careful of Omacor!, posted by jed on June 5, 2007, at 20:25:35
> I just found out that Omacor has a mystery ingredient other than omega 3 fatty acids. Its action is to "inhibit certain liver enzymes." Omega 3's don't do that, and I don't want my liver enzymes "inhibited," so I stopped taking it. I should have figured that a pharmaceutical company wouldn't concentrate something natural without throwing something funny in...
By law, all ingredients have to be listed for any substance that's ingested, at least in the US. So whatever this mystery ingredient is, if the product is sold in the US, it has to be identified somewhere on the container. If you haven't bought the product but just seen marketing for it, the company has to provide the names of all ingredients on request.
This is the end of the thread.
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