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contents

DEPARTMENTS

FEATURES

SPRING 2016 • IHPMAGAZINE.COM 4

7 Publisher’s Letter

8 Editorial Board

10 Product Pro�les

16 Clinic Pro�leP3 Health

30 Post Scriptum

12 Cyber Security

22 The Use of Omega-3 in Psychiatric Diagnoses

26 French Maritime Pine Bark Extract(Pycnogenol®) Effects on Human Skin: Clinical and Molecular Evidence

�nd us on2616

22

IHP Contents.indd 4 2016-04-21 10:12 AM


publisher’s letter

O ver the years, we have had to adapt

to the ever-changing industry. We

constantly have to ask ourselves, “Is

this case the same as the last?” The answer,

of course, is “absolutely not.”

Although Millennials are often dismissed,

they are actually redefining the health-care

industry. Some sources state that Millennials

represent about 25 per cent of the U.S.

population. That is a lot of people who are

starting to care about their health like never

before. It’s time to start thinking out of the

box when it comes to certain treatments.

What sets Millennials apart from other

generations is that they have knowledge

right at their fingertips and aren’t afraid to

use it. They aren’t satisfied with cut-and-dry

diagnosis, they want to partake in a lifestyle.

Millennials are realizing that health care is

more than a prescription. So, while they

might want a quick fix, they also want to be

able to connect and relate to each other’s

experiences. This is an opportunity to make

your business more personal. Your commu-

nity can be the first step, and sharing news

with it—such as a new treatment—will draw

in those who are interested in what you are

doing differently.

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Founder Sanjiv Jagota

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Contributors

Hillary Booth, Phill Feltham, Rochelle Fernandes, Susanne

Grether-Beck, Thomas Jaenicke, Jean Krutmann, Alessandra

Marini, Makoto Trotter, Erin Wiley.

IHP Magazine Inc.

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Advertising Olivier Felicio Weng Ng(416) 203-7900 x 6107 (416) 203-7900 x [email protected] [email protected]

SPRING 2016 • Volume 9 Issue 2

Olivier Felicio

Publisher/Editor-in-Chief

Know your patients

IHP PubLetter.indd 7 2016-04-21 10:12 AM


cover story

THE USE OF OMEGA-3 IN PSYCHIATRIC

DIAGNOSESBy Rochelle Fernandes, MSc., ND (cand.)

Peer-reviewed by Makoto Trotter BSc(Hons), ND, Erin Wiley, ND, & Hilary Booth, ND, HBSc

IHP Cover Story.indd 22 2016-04-21 10:31 AM


P sychiatric diagnoses can be challenging to treat.

While antipsychotic and antidepressant medica-

tions are designed to treat psychotic and affective

symptoms, the effects are often suboptimal, and are

accompanied by several side effects. There seems to be

a growing need to supplement conventional treatment

with naturopathic options in this group of disorders. As

such, there has been an increasing interest and recent

research on omega-3 supplementation in psychiatric

disorders (schizophrenia, attention deficit hyperactivity

disorder (ADHD), bipolar disorder and depression).

MECHANISMS OF ACTION OF OMEGA-3 IN PSYCHIATRIC DISORDERSIt has been hypothesized that omega-3/polyunsaturated

fatty acid (n-3 PUFA) supplementation may confer neuro-

protective effects. Several studies have shown that an

accumulation of n-3 PUFAs in neural cells may have a

positive effect on neuronal function, alongside anti-in-

flammatory and antioxidant activities (Itua, 2010), (Orr,

2013). Other activities include that n-3 PUFA increases

membrane fluidity (Meijerink, 2013), activates peroxisome

proliferator activated receptors, and enhances neuro-

trophic support (Kou, 2008). These multi-faceted mech-

anisms of action lend support for theories of possible

neuroprotective and cognitive benefits in psychiatric

disorders.

Reviews on the subject concluded that PUFAs and their

mediators are responsible for certain processes within

the central nervous system: (1) the maintenance of cell

structure and function of neurons, glial cells and endothelial

cells; (2) the regulation of neuro-inflammatory processes;

and (3) the modulation of neurotransmission (Bazinet,

2014). These mechanisms provide a basis for mood reg-

ulation, symptom control and cognitive function. This

enables an understanding of how n-3 PUFA may be a novel

therapeutic target of interest in several psychiatric dis-

orders, such as depression and schizophrenia.

It is thought that altered mechanisms of action, includ-

ing, but not limited to decreased levels of eicosapentaenoic

acid (EPA) and docosahexaenoic acid (DHA), are one of

the causes of certain psychiatric disorders. One meta-anal-

ysis of 14 case-control studies showed significant reduc-

tions in EPA and DHA in plasma and erythrocytes in subjects

with major depression (Lin, 2010). Another set of studies

showed that bipolar patients had significant erythrocyte

DHA and/or EPA deficits when cross comparing them to

healthy counterparts (Chiu, 2003, McNamara, 2015). Cross-

sectional studies have found that children with a very high

risk for mood disorders have erythrocyte EPAand DHA

deficits compared with healthy individuals (Clayton, 2008).

Well established erythrocyte EPAandDHA low levels

were also seen in those with social anxiety disorder (Green,

2006), and plasma EPAandDHA deficits were found in those

with major depression alongside comorbid anxiety disor-

ders (Liu, 2013). One study showed that those who had

taken no medication at the onset of psychosis had eryth-

rocyte DHA and arachidonic acid (AA) deficits compared

with healthy individuals (Khan, 2002). An interesting

meta-analysis of 18 case-control studies also showed

significant low levels of DHA and AA in schizophrenic indi-

viduals (Hoen, 2013). These studies suggest that deficits

in erythrocyte DHA and AA may predispose patients to

psychosis, and persist in those diagnosed.

This same logic was used in another meta-analysis of

nine cross-sectional studies that found lower blood EPA

and DHA levels in children with ADHD compared with

healthy controls (Hawkey, 2014). The rationale behind the

use of omega-3 supplementation is an intent to treat;

correcting this deficiency.



cover story

EVIDENCE FOR USING OMEGA-3 IN SCHIZOPHRENIAA growing body of evidence exists for the use of omega-3s

in schizophrenia. When any dose of omega-3 ethyl-EPA

(E-EPA or EPA) is compared with placebo, a small, short set

of studies suggest that the need for neuroleptic medication

seems to be decreased for people taking omega-3 (n=30,

1 RCT, RR 0.73 CI 0.54 to 1.00) and mental state may improve

(n=30, 1 RCT, RR not gaining 25 per cent change in PANSS

scores 0.54 CI 0.30 to 0.96, NNT3 CI 2-29) (Joy, 2006).

A Cochrane Review investigated the use of omega-3

and evening primrose oil to treat symptoms of schizophre-

nia. The review found a positive effect of EPA versus placebo

for scale-derived mental state outcomes, in the context of

symptom improvement. It should be noted that the data

is preliminary and further studies with more power are

necessary to confirm the effect to a greater degree. A

smaller study within this review looked at using EPA as the

only treatment for people hospitalized for relapse. The

results showed that EPA may help 33 per cent of people

who avoid using antipsychotic medication for twelve weeks

(RR 0.6, CI 0.4-0.91) (Joy, 2000).

One meta-analysis showed that when individuals in the

prodromal state of schizophrenia took omega-3, it reduced

psychotic symptom severity and lowered conversion rates

to first-episode psychosis. Similar findings were echoed

with first-episode schizophrenia; omega-3 lowered non-psy-

chotic symptoms, required smaller antipsychotic medica-

tion dosages, and heightened early treatment response

rates (Chen, 2015).

One randomized, placebo controlled study provided clin-

ical value by mention of dosage; 2,200 milligrams of n-3 PUFA

or placebo was given for 26 weeks and the study evaluated

symptoms in first episode schizophrenia. They concluded

that this dosage was effective as an adjunctive therapy as

per the following results: improvement of 50 per cent in

symptom severity; (p = 0.017), an improvement in depressive

symptoms (p = 0.006), and a higher level of functioning (p =

0.01) in the n-3 PUFA group (Pawełczyk, 2016).

It should be noted that many studies used only EPA and/

or did not always cite the ratio of EPA:DHA, however, this

could be an interesting point for further examination.

Overall, the dosage of omega-3 used in schizophrenia

seems to be approximately 2,200 milligrams.

EVIDENCE FOR USING OMEGA-3 IN BIPOLAR DISORDER, ADHD AND DEPRESSIONN3-PUFA is thought to be involved in the pathophysiology,

treatment and prevention of bipolar disease (BD) (Sublette

M. E., 2011). The protective function of n-3 PUFA was exam-

ined in patients with BD. DHA and EPA caused increased

membrane fluidity, as detected by reductions in T2 (a

membrane integrity marker) values, compared to controls

in a four-week study (Hirashima, 2004).

A small, double-blind, placebo controlled trial examined

the effects of EPA treatment in BD patients, as associated

with increased brain levels of N-acetyl aspartate (NAA), a

marker thought to be active in neuronal integrity. Fourteen

female BD patients were given two grams of E-EPA per day

or placebo for 12 weeks. The results showed a significant

rise in NAA levels in the E-EPA group versus placebo (p =

0.027), thus establishing grounds for a possible neuropro-

tective role of n-3 PUFA in BD that can be further examined

with larger studies (Frango, 2007).

N-3 PUFA was also proposed to be useful in the treatment

of ADHD. One meta-analysis showed that in the primary

analyses, n-3 PUFA did not show improvements in emotional

lability (EL), oppositional behaviour, conduct problems or

aggression. However, subgroup analyses of higher quality

studies and those meeting strict inclusion criteria found a

significant reduction in EL and oppositional behaviour. This

could indicate that larger sample sizes may amplify this

effect and show value in highlighting the effects of n-3

PUFA on reducing EL in subsets of children with ADHD

(Cooper, 2016). A randomized controlled trial showed that

supplementation with n-3 PUFA improved the red blood

cell fatty acid profile by significantly reducing AA/DHA in

the intervention group when compared with controls (P=

0.000) in children with ADHD (Wu, 2015).

Cross-sectional studies have found that children with a very high risk for mood disorders have erythrocyte EPA and DHA deficits compared

with healthy individuals



Much like BD, n-3 PUFA has also been proposed to have

a beneficial effect when used alongside conventional med-

ication in major depressive disorder (MDD). A meta-analysis

demonstrated a beneficial effect of omega-3 PUFAs on

depressive symptoms in MDD (standardized mean differ-

ence=0.398 (0.114-0.682), (P=0.006); the statistics showed

a positive correlation between increasing the EPA dose and

positive effects on MDD symptoms. EPA was also shown to

provide better outcomes in patients taking antidepressants

than in those who were taking EPA alone (Mocking, 2016).

The clinical benefit appears as follows: it seems that

dosage ranges of omega 3 vary in these disorders. However,

several studies including a valuable meta-analysis sug-

gested that an administration of at least 60 per cent or

more of EPA, with a dosage range of 200 to 2,200 milligrams

of EPA over the amount of DHA showed beneficial outcomes

in depression (Sublette E. M., 2011).

Overall, n-3 PUFAs are thought to be involved in the

pathophysiology, treatment and prevention of BD, ADHD,

MDD and schizophrenia. The clinical value from the studies

mentioned above is at an average dose of 200 to 2,200

milligrams for psychiatric disorders in this article. The

mechanisms of action involved are thought to include a

reduction or alteration of cellular/plasma EPA and DHA,

with the aim of supplementation to correct this deficit.

Further research and future directions of study are required

to solidify this effect by designing studies with greater

statistical power that could include a thorough examination

of EPA:DHA ratios specific to each of these disorders.

Nonetheless, many studies have already shown successful

adjuvant treatment of omega-3s alongside conventional

medicines, with improvement at the cellular and clinical

level. These findings warrant omega-3s as a valuable ther-

apeutic option for psychiatric diagnoses.

NPN80051437

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