Attempts to treat autism with pharmaceuticals have had limited success, in part because the associated side effects can mask or outweigh any potential benefits.  Increasing numbers of studies are showing that daily supplements of vital nutrients, such as essential vitamins, minerals, specific amino acids and omega-3 fatty acids often effectively reduce patients’ symptoms, because they are directly converted into the neurotransmitters that pharmaceuticals aim to chemically induce.

Diet quality, which can be defined in terms of energy density, can have a profound impact on neurotransmitter function.  Western diets are typically comprised of energy-dense, nutrient-poor foods, such as those high in refined grains, added sugars and added omega-6 fats, and feature highly in a poor quality diet.  The introduction of intensive farming methods, food processing, refining and the use of pesticides, herbicides and fertilizers has led to cheaper, highly available foods, some of which are of poor nutritional value because they are essentially stripped of their nutritional content. In contrast, low energy-dense foods, such as fish, fresh vegetables and fruit, which have a high content of vitamins, minerals, and omega-3 fatty acids, are characteristic of better quality diets.

For example, the central nervous system is rich in highly unsaturated fatty acids, which cannot be synthesised by the human body but must be supplied by the diet. These highly unsaturated fatty acids are essential for normal brain development and function and play a key role in neurotransmitter regulation, including those involved in autism.  Dietary consumption of the long-chain omega-3 fatty acid EPA, commonly found in fish and fish oil, is thought to modify the risk for certain adult neuropsychiatric disorders and neurodevelopmental disorders.  There is also increasing evidence that fatty acid deficiencies or imbalances may contribute to childhood neurodevelopmental disorders, including attention-deficit/hyperactivity disorder, dyslexia, dyspraxia, and autistic spectrum disorders.  Parents of children with autism who have supplemented their children with omega-3 EPA have reported improvements in general health, sleeping patterns, cognitive and motor skills, concentration, eye contact, and sociability, as well as reductions in irritability, aggression and hyperactivity.^1,2

Other dietary interventions that have been shown to be beneficial in the management of autistic symptoms include supplementing with essential vitamins and minerals such as zinc, magnesium and several of the B vitamins known to act as co-factors in the production of neurotransmitters. Deficiencies in those nutrients that are commonly stripped from foods are becoming commonplace in the developed world.

The impact of nutritional deficiencies can have profound effects on most physiological and metabolic pathways. Given the lack of efficacy and the side effects associated with many pharmaceutical interventions, it is not surprising that patients are looking at diet as a natural method of modulating the symptoms of autism.

1. Bell JG, Miller D, MacDonald DJ, MacKinlay EE, Dick JR, Cheseldine S, Boyle RM, Graham C, O’Hare AE. (2010) The fatty acid compositions of erythrocyte and plasma polar lipids in children with autism, developmental delay or typically developing controls and the effect of fish oil intake. Br J Nutr. 103:1160-7.
2. Amminger GP, Berger GE, Schäfer MR, Klier C, Friedrich MH, Feucht M. (2007) Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study.  Biol Psychiatry. 61:551-3.

Recent evidence suggests that inflammation within the gastrointestinal tract may be of great importance in the development of IBS, and that this inflammation is directly linked to the types of food we eat and the source of fat in our diets.¹

The science

Arachidonic acid (AA) is an omega-6 polyunsaturated fatty acid (PUFA) and the precursor to a number of important immune and inflammatory substances such as prostaglandin E2 (PGE2) and leukotriene B4 (LTB4).   LTB4 is a potent immune-regulating product that is rapidly generated from cells of the immune system such as neutrophils, macrophages, and mast cells.  These cells act in part by attracting other immune cells to the site of action.  However, if the signals are not controlled correctly and LTB4 continues to be produced, this can lead to prolonged and unregulated inflammation.   Elevated levels of LTB4 have been reported in various immune and allergic diseases, including IBS²; these levels have been related to disease activity and response to treatment.  As LTB4 is not stored and released, but synthesised directly from AA, reducing the amount of AA from which LTB4 can be produced offers potential to regulate inflammation.

The fatty acid composition of the body (in other words, the type and distribution of fats that make up our cell membranes) is largely determined by what we put on our plates. Western society consumes a high ratio of omega-6 PUFA compared with omega-3 PUFA, due to excessive intake of omega-6 rich vegetable oils together with low consumption of omega-3 rich foods such as oily fish. This is bad news for people experiencing high levels of inflammation since we know that dietary dominance of the omega-6 family gives rise to pro-inflammatory products, with long-term health consequences. Replacing ‘bad’ fats in the diet with healthful monounsaturated and polyunsaturated omega-3s is essential in order to control levels of inflammation and overall health.

EPA, the long-chain omega-3 fatty acid found primarily in fish and fish oil, has been extensively researched for its potent dual-action anti-inflammatory health benefits.  Studies have shown that high doses of EPA not only reduces the amount of AA available for conversion to inflammatory products, but also gives rise to a series of anti-inflammatory products that further reduce the inflammatory state of the gut.  Given that approximately one-third of the entire immune system is located in the gastrointestinal tract, it’s not surprising that the fatty acid composition of these immune cells can impact our gut function. We also know that the fatty acid composition of inflammatory and immune cells is sensitive to change according to the fats in our diet, so we are able to manage inflammation by restricting our intake of foods rich in AA, whilst increasing foods rich in EPA.

AA-rich foods to restrict that are inflammatory:

• animal-derived products such as eggs and dairy (in particular those fed on grains)
• red meat, especially if not organic or grass-fed, is particularly rich in AA and in general, the fattier the meat, the more AA it contains

EPA-rich foods to eat more of, for anti-inflammatory benefits:

• oily fish are a direct source of EPA; limiting to two portions weekly, however, may be wise when considering the potential health issues connected to contamination of marine products with heavy metals, dioxins and PCBs.  Bear in mind that fish higher in the food chain contain higher amounts of contaminants, whereas short-lived fish tend to be ‘cleaner’. Tuna or swordfish, for example, are best restricted to two portions, whereas sardines or anchovies can be safely eaten more frequently. An alternative to consuming fish or a safe way to increase EPA levels in addition to (or instead of) fish consumption is through the use of purified EPA supplements (encapsulated to protect against oxidation), such as E-EPA 90 and Vegepa E-EPA 70.

Restricting intake of foods known to elevate AA whilst increasing EPA levels can have a positive outcome on immune and inflammatory status, not only for IBS but for overall health.  The ratio of AA to EPA within cell membranes is increasingly recognised as an indicator of general health status, and managing the ratio can offer significant long-term health benefits.  An AA:EPA ratio of less than 3 but not less than 1.5 indicates a better balance of ’anti-inflammatory’ to ’inflammatory’ products in the body. If the body reaches a ratio of 7 or more, indicating EPA deficiency, this implies that the body is in a state of ‘silent-inflammation’, which is associated with a higher risk of developing inflammatory-based conditions.

Supplementing with EPA can help to restore the natural balance of AA to EPA within the body, with 1g pure EPA daily offering significant health benefits not only for immune and inflammatory status, but also for the regulation of the cardiovascular system and for ensuring optimal brain health.

References

1. Solakivi T, Kaukinen K, Kunnas T, Lehtimäki T, Mäki M, Nikkari ST. (2011) Serum fatty acid profile in subjects with irritable bowel syndrome. Scand J Gastroenterol. 46:299-303.

2. Clarke G, Fitzgerald P, Hennessy AA, Cassidy EM, Quigley EM, Ross P, Stanton C, Cryan JF, Dinan TG. (2010) Marked elevations in pro-inflammatory polyunsaturated fatty acid metabolites in females with irritable bowel syndrome. J Lipid Res. 51:1186-92.

Isu H., Kobayashi M., Ishihara J., Sasaki S., Okada K., Kita Y., Kokubo Y., Tsugane S. Intake of Fish and n3 Fatty Acids and Risk of Coronary Heart Disease Among Japanese Circulation. 2006;113:195-202

Hu F.B., Bronner L., Willett W.C., Stampfer M.J., Rexrode K.M., Albert C.M., Hunter D., Manson J.E., Fish and Omega-3 Fatty Acid Intake and Risk of Coronary Heart Disease in Women, JAMA, 2002; 287;1815-1821.

Gebauer S.K., Psota T.L., Harris W.S., Kris-Etherton P.M., n-3 Fatty acid dietary recommendations and food sources to achieve essentiality and cardiovascular benefits, American Journal of Clinical Nutrition, 2006, Vol. 83, No. 6, S1526-1535S.

Panagiotakos D.B., Pitsavos C., Polychronopoulos E., Chrysohoou C., Zampelas A., Trichopoulou A., Can a Mediterranean diet moderate the development and clinical progression of coronary heart disease? A systematic review Med Sci Monit. 2004 Aug;10(8):RA193-8.

Yokoyama M., Origasa H., Matsuzaki M. et al. Long term use of eicosapentaenoic acid reduced major coronary events in hypercholesterolaemia, Lancet (2007);369:1090–8.

Depression is the number one psychological disorder in the UK and 10 times more people suffer from it today than 60 years ago [1], but is the UK relying too much on  prescription drugs as the sole solution for its depression problem?

The latest research shows that last year, 43.4 million prescriptions were dispensed for antidepressants – a figure 20% [2] higher than four years ago; and with one in ten people living with the condition at any one time in the UK, [3] sufferers need a more comprehensive solution.

The heart health benefits of fish oils have been well documented for decades, but it is only during recent years that their antidepressant qualities have come to light. As with commonly prescribed antidepressants, dosing and the length of the regime are key players when addressing the efficacy of any treatment.  Based on clinical studies, a daily dose of 1g pure EPA for a minimum period of three months is now advocated in order to provide relief from symptoms.

Nutrition scientist Dr Nina Bailey comments: “Modern diets rich in omega-6 and often low in long-chain omega-3 fats can leave us deficient in mood-regulating ‘good fats’ such as EPA. With sufficient levels of EPA, our bodies are able to normalise the production of inflammatory products that, in turn, influence neurotransmitter function, including the feel-good chemicals tryptophan and serotonin. In other words, EPA’s mode of action is similar to those of SSRI antidepressants, but with added benefits such as reducing cortisol, increasing blood flow to the brain, reducing inflammation, and all without the side effects associated with common antidepressants. I would urge clinicians to review the evidence in favour of EPA, and consider it as a viable add-on treatment for depressed patients.”

Anyone considering using omega-3 fish oil as part of their recovery from depression may want to muse over a few key facts before reaching out for the nearest product. The market is saturated with choice and supplements range not only in price, but also in purity, concentration, and most importantly in levels of the key active ingredient – EPA.  Whilst the research behind the potential therapeutic role of fish oil has been steadily mounting, with over 30 peer-reviewed papers published over the last decade, outcomes have often been varied and contradictory

This led researchers to investigate the discrepancies between studies in a bid to understand why some oils work and some oils simply do not.  Understandably, people trying generic fish oils for mood-enhancing benefits have often been disappointed at the results – but this is likely due to the inferior composition of standard fish oil. Not only do the majority of omega fish oil supplements available fail to offer the required dosage of 1 gram EPA required to alleviate depression symptoms, but the length of treatment of three months is also often not adhered to.

There are two omega-3s found in fish oil and the answer, it seems, lies in the greater antidepressant and anti-inflammatory efficacy of EPA than DHA [4,5]. Due to similarities in structure, EPA and DHA compete 1:1 for sites of action and the DHA within a treatment regime appears to ‘block’ the therapeutic actions of EPA, rendering the oil ineffective as an antidepressant [6].   Given that the majority of fish oils contain both EPA and DHA, often in very similar ratios, it is not surprising that there is a lack of efficacy with use of these generic products.

Removing the DHA, heavy metals, PCBs and dioxins purifies the product, whilst concentrating the EPA allows delivery of a prescription-strength dose, thereby increasing the efficacy of a treatment regime.  A pure EPA product offers significant outcomes on mood, feelings of anxiety, inflammation and levels of stress hormones – all known to play a role in the symptoms of depression that generic oils simply do not deliver. EPA is essentially an anti-inflammatory ‘good fat’ that enables our bodies to normalise inflammation, which in turn regulates neurotransmitter function and balances the feel-good chemicals tryptophan and serotonin, as well as the stress hormone cortisol. Ethyl-EPA is especially concentrated, and has been shown to offer effective support for brain cell signalling and mood balance when taken at a dosage of 1 gram daily for three months. As effective as Prozac in its actions [7,8], ethyl-EPA is becoming recognised as a safe, convenient treatment for depression and without the negative side effects associated with conventional antidepressants.

Igennus ethyl-EPA products are prescription-strength, ultra-purified and independently batch-tested, guaranteeing optimum purity and safety. An initial loading dose of E-EPA 90 is recommended, before reducing to a maintenance dose of Vegepa E-EPA 70 for long-term support. Both products are available at our online shop, Nutri Centres, Revital, Bodykind.com and all good independent health food stores.

***We’ll be donating 50 pence per box of E-EPA 90 and Vegepa E-EPA 70 sold to Depression Can Be Fun to help support the running costs of this worthy support organisation.***

[1] http://www.clinical-depression.co.uk/dlp/depression-information/major-depression-facts

[2] http://www.guardian.co.uk/uk/feedarticle/10017345

[3] http://www.mind.org.uk/help/research_and_policy/statistics_1_how_common_is_mental_distress#_edn3

[4] Martins JG, Bentsen H, Puri BK. (2012) Eicosapentaenoic acid appears to be the key omega-3 fatty acid component associated with efficacy in major depressive disorder: a critique of Bloch and Hannestad and updated meta-analysis. Mol Psychiatry. 2012 Apr

[5] Martins JG. (2009) 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.  28:525-42. Review.

[6] Sublette ME, Ellis SP, Geant AL, Mann JJ. (2011) Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry. 72:1577-84.

[7] Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, Peet M. (2008) Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry. 42:192-8.

[8] Jazayeri S, Keshavarz SA, Tehrani-Doost M, Djalali M, Hosseini M, Amini H, Chamari M, Djazayery A. (2010) Effects of eicosapentaenoic acid and fluoxetine on plasma cortisol, serum interleukin-1beta and interleukin-6 concentrations in patients with major depressive disorder. Psychiatry Res. 178:112-5.

The balance of omega-6 and omega-3 fatty acids within plasma and red blood cell membranes has, for many years, been accepted as a recognised marker of cardiovascular health.  More recently, specific information on individual fatty acids has led researchers to acknowledge that the omega-6:omega-3 ratio may not be as truly a representative biomarker as previously thought.    Both classes of fatty acids encompass many different types of fats but were previously grouped together under one ‘roof’ in regard to their health benefits. Recognising that not all omega-6 and omega-3 fatty acids within these families offer the same health benefits has led to the investigation of the specific long-chain fatty acids EPA and AA, which, unlike their short-chain precursors, give rise to a family of hormone-like substances that have mutually opposing effects on cardiovascular health.  As such, the plasma AA:EPA ratio is becoming recognised not only as a marker of inflammation but more specifically as an atherosclerotic biomarker reflecting the intrinsic omega-6:omega-3 ratio.

The specific ratio of the principal omega-3 and omega-6 fatty acids EPA and AA provides valuable information on the measure and balance of eicosanoids – hormone-like substances produced by the body that regulate a variety of immune, inflammatory and cardiovascular processes.   As a useful indicator of general health status, managing the AA/EPA ratio can offer significant long-term health benefits.  A lower AA/EPA ratio, of less than 3 but not less than 1.5, indicates a better balance of ’anti-inflammatory’ to ’inflammatory’ eicosanoids in the body. If the body reaches a ratio of 7 or over, this implies that the body is in a state of ‘silent-inflammation’ and may be at a higher risk of developing inflammatory-based conditions.  In contrast, anything exceeding a ratio of 15 means a high level of inflammation, common to many inflammatory conditions, including PAD.

Reducing the AA:EPA ratio by high dose supplementation with ethyl-EPA (E-EPA) can have significant positive benefits for many areas of cardiovascular health.     For example, the JELIS study is one of the largest cardiovascular studies and the first to have shown the benefits of high E-EPA dosing in individuals with elevated cholesterol levels. Subjects given 1.8g EPA daily saw a marked reduction in the AA:EPA ratio associated with 19% reduction in cardiovascular events during the next four and a half years². Since then, outcomes from the JELIS study have continued to show the cardiovascular health benefits of E-EPA, which is now becoming hailed as the ‘gold standard’ in treatments for PAD³.  The benefits of supplementing with E-EPA, it seems, lies in the reduction of the AA:EPA ratio and subsequent reduced production of inflammatory products produced by AA.

Igennus Healthcare Nutrition have recently launched E-EPA 90, the purest ethyl-EPA concentrate available without prescription, suitable for counteracting omega-3 deficiencies and restoring a healthy omega-6 to omega-3 ratio.   Taking just two capsules daily provides the 1g E-EPA that is consistent with published findings for long-chain omega-3 and heart health benefits.

 References

1. Fujihara M, Fukata M, Odashiro K, Maruyama T, Akashi K, Yokoi Y. Reduced Plasma Eicosapentaenoic Acid-Arachidonic Acid Ratio in Peripheral Artery Disease. Angiology. 2012 Feb 26. [Epub ahead of print]

2. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; Japan EPA lipid intervention study (JELIS) Investigators.  Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis.  Lancet. 2007 369:1090-8.

3. Yamanouchi D, Komori K. Eicosapentaenoic acid as the gold standard for patients with peripheral artery disease? – subanalysis of the JELIS trial -. Circ J. 2010 Jul;74(7):1298-9.

I also suffer with psoriasis, which I’ve had from very young, always in a chronic state, without any clearance at all. To my amazement, after eight months taking Vegepa, my skin has improved nearly 100%.  I’ve never felt it so soft and clear, with only a few patches of psoriasis which are hardly noticeable. I have also cut out wheat and dairy products.  The combination of all I have been advised to do has improved my health.  I am so glad to have been told about Vegepa.  I will continue to take it for the rest of my life!

I started taking Vegepa from Igennus in October 2011 taking 8 per day. Within a couple of months I was thinking a lot clearer and my concentration seemed to dramatically improve. Muscle soreness, energy levels and sleep patterns also improved. As well as the supplements I was doing gentle yoga stretches 1-3 times per week. I had the Perrin technique for a couple of months and then felt able to maintain my health using Vegepa and the Perrin technique homecare routine. I have now reduced the Vegepa supplements to 4 per day as a maintenance dose. From my experience I highly recommend taking Vegepa as I have found it extremely helpful to my on-going recovery.