By Dr. Erin Wiley, ND

Stay tuned to the BLOG for part four in the “Brain on Fire” series by Dr. Wiley!

Fish oil has had a long track record of good evidence supporting its ability to decrease inflammation, influence mood and support mental health. The active nutrients in fish oil are Omega -3 Fatty acids: EPA and DHA. EPA is the primary anti-inflammatory omega 3 in the brain, while DHA is the primary structural component. When omega-3 fatty acids levels are low in the brain, increased neuro-inflammation occurs.

Studies on fish oil vary. but the focus is on finding the best therapeutic dose and balance between EPA and DHA. One study has compared the therapeutic effects of EPA to a common anti-depressant fluoxetine. The results showed that taking both an antidepressant and EPA had the greatest therapeutic effect. When compared side-by–side, participants taking 1000mg of EPA saw the same benefits as participants taking 20mg of the antidepressant alone and both treatment groups saw significant improvements over placebo [18]. When we look at larger meta-analysis of studies on fish oil and depression across the board, again we see that results vary based on the therapeutic dose but that there is a consistent therapeutic effect across the board [19].

The key thing to keep in mind when choosing fish oil as a therapeutic option is that the therapeutic dose for inflammation is a concentration of EPA that is greater than 2000mg/day. While the therapeutic dose for improved mood is achieved at concentrations of EPA above 1000mg per day, the ratio of EPA to DHA is very important and needs to be greater than 6:1.

Fish oil has an outstanding safety profile. This fact cannot be ignored. Compared to conventional options, fish oil offers little to no safety risk outside of food allergy and does not pose a threat to drug interactions with antidepressant medications. However, the product should be checked to ensure that is it does not contain mercury or other heavy metals and pollutants. The product should not be exposed to the air as it will oxidize and the product should be made from an environmentally sustainable source.

Due to the great number of benefits from omega-3 fatty acids, clients often ask my opinion on two main areas: Can we get enough omega-3s from eating fish and can I choose other oils that are high in omega-3 such as flax oil. The answer to both of these questions comes down to therapeutic dose. While eating fish and consuming flax oil as part of a healthy diet are generally recommended, it would seem impractical to consume enough fish daily to achieve 2000mg per day of EPA and impossible to convert enough flax oil to the proper dose and ratio to have the specific anti-depressant effects.

Another supplement that has been well established for its effects on inflammation are probiotics, or the healthy bacteria that live in your gut. Recent studies on a particular strain of bacteria, Lactobacillus Rhamnosus, suggest a direct connection between the health of the gut and  the health of the brain. Studies on mice showed that Lactobacillus Rhamnosus reduced inflammatory markers, lowered corticosteroid hormone release and elevated GABA [20], thus having a direct effect on neurotransmitters by reducing inflammation, decreasing stress hormone production and producing calming brain chemicals. Probiotics also have an amazing safety profile with little side effects and no evidence that they would interfere with anti-depressant medications.

Both fish oil and probiotics are recommended by most Naturopathic doctors as either a preventive strategy for depression or as part of a comprehensive treatment plan. These supplements can be taken daily and are safe to use long term.

References

18. Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, et al. 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. 2008 Mar;42(3):192-8.

19. Lin PY, Su KP. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry. 2007 Jul;68(7):1056-61.

20. Bravo JA, Forsythe P, Chew MV, Escaravage E, Savignac HM, Dinan TG, et al.  Proc Natl Acad Sci U S A. 2011 Sep 20;108(38):16050-5. Epub 2011 Aug 29.

Dr. Erin Wiley is a naturopathic doctor with a strong focus on preventative and integrative medicine. She is the Co-founder and Clinic Director of the Integrative Health Institute, an integrative medical clinic located in downtown Toronto. Erin has a strong clinical emphasis on stress related illness, anxiety, depression and hormone balance. As a naturopathic doctor, Erin is passionate about working with people to help them better understand their health and achieve their health goals.

About Integrative Health Institute:

The Integrative Health Institute (IHI) is a modern and dynamic clinic, founded in naturopathic philosophy and embodying team-driven healthcare. IHI reflects a vision to create an urban health centre that is driven by a team of practitioners passionate about health promotion and illness prevention. Since its inception, IHI has grown to become a full service integrative health clinic, with more than 13 practitioners including naturopathic doctors, osteopathic & chiropractic doctors, massage therapists, and nutritional/lifestyle coaches.

Contact Information:

Dr. Erin Wiley can be reached at ewiley@IntegrativeHealthInstitute.ca or please visit her website at www.integrativehealthinstitute.ca

main image via jypsygen via Compfight