I appreciate everyone’s prayers and encouragement as I continue on my PBS tour. The program is one of the top shows for PBS this season, which means people are interested in brain health.  I am traveling to 8 cities over the next week or so, including Hartford, CT (tonight), Pittsburgh, Tampa Bay, Long Island, NY, Miami, Raleigh, Phonex and Detroit.
Also, in the morning (Tues AM) I will be on Good Morning America talking about the brain and poor judgment with the current scandal in New York.
I was emailed today a wonderful interview about fish oil, substance abusers and anger reduction. I include it here for your information. It is great reading and a very forward thinking study.
Substance Abuse, Anger and Omega-3 Fatty Acids
Laure Buydens-Branchey, M.D.
Research Service (151/BK)
VA New York Harbor Healthcare System – Brooklyn Campus
800 Poly Place, Brooklyn, NY, 11209, USA
“Long-chain N-3 Polyunsaturated Fatty Acids
Decrease Feelings of Anger in Substance Abusers,”
Psychiatry Res, 2008 Jan 15;157(1-3):95-104 45708 (2/2008)
Kirk Hamilton: Can you please share with us your educational background and current position?
Laure Buydens-Branchey: I have an MD degree and was trained as a psychiatrist at the Payne Whitney
Clinic, The New York Hospital (now the Weil Cornell Medical College) in New York, NY. I am presently a psychiatrist assigned to the Research Service at the New York Harbor Healthcare System – Brooklyn Campus in Brooklyn, NY.
KH: What got you interested in studying the role of omega-3 fatty acids and the feelings of anger insubstance abusers?
LBB: There were some data indicating that fatty acids supplementation decreased hostility but these data were scant. We were interested in studying omega-3 effects in substance abusers because there are strong associations between high-frequency and high-severity aggressive behaviors and substance use disorders on one hand and because we had observed that the diets of substance abusers are deficient in many nutrients, including omega-3s.
KH: When you say omega-3 fatty acids are you talking about eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA)? What is the physiology of omega-3 fatty acids that might improve aggressive tendencies in substance abusers?
LBB: There are two omega-3 fatty acids that have been shown to play a role in the pathophysiology of a wide range of psychiatric disorders. They are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), usedeither singly or in combination. The effects of these fatty acids are diverse and complex and their respectiveroles in specific behavioral problems have not yet been completely elucidated. DHA is an important componentof the membranes of neurons (brain cells) and could affect the function of neurotransmitters, includingserotonin that has been implicated in violence. EPA, on the other hand, is not concentrated in neuronalmembranes but may affect the function of neurotransmitter systems via neuroimmunological and vascular effects. It could for instance increase the blood flow in the brain.
KH: Where did you come up with a dose of 3 gm/d of omega-3 fatty acids? What was the breakdown of EPA and DHA in mg per capsule? Were they given in a single dose or divided dose? With meals or away from meals?
LBB: No consensus has been reached yet about the ideal dose of omega-3 polyunsaturated fatty acids (PUFAs) that should be used to promote psychiatric health. Based on a review of major epidemiological studies conducted in the US, the daily intake of EPA and DHA recommended by the International Society for the Study of Fatty Acids and Lipids (ISSFAL) for cardiovascular health is 500 mg. More recently Hibbeln et al (2006) have proposed that the daily allowance of long-chain (LC) omega-3 PUFAs that would protect the US population against both cardiovascular and major psychiatric diseases should be as high as 3.5 grams per day for a 2000 Kcal diet. Several studies had shown that a daily dose of 3 grams of omega-3 PUFAs was effective in alleviating a variety of psychiatric symptoms and was almost entirely devoid of side effects. No consensus has been reached about the relative proportions of EPA and DHA that should be used. Available evidence seems to indicate that EPA either alone or in combination with DHA is more effective than DHA alone. For these reasons, participants in our study taking the active substance were given capsules containing 450 mg of EPA, 100 mg of DHA and 50 mg of other omega-3 LC PUFAs and were told to take 5 capsules daily. They were not instructed to take the capsules with meals but were told that they could take them in divided doses.
KH: Were fatty acids levels done on these patients before, during or after the study? If so did the levels correlate with supplementation or symptoms?
LBB: Fatty acids profiles were obtained before and after the 3-month supplementation period used in our study. Our data show a strong correlation between changes in plasma levels of omega-3 PUFAs and psychological changes. More important increases in plasma levels were associated with more pronounced decreases in anger. These data have not been published yet.
KH: Can you tell us about your study and the basic results?
LBB: In a randomized, double-blind, placebo-controlled study involving 24 subjects with substance use disorders, supplementation with omega-3 PUFAs was found to decrease feelings of anger. The subjects were randomized to one of two groups for 3 months: (1) PUFA group (n=13) receiving 3 g of omega-3 PUFAs (EPA + DHA) daily; (2) placebo group (n=11) receiving placebo daily. Subjects in the PUFA group showed a progressive decline in anger scores (assessed with a scale), with no decline observed in the placebo group. Following the end of the supplementation, 6 subjects from the PUFA group and 8 subjects from the placebo group were followed for 3 additional months. Anger scores remained significantly decreased among the PUFA group subjects. Though preliminary, these data indicate that n-3 PUFA supplementation could be beneficial in the treatment of some patients with hostile tendencies.
KH: Were there any side effects with the therapy? How was the patient compliance?
LBB: Side effects were almost non existent. Two patients reported having loose stools.
KH: Do substance abusers have an increased need for omega-3 fatty acids?
LBB: Yes, they do. Although we cannot generalize our findings to all abusers of substances, the different groups of patients we studied ate approximately one third of the long chain polyunsaturated fatty acids (which include EPA and DHA) of the daily amounts recommended by ISSFAL.
KH: How do you determine who is a candidate for omega-3 fatty acid therapy?
LBB: We cannot say for sure who the best candidates for omega-3 therapy might be. It would stand to reason that individuals whose omega-3 intake is suboptimal and who present psychological or psychiatric problems might benefit from supplementation. This would necessitate the recording of a dietary history or, better a determination of omega-3 blood levels but this determination is not part of routine laboratory tests.
KH: Do you think that omega-3 fatty acids could be used for aggressive behavior in individuals other than those with substance abuse issues?
LBB: The answer to this question is yes. In one study, DHA supplementation prevented an increase in aggression at times of stress in Japanese students. In another study, EPA was found more effective than a placebo in diminishing aggression in women with untreated borderline personality disorder and in yet another study, prisoners treated with a cocktail of supplements that included omega-3’s had fewer disciplinary incidents.
). The question that surprised me the most was about the impact of general anesthesia on memory. I have been asked this question in every city. I noticed 10 years ago that some patients lose memory after general anesthesia and the docs usually do not tell you it is a potential side effect. I have seen it firsthand along with the damage on scans.  Being on a brain healthy program is important at all times, but especially before and after undergoing anesthesia.Â