Improving Mental Health by Enhancing Omega-3 Levels

My wife and registered dietitian, Joan O'Keefe, recently saw a 16-year-old girl whose mother brought her in for dietary counseling. As Joan began interviewing the young woman (let’s call her Brittany) about her diet and lifestyle, tears of sadness appeared out of the blue and streamed down Brittany’s face, dripping off her chin. Upon further questioning, it became clear that Brittany, as a junior in high school, was struggling with paralyzing anxiety and deep depression.

As she looked over the 10-day food diary Brittany had filled out, Joan commented, “She seems to be eating no fish or seafood.” Her mom laughed and said, “This kid hasn’t eaten a bite of fish or seafood since she was 2 years old!” So, Joan worked out a diet plan with Brittany, and because eating enough fish was not an option on the table, Joan recommended an omega-3 supplement as well.

Four weeks later at her follow-up appointment, Brittany came bouncing through the door like Tigger from Winnie the Pooh. Joan looked at her mom in amazement and asked, “Is this the same girl?”

This time the waterworks were tears of gratitude running down Brittany’s mom’s face, as she responded, “Yes, it is!” Ever since then, Brittany happily takes her daily omega-3 supplement on her own because she can feel the difference in her mood - making her day-to-day life brighter and more joyful, and the emotional hurdles of being a teenage girl easier to manage.

The Depression Epidemic:

Unfortunately, Brittany is not alone in her depressive struggles; depression is estimated to affect 350 million people. The World Mental Health Survey conducted in 17 countries found that on average about 1 in 20 people reported having an episode of depression during the previous year. According to the World Health Organization which describes depression as an epidemic, depression will be second only to cardiovascular disease in terms of disease prevalence on a global level within 20 years. Importantly, the increased incidence of depression over the last several decades has occurred in part due to changes in the modern western diet.

Studies show a bidirectional connection between depression and cardiovascular disease, whereby at least a quarter of cardiac patients subsequently develop depression, and in turn, adults with depression are at increased risk of developing heart disease. The American Heart Association has even issued a warning that teens with depression and bipolar disorder stand at increased risk for developing cardiovascular disease earlier in life. Both disorders share similar risk factors such as heightened levels of proinflammatory cytokines, plasma homocysteine levels, adrenergic stimulation, and emotional stress, as well as endothelial dysfunction. While depression and cardiovascular disease are both highly complex conditions, with many potential causes and predisposing factors, one simple and easily modifiable risk factor that may improve the health of the heart and the brain is omega-3.

Omega-3 and Depression:

In the largest study ever evaluating the effects of over-the-counter (OTC) nutrients on psychiatric well-being, researchers found that omega-3 was the most effective supplement for improving mental health.

Published in World Psychiatry, the meta-synthesis analyzed 33 meta-analyses and other data from nearly 11,000 people treated for mental illnesses including depression, stress and anxiety disorders, bipolar disorder, personality disorders, schizophrenia and attention-deficit/hyperactivity disorder (ADHD). Their goal was to develop an understanding of what treatments were effective while ensuring recommended dosages were followed and no adverse effects occurred.

The results showed strong support for omega-3 as an additional treatment for certain mental disorders with the strongest support for high dose EPA, an omega-3 fatty acid, as an add-on treatment with antidepressants for improving depression-related symptoms.

While the amino acid N-acetylcysteine saw promise in mood disorders and special types of folate had some effect on major depression and schizophrenia, the evidence was strongest for omega-3 improving mental health.

This makes sense for several reasons:
• Among the well-researched aspects of omega-3 fatty acids is their anti-inflammatory effect and their role in the structural changing of the brain
• Growing clinical research has found that numerous mental illnesses are tied to increased levels of markers of oxidative stress and inflammation.
• By making lifestyle and pharmacological changes such as adding omega-3 to the diet we can reduce inflammation and improve mood and brain function in general
• Data also shows that mental disorders are associated with lowered serum levels of several essential nutrients, including omega-3, so by optimizing intake of these key nutrients the symptoms of depression and anxiety may be improved.

The review adds to the growing body of evidence showing how nutrient intake can impact more than just physical health. Recently, a vitamin D study reported how the critical nutrient played a role in depression as well with a 75% increased risk for those with a deficiency in the sunshine nutrient. More research is also recently been published on brain-health related probiotics, called psychobiotics, and their role in influencing the gut flora and improving mental health.

Mood-Brightening Effects of Omega-3

When Joan was 27 years old and 5 months pregnant with Jimmy, our oldest child, we discovered that she had lymphoma - cancer of the lymph nodes. At the time, her wise mother Kathleen said to her, “Joanie, nobody promised you that your life was going to be a rose garden.”

We all go through times in our life when unavoidable stresses descend upon us and test our coping abilities. Unfortunately, many of us do not have the built-in support systems most of our ancestors had; a large extended family nearby, life-long friends, a tightknit community, friendly neighbors and unwavering faith. Hopelessness, anxiety, road-rage, bullying, even shooting rampages and other tragedies can erupt when these stresses overwhelm our brain’s capacity to cope.

It’s during these times when it is very important to have a healthy brain that can enable us to be hardy and resourceful. Nutritional deficiencies of DHA and EPA increase vulnerability to stress, and can increase risk of major depression, impulsive violence, and suicide.

Studies show that people who eat a diet low in omega-3 have an increased risk of suicide. Furthermore, low blood from levels of DHA have been associated with an increased likelihood of attempting suicide (see figure). In a small randomized placebo-controlled trial, two grams per day of DHA + EPA decreased symptoms of depression, lowered stress levels and reduced suicidal thinking.

Supercomputer Made of Fat

Your brain is the most complex, intelligent and downright astounding creation in the known universe. Although it weighs just 3 pounds - a mere 2% of your body weight - your brain burns 25% of the calories you consume and 20% of the oxygen you breathe. In other words, your brain is by far your most energy-demanding organ, surging with precise and intricate electrical impulses that enable you to continuously monitor and control your body, make sense of the world and navigate safely through your life.

If someone calls you a fathead, don’t take it personally - 60% of the dry weight of the brain is fat. Inside the skull is packed with fatty components: the cell membranes that encircle each of the 100 billion cells in our brain are made up of phospholipids - a special type of fat that keeps the cells soft, supple, and responsive so that they can effortlessly communicate with the other cells in the brain.

Another unique type of fat called myelin insulates the nerves, which keeps the electrical signals true and information flowing fast and accurately. Axons are the long threadlike extensions from a nerve that reach out to carry and receive messages to and from other cells in the brain and body. Myelin sheaths are sleeves of fatty tissue that protect these fibers and ensure the fidelity of these electrical signals.

Prevent Age-Related Brain Shrinkage

It’s true that you are what you eat - and nowhere is this more apparent than in the brain. A sharp and cheerful mind requires a brain made up of the right types of fats. In order to build an optimally healthy brain with communicative cell membranes, responsive neurons and intact myelin sheaths, we need to be consuming a lot of omega-3.

My mother Leatrice was born a few days after the Stock Market Crash of 1929. We recently threw her a blowout bash of a 90th birthday party here in Kansas City. Her mind is still as bright as ever, with a loving and kind nature and a great sense of humor.

I attribute some of Leatrice’s remarkable and enduring mental capacities to her love of nuts, which have always been among her favorite foods. Yet, Leatrice, like Brittany, doesn’t prefer the taste of fish. So, for decades we have brow-beaten her into taking an omega-3 supplement, and she begrudgingly swallows her fish oil pills each day

The human brain tends to shrink as the decades roll by; a shriveled-up brain is typical among people with Alzheimer’s and other neurodegenerative diseases. One of the best ways to keep your brain plump and fully functional is to feed it the right kinds of fat - like those found in oily fish - ideally fish caught in the wild.

A study of 240 people over 65 and with mild cognitive impairment (memory problems) published in The Journal of Alzheimer’s Disease randomized half of the patients to receive 2 grams per day of DHA for 12 months. The other half got a look-alike placebo. After one year, the group assigned to take DHA showed significantly less brain shrinkage than the placebo group.

These benefits were particularly apparent in the hippocampus - a region of the brain crucial for memory and spatial navigation, and the cerebral cortex - a region controlling higher-level thinking and movement. In another analysis, this one an observational study, the authors reported a favorable association between a blood marker of omega-3 status (the Omega-3 Index) and brain volume - specifically hippocampal volume - on head CT scans.

The bottom line is that the brain tends to shrink as we age, and as the neurons wither, our thinking power can diminish. A plump and youthful brain promotes a strong intellect, quick thinking, and preserved abilities to learn new things and adapt to change, regardless of your age. Consequently, it’s important to eat fish and seafood regularly, and take a purified and concentrated omega-3 supplement that contains the two most important omega-3s: DHA and EPA.

Preventing Rust in the Brain and Body

A growing body of clinical research indicates that numerous mental illnesses are tied to increased levels of oxidative stress and inflammation. Think of this like rust in the brain and body. Higher dose omega-3 supplementation can provide powerful anti-inflammatory effects throughout your system, which turns out to be advantageous for keeping other vital organs healthy as well.

Joan recently saw another memorable teenager, an 18-year-old we’ll call Zach, who suffers from Crohn’s disease, a severe inflammatory bowel condition. Zach’s breakfast each morning consisted of Mountain Dew and donuts. A health crisis required that his doctors surgically remove part of his small intestine. This got Zach’s attention, and Joan made sure to turn it into a teachable moment. She told him, “You won’t survive this unless you drastically change your diet.” Now Zach’s breakfast is eggs and avocados, or unsweetened Greek yogurt with nuts and berries. He drinks water, sparkling water, tea, or coffee and takes his omega-3 supplement and is doing dramatically better.

How Much Omega-3 is Optimal?

Doses of omega-3 for promoting a sunny disposition and a discerning mind start at a minimum of 1,000 mg (or 1 gram/day) and range up to 4 grams per day. Most experts advise 1 to 2 grams of EPA + DHA per day for optimal brain health.

The first step in changing anything is measuring it, so we recommend checking your omega-3 Index using a test kit from OmegaQuant to determine exactly how much omega-3 your cell membranes contain. This is an easy test to do yourself for just $50. It requires only a few drops of blood that you place on a special card and mail it off. Most Americans have an omega-3 Index of 4% or less; ideal is 8% or higher, and over 90% of children and adults are not in this protective range.

Typically, people tolerate omega-3 without difficulty. After all, omega-3 is a food and there is no serious downside to consuming it. Gastrointestinal issues including upset stomach, loose stools or fishy burp/aftertaste are the most common side effects.

These can be minimized by taking a more purified, concentrated form of omega-3, as well as taking the pills or liquid omega-3 immediately before or with a meal. The latest studies have reassured us that omega-3s do not substantially increase the risk of bleeding unless high doses are used (more than 7 grams/day of EPA + DHA). Because omega-3s are key building blocks for the developing brain, it is especially important for toddlers, children, and teenagers to be getting enough omega-3. It is also essential for pregnant and nursing mothers to take an omega-3 supplement.

Take-Home Messages on Omega-3s

Eating the typical American diet predisposes a person to a dysfunctional brain. And living in America in 2021 can be stressful. Teenagers are especially vulnerable to emotional turbulence.

Omega-3 isn’t a cure-all for mental health, but consuming plenty of these beneficial fats may help to keep your brain plump and non-inflamed, with an upbeat mood and a resilient mind. This is a simple, safe and effective way to help buffer you from the unavoidable stresses of modern-day life.

Importantly, the latest studies have also confirmed that high-dose omega-3 is protective for the heart and blood vessels - reducing risks for heart attack, stroke and sudden death. Try to prioritize getting your omega-3s each day, by consuming fish/seafood and taking an omega-3 supplement.

In Good Health,

James O'Keefe, MD, Joan O'Keefe, RD

SEE MORE BENEFITS OF OMEGA-3

READ WHAT ELSE PREVENTIVE
CARDIOLOGIST DR. JAMES O'KEEFE 
HAD TO SAY ABOUT THE 
WONDER NUTRIENT 

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DiNicolantonio JJ, O'Keefe JH. The Importance of Marine Omega-3s for Brain Development and the Prevention and Treatment of Behavior, Mood, and Other Brain Disorders. Nutrients. 12(8):E2333. 2020 Aug.