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SPRING 2016

The Three Ps of Health Cyber Security

contents

FEATURES 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

22

DEPARTMENTS 7

Publisher’s Letter

8

Editorial Board

10

Product Profiles

16 30

Clinic Profile

P3 Health

Post Scriptum

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publisher’s letter

Know your patients

O

ver the years, we have had to adapt

able to connect and relate to each other’s

to the ever-changing industry. We

experiences. This is an opportunity to make

constantly have to ask ourselves, “Is

your business more personal. Your commu-

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

nity can be the first step, and sharing news

of course, is “absolutely not.”

with it—such as a new treatment—will draw

Although Millennials are often dismissed, they are actually redefining the health-care

in those who are interested in what you are doing differently.

industry. Some sources state that Millennials represent about 25 per cent of the U.S. population. That is a lot of people who are

Please don’t forget to download

starting to care about their health like never

your IHP App to have access to

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

exclusive content and full-length

box when it comes to certain treatments.

reference material.

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

Olivier Felicio

might want a quick fix, they also want to be

Publisher/Editor-in-Chief

SPRING 2016 • Volume 9 Issue 2 Founder Sanjiv Jagota

Circulation

Publisher & Editor-in-Chief Olivier Felicio

IHP Magazine Inc. 1235 Bay St., Suite 700; Toronto, Ontario, M5R 3K4 Email: circulation@ihpmagazine.com

Managing Editor Inna Levchuk Associate Editor Cayla Ramey Art Director Scott Jordan

Advertising

Junior Graphic Designer Janelle Scriver

Olivier Felicio (416) 203-7900 x 6107 olivier@rivegauchemedia.com

Contributors

Hillary Booth, Phill Feltham, Rochelle Fernandes, Susanne Grether-Beck, Thomas Jaenicke, Jean Krutmann, Alessandra Marini, Makoto Trotter, Erin Wiley.

IHP Magazine Inc. President Olivier Felicio General Manager Melanie Seth General Customer Care Manager Lucy Holden Subscription Rates

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Weng Ng (416) 203-7900 x 6128 weng@thergmgroup.net

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cover story

THE USE OF OMEGA-3 IN

PSYCHIATRIC DIAGNOSES

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

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

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P

sychiatric diagnoses can be challenging to treat.

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

While antipsychotic and antidepressant medica-

therapeutic target of interest in several psychiatric dis-

tions are designed to treat psychotic and affective

orders, such as depression and schizophrenia.

symptoms, the effects are often suboptimal, and are

It is thought that altered mechanisms of action, includ-

accompanied by several side effects. There seems to be

ing, but not limited to decreased levels of eicosapentaenoic

a growing need to supplement conventional treatment

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

with naturopathic options in this group of disorders. As

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

such, there has been an increasing interest and recent

ysis of 14 case-control studies showed significant reduc-

research on omega-3 supplementation in psychiatric

tions in EPA and DHA in plasma and erythrocytes in subjects

disorders (schizophrenia, attention deficit hyperactivity

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

disorder (ADHD), bipolar disorder and depression).

showed that bipolar patients had significant erythrocyte DHA and/or EPA deficits when cross comparing them to

MECHANISMS OF ACTION OF OMEGA-3 IN PSYCHIATRIC

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

DISORDERS

sectional studies have found that children with a very high

It has been hypothesized that omega-3/polyunsaturated

risk for mood disorders have erythrocyte EPA and DHA

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

deficits compared with healthy individuals (Clayton, 2008).

protective effects. Several studies have shown that an

Well established erythrocyte EPA and DHA low levels

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

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

positive effect on neuronal function, alongside anti-in-

2006), and plasma EPA and DHA deficits were found in those

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

with major depression alongside comorbid anxiety disor-

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

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

membrane fluidity (Meijerink, 2013), activates peroxisome

taken no medication at the onset of psychosis had eryth-

proliferator activated receptors, and enhances neuro-

rocyte DHA and arachidonic acid (AA) deficits compared

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

with healthy individuals (Khan, 2002). An interesting

anisms of action lend support for theories of possible

meta-analysis of 18 case-control studies also showed

neuroprotective and cognitive benefits in psychiatric

significant low levels of DHA and AA in schizophrenic indi-

disorders.

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

Reviews on the subject concluded that PUFAs and their mediators are responsible for certain processes within

in erythrocyte DHA and AA may predispose patients to psychosis, and persist in those diagnosed.

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

This same logic was used in another meta-analysis of

structure and function of neurons, glial cells and endothelial

nine cross-sectional studies that found lower blood EPA

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

and DHA levels in children with ADHD compared with

and (3) the modulation of neurotransmission (Bazinet,

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

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

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

ulation, symptom control and cognitive function. This

correcting this deficiency.

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cover story

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

EVIDENCE FOR USING OMEGA-3 IN SCHIZOPHRENIA

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

A growing body of evidence exists for the use of omega-3s

could be an interesting point for further examination.

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

Overall, the dosage of omega-3 used in schizophrenia

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

seems to be approximately 2,200 milligrams.

of studies suggest that the need for neuroleptic medication seems to be decreased for people taking omega-3 (n=30,

EVIDENCE FOR USING OMEGA-3 IN BIPOLAR DISORDER,

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

ADHD AND DEPRESSION

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

N3-PUFA is thought to be involved in the pathophysiology,

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

treatment and prevention of bipolar disease (BD) (Sublette

A Cochrane Review investigated the use of omega-3

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

and evening primrose oil to treat symptoms of schizophre-

ined in patients with BD. DHA and EPA caused increased

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

membrane fluidity, as detected by reductions in T2 (a

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

membrane integrity marker) values, compared to controls

symptom improvement. It should be noted that the data

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

is preliminary and further studies with more power are

A small, double-blind, placebo controlled trial examined

necessary to confirm the effect to a greater degree. A

the effects of EPA treatment in BD patients, as associated

smaller study within this review looked at using EPA as the

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

only treatment for people hospitalized for relapse. The

marker thought to be active in neuronal integrity. Fourteen

results showed that EPA may help 33 per cent of people

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

who avoid using antipsychotic medication for twelve weeks

or placebo for 12 weeks. The results showed a significant

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

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

One meta-analysis showed that when individuals in the

0.027), thus establishing grounds for a possible neuropro-

prodromal state of schizophrenia took omega-3, it reduced

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

psychotic symptom severity and lowered conversion rates

with larger studies (Frango, 2007).

to first-episode psychosis. Similar findings were echoed

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

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

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

chotic symptoms, required smaller antipsychotic medica-

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

tion dosages, and heightened early treatment response

lability (EL), oppositional behaviour, conduct problems or

rates (Chen, 2015).

aggression. However, subgroup analyses of higher quality

One randomized, placebo controlled study provided clin-

studies and those meeting strict inclusion criteria found a

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

significant reduction in EL and oppositional behaviour. This

or placebo was given for 26 weeks and the study evaluated

could indicate that larger sample sizes may amplify this

symptoms in first episode schizophrenia. They concluded

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

that this dosage was effective as an adjunctive therapy as

PUFA on reducing EL in subsets of children with ADHD

per the following results: improvement of 50 per cent in

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

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

supplementation with n-3 PUFA improved the red blood

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

cell fatty acid profile by significantly reducing AA/DHA in

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

the intervention group when compared with controls (P=

It should be noted that many studies used only EPA and/ 24

IHP Cover Story.indd 24

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

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

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

a beneficial effect when used alongside conventional med-

milligrams for psychiatric disorders in this article. The

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

mechanisms of action involved are thought to include a

demonstrated a beneficial effect of omega-3 PUFAs on

reduction or alteration of cellular/plasma EPA and DHA,

depressive symptoms in MDD (standardized mean differ-

with the aim of supplementation to correct this deficit.

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

Further research and future directions of study are required

a positive correlation between increasing the EPA dose and

to solidify this effect by designing studies with greater

positive effects on MDD symptoms. EPA was also shown to

statistical power that could include a thorough examination

provide better outcomes in patients taking antidepressants

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

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

Nonetheless, many studies have already shown successful

The clinical benefit appears as follows: it seems that

adjuvant treatment of omega-3s alongside conventional

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

medicines, with improvement at the cellular and clinical

several studies including a valuable meta-analysis sug-

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

gested that an administration of at least 60 per cent or

apeutic option for psychiatric diagnoses.

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

View the references on your tablet.

pathophysiology, treatment and prevention of BD, ADHD, MDD and schizophrenia. The clinical value from the studies

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