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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
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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
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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).
SPRING 2016 • IHPMAGAZINE.COM
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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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