I am convinced that the single greatest mental health issue for young people (and adults) is a deficiency in Omega-3 fats in the diet. Humans are designed by evolution to function on a 1:3 ratio of omega-3 fats to omega-6 fats (some even suggest a 1:1 ratio), but we are more in the range of 1:17 or, in some cases, 1:30. Not good. The repercussions of this imbalance are extensive.
Here is one summary of the physical element of this imbalance, from The Center for Genetics, Nutrition and Health, Washington, DC:
Several sources of information suggest that human beings evolved on a diet with a ratio of omega-6 to omega-3 essential fatty acids (EFA) of approximately 1 whereas in Western diets the ratio is 15/1-16.7/1. Western diets are deficient in omega-3 fatty acids, and have excessive amounts of omega-6 fatty acids compared with the diet on which human beings evolved and their genetic patterns were established. Excessive amounts of omega-6 polyunsaturated fatty acids (PUFA) and a very high omega-6/omega-3 ratio, as is found in today's Western diets, promote the pathogenesis of many diseases, including cardiovascular disease, cancer, and inflammatory and autoimmune diseases, whereas increased levels of omega-3 PUFA (a low omega-6/omega-3 ratio) exert suppressive effects. In the secondary prevention of cardiovascular disease, a ratio of 4/1 was associated with a 70% decrease in total mortality. A ratio of 2.5/1 reduced rectal cell proliferation in patients with colorectal cancer, whereas a ratio of 4/1 with the same amount of omega-3 PUFA had no effect. The lower omega-6/omega-3 ratio in women with breast cancer was associated with decreased risk. A ratio of 2-3/1 suppressed inflammation in patients with rheumatoid arthritis, and a ratio of 5/1 had a beneficial effect on patients with asthma, whereas a ratio of 10/1 had adverse consequences. These studies indicate that the optimal ratio may vary with the disease under consideration. This is consistent with the fact that chronic diseases are multigenic and multifactorial. Therefore, it is quite possible that the therapeutic dose of omega-3 fatty acids will depend on the degree of severity of disease resulting from the genetic predisposition. A lower ratio of omega-6/omega-3 fatty acids is more desirable in reducing the risk of many of the chronic diseases of high prevalence in Western societies, as well as in the developing countries, that are being exported to the rest of the world.This view is becoming widely accepted by health professionals, but the same fats play crucial roles in mental health as well. Every cell in the body is made from fats, and nowhere in the body is this more true than in the brain.
This is from Medscape Today, by WebMD:
The group writes that in addition, the fatty acid composition of the Western diet changed "dramatically" after 1913, when refined vegetable oil, a major source of omega-6 fatty acids, entered the diet (in the form of margarine, etc), and there was also a decrease in the consumption of foods high in omega-3 fatty acid such as fish, wild game, nuts, seeds, and green, leafy vegetables. Whereas the early hunter-gatherers had a dietary omega-6:omega-3 ratio of 2:1 to 3:1, this ratio is now 15:1 to 17:1 in North America today.
It is believed that these dietary changes might be related to increases in inflammatory-related diseases, including depression and cardiovascular disease, the group writes. They also note that in a "provocative" study by Maes and colleagues published in the May 15, 2000, issue of Biological Psychiatry, students who had higher omega-6:omega-3 ratios before examinations showed larger increases in inflammatory responses when they were stressed during examinations.
Omega-3 fats are not just beneficial in depression, they are also useful in ADHD:
Dietary supplementation with fish oils (providing EPA and DHA) appears to alleviate ADHD-related symptoms in at least some children, and one study of DCD children also found benefits for academic achievement. Larger trials are now needed to confirm these findings, and to establish the specificity and durability of any treatment effects as well as optimal formulations and dosages. Omega-3 is not supported by current evidence as a primary treatment for ADHD or related conditions, but further research in this area is clearly warranted. Given their relative safety and general health benefits, omega-3 fatty acids offer a promising complementary approach to standard treatments.
The results have actually been better than this abstract suggests. In fact, the University of Maryland Medical Center lists a whole range of mental health benefits from omega-3 fat supplementation:
Depression People who do not get enough omega-3 fatty acids or do not maintain a healthy balance of omega-3 to omega-6 fatty acids in their diet may be at an increased risk for depression. The omega-3 fatty acids are important components of nerve cell membranes. They help nerve cells communicate with each other, which is an essential step in maintaining good mental health. In particular, DHA is involved in a variety of nerve cell processes. Levels of omega-3 fatty acids were found to be measurably low and the ratio of omega-6 to omega-3 fatty acids were particularly high in a clinical study of patients hospitalized for depression. In a clinical study of individuals with depression, those who ate a healthy diet consisting of fatty fish 2 - 3 times per week for 5 years experienced a significant reduction in feelings of depression and hostility. Bipolar disorder In a clinical study of 30 people with bipolar disorder, those who were treated with EPA and DHA (in combination with their usual mood stabilizing medications) for 4 months experienced fewer mood swings and recurrence of either depression or mania than those who received placebo. Another 4-month long clinical study treating individuals with bipolar depression and rapid cycling bipolar disorder did not find evidence of efficacy for the use of in EPA in these patients. Schizophrenia Preliminary clinical evidence suggests that people with schizophrenia experience an improvement in symptoms when given omega-3 fatty acids. However, a recent well-designed study concluded that EPA supplements are no better than placebo in improving symptoms of this condition. The conflicting results suggest that more research is needed before conclusions can be drawn about the benefit of omega-3 fatty acids for schizophrenia. Similar to diabetes, individuals with schizophrenia may not be able to convert ALA to EPA or DHA efficiently. Attention deficit/hyperactivity disorder (ADHD) Children with attention deficit/hyperactivity disorder (ADHD) may have low levels of certain essential fatty acids (including EPA and DHA) in their bodies. In a clinical study of nearly 100 boys, those with lower levels of omega-3 fatty acids demonstrated more learning and behavioral problems (such as temper tantrums and sleep disturbances) than boys with normal omega-3 fatty acid levels. In animal studies, low levels of omega-3 fatty acids have been shown to lower the concentration of certain brain chemicals (such as dopamine and serotonin) related to attention and motivation. Clinical studies that examine the ability of omega-3 supplements to improve symptoms of ADHD are still needed. At this point in time, eating foods high in omega-3 fatty acids is a reasonable approach for someone with ADHD. A clinical study used omega-3 and omega-6 fatty acid supplementation in 117 children with ADHD. They study found significant improvements in reading, spelling, and behavior in the children over the 3 months of therapy. Another clinical study found that omega-3 fatty acid supplementation helped to decrease physical aggression in school children with ADHD. More studies, including comparisons with drug therapies (such as stimulants), should be performed. Eating disorders Clinical studies suggest that men and women with anorexia nervosa have lower than optimal levels of polyunsaturated fatty acids (including ALA and GLA). To prevent the complications associated with essential fatty acid deficiencies, some experts recommend that treatment programs for anorexia nervosa include PUFA-rich foods such as fish and organ meats (which include omega-6 fatty acids).
All of this is a lead up to new research suggesting the benefits of omega-3 fats in children with bipolar disorder, as posted at Discover and Recover:
In an open-label study involving 18 children and adolescents with juvenile bipolar disorder, supplementation with long-chain omega-3 polyunsaturated fatty acids (360 mg/d EPA and 1,560 mg/d DHA) for a period of 6 weeks was found to significantly reduce clinician ratings of mania and depression, significantly improve global functioning, and significantly reduce parent ratings of internalizing and externalizing behaviors. The authors conclude, “A larger randomized controlled trial appears warranted in this participant population.
There is a good, full-length article available online that looks at the use of omega-3 fats in mental health. As usual, their outlook is too conservative to me.
Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid?
I hope that doctors get on board with this sooner rather than later. There are NO downsides to omega-3 supplementation, and the health benefits are so full-spectrum as to seem miraculous.Results
Most trials involved a small number of participants but were largely well designed. Omega-3 PUFA were well tolerated by both children and adults with mild gastrointestinal effects being the only consistently reported adverse event. For schizophrenia and borderline personality disorder we found little evidence of a robust clinically relevant effect. In the case of attention deficit hyperactivity disorder and related disorders, most trials showed at most small benefits over placebo. A limited meta-analysis of these trials suggested that benefits of omega-3 PUFA supplementation may be greater in a classroom setting than at home. Some evidence indicates that omega-3 PUFA may reduce symptoms of anxiety although the data is preliminary and inconclusive. The most convincing evidence for beneficial effects of omega-3 PUFA is to be found in mood disorders. A meta-analysis of trials involving patients with major depressive disorder and bipolar disorder provided evidence that omega-3 PUFA supplementation reduces symptoms of depression. Furthermore, meta-regression analysis suggests that supplementation with eicosapentaenoic acid may be more beneficial in mood disorders than with docosahexaenoic acid, although several confounding factors prevented a definitive conclusion being made regarding which species of omega-3 PUFA is most beneficial. The mechanisms underlying the apparent efficacy of omega-3 PUFA in mood disorders compared to schizophrenia are discussed as is a rational for the possibly greater efficacy of EPA compared to DHA.
Conclusion
While it is not currently possible to recommend omega-3 PUFA as either a mono- or adjunctive-therapy in any mental illness, the available evidence is strong enough to justify continued study, especially with regard to attentional, anxiety and mood disorders.
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