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WWW.IHPMAGAZINE.COM SPRING 2016
The Three Ps of Health
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DEPARTMENTS
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SPRING 2016 • IHPMAGAZINE.COM 4
7 Publisher’s Letter
8 Editorial Board
10 Product Pro�les
16 Clinic Pro�leP3 Health
30 Post Scriptum
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
�nd us on2616
22
IHP Contents.indd 4 2016-04-21 10:12 AM
SPRING 2016 • IHPMAGAZINE.COM 7
publisher’s letter
O ver the years, we have had to adapt
to the ever-changing industry. We
constantly have to ask ourselves, “Is
this case the same as the last?” The answer,
of course, is “absolutely not.”
Although Millennials are often dismissed,
they are actually redefining the health-care
industry. Some sources state that Millennials
represent about 25 per cent of the U.S.
population. That is a lot of people who are
starting to care about their health like never
before. It’s time to start thinking out of the
box when it comes to certain treatments.
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
might want a quick fix, they also want to be
able to connect and relate to each other’s
experiences. This is an opportunity to make
your business more personal. Your commu-
nity can be the first step, and sharing news
with it—such as a new treatment—will draw
in those who are interested in what you are
doing differently.
Please don’t forget to download
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Founder Sanjiv Jagota
Publisher & Editor-in-Chief Olivier Felicio
Managing Editor Inna Levchuk
Associate Editor Cayla Ramey
Art Director Scott Jordan
Junior Graphic Designer Janelle Scriver
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
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Canada Post Canadian Publication Mail Agreement Number 4067800 The pub-lisher does not assume any responsibility for the contents of any advertisement and any and all representations or warranties made in such advertising are those of the advertiser and not of the publisher. The publisher is not liable to any advertiser for any misprints in advertising not the fault of the publisher and in such an event the limit of the publisher’s liability shall not exceed the amount of the publisher’s charge for such advertising. No portion of this publication may be reproduced, in all or part, without the express written permission of the pub-lisher. ihp magazine is pleased to review unsolicited submissions for editorial consideration under the following conditions: all material submitted for edito-rial consideration (photographs, illustrations, written text in electronic or hard copy format) may be used by ihp Media Inc. and their af�liates for editorial pur-poses in any media (whether printed, electronic, internet, disc, etc.) without the consent of, or the payment of compensation to, the party providing such mate-rial. Please direct submissions to the Editor, ihp magazine.
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CirculationIHP Magazine Inc.1235 Bay St., Suite 700; Toronto, Ontario, M5R 3K4Email: [email protected]
Advertising Olivier Felicio Weng Ng(416) 203-7900 x 6107 (416) 203-7900 x [email protected] [email protected]
SPRING 2016 • Volume 9 Issue 2
Olivier Felicio
Publisher/Editor-in-Chief
Know your patients
IHP PubLetter.indd 7 2016-04-21 10:12 AM
SPRING 2016 • IHPMAGAZINE.COM 22
cover story
THE USE OF OMEGA-3 IN PSYCHIATRIC
DIAGNOSESBy Rochelle Fernandes, MSc., ND (cand.)
Peer-reviewed by Makoto Trotter BSc(Hons), ND, Erin Wiley, ND, & Hilary Booth, ND, HBSc
IHP Cover Story.indd 22 2016-04-21 10:31 AM
SPRING 2016 • IHPMAGAZINE.COM 23
P sychiatric diagnoses can be challenging to treat.
While antipsychotic and antidepressant medica-
tions are designed to treat psychotic and affective
symptoms, the effects are often suboptimal, and are
accompanied by several side effects. There seems to be
a growing need to supplement conventional treatment
with naturopathic options in this group of disorders. As
such, there has been an increasing interest and recent
research on omega-3 supplementation in psychiatric
disorders (schizophrenia, attention deficit hyperactivity
disorder (ADHD), bipolar disorder and depression).
MECHANISMS OF ACTION OF OMEGA-3 IN PSYCHIATRIC DISORDERSIt has been hypothesized that omega-3/polyunsaturated
fatty acid (n-3 PUFA) supplementation may confer neuro-
protective effects. Several studies have shown that an
accumulation of n-3 PUFAs in neural cells may have a
positive effect on neuronal function, alongside anti-in-
flammatory and antioxidant activities (Itua, 2010), (Orr,
2013). Other activities include that n-3 PUFA increases
membrane fluidity (Meijerink, 2013), activates peroxisome
proliferator activated receptors, and enhances neuro-
trophic support (Kou, 2008). These multi-faceted mech-
anisms of action lend support for theories of possible
neuroprotective and cognitive benefits in psychiatric
disorders.
Reviews on the subject concluded that PUFAs and their
mediators are responsible for certain processes within
the central nervous system: (1) the maintenance of cell
structure and function of neurons, glial cells and endothelial
cells; (2) the regulation of neuro-inflammatory processes;
and (3) the modulation of neurotransmission (Bazinet,
2014). These mechanisms provide a basis for mood reg-
ulation, symptom control and cognitive function. This
enables an understanding of how n-3 PUFA may be a novel
therapeutic target of interest in several psychiatric dis-
orders, such as depression and schizophrenia.
It is thought that altered mechanisms of action, includ-
ing, but not limited to decreased levels of eicosapentaenoic
acid (EPA) and docosahexaenoic acid (DHA), are one of
the causes of certain psychiatric disorders. One meta-anal-
ysis of 14 case-control studies showed significant reduc-
tions in EPA and DHA in plasma and erythrocytes in subjects
with major depression (Lin, 2010). Another set of studies
showed that bipolar patients had significant erythrocyte
DHA and/or EPA deficits when cross comparing them to
healthy counterparts (Chiu, 2003, McNamara, 2015). Cross-
sectional studies have found that children with a very high
risk for mood disorders have erythrocyte EPAand DHA
deficits compared with healthy individuals (Clayton, 2008).
Well established erythrocyte EPAandDHA low levels
were also seen in those with social anxiety disorder (Green,
2006), and plasma EPAandDHA deficits were found in those
with major depression alongside comorbid anxiety disor-
ders (Liu, 2013). One study showed that those who had
taken no medication at the onset of psychosis had eryth-
rocyte DHA and arachidonic acid (AA) deficits compared
with healthy individuals (Khan, 2002). An interesting
meta-analysis of 18 case-control studies also showed
significant low levels of DHA and AA in schizophrenic indi-
viduals (Hoen, 2013). These studies suggest that deficits
in erythrocyte DHA and AA may predispose patients to
psychosis, and persist in those diagnosed.
This same logic was used in another meta-analysis of
nine cross-sectional studies that found lower blood EPA
and DHA levels in children with ADHD compared with
healthy controls (Hawkey, 2014). The rationale behind the
use of omega-3 supplementation is an intent to treat;
correcting this deficiency.
IHP Cover Story.indd 23 2016-04-21 10:31 AM
SPRING 2016 • IHPMAGAZINE.COM 24
cover story
EVIDENCE FOR USING OMEGA-3 IN SCHIZOPHRENIAA growing body of evidence exists for the use of omega-3s
in schizophrenia. When any dose of omega-3 ethyl-EPA
(E-EPA or EPA) is compared with placebo, a small, short set
of studies suggest that the need for neuroleptic medication
seems to be decreased for people taking omega-3 (n=30,
1 RCT, RR 0.73 CI 0.54 to 1.00) and mental state may improve
(n=30, 1 RCT, RR not gaining 25 per cent change in PANSS
scores 0.54 CI 0.30 to 0.96, NNT3 CI 2-29) (Joy, 2006).
A Cochrane Review investigated the use of omega-3
and evening primrose oil to treat symptoms of schizophre-
nia. The review found a positive effect of EPA versus placebo
for scale-derived mental state outcomes, in the context of
symptom improvement. It should be noted that the data
is preliminary and further studies with more power are
necessary to confirm the effect to a greater degree. A
smaller study within this review looked at using EPA as the
only treatment for people hospitalized for relapse. The
results showed that EPA may help 33 per cent of people
who avoid using antipsychotic medication for twelve weeks
(RR 0.6, CI 0.4-0.91) (Joy, 2000).
One meta-analysis showed that when individuals in the
prodromal state of schizophrenia took omega-3, it reduced
psychotic symptom severity and lowered conversion rates
to first-episode psychosis. Similar findings were echoed
with first-episode schizophrenia; omega-3 lowered non-psy-
chotic symptoms, required smaller antipsychotic medica-
tion dosages, and heightened early treatment response
rates (Chen, 2015).
One randomized, placebo controlled study provided clin-
ical value by mention of dosage; 2,200 milligrams of n-3 PUFA
or placebo was given for 26 weeks and the study evaluated
symptoms in first episode schizophrenia. They concluded
that this dosage was effective as an adjunctive therapy as
per the following results: improvement of 50 per cent in
symptom severity; (p = 0.017), an improvement in depressive
symptoms (p = 0.006), and a higher level of functioning (p =
0.01) in the n-3 PUFA group (Pawełczyk, 2016).
It should be noted that many studies used only EPA and/
or did not always cite the ratio of EPA:DHA, however, this
could be an interesting point for further examination.
Overall, the dosage of omega-3 used in schizophrenia
seems to be approximately 2,200 milligrams.
EVIDENCE FOR USING OMEGA-3 IN BIPOLAR DISORDER, ADHD AND DEPRESSIONN3-PUFA is thought to be involved in the pathophysiology,
treatment and prevention of bipolar disease (BD) (Sublette
M. E., 2011). The protective function of n-3 PUFA was exam-
ined in patients with BD. DHA and EPA caused increased
membrane fluidity, as detected by reductions in T2 (a
membrane integrity marker) values, compared to controls
in a four-week study (Hirashima, 2004).
A small, double-blind, placebo controlled trial examined
the effects of EPA treatment in BD patients, as associated
with increased brain levels of N-acetyl aspartate (NAA), a
marker thought to be active in neuronal integrity. Fourteen
female BD patients were given two grams of E-EPA per day
or placebo for 12 weeks. The results showed a significant
rise in NAA levels in the E-EPA group versus placebo (p =
0.027), thus establishing grounds for a possible neuropro-
tective role of n-3 PUFA in BD that can be further examined
with larger studies (Frango, 2007).
N-3 PUFA was also proposed to be useful in the treatment
of ADHD. One meta-analysis showed that in the primary
analyses, n-3 PUFA did not show improvements in emotional
lability (EL), oppositional behaviour, conduct problems or
aggression. However, subgroup analyses of higher quality
studies and those meeting strict inclusion criteria found a
significant reduction in EL and oppositional behaviour. This
could indicate that larger sample sizes may amplify this
effect and show value in highlighting the effects of n-3
PUFA on reducing EL in subsets of children with ADHD
(Cooper, 2016). A randomized controlled trial showed that
supplementation with n-3 PUFA improved the red blood
cell fatty acid profile by significantly reducing AA/DHA in
the intervention group when compared with controls (P=
0.000) in children with ADHD (Wu, 2015).
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
IHP Cover Story.indd 24 2016-04-21 10:31 AM
SPRING 2016 • IHPMAGAZINE.COM 25
Much like BD, n-3 PUFA has also been proposed to have
a beneficial effect when used alongside conventional med-
ication in major depressive disorder (MDD). A meta-analysis
demonstrated a beneficial effect of omega-3 PUFAs on
depressive symptoms in MDD (standardized mean differ-
ence=0.398 (0.114-0.682), (P=0.006); the statistics showed
a positive correlation between increasing the EPA dose and
positive effects on MDD symptoms. EPA was also shown to
provide better outcomes in patients taking antidepressants
than in those who were taking EPA alone (Mocking, 2016).
The clinical benefit appears as follows: it seems that
dosage ranges of omega 3 vary in these disorders. However,
several studies including a valuable meta-analysis sug-
gested that an administration of at least 60 per cent or
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
pathophysiology, treatment and prevention of BD, ADHD,
MDD and schizophrenia. The clinical value from the studies
mentioned above is at an average dose of 200 to 2,200
milligrams for psychiatric disorders in this article. The
mechanisms of action involved are thought to include a
reduction or alteration of cellular/plasma EPA and DHA,
with the aim of supplementation to correct this deficit.
Further research and future directions of study are required
to solidify this effect by designing studies with greater
statistical power that could include a thorough examination
of EPA:DHA ratios specific to each of these disorders.
Nonetheless, many studies have already shown successful
adjuvant treatment of omega-3s alongside conventional
medicines, with improvement at the cellular and clinical
level. These findings warrant omega-3s as a valuable ther-
apeutic option for psychiatric diagnoses.
NPN80051437
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