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What are omega (essential) fatty acids?

In his pathbreaking study of bipolar disorder, Dr. Andrew Stoll posed that fatty acids may inhibit neuronal signal transduction pathways in a manner similar to that of lithium carbonate and valproate, two effective treatments for bipolar disorder. His study was performed to examine whether omega-3 fatty acids also exhibit mood-stabilizing properties in bipolar disorder.  The results of the research indicated that the omega-3 fatty acid patient group had a significantly longer period of remission from the symptoms of bipolar disorder than the placebo group (P=.002; Mantel-Cox). In addition, for nearly every other outcome measure, the omega-3 fatty acid group performed better than the placebo group.  Omega-3 fatty acids were thus well tolerated and improved the short-term course of illness in among patients with bipolar disorder.

According to Stoll, the rates of autism, depression and bipolar disease are increasing with every birth cohort.  He argues that the origins of this increase is inversely proportional to the amount of fatty acids obtained from the diet.  In other words, the less fatty acids we eat, the more depressed we get.  The modern Western diet is profoundly depleted of essential fatty acids and trace minerals.  For example, the traditional diet in the Arctic regions of North America provides 15-19 grams of omega-3 fatty acids per day.  In the United States, we're lucky to get any fatty acids naturally in our diet, and on average consume less than one gram of EFAs per day.

Perhaps the most startling illustration of this problem is in Hibbeln's Lancet article from 1998 (Hibbeln, J.R., "Fish consumption and major depression" Lancet 1998) and the subsequent article from 2002 ("Seafood consumption, the DHA content of mothers' milk and prevalence rates of postpartum depression: a cross-national, ecological analysis."  Hibbeln JR.  Laboratory of Membrane Biophysics and Biochemistry, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Park 5, Room 150, 12420 Parklawn Drive, Rockville, MD 20892, USA. jhibbeln@niaaa.nih.gov).  Here's the abstract from the latter article about post-partum depression:

"Mothers selectively transfer docosahexaenoic acid (DHA) to their fetuses to support optimal neurological development during pregnancy. Without sufficient dietary intake, mothers become depleted of DHA and may increase their risk of suffering major depressive symptoms in the postpartum period. We postulated that the DHA content of mothers' milk and seafood consumption would both predict prevalence rates of postpartum depression across countries. METHODS: Published prevalence data for postpartum depression were included that used the Edinburgh Postpartum Depression Scale (n=14532 subjects in 41 studies). These data were compared to the DHA, eicosapentaenoic acid (EPA) and arachidonic acid (AA) content in mothers' milk and to seafood consumption rates in published reports from 23 countries. RESULTS: Higher concentrations of DHA in mothers' milk (r=-0.84, p<0.0001, n=16 countries) and greater seafood consumption (r=-0.81, p<0.0001, n=22 countries) both predicted lower prevalence rates of postpartum depression in simple and logarithmic models, respectively. The AA and EPA content of mothers' milk were unrelated to postpartum depression prevalence. LIMITATIONS: These findings do not prove that higher omega-3 status cause lower prevalence rates of postpartum depression. Data on potentially confounding factors were not uniformly available for all countries. CONCLUSIONS: Both lower DHA content in mothers' milk and lower seafood consumption were associated with higher rates of postpartum depression. These results do not appear to be an artifact of cross-national differences in well-established risk factors for postpartum depression. Interventional studies are needed to determine if omega-3 fatty acids can reduce major postpartum depressive symptoms."

So what does this have to do with autism? 

bulletVancassel et.al. (Vancassel S, Durand G, Barthelemy C, Lejeune B, Marineau J, Guilloteau D, Andres C, Chalon S. Plasma fatty acid levels in autistic children. Prostaglandins Leukot Essent Fatty Acids 2001;65(1):1-7) designed a study to compare the phospholipid fatty acids in the plasma of a population of autistic subjects compared to mentally retarded controls.  The group found that autistic children had a 23% lower blood level of DHA when compared to the controls.  Furthermore, autistic children had a 20% lower blood level of total omega-3 without a significant reduction in omega-6 fatty acids when compared to controls.  This led to a 25% increase in the omega-6:omega-3 ratio.
bulletStevens et. al. (Stevens, L., et al. Omega-3 fatty acids in boys with behavior, learning, and health problems. Physiology & Behavior, 1996) designed a study to compare behavior, learning and health problems in two groups of boys, ages 6 to 12.  Group 1 had low blood levels of omega-3 or omega-6 fatty acids, and group 2 had high levels of omega-3 and omega-6 fatty acids.  The researchers found that a greater number of behavior problems, assessed by the Conners' Rating Scale, temper tantrums, and sleep problems were reported in subjects with lower blood omega-3 levels.  This group was also associated with more learning and health problems.  In addition, more colds and antibiotic use were reported by subjects that had lower total omega-6.
bulletRichardson and Ross (Richardson, A.J. and Ross, M.A. (2000) Prostaglandins, Leukotrienes and Essential Fatty Acids 63 1-9.  Fatty acid metabolism in neurodevelopmental disorder: a new perspective on associations between attention-deficit / hyperactivity disorder, dyslexia, dyspraxia and the autistic spectrum) argue the following hypothesis:

"There is increasing evidence that abnormalities of fatty acid and membrane phospholipid metabolism play a part in a wide range of neurodevelopmental and psychiatric disorders. This proposal is discussed here in relation to attention-deficit / hyperactivity disorder (ADHD), dyslexia, developmental coordination disorder (dyspraxia) and the autistic spectrum. These are among the most common neurodevelopmental disorders of childhood, with significant implications for society as well as for those directly affected. However, controversy still surrounds both the identification and management of these conditions, and while their aetiology is recognized as being complex and multifactorial, little progress has yet been made in elucidating predisposing factors at the biological level. An overview is provided here of the contents of this Special Issue, which contains a selection of reports from a unique multidisciplinary workshop involving both researchers and clinicians. Its purpose was to explore the possibility that ADHD, dyslexia, dyspraxia and autism fall within a phospholipid spectrum of disorders. This proposal could explain the high degree of co-morbidity between these conditions, their aggregation within families and relation to other psychiatric disorders, and a range of associated features that are already well known at a clinical level. The existing evidence for fatty acid abnormalities in these disorders is summarized, and new approaches are outlined that have the potential to improve both the identification and the management of these and related neurodevelopmental and psychiatric conditions."

As of today, we don't have any solid evidence or studies to indicate for sure how or why these essential fatty acids might work well for kids with autism.  Controlled studies are yet to be completed, although many parents anecdotally believe that omega fatty acids have helped alleviate their children's autistic behaviors.  For example, the Autism Research Institute (March 2005) reports that 55% of parents who gave their children fatty acids saw a marked improvement in behaviors.  In contrast, 42% saw no change in behaviors, and 3% reported that behaviors worsened (n=626).
 

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