Fish Consumption and Suicide

Sept 12 Fish Consumption copy.jpeg

Depression is a serious and common mental disorder responsible for the majority of suicides. As I've covered in Antioxidants & Depression, intake of fruits, vegetables, and naturally occurring antioxidants have been found to be protectively associated with depression. Therefore, researchers have considered that "it may be possible to prevent depression or to lessen its negative effects through dietary intervention."

But not so fast. Cross-sectional studies are snapshots in time, so we don't know "whether a poor dietary pattern precedes the development of depression or if depression causes poor dietary intake." Depression and even treatments for depression can affect appetite and dietary intake. Maybe people who feel crappier just eat crappier, instead of the other way around.

What we need is a prospective study (a study performed over time) where we start out with people who are not depressed and follow them for several years. In 2012, we got just such a study, which ran over six years. As you'll see in my video Fish Consumption and Suicide, those with higher carotenoid levels in their bloodstream, which is considered a good indicator of fruit and vegetable intake, had a 28% lower risk of becoming depressed within that time. The researchers conclude that having low blood levels of those healthy phytonutrients may predict the development of new depressive symptoms. What about suicide?

Worldwide, a million people kill themselves every year. Of all European countries, Greece appears to have the lowest rates of suicide. It may be the balmy weather, but it may also have something to do with their diet. Ten thousand people were followed for years, and those following a more Mediterranean diet pattern were less likely to be diagnosed with depression. What was it about the diet that was protective? It wasn't the red wine or fish; it was the fruit, nuts, beans, and effectively higher plant to animal fat ratio that appeared protective. Conversely, significant adverse trends were observed for dairy and meat consumption.

A similar protective dietary pattern was found in Japan. A high intake of vegetables, fruits, mushrooms, and soy products was associated with a decreased prevalence of depressive symptoms. The healthy dietary pattern was not characterized by a high intake of seafood. Similar results were found in a study of 100,000 Japanese men and women followed for up to 10 years. There was no evidence of a protective role of higher fish consumption or the long-chain omega 3s EPA and DHA against suicide. In fact, they found a significantly increased risk of suicide among male nondrinkers with high seafood omega 3 intake. This may have been by chance, but a similar result was found in the Mediterranean. High baseline fish consumption with an increase in consumption were associated with an increased risk of mental disorders.

One possible explanation could be the mercury content of fish. Could an accumulation of mercury compounds in the body increase the risk of depression? We know that mercury in fish can cause neurological damage, associated with increased risk of Alzheimer's disease, memory loss, and autism, but also depression. Therefore, "the increased risk of suicide among persons with a high fish intake might also be attributable to the harmful effects of mercury in fish."

Large Harvard University cohort studies found similar results. Hundreds of thousands were followed for up to 20 years, and no evidence was found that taking fish oil or eating fish lowered risk of suicide. There was even a trend towards higher suicide mortality.

What about fish consumption for the treatment of depression? When we put together all the trials done to date, neither the EPA nor DHA long-chain omega-3s appears more effective than sugar pills. We used to think omega-3 supplementation was useful, but several recent studies have tipped the balance the other way. It seems that "[n]early all of the treatment efficacy observed in the published literature may be attributable to publication bias," meaning the trials that showed no benefit tended not to get published at all. So, all doctors saw were a bunch of positive studies, but only because a bunch of the negative ones were buried.

This reminds me of my Is Fish Oil Just Snake Oil? video. Just like we thought omega-3 supplementation could help with mood, we also thought it could help with heart health, but the balance of evidence has decidedly shifted. I still recommend the consumption of pollutant-free sources of preformed long-chain omega 3s for cognitive health and explain my rationale in Should We Take DHA Supplements to Boost Brain Function? and Should Vegans Take DHA to Preserve Brain Function?


For more on the neurotoxic nature of mercury-contaminated seafood, see:

What can we do to help our mood? See:

What about antidepressant drugs? Sometimes they can be absolutely life-saving, but other times they may actually do more harm than good. See my controversial video Do Antidepressant Drugs Really Work?.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Original Link

Fish Consumption and Suicide

Sept 12 Fish Consumption copy.jpeg

Depression is a serious and common mental disorder responsible for the majority of suicides. As I've covered in Antioxidants & Depression, intake of fruits, vegetables, and naturally occurring antioxidants have been found to be protectively associated with depression. Therefore, researchers have considered that "it may be possible to prevent depression or to lessen its negative effects through dietary intervention."

But not so fast. Cross-sectional studies are snapshots in time, so we don't know "whether a poor dietary pattern precedes the development of depression or if depression causes poor dietary intake." Depression and even treatments for depression can affect appetite and dietary intake. Maybe people who feel crappier just eat crappier, instead of the other way around.

What we need is a prospective study (a study performed over time) where we start out with people who are not depressed and follow them for several years. In 2012, we got just such a study, which ran over six years. As you'll see in my video Fish Consumption and Suicide, those with higher carotenoid levels in their bloodstream, which is considered a good indicator of fruit and vegetable intake, had a 28% lower risk of becoming depressed within that time. The researchers conclude that having low blood levels of those healthy phytonutrients may predict the development of new depressive symptoms. What about suicide?

Worldwide, a million people kill themselves every year. Of all European countries, Greece appears to have the lowest rates of suicide. It may be the balmy weather, but it may also have something to do with their diet. Ten thousand people were followed for years, and those following a more Mediterranean diet pattern were less likely to be diagnosed with depression. What was it about the diet that was protective? It wasn't the red wine or fish; it was the fruit, nuts, beans, and effectively higher plant to animal fat ratio that appeared protective. Conversely, significant adverse trends were observed for dairy and meat consumption.

A similar protective dietary pattern was found in Japan. A high intake of vegetables, fruits, mushrooms, and soy products was associated with a decreased prevalence of depressive symptoms. The healthy dietary pattern was not characterized by a high intake of seafood. Similar results were found in a study of 100,000 Japanese men and women followed for up to 10 years. There was no evidence of a protective role of higher fish consumption or the long-chain omega 3s EPA and DHA against suicide. In fact, they found a significantly increased risk of suicide among male nondrinkers with high seafood omega 3 intake. This may have been by chance, but a similar result was found in the Mediterranean. High baseline fish consumption with an increase in consumption were associated with an increased risk of mental disorders.

One possible explanation could be the mercury content of fish. Could an accumulation of mercury compounds in the body increase the risk of depression? We know that mercury in fish can cause neurological damage, associated with increased risk of Alzheimer's disease, memory loss, and autism, but also depression. Therefore, "the increased risk of suicide among persons with a high fish intake might also be attributable to the harmful effects of mercury in fish."

Large Harvard University cohort studies found similar results. Hundreds of thousands were followed for up to 20 years, and no evidence was found that taking fish oil or eating fish lowered risk of suicide. There was even a trend towards higher suicide mortality.

What about fish consumption for the treatment of depression? When we put together all the trials done to date, neither the EPA nor DHA long-chain omega-3s appears more effective than sugar pills. We used to think omega-3 supplementation was useful, but several recent studies have tipped the balance the other way. It seems that "[n]early all of the treatment efficacy observed in the published literature may be attributable to publication bias," meaning the trials that showed no benefit tended not to get published at all. So, all doctors saw were a bunch of positive studies, but only because a bunch of the negative ones were buried.

This reminds me of my Is Fish Oil Just Snake Oil? video. Just like we thought omega-3 supplementation could help with mood, we also thought it could help with heart health, but the balance of evidence has decidedly shifted. I still recommend the consumption of pollutant-free sources of preformed long-chain omega 3s for cognitive health and explain my rationale in Should We Take DHA Supplements to Boost Brain Function? and Should Vegans Take DHA to Preserve Brain Function?


For more on the neurotoxic nature of mercury-contaminated seafood, see:

What can we do to help our mood? See:

What about antidepressant drugs? Sometimes they can be absolutely life-saving, but other times they may actually do more harm than good. See my controversial video Do Antidepressant Drugs Really Work?.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Original Link

Fish Consumption and Suicide

Sept 12 Fish Consumption copy.jpeg

Depression is a serious and common mental disorder responsible for the majority of suicides. As I've covered in Antioxidants & Depression, intake of fruits, vegetables, and naturally occurring antioxidants have been found to be protectively associated with depression. Therefore, researchers have considered that "it may be possible to prevent depression or to lessen its negative effects through dietary intervention."

But not so fast. Cross-sectional studies are snapshots in time, so we don't know "whether a poor dietary pattern precedes the development of depression or if depression causes poor dietary intake." Depression and even treatments for depression can affect appetite and dietary intake. Maybe people who feel crappier just eat crappier, instead of the other way around.

What we need is a prospective study (a study performed over time) where we start out with people who are not depressed and follow them for several years. In 2012, we got just such a study, which ran over six years. As you'll see in my video Fish Consumption and Suicide, those with higher carotenoid levels in their bloodstream, which is considered a good indicator of fruit and vegetable intake, had a 28% lower risk of becoming depressed within that time. The researchers conclude that having low blood levels of those healthy phytonutrients may predict the development of new depressive symptoms. What about suicide?

Worldwide, a million people kill themselves every year. Of all European countries, Greece appears to have the lowest rates of suicide. It may be the balmy weather, but it may also have something to do with their diet. Ten thousand people were followed for years, and those following a more Mediterranean diet pattern were less likely to be diagnosed with depression. What was it about the diet that was protective? It wasn't the red wine or fish; it was the fruit, nuts, beans, and effectively higher plant to animal fat ratio that appeared protective. Conversely, significant adverse trends were observed for dairy and meat consumption.

A similar protective dietary pattern was found in Japan. A high intake of vegetables, fruits, mushrooms, and soy products was associated with a decreased prevalence of depressive symptoms. The healthy dietary pattern was not characterized by a high intake of seafood. Similar results were found in a study of 100,000 Japanese men and women followed for up to 10 years. There was no evidence of a protective role of higher fish consumption or the long-chain omega 3s EPA and DHA against suicide. In fact, they found a significantly increased risk of suicide among male nondrinkers with high seafood omega 3 intake. This may have been by chance, but a similar result was found in the Mediterranean. High baseline fish consumption with an increase in consumption were associated with an increased risk of mental disorders.

One possible explanation could be the mercury content of fish. Could an accumulation of mercury compounds in the body increase the risk of depression? We know that mercury in fish can cause neurological damage, associated with increased risk of Alzheimer's disease, memory loss, and autism, but also depression. Therefore, "the increased risk of suicide among persons with a high fish intake might also be attributable to the harmful effects of mercury in fish."

Large Harvard University cohort studies found similar results. Hundreds of thousands were followed for up to 20 years, and no evidence was found that taking fish oil or eating fish lowered risk of suicide. There was even a trend towards higher suicide mortality.

What about fish consumption for the treatment of depression? When we put together all the trials done to date, neither the EPA nor DHA long-chain omega-3s appears more effective than sugar pills. We used to think omega-3 supplementation was useful, but several recent studies have tipped the balance the other way. It seems that "[n]early all of the treatment efficacy observed in the published literature may be attributable to publication bias," meaning the trials that showed no benefit tended not to get published at all. So, all doctors saw were a bunch of positive studies, but only because a bunch of the negative ones were buried.

This reminds me of my Is Fish Oil Just Snake Oil? video. Just like we thought omega-3 supplementation could help with mood, we also thought it could help with heart health, but the balance of evidence has decidedly shifted. I still recommend the consumption of pollutant-free sources of preformed long-chain omega 3s for cognitive health and explain my rationale in Should We Take DHA Supplements to Boost Brain Function? and Should Vegans Take DHA to Preserve Brain Function?


For more on the neurotoxic nature of mercury-contaminated seafood, see:

What can we do to help our mood? See:

What about antidepressant drugs? Sometimes they can be absolutely life-saving, but other times they may actually do more harm than good. See my controversial video Do Antidepressant Drugs Really Work?.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Original Link

Children’s Supplements Found Contaminated With Pollutants

NF-May19 PCBs in Children's Fish Oil Supplements.jpeg

A number of case-control studies have found that giving kids cod liver oil supplements may increase their risk of asthma later in life. Case-control studies are done by asking about past behavior in cases (those with asthma) versus controls (those without asthma) to see if certain past behaviors are more likely among the disease group. The problem is that asking people to remember what they were doing years ago, when most people can't remember what they had for breakfast last week, is unreliable. When interpreting the results from case-control studies, we also can't rule out something called reverse causation. Maybe cod liver oil doesn't lead to asthma, but asthma led to the use of cod liver oil.

It would therefore be nice to see a cohort study. In a cohort study, researchers would take people without asthma and follow them over time to see if those taking cod liver oil are more likely to develop it. Because people without the disease and their diets are followed over time, cohort studies bypass the problems of recall bias and reverse causation.

In 2013, we finally got one such study. 17,000 people free of asthma were followed over 11 years. Researchers knew who was taking cod liver oil and who wasn't, and then sat back and watched to see who got asthma over the subsequent 11 years. The researchers found that cod liver oil intake was indeed significantly associated with the development of asthma. They thought it might be the excessive vitamin A in the cod liver oil that was causing the problem, but there are also a number of substances in fish oil we may not want our children exposed to.

Researchers from Philadelphia University, highlighted in my video PCBs in Children's Fish Oil Supplements, recently looked at 13 over-the-counter children's dietary supplements containing fish oil to assess potential exposure to PCBs, toxic industrial pollutants that have contaminated our oceans. PCBs were detected in all products. Could we just stick to the supplements made from small, short-lived fish like anchovies instead of big predator fish like tuna to reduce the impact of biomagnification? Or use purified fish oils? No, the researchers found no significant difference in PCB levels whether the supplements were labeled as molecularly distilled or how high up the food chain the fish were.

The researchers concluded that while children's dietary supplements containing the long-chain omega-3's from fish oils may claim to benefit young consumers, "daily ingestion of these products may provide a vector for contaminant exposure that may off-set the positive health effects." What positive health benefits are they talking about?

Researchers publishing in the journal, Early Human Development, found that infants given DHA-fortified formula may have better development of their eyes and brains compared to infants getting non DHA-fortified formula. What was the source of the DHA? Not fish, but algae-derived DHA. In that way we can get the benefits of omega 3's without the contaminant risks. But of course, breast milk is the gold standard, significantly better than either of the formula fed infants. So the best source of omega-3's is mom.

It's bad enough when supplement manufacturers exploit adults when they're sick and vulnerable with pills that are often useless or worse, but taking advantage of our parental drive to do what's best for our children with contaminated products that may make them sick, makes me sick.

More on supplements in:

And speaking of which, Is Fish Oil Just Snake Oil?

Also check out these videos on fish oil and DHA: Omega-3's and the Eskimo Fish Tale and Should We Take EPA and DHA Omega-3 For Our Heart?

What about omega 3's for our child's growing brain? See my video Mercury vs. Omega-3s for Brain Development

We can also be exposed to PCBs in food. See Food Sources of PCB Chemical Pollutants.

More on the polluted aquatic food chain in:

What can we do to lower the risk of childhood asthma and other allergic-type diseases? See:

In health,
Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Image Credit: Lars Plougmann / Flickr

Original Link

The Reversal on Fish Oil

NF-Feb26 Is Fish Oil Just Snake Oil?.jpg

Are the purported benefits of fish oil supplementation for the prevention and treatment of heart disease just a "fish tale"? Thanks to recommendations from organizations such as the American Heart Association that individuals at high risk for heart disease ask their physicians about fish oil supplementation, fish oil has grown into a multibillion dollar industry. We now consume over 100,000 tons of fish oil every year.

But what does the science say? A systematic review and meta-analysis published in the Journal of the American Medical Association, highlighted in my video Is Fish Oil Just Snake Oil? looked at all the best "randomized clinical trials evaluating the effects of omega-3's on lifespan, cardiac death, sudden death, heart attack, and stroke." The studies told the subjects to either eat more oily fish or to take fish oil capsules. What did the study find? Overall, the researchers found no protective benefit for all-cause mortality, heart disease mortality, sudden cardiac death, heart attack, or stroke.

What about for those who already had a heart attack and are trying to prevent another? Still no benefit. Where did we even get this idea that omega 3's were good for the heart? If we look at some of the older studies, the results seemed promising. For example, there was the famous DART trial back in the 80s involving 2,000 men. Those advised to eat fatty fish had a 29% reduction in mortality. Pretty impressive--no wonder it got a lot of attention. But people seemed to have forgotten the sequel, the DART-2 trial. The same group of researchers, and an even bigger study (3,000 men). In DART-2 "those advised to eat oily fish and particularly those supplied with fish oil capsules had a higher risk of cardiac death."

Put all the studies together, and there's no justification for the use of omega 3s as a structured intervention in everyday clinical practice or for guidelines supporting more dietary omega-3's. So what should doctors say when their patients follow the American Heart Association advice to ask them about fish oil supplements? Given this and other negative meta-analyses, "our job as doctors should be to stop highly marketed fish oil supplementation in all of our patients."

I've previously discussed fish oil supplements in the context of risks versus purported cardiovascular benefits:

But if the benefits aren't there, then all one is left with are concerns over the industrial pollutants that concentrate in the fish fat (even in distilled fish oil, see Is Distilled Fish Oil Toxin-Free?).

These same contaminants are found in the fish themselves. This raises concern for adults (Fish Fog), children (Nerves of Mercury), and pregnant moms:

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day ,and From Table to Able.

Image Credit: Jo Christian Oterhals / Flickr

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How Long to Avoid Fish Before Conception?

NF-Dec25 How Long to Detox from Fish Before Pregnancy?.jpg

Mothers' increased consumption of fish before and during pregnancy leads to increased exposure to both mercury and the long-chain omega 3 DHA. Mercury may negatively affect brain development in one's unborn baby, whereas DHA may stimulate brain development. However, the negative effect of mercury appears to outweigh the beneficial effect of DHA for most species of fish (see Mercury vs. Omega-3s for Brain Development).

Unfortunately, women of childbearing age appear less aware and knowledgeable about this problem than other women, despite FDA and EPA campaigns to inform every OB/GYN and pediatrician in the country about the potential risks of mercury in fish.

Since mercury sticks around in the body, women may want to avoid fish with high levels of mercury for a year before they get pregnant, not just during pregnancy. The rationale for avoiding fish for a year before pregnancy is because the half-life of mercury in the body is estimated to be about two months. In a study I profile in my video How Long to Detox from Fish Before Pregnancy a group of researchers fed subjects two servings a week of tuna and other high mercury fish to push their mercury levels up, and then stopped the fish. Slowly but surely their levels came back down (see the video for the graph). I know a lot of moms are concerned about exposing their children to mercury containing vaccines, but if they eat even just a serving a week of fish during pregnancy, the latest data shows that their infants end up with substantially more mercury in their bodies than if they were injected with up to six mercury-containing vaccines.

Given the two-month half-life of mercury, within a year of stopping fish consumption our bodies can detox nearly 99% of the mercury. Unfortunately the other industrial pollutants in fish can take longer for our body to get rid of. Certain dioxins, PCBs, and DDT metabolites found in fish have a half-life as long as ten years. So getting that same 99% drop could take 120 years, which is a long time to delay one's first child.

The fact that we can still find DDT in umbilical cord blood decades after the pesticide was banned speaks to the persistence of some pollutants. There's a shortcut for moms, but it's The Wrong Way to Detox.

What effects do these other pollutants have? Well, high concentrations of industrial contaminants are associated with 38 times the odds of diabetes--that's as strong as the relationship between smoking and lung cancer! Isn't diabetes mostly associated with obesity though? Well, these pollutants are fat-soluble, so "as people get fatter the retention and toxicity of persistent organic pollutants related to the risk of diabetes may increase." This suggests the shocking possibility that obesity "may only be a vehicle" for such chemicals.

Now the pollutants could just be a marker for animal product consumption, which may be why there's such higher diabetes risk, since more than 90% of the persistent organic pollutants comes from animal foods. And indeed, in the U.S. every additional serving of fish a week is associated with a 5% increased risk of diabetes, which makes fish consumption about 80% worse than red meat. PCBs are found most concentrated in fish and eggs (Food Sources of PCB Chemical Pollutants), which may be why there are lower levels of Industrial Pollutants in Vegans. This may also help explain the remarkable findings in Eggs and Diabetes.

More on the risks of mercury can be found in these videos:

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Image Credit: Tatiana Vdb / Flickr

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How Seafood Can Impact Brain Development

NF-Oct30 How Seafood Can Impact Brain Development.jpg

In my video Fish Intake Associated With Brain Shrinkage, I discussed evidence suggesting that mercury exposure through fish intake during pregnancy may decrease the size of the newborn's brain. However, just because fish-eating mothers may give birth to children with smaller brains doesn't necessarily mean their children will grow up with neurological defects. In the video, Mercury vs. Omega-3s for Brain Development, you can see real-time functional MRI scans of teens whose moms ate a lot of seafood when pregnant. Because these kinds of scans can measure brain activity, as opposed to just brain size, we can more accurately determine if exposure to mercury and PCBs affected these kids. You can see an MRI of what a normal brain looks like when you flash a light in someone's eyes, but the MRI is significantly different for the mercury and PCB exposed brains, suggesting toxicant related damage to the visual centers in brain. (For more on the effect of mercury on teens, see Nerves of Mercury). Fish consumption may also increase the risk of our children being born with epilepsy.

So does maternal fish consumption have an effect on how smart our kids turn out? The DHA in fish--a long chain omega 3 fatty acid--is good for brain development, but mercury is bad for brain development. So a group of researchers looked at 33 different fish species to see what the net effect of these compounds would have on children's IQ. For most fish species, they found that "the adverse effect of mercury on the IQ scores of children exceeded the beneficial effects of DHA." In fact, so much brainpower may be lost from fish consumption that the United States may actually lose $5 billion in economic productivity every year.

For example, if pregnant women ate tuna every day, the DHA would add a few IQ points. But the mercury in that very same tuna would cause so much brain damage that the overall effect of eating tuna while pregnant would be negative, wiping out an average of eight IQ points. The only two fish that were more brain-damaging than tuna were pike and swordfish.

At the other end of the spectrum, the brain boosting effect of DHA may trump the brain damaging effects of mercury in salmon by a little less than one IQ point. Unfortunately, IQ only takes into consideration the cognitive damage caused by mercury, not the adverse effects on motor function and attention and behavior deficits. We think that attention span may be particularly vulnerable to developmental mercury exposure, probably due to damage to the frontal lobes of the brain.

And the IQ study didn't take into account the relatively high levels of PCBs in salmon and the accompanying concerns about cancer risk. Sustainability concerns are another wrinkle, as farm-raised salmon are considered a "fish to avoid." While king mackerel is considered a best choice for sustainability, the mercury levels are so high as to warrant avoiding consumption--exceeding both the FDA and EPA action levels for mercury contamination. But why risk any loss in intelligence at all when pregnant women can get all the DHA they want from microalgae supplements without any of the contaminants? We can then get the brain boost without the brain damage.

More on PCBs in:

-Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, and From Table to Able.

Images thanks to Dion van Huyssteen / Flickr

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