The Omega-3 Connection: The Groundbreaking Omega-3 Antidepression Diet and Brain Program

By Andrew L. Stoll

Simon & Schuster, 2001

Hardcover, 304 pages, $35.50

available at Amazon.com | Amazon.ca

Reviewed by SYD BAUMEL

Fat (the dietary kind) is hot stuff. And on the cutting edge is the relationship between the grease on our plates and the molecules in our brains. Harvard psychiatrist Andrew Stoll is helping to define that edge. In 1999, he was lead author of a study that suggested megadoses of fish oil could dramatically improve the course of severe bipolar disorder (also known as manic-depression). Fish oil and flax oil are notable for being the major dietary source of the hottest fats of all, the omega-3 essential fatty acids. They're the focus of this thoughtful, fact-packed book.

The Omega-3 Connection is divided into two parts. In Part I, "The Omega-3 Deficit," Stoll begins by recounting how he and a colleague tumbled to the clinical potential of the omega-3s in the early 90s. They had set out to comb the literature for safe substances that share the physiological effects of mood stabilizing drugs like lithium and valproate (Depakote). To their surprise, omega-3 fatty acids were the best fit. In time, they discovered that "omega-3 fatty acids were . . . safer than valproate and lithium: they had few side effects, and, in my [Stoll's] practice, at least, they have become one of the most frequently prescribed ‘medications’ for patients with mood disorders."

Stoll follows with a superb primer on dietary fats and the specific role of omega-3 deficiency in undermining physical, mental, and neurological health. He puts this into evolutionary perspective, explaining how modern changes in animal feed and the human diet have all but drained the omega-3s from our ancestral diets while radically boosting the intake of the physiologically complementary – and antagonistic – omega-6 fatty acids. 

The heart of the book, and the bulk of Part I, details the connections that Stoll and dozens of other scientists are making between this omega-3 deficit/omega-6 excess and a diverse range of psychiatric and neurologic diseases and disorders. "The case we present to you is not yet solid," Stoll cautions. "Many more studies are needed." But with such a consistent pattern in the research, it's hard not to be concerned about the apparent hazards and inspired by the therapeutic possibilities Stoll lays out in tight, "evidence-based" detail. Consider some examples:

• The developing human fetus is an omega-3 sponge, capable of depleting the mother's reserves to build its own omega-3-rich nervous system. There is evidence that if a pregnant woman hasn't enough omega-3s, she will be at increased risk of potentially fatal eclampsia and her baby will be more likely to enter the world prematurely, at low birth weight, and with a faulty nervous system, among other handicaps. That same omega-3 deficiency could psychologically depress the mother during pregnancy or cause postpartum depression or psychosis later. Stoll describes a study from the U.S. National Institutes of Health: "Across the board, nations with high levels of fish consumption . . . had the lowest levels of postpartum depression," and vice versa.
• Considerable evidence implicates omega-3 deficiency as a risk factor for any kind of depression. While controlled clinical trials of omega-3s for major depression are underway, Stoll has experimented less formally. When he added fish oil or flax seed oil (also known as linseed oil) to the regime of antidepressant-resistant patients, "five of sixteen responded at least partially, and four of those experienced marked improvement."
• Stoll discusses the aftermath of his groundbreaking controlled trial of fish oil for bipolar disorder. "To date, I have used, or consulted on the use of, fish oil in the treatment of hundreds of patients, usually using it in addition to lithium, valproate, and other mood stabilizers. For those with milder forms of the disorder, and rarely in more severe cases, I have used the omega-3 fatty acids alone."
• There is intriguing evidence that road rage and other acts of impulsive violence, as well as simple hostility, could be fuelled in part by a lack of omega-3s. In one study, Japanese scientists found that exam-time pressures created increased signs of hostile ideation in medical students – unless they'd been taking supplements of DHA, one of the three main omega-3s. Upping the ante, Stoll writes that "researchers studying violent criminals have . . . documented a defect in the biochemical system responsible for carrying DHA into the brain." He cites an NIH colleague who therefore suggests that "higher than normal doses of omega-3 might reverse the trend." 
• Twenty years ago, researchers first noticed many clinical similarities between omega-3 deficiency and attention deficit hyperactivity disorder (ADHD). "Most striking," Stoll notes, "some 40 percent of those with ADHD had low levels of omega-3 fatty acids in the blood." Researchers at Purdue University later found that ADHD children appear to require a much higher omega-3 intake than other children to achieve normal body levels. The Purdue group is now conducting a trial to see if DHA will relieve ADHD. [UPDATE: Disappointingly, a Mayo Clinic study has since found no advantage of DHA over placebo for ADHD children. However, an Oxford University study did find that a broader spectrum supplement of essential fatty acids did improve ADHD-type symptoms in children with learning disabilities.]
• One research group has found the same kind of powerful correlation between omega-3 intake in different countries and schizophrenia as others have found for depression and heart disease. In preliminary reports, supplementation with EPA (another major omega-3 fatty acid), but not DHA, has had modest to dramatic clinical effects on schizophrenic patients.

As with many "latest breakthroughs," the omega-3/brain connection isn't really new. As early as 1981, a Harvard-trained physician named Donald O. Rudin began publishing papers and books presenting his theory and evidence that a modern Western epidemic of omega-3 deficiency is wreaking havoc with people's health – bipolar disorder and schizophrenia being two of the worst symptoms. Commendably, Stoll credits Rudin for his obscure, yet pioneering contribution.

If you've ever wished for a book that could be called "Your Brain on Fats," you've come to the right place.