Ocean Nutrition Canada Limited (ONC), based out of Dartmouth, Nova Scotia, is pleased to announce the launch of Irish Pride Bakeries’ first Omega-3 bakery product. Irish Pride Vita Kids Bread is fortified with Omega-3 EPA/DHA and is made specifically with kid’s nutrition in mind. Every 100 grams of Vita Kids Bread provides 40 mg Omega-3 EPA/ DHA, is a source of folic acid, Vitamin C, Vitamin D, is preservative-free and has 25% reduced salt. Children’s particular tastes often make it difficult for parents to serve them a complete, healthy and balanced diet, including fish and all other food groups. Products like Irish Pride Vita Kids Bread make it easier to fit important Omega-3s and necessary vitamins and minerals into children’s sometimes-picky food preferences. Jon Getzinger, Chief Sales and Marketing Officer at ONC said, “We are excited to be a part of Irish Pride’s first ever Omega-3 fortified bread. EPA/ DHA is important at all life stages and it’s great to see a product like this that helps to address low Omega-3 intake levels in Irish children, while also providing necessary vitamins and minerals.”
Centralized application service makes life easier for aspiring naturopathic doctors
The Association of Accredited Naturopathic Medical Colleges (AANMC) is pleased to announce the first centralized application service for naturopathic medical (ND) school applicants. Scheduled to launch in September 2011, the Naturopathic Doctor Centralized Application Service (NDCAS) is well into development, and is currently in the process of enrolling participating schools into the service. At this time the following naturopathic schools plan to offer this online service to their fall 2011 applicants: Boucher Institute of Naturopathic Medicine (Vancouver, British Columbia), Canadian College of Naturopathic Medicine (Toronto, Ontario), Southwest College of Naturopathic Medicine & Health Sciences (Phoenix, Arizona), University of Bridgeport College of Naturopathic Medicine (Bridgeport, Connecticut). NDCAS will serve to streamline and simplify the application process for prospective students applying to multiple ND schools, thereby reducing both time and cost. The applicant will simply submit a single application through NDCAS and select his or her schools of choice. Student applicants may then monitor the progress and status of their application online, and may acquire assistance through the helpline during business hours. The participating schools look forward to seeing an enthusiastic response from the fall 2011 ND school applicants.
Carlson Laboratories to Partner with Natural Products Foundation
Carlson Laboratories has announced their new partnership with the Natural Products Foundation to support research and education. A portion of the proceeds from the sale of each specially labeled Carlson Super Omega-3 Gems supplement will benefit Foundation programs. The promotion began in June 2011 and was going to be continued while supplies lasted. The mission of the Natural Products Foundation is to promote and facilitate research and education related to natural products for the benefit of consumers and industry. Since Carlson also highly values the education of its consumers, the partnership was a natural decision. “We are so excited to be able to work with the Natural Products Foundation,” said Carilyn Anderson, President of Carlson Laboratories. “We have many common goals, including the wellness and education of our customers, so this was the perfect choice for us at this time.”
BINM to offer Canada’s first naturopathic midwifery program
The Boucher Institute of Naturopathic Medicine (BINM) has announced their commitment to offer Canada’s first naturopathic midwifery program beginning in the fall of 2011. The Chair of Women’s and Children’s Health at the Boucher Institute, Cathy Carlson-Rink, ND has begun development of individual certificate courses in naturopathic therapeutics in obstetrics, gynaecology and paediatrics. These certificate credits will be applied to the completion of the comprehensive midwifery program when accreditation is achieved. “We are thrilled to be moving forward with this initiative,” said Boucher Institute President, Patricia Wolfe, ND. “Helping women to naturally prepare for and accomplish childbirth, and supporting them as new mothers to make the best health choices for themselves and their babies, is a profound and effective way to promote wellness extending into the next generation.” The development of this important post-graduate program holds to BINM’s firm commitment to advance naturopathic knowledge and skills. Midwifery is an intrinsically holistic practice, combining an understanding of the physical, emotional, environmental, social and cultural aspects of a woman’s reproductive health experience. Much like naturopathic medicine, midwifery is collaborative by nature and promotes health and wellness among women, babies and families.
X YMOGEN Announces Emergence into Canadian Market
OXYMOGEN, a US- based provider of functional food and nutraceutical products servicing the professional market for over 25 years, has announced its arrival to the Canadian market as of the fourth quarter of 2011. The company offers over 150 products, manufactured in TGA-certified facilities and is engaged with Health Canada to obtain NPN numbers on as many products as possible for distribution in Canada. Many of their formulas are based upon licenses of exclusivity from partners such as Johns Hopkins University, InstitutRosell, and ProliantBiologicals. XYMOGEN was recognized in 2007, 2008, and again in 2010 by American Business Magazine, Inc. as one of the 5000 fastest-growing private companies in America. The company cites “research-based doses of ingredients in single and combination products” and the fact that many products are published in peer reviewed journals, as a major basis for the success it has enjoyed with ND’s, MD’s, and other integrated healthcare providers.
Methylation testing now available with Doctor’s Data Inc.
Doctor’s Data, Inc. (DDI) has developed a Methylation Profile to report on plasma concentrations of key amino acids and intermediary metabolites in order to permit the evaluation of disorders in methionine metabolism. Potential consequences of untreated aberrant methionine metabolism include abnormal neurotransmitter metabolism and neuropsychiatric disorders, nitric oxide dyshomeostasis, global under-methylation/synthesis/ repair of DNA, immune dysregulation, cancer, cardiovascular disease, congenital heart disease/birth defects, neurodegenerative disease, impaired endogenous detoxification and increased risk for Down syndrome. Improvements in disordered methionine metabolism may be accomplished through nutritional intervention guided by the DDI Methylation Profile.
The treatment of hypertension is improving in Canada
A recent study has revealed that the treatment of hypertension has vastly improved over the past two decades in Canada (CMAJ. 2011 Jun 14;183(9):1007-13) as awareness of the condition’s risks grows and drug treatments become more prevalent. The study looked at blood pressure measurements of Canadians between the ages of 20 and 79 and found that while the rate of hypertension remained stable at 19.7% to 21.6% of the population, rates of treatment and control had greatly improved. Over the period of the study, which was based on the review of three large-scale surveys, control of the condition through drug regimes had substantially improved, with 64.6% of those with the condition receiving treatment in 2009, up from 13.2% in 1992, ranking Canada as one of the most successful nations at treating hypertension. Despite the improvement in awareness and treatment, the study revealed that while Canada has one of the world’s lowest hypertension rates, a third of the population still has blood pressure above recommended targets and cardiovascular disease remains the most common cause of death and disability.
WHO says cell phone use “possibly carcinogenic”
Using a mobile phone might increase the risk of developing certain types of brain tumors and consumers should consider ways of reducing their exposure, World Health Organisation (WHO) cancer experts said. A working group of 31 scientists from 14 countries meeting at the WHO’s International Agency for Research on Cancer (IARC) said a review of all the available scientific evidence suggested cell phone use should be classified as “possibly carcinogenic.” The classification, which puts mobile phone use in the same broad IARC cancer risk category as lead, chloroform and coffee, could spur the United Nations health body to look again at its guidelines on mobile phones, the scientists said. Institute 20 years ago and he is the chief science officer for Metagenics, Inc. Bland has devoted his life to helping people realize optimal health by addressing the causes of impaired metabolism and physiology, and then applying individualized responses. He has inspired many with his groundbreaking work in the fields of nutrition and nutrigenomics and his leadership in the growing specialty of lifestyle medicine, helping people make lifestyle changes to promote lifelong health and avoid chronic illness. Considered the “Father of Functional Medicine,” Bland’s vision, brilliance, and leadership have inspired a worldwide community of clinicians, scientists, and educators to transform clinical practice and educational curricula.
Health Canada announces funding for clinical trials of liberation therapy for MS patients
On June 29, 2011, the federal government announced that it will fund clinical trials of the so-called liberation therapy for multiplesclerosis(MS)patients.Liberation is an unproven therapy based on the theory of Italian neurologist Dr. Paolo Zamboni that stenosis, a narrowing or blockage of veins in the neck which drain blood from the brain, results in a medical condition known as Chronic Cerebrospinal Venous Insufficiency (CCSVI), which may cause MS symptoms. Removing the blockage using a procedure similar to balloon angioplasty known as percutaneous transluminal angioplasty (PTA) was found to improve blood flow, which in turn improved balance and walking, while reducing dizziness, fatigue, muscle spasms and incontinence. Although the cause of MS is unknown, several new studies are pointing toward CCSVI as being a culprit in the pathogenesis of MS. The push for clinical trials in Canada has been increasing as dozens of patients who underwent the operation abroad at their own expense claim their lives have changed for the better.
Phospholipids choline, serine, and inositol
Phospholipids choline, serine, and inositol
Effects on Major Depressive Disorder
Introduction
Depression or Major Depressive Disorder (MDD) is a serious illness that interferes with a patient’s mental, physical and cognitive well being (Soleimani 2011). It is described as “a broad and heterogeneous diagnostic grouping, central to which is depressed mood or loss of pleasure in most activities” (Middleton 2005). Since depression affects the quality of life and productivity of the patient, an early diagnosis is crucial for effective treatment. It has been reported that 60-70% of patients with depression will respond to treatment if diagnosed early and appropriately treated (Shah 1999). The annual prevalence of depression in Canada is estimated at 4.8% (Patten 2006). According to the National Comorbidity survey, the average lifetime estimate of depression in the United States is 12% for males and 26% for females with an average lifetime prevalence of 17% (Shah 1999). The World Health Organization (WHO) in the 1990s ranked depression to be the fourth cause of global disease burden. In 2001, depression rose to be the third leading cause of Global Disease Burden (GDB) worldwide (Murray 1997).
The most important factor predicting the risk of a depressive episode is having had depression in the past. Patients who have had depression in the past have more than a 50% chance of having another episode in the future. Females have double the risk of being depressed than males in their lifetime and first-degree relatives are three times more likely to develop depression than the general public (Shah 1999).
Two existing criteria are used to diagnose depression; the American Psychiatric Association’s Diagnostic and statistical Manual version four (DSM-IV), and the World Health Organization’s International classification of disease tenth revision (ICD-10). The DSM-IV-RT defines depression as a mood disorder. A patient is diagnosed with MDD based on the DSM-IV if they meet the following criteria: the patient should not have a history of bipolar disorder, the patient should have a depressive episode for at least two weeks and the patient has to experience at least five of the following symptoms: depressed mood, weight gain or loss, psychomotor agitation or retardation, inability to enjoy activities otherwise enjoyable, feeling guilty, feeling worthless, insomnia and recurrent thoughts of death or suicide. Moreover, these symptoms have to cause significant impairment to the patient’s functioning and cannot be related to substance abuse (American Psychiatric Association [DSM-IV-TR] 2000). After diagnosis, symptoms will be classified according to severity to indicate mild, moderate or severe depression. Mild depression is classified by meeting the minimum criteria and slightly more symptoms; moderate depression episodes are classified by meeting the minimum criteria plus symptoms that interfere with the patient’s social and occupational life. If psychotic features or suicidal thoughts accompany an episode, the patient is considered to have severe depression, even if they only meet the DSM-IV minimum criteria (Hamilton 1960). Recommended treatment differs based on disease severity.
The course of action for mild depression is often watchful waiting, with the expectation that symptoms will subside in 14 days (Whooley 2000). In the case of moderate or severe depression, selective serotonin reuptake inhibitors (SSRIs) are used as the first line of treatment. Patients with severe depression should be closely monitored for suicidality with referral or admission to hospital if necessary (Soleimani 2011).
A meta analysis published in 2010 found that SSRI treatment is no better than placebo for mild to moderate depression (Fournier 2010). In addition, subgroup analysis from the Women’s Health Survey study also found that women using SSRIs for depression are at a significantly higher risk of sudden cardiac death (William 2009). This recent research highlights the need for safe and effective treatment alternatives to drug therapy.
Interest in administering phospholipids for treatment of MDD stems from animal and human data demonstrating that certain areas of the brain, plasma and CSF can show deficiencies in phospholipids in depressed patients. Phospholipids are also integral in CNS second messenger systems raising questions as to whether these deficiencies contribute to the symptomology of major depression. This review will focus on the effects of administering phosphatidylinositol, phosphatidylserine or phosphatidylcholine on unipolar depression by reviewing current human trials and animal data. A comprehensive literature review was conducted and revealed one systematic review, three clinical trials and four animal studies on inositol and depression, three human and one animal study on phosphatidylserine and no human or animal studies on the relationship between depression and phosphatidylcholine. The remainder of the article will focus on inositol and phosphatidylserine as possible treatments for major depression.
Phosphatidylinositol
Inositol is a sugar alcohol that is a component of cell membrane phospholipids and a part of the intracellular phosphatidylinositol second-messenger system associated with receptors of norepinephrine, serotonin and choline (Berridge 1989).
In total, four studies of inositol treatment for depression in rats were found. Well- defined parameters of antidepressant response based primarily on locomotion indices serve as endpoint measures. All four studies demonstrated a significant antidepressant effect from administration of inositol relative to placebo (Einat 1999, Einat 2002, Kofman 1993, Kofman 1998).
In 1978 Barkai and colleagues found that patients with MDD have significantly decreased inositol levels in CSF when compared to healthy controls. This finding was investigated further in 1993 where inositol was administered to subjects and results were recorded. The conclusion was that administering inositol to depressed patients increases their CSF inositol levels significantly (Levine 1993); the findings inspired the first randomized clinical trial done by Levine and colleagues in 1995.
A total of three human trials were identified investigating the effects of inositol administration on depression. Levine and colleagues conducted the first randomized clinical trial using the Hamilton Depression Rating Scale (HDRS) as their primary endoint measure (Levine 1995). After administering 12g of inositol or placebo for four weeks, the authors found a significant reduction in depression scores in the inositol group compared to the placebo group.
Plausibility of a physiologic reaction to inositol in MDD was elevated by a follow up of this study group 10-12 months after the initial study had ceased. 50% of patients who responded to inositol in the initial trial had experienced a relapse in depressive symptoms after discontinuing treatment and no patients in the placebo arm who initially reported benefit experienced a relapse in symptoms. (Levine 1995b)
In 1999, two studies were published that investigated inositol effects on HDRS. Levine and colleagues (1999) administered inositol and standard SSRI treatment in the experimental group and used placebo with SSRIs as a control. After four weeks, authors found that there was no significant difference between the groups on HDRS scores, however there was an expected improvement in the scores of both groups as both groups received SSRI therapy. Nemets and colleagues (1999) conducted a study to investigate the effects of inositol on depression after failed SSRI treatment. Depressed patients that failed to respond to three weeks of SSRI treatment were enrolled in this study and randomized into two groups: inositol group or placebo group. Patients continued their SSRI treatment during the four weeks period of the study. The authors concluded that there was no significant difference in the depression scores when comparing both groups.
Levine (1995) included 4 patients with bipolar depression in the inositol group (N=9). Inclusion of patients with bipolar depression could potentially explain the apparent improvement in mean HDRS scores as almost half the treatment group was classified as bipolar. This inclusion of patients with bipolar makes it difficult to conclude whether inositol is effective in reducing depression in patients with unipolar depression.
Each of the three studies reviewed above have two main limitations: small sample size and a short study period. The duration of the two studies conducted in 1999 was adopted from the first study (Levine 1995) that reported significant reduction in HDRS after 4 weeks. A longer study is needed to define when inositol becomes effective in reducing depression symptoms if at all. The patients in the original study were not using concurrent SSRI treatment and were not labeled as SSRI non-responders which may explain the difference in results when compared to the studies conducted in 1999. Thus, a follow up study with a greater sample size, longer duration and patients with MDD who have no history of SSRI use may produce more conclusive results. Future directions for the study of inositol and MDD should also include investigation into the potential applications of the different stereoisomers of inositol including myo-inositol and d-chiro-inositol.
A Cochrane systematic review (Taylor 2004) combined all of the three studies and included a study that recruited only bipolar patients and found that even with a combined sample (n=141), the effect of inositol on depression scores is still not significant.
In conclusion, the three RCTs (Levine 1995, Levine 1999, Nemets 1999) show conflicting results regarding the treatment effect of inositol.
Phosphatidylserine
Phosphatidylserine is one of the most important phospholipids in the central nervous system. It mainly plays a role in the function and homeostasis of nerve cells and is involved in cell-to-cell recognition and communication and affects levels of neurotransmitters such as dopamine, acetylcholine, and norepinephrine. For these reasons, phosphatidylserine has mostly been studied for its role in memory and cognitive functions (Kidd 1999).
One study was identified examining endpoints relating to depression following administration of phosphatidylserine in rats. Significant antidepressant outcomes were demonstrated relative to administration of placebo (Castilho 2004).
Three studies have investigated the effects of administering phosphatidylserine to patients with depression. Maggioni and colleagues (1990) conducted a placebo- controlled crossover study looking at the effects of administering phosphatidylserine to elderly female patients with depression. All 10 patients received both the treatment and placebo, thus served as their own controls. Symptoms were measured using the HDRS. All patients received the placebo for at least 7 days followed by a washout period before receiving 300mg/day of phosphatidylserine for 30 days. Depression scores were recorded before placebo (phase I), before phosphatidylserine treatment (phase II) and after phosphatidylserine treatment (phase III). Rating scores before and after placebo administration did not change. However, depression scores were reduced significantly after phosphatidylserine treatment (Maggioni 1990).
Brambilla and colleagues (1995) recruited 10 elderly female patients (8 with MDD and 2 with bipolar depression) to study the effects of administering phosphatidylserine on depression. Patients received a dose of 600mg of phosphatidylserine per day. Patients had a significant reduction in the HDRS after 30 days (Brambilla 1995).
Brambilla, & Maggioni (1998) studied phosphatidylserine and depression in an elderly female sample. Ten females were recruited for this study, 8 with MDD and 2 with bipolar depression. The average age of the patients were consistent with earlier studies and included women between the ages of 66 to 78 years. Patients received 200 mg of PS three times a day for 30 days after 15 days of hospitalization for depression. Effects were measured based on HDRS and a significant improvement was seen after 30 days in the treatment group when compared to controls (Brambilla 1998).
Discussion
The need for an alternative treatment for depression magnified after a prospective study of nurses found that using SSRIs significantly increases the risk of sudden cardiac death. The current findings indicate that administering inositol to rats creates a significant reduction in depressive symptoms as reported by several studies (Einat 2000, Einat 2002, Kofman 1998, Kofman 1993). On the other hand, only one (Levine 1995) of three (Levine 1999, Nemets 1999) human studies found a significant effect following administration of inositol on depressive symptoms. The type of patients (MDD, unipolar depression versus bipolar disorder) and the use of adjunct pharmacotherapy may explain the difference in results. The positive effects of inositol in rats strengthen the case for further investigation of inositol treatment for depression in humans.
In studies of phosphatidylserine, three human trials and an animal study showed a significant reduction in depressive scores after treatment. The human studies presented in this paper found that phosphatidylserine is effective in reducing depression scores in elderly female patients. Although it was very effective in treating depression, no studies have been published looking at the effects of phosphatidylserine on depression in a sample of adult males or younger adult females. Questions as to whether the antidepressant effects of phosphatidylserine are age or gender dependent requires further study across male and younger female patient populations.
Conclusion
Based on the current findings, the effect of inositol administration on depressive symptoms is not clear and requires further investigation in humans. For phosphatidylserine, three human trials and one animal study confirm an antidepressant effect. Administering between 300-600mg/day for 30 days has been shown to significantly reduce symptoms in elderly females with depression. Continued research in the use of phospholipids in the treatment of depression is warranted given their high safety profile and potential to improve symptoms in depressed patients.
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