Chapter Two

FROM THE BEGINNINGS

Q. How did DHA help me even before I was conceived?

A. By helping your mother. And your father, too. In women, the first pregnancy-related need for fatty acids occurs during the three months before conception. During this critical time, cells in the ovaries are dividing and committing themselves to becoming egg cells. Healthy, viable eggs require DHA and arachidonic acid to grow and develop.

In men, DHA is highly concentrated in the testicles, where sperm form. It is needed to regulate enzymes in the process of making sperm. Sperm itself has high concentrations of DHA, too. Here, DHA seems to be needed to help energize sperm and increase its mobility. In fact, infertile men have been found to have low DHA levels.

Clearly, healthy eggs and viable sperm need DHA. The details of this important role is still being worked out. When a sperm cell fertilizes an egg cell, conception occurs, and an incredible nine-month journey begins. Even though we know some of what goes on during pregnancy, we are far from fully comprehending the details. No human technology comes remotely close to matching the speed, efficiency, accuracy, and intricacy with which fetal development occurs inside the womb. And the success of the process will depend in part on adequate amounts of DHA.

Q. How do omega-3 fatty acids help protect a pregant woman?

A. Pregnancy can be both an exciting as well as stressful time for both mother and father. But the mother experiences tremendous extra demands on her body. Her blood pressure may increase. Blood lipids, triglycerides, and cholesterol levels may shoot up several times above normal. She may retain water and become edemic. Unusually large amounts of proteins may escape from her body and be excreted in her urine. All these problems may combine to result in a condition called pre-eclampsia. Even more severe is eclampsia, where convulsions and coma occurs. Obviously, these conditions are dangerous for both mother and fetus. Thus, efforts to prevent the complications encourage a safe pregnancy.

Omega-3 fatty acids from fish and fish oil supplements are known for being very effective at reducing blood pressure and triglyceride levels. At the University Hospital of Aarhus, Denmark, Dr. S. Olsen led a team to examine how fish oil supplements affected pregnant women. They discovered that supplementing two to three grams of omega-3 fatty acids per day effectively lowered the blood pressure of pregnant women, prolonged gestation, increased the weight of the newborn, and reduced the incidence of premature birth. However, no benefit was found if women began to taking the fatty acids after the 30th week. This suggests early supplementation may be more effective. Based on such research, the Canadian Hypertenstion Society encourages pregnant women at high risk for developing high blood pressure take fish oil supplements.

Q. What happens to a pregnant woman's DHA levels?

A. The last trimester (6th to 9th months) is when the nervous system of the fetus is developing most. It greedily accumulates DHA in its liver and brain. The DHA, of course, comes from the mother. In fact, during pregnancy, the level of omega-3 fatty acids in the blood of mothers drops considerably, and the low levels may continue long after giving birth. Some researchers are investigating whether the depression some mothers experience after giving birth (the so-called "post-partum blues") is caused by depleted DHA levels.

DHA levels in women who are pregnant for the second or more time are lower than in first time mothers. The demands on the mother's DHA store may be so great when she carried her first child that she was never able to fully recover afterwards. Supplementing with DHA during the second or more pregnancy thus makes a lot of sense.

Q. How much DHA does a pregnant mother need?

A. Recent data suggest at least 100 mg to 400 mg daily. This is about how much DHA is in a 4 ounce serving of a cold water, fatty fish, like cod or salmon. Interestingly, some Oriental cultures are extremely careful about what a pregnant woman can or cannot eat, and one of the extra foods she is urged to eat is fish. Such nutritional wisdom based on observation and common sense now makes tremendous sense scientifically.

Q. What will happen if the mother does not have enough DHA to provide the fetus?

A. The fetus simply does not have the enzymes necessary to form its own DHA. It relies entirely on the mother to provide it. If the mother simply does not have enough, the fetus will have no choice but substitute other fatty acids instead, inferior materials which were not meant to be used. This may result in irreversible damage to the brain and nerve tissue. Later in life, the child may suffer serious vision problems, or have difficulty learning and thinking. This unfortunate consequence is often observed in those who were born prematurely.

Q. How do low levels of DHA in premature babies affect them later on in life?

A. Sometimes, something goes wrong, and a baby is born ahead of schedule. Modern medical technology has advanced to a point where even if a baby is born after only 21 weeks (about half the normal time), he can still live. He is placed in an incubator, where the temperature and humidity is carefully controlled to mimic the womb, and where he is fed his mothers milk or standard formula. But often, these babies develop visual, cognitive, and other neural disabilities later in life. Serious problems that may develop include mental retardation and cerebral palsy.

Premature babies are deficient in DHA, arachidonic acid, and the antioxidant enzymes needed to protect polyunsaturated fatty acids. Their deficiencies in DHA have been associated with poor vision, suppressed mental functions, and poor coordination. Low arachidonic acid levels reflect slightly suppressed growth. Fortunately, direct supplementation seems to help. For instance, numerous studies by Dr. S. Carlson at the University of Tennessee found giving premature babies DHA at 0.2% of their total fatty acid intake greatly improved their visual acuity and mental development. Consequently, the International Society for Study of Fatty Acids and Lipids now recommends that premature baby formula be supplemented with arachidonic acid and DHA. Specifically, arachidonic acid should be given in the amount of 60-100 mg/kg bodyweight/day, and DHA, 35-75 mg/kg/day.

Q. How does the normal, healthy infant get DHA?

Newborns are unable to make enough DHA for themselves. This is because the biochemical tools needed to synthesize DHA are not ready to function at peak capacity. During the few months after birth, though, the brain and nervous system continues to grow and develop at a maddening pace. The need for DHA is still critical, as it was in the womb.

Since the infant can't make its own DHA, it needs to get it from somewhere else. Nature has provided an excellent source of DHA and other important fatty acids: breast milk. In western cultures, breast milk contains about 0.2% DHA of total fatty acids. In eastern cultures, it goes as high as 0.9%. This difference may reflect that much more fish and seafood products are part of the eastern diet. Compared to those fed standard baby formula, infants weaned on breast milk have better vision, score higher on intelligence and developmental tests, and may be less likely to succumb to mental illness in old age.

Q. Do baby-food formulas provide enough DHA for the growing infant?

Here lies a grave omission on the part of baby formula manufacturers: no DHA, arachidonic acid, or other important fatty acids are included in the formulas. Most baby foods are derived from cow milk, but the little alpha-linolenic acid present does not adequately maintain DHA-levels in the blood comparable to breast fed infants. When breast feeding is not possible, experts suggest adding DHA into standard formula so that it will be about 0.2% of the total fatty acid content. This comes out to be about a minimum of 30 mg DHA per day. The European Union acknowledged the importance of these findings by issuing a directive on infant formula in 1995, specifying 1% of the total fats should be omega-3 fatty acids, and EPA levels should be lower than DHA. Most U.S. manufacturers have not added DHA or EPA to their infant formulas, but some are considering the issue.

Q. Does adding DHA to baby-food formulas actually help?

A. Researchers have investigated this carefully. Here are some highlights of a few studies:

Infants fed a special formula enriched with arachidonic acid (0.44%) and DHA (0.3%) had developmental scores similar to those from infants who were breast fed 4 months.

Another study found that babies fed formulas containing adequate amounts of linoleic and linolenic acids, the precursors of arachidonic acid and DHA, developed normal vision and memory abilities.

Babies given supplements of polyunsaturated fatty acids exhibited superior problem-solving skills, compared to those who did not.

However, some evidence suggests that standard formula is just as good as enriched formula for developing vocabulary and motor skills. This is clearly a multi-faceted question which requires more research to understand clearly.

Q. Can the DHA levels in natural breast milk be increased?

A. For those who prefer the natural way of breast feeding, increasing DHA-rich foods or supplements during pregnancy and lactation can help increase the DHA content of breast milk. In one study led by Dr. I. Helland at the University of Oslo, Norway, taking 5 to 10 ml of cod liver oil daily increased the EPA and DHA concentrations of breast milk, without increasing arachidonic acid levels. In another, Dr. M. Makrides at the Flinders Medical Center, Australia, reported supplements providing from 200 mg to 1300 mg DHA per day increased milk DHA levels accordingly. The more DHA the mother intakes, the higher the DHA levels were found in her milk. The Australian group also found that the increase of DHA in breast milk is effectively passed on to the infant, but after the DHA concentration rises past 0.8% of the total fatty acids in the milk, the infant does not seem to benefit in any extra way.

Q. What extra precautions should vegetarian mothers take?

A. Vegetarian diets have been found to be very low or non-existent in DHA. One study by Dr. S. Reddy at the King's College London found that vegetarians give birth to infants with less DHA, although this did not directly affect the birth-weight or size of the child. Another study by Dr. T. Sanders at the University of London found that babies breast fed by vegan mothers had 1.9% DHA in their red-blood cells, compared to 6.2% in babies with non-vegetarian mothers. In light of this, DHA supplementation for vegetarian mothers seems justified.

To examine the effectiveness of DHA supplementation in vegetarians, Dr. J. Conquer at the University of Guelph, Canada, gave twenty-four healthy vegetarians DHA (1.62 g/day) for 6 weeks. He reported a 246% increase in blood DHA levels and a 225% increase in DHA levels in a certain kind of blood cell, the platelets, which help form blood clots. (Incidentally, the source of DHA in this study was algae, a marine vegetable, so the participants could maintain their vegetarianism.)

Q. Is DHA important for children beyond infancy?

A. During the first decade and a half of life, the brain continues to grow. Learning, both in school and out of school, is the primary occupation of most kids this age. Language and math skills are established. Athletic coordination is developed. Social graces are instilled. Artistic and musical appreciation, emotional expression, and even spiritual awareness all begin. In short, who we are the rest of our lives is largely laid down during these exciting, and sometimes turbulent years. If we could peek inside the brain of a child as he learns to play the piano or ride a bicycle, we would see neurons forming countless new connections, and the synapses wild with chemical and electrical activity. Each new word learned, each new thought and feeling, each new memory are all recorded as permanent, physical changes in the brain. And each require DHA to form properly.

Q. Can children get enough DHA from what they normally eat?

A. What also forms during the childhood years is dietary preferences. Yet the diet of most children in the United States is loaded with omega-6 fatty acids, and barely any omega-3's, let alone EPA and DHA. Foods in our society revolve around animal meat, warm climate vegetable oils like corn oil, fried foods, and commercially prepared foods. Animal meat and corn oil supply mostly saturated and omega-6 fatty acids. Frying destroys polyunsaturated fatty acids, and creates harmful free radical products. Commercially processed foods are high in trans-fatty acids, very different in structure from natural cis-fatty acids. So, most American kids are probably not getting enough DHA when they need it most.

Adding to the problem, our society's obsession with the slim figure causes many children, particularly girls, to severely restrict their intake of foods, especially fatty foods. This tendency may be aggravated by the physical demands of athletic involvement, such as gymnastics, ballet, or figure skating, where smaller is better. These children manage to maintain a sleek body often at the expense of a sound mind. Ironically, the scant fatty acid levels in the low calorie diets meant to optimize their performance may be preventing them from performing as well as they can.

Q. Can DHA help those with Attention-Deficit Hyperactive Disorder?

A. A growing childhood malady is Attention-Deficit Hyperactive Disorder (ADHD). The ADHD child finds it impossible to concentrate in school. He is fidgety, can't sit still very long, and may be destructive. Researchers are just starting to study the connection between ADHD and DHA levels. For instance, Dr. L. Stevens at Purdue Universtiy, Indiana, reports that boys diagnosed with ADD have low levels of DHA and EPA. Interestingly, another study at Purdue University found that children who were breast fed as infants were less likely to have ADHD. Based on these observations, scientists such as Dr. Stevens hypothesize that faulty fatty acid metabolism may contribute to ADHD.

To test whether raising DHA levels via supplementation may alleviate ADHD, several research groups are planning studies. As of the time of this writing, no such studies have been completed. Yet, the results are eagerly anticipated and will likely be announced through the media and health-related newsletters. On the other hand, a group at the Toyama Medical and Pharmaceutical University in Japan led by Dr. Hamazaki was interested in whether DHA would reduce aggression in students undergoing final exams. (The Japanese exam periods are extremely mentally stressful, and students would often become aggressive toward others as a result.) The researchers gave 41 students either daily capsules of 1.5 grams DHA, or soybean oil lacking DHA. At the end of the testing period, the control group receiving the soybean oil exhibited significantly increased levels of aggressive behavior, as was expected. However, those who received DHA did not show signs of aggression. The researchers concluded that DHA supplementation prevented extra-aggression from increasing during times of mental stress in students.