Omega 3 - Not the Cure for Alzheimer's (Again)

Another quick one - into my email this morning came this link:

Another study of Alzheimer's Disease and Omega 3 fatty acids. (That link goes to JAMA "free" full text article published this week but I had to watch a Vytorin add for a minute).

400 some-odd elders with mild to moderate dementia were randomized to 2 grams of algal DHA daily or placebo for 18 months. They were followed with a bunch of neuropsych measures, and a subgroup was examined with serial spinal taps for CSF DHA (not surprisingly increased in the DHA group), and another subgroup was monitored via MRI for brain atrophy (no difference between treatment and control groups). So you can't say the researchers didn't give it their all.

Fish oil is cheap and sexy and biologically awesome, but it won't reverse the neuronal brain damage of full-blown dementia. Nor does it appear to slow it down (though some APOE4 negative DHA folks did better on some of the cognitive tests than the controls). I think it likely works far better (and makes more sense biologically) as a long-term preventative measure rather than as a treatment or cure. Fish eaters in epidemiological studies tend to eat fish for many years, or be in populations where eating fish is extremely common and lifelong, and dementia is less common than in non-fish eaters. Of course that's a correlation - but at least it is a biologically plausible one. Maybe we need a salmon clinical trial in lieu of a algal DHA one.

Adverse events was also interesting - how safe is fish oil with warfarin (a blood thinner)? These relatively high doses of DHA resulted in 3 people on warfarin having an INR (measure of blood-thinning) out of range once during the trial. One of the control group on warfarin had an INR out of range. Since anyone on warfarin ought to have INRs measured regularly, a consistent fish oil dose should not pose a problem, I would think.

If one is looking for a cure or significant improvement for Alzheimer's, I would bet more money on decreasing acute inflammation or improving energy efficiency in the brain via ketosis. This article was also linked to my email: New Drug may halt and even reverse the effects of Alzheimer's. The "new drug" is immune globulin with beta amyloid antibodies administered IV. I have to find the actual article to take a gander and won't have time until later - so more updates then. It would be interesting to see that immune globulin helps Alzheimer's when beta amyloid vaccine doesn't seem to do much at all (other than get rid of beta amyloid) - the dementia remains.

I don't know that there will be a longer term clinical trial of omega 3 fatty acids - such trials are expensive, and not sexy. We'll see.