Fish Oil

(I asked by John Kender to write something for me about the reports about fish oil from some users.  Please note that this is not medical advice and you are advized to always consult your physician first, before trying any product.)

I don't have a good idea of why fish oil should work. It might not even be the DHA that the users claim, but rather the EPA that unavoidably comes with it, that is doing the job. Even the researchers who have found it clinically effective if taken for a long time for some other disorders (like bipolar disorder) don't have much idea about what it does. So, as a scientist, I am a bit reluctant to talk about it until I understand it better. In the meantime, some of the more enthusiastic users of fish oil are finding that it sometimes stops working unless you take a steady supply of it every single day. That also is puzzling to me, since the medical researchers suspect that it might be altering the membranes of neurons in the brain, but that is a process that takes weeks (which is why Prozac, etc., take weeks, too). Missing a day shouldn't make a big difference, but it
does.

As long as I am mystified, I won't be able to find much to say. Not to mention the fact that I did try fish oil for one day, and that was plenty for me, burping up a fishy taste a lot.

There may be something there, and I am monitoring the Trichees group on Yahoo where the idea started, so I'm not yet ruling it out. You can recommend it if you wish--it doesn't cause any harm, just burps, grease, and diarrhea. But I think the only thing you can honestly say is that some people have found it effective if they take 5 capsules of 250mg DHA a day, every day, and no one knows why.
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I noted on one website that recently two people who have been taking fish oil have reported a worrisome side effect.

Fish oil is not the same as cod liver oil. Instead of being filled  with vitamin A and D, two of its principal ingredients are long chain fatty acids, DHA and EPA. From my understanding, the cold water fish that produce these highly unsaturated compounds use them as a form of antifreeze. How DHA and EPA affect TTM is unknown, but some people think they affect nerve cell membranes, making them more fluid. Why this would help certain disorders but not others is unexplained,
except that it might alter a "chemical imbalance": too much black bile, I suppose (Greek physician Galen, 130 A.D.). Fish oil doesn't always work for TTM, and even for those it does work, it appears that often one has to be very faithful to maintaining a high daily dosage level.

In any case, these chemicals also have the additional, and possibly related, effect of affecting the blood clotting time for the humans that take it. What the two people reported were, respectively, anincrease in nosebleeds and the appearance of blood in the urine. Of course both can be due to other causes. But the timing of their appearance was suspicious enough to get the two people to post their observations, and to relate them to the warnings that appear on the supplements. Those warnings say that people taking blood thinners or anticipating surgery should not take fish oil.

I'm not trying to be alarmist. These people haven't been opening envelopes with anthrax powder in them, etc. However, I still remain puzzled by fish oil. I don't know what part of it may be helping (I think it is the EPA, not the DHA that the users believe), or how it works (I think it works in the gut, not in the brain), even how safe it is (obviously not 100%, but one can get bad effects from anything, including too much oxygen or water). I'm still researching it, but it is hard to find even simple chemical analyses of the product.  Basically, it is squished fish, and it does seem to depend somewhat on which kind of fish was squished. One should probably talk about fish oils in the plural instead. But since they are "all natural", they  don't come with a list of ingredients printed on the side of the bottle (or of the fish).

In the meantime, Let's be careful out there.

John Kender
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(info from another trichster)

Fish body oil is indeed known to interfere with blood clotting when
taken in doses exceeding 3 grams/day which contains enough EPA (540
mg) but a low quantity of DHA (360 mg) with reference to the common
percentage of these acids and the needs of trichs as suggested in your
last note. See www.gnc.com

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As promised, here is a bit more on what I have dug up about fish oil. I have
been intrigued by people's reports about it, even though they are very much
all over the place in terms of kind, amount, dosing schedule, time to work,
length of effect, etc.

As far as I can determine, one way that fish oil might work is that it
may be addressing separately The Urge and The Itch. Both of these may 
have in common an origin in chemicals that are derived from arachidonic
acid (AA), a long chain polyunsaturated fatty acid. 

The Itch may be related to LTB4, a derivative of AA which causes a kind of
itch in the skin. If so, the EPA found in fish oil is known to interfere with
LTB4 production. Interstingly, this is would be a fairly rapid effect as it
is due to enzyme inhibition rather than with the amount of AA stored in the
body, so that matches some reports that fish oil "works" within a couple of
days. If this is the mechanism involved, it would say two things. First,
people who experience an itch would respond better and more quickly to fish
oil. Second, taking GLA (gamma-linolenic acid, found in other oils) would
work just as well, since it has the same effect on LTB4 as EPA does. 
So, itchy pullers might investigate GLA, and non-itchy pullers shouldn't
expect a rapid response to any of these oils.

The Urge, and quite possibly The Fog that often comes with it, might be
related to the production of anandamides from AA. These chemicals are the
body's "inner marijuana", and they are dependent on the presence of a
component of lecithin called phosphatidylethanolamine(PE). This PE is found
in lecithin, and related anandamides are found in chocolate (which furthermore
has extra lecithin added). The DHA found in fish oil is known to cut down on
the amount of PE stored in the body. If this is what is going on, it says
several things. The lessening of The Urge and The Fog would be a more long
term effect, as the fat composition of the body has to turn over to get rig of
the PE. And, it would not be as powerful an effect as the one that works on
The Itch, as there is always some EP around; it is necessary in the membranes
of cells. People who don't find The Itch a factor in their pulling would have
to wait longer for the DHA to work and it wouldn't shut the pulling completely
down. It is interesting to note that inositol also reduces PE, so maybe that's
involved with how it works, too.

Two related things also came up in the hunt. One is that glucose (part of
plain old sugar) tends to increase the body's production of AA. And,
yeasts are known to be able to use and modify AA, too.

My conclusion is that there very well may be something effective about fish
oil, but like many other things related to TTM, it probably varies a lot
depending on which kind of TTM one has. I won't recommend it yet until I
personally experiment with it (I only lasted one day the last time due to 
its yucky taste), but I am tempted to try it out again now that I have some
better idea of what to expect.

John

Two more things about fish oil and arachidonic acid (AA).

1) Too much fish oil is bad, for three reasons. It is a blood thinner. It
interferes with the body's immune system. It is also interferes with insulin:
if you are diabetic, that can be critical.

2) Yeasts (my favorite topic) turn out to have a very interesting relationship
to AA. First, they release chemicals that cause the body to release AA. Then
they use it for food. (In the words of the very old Gravy Train commercial:
they make their own gravy.) And, they further use AA to produce immune system
chemicals that tell the body not to go after them. Sneaky little devils. My
guess is that this is one of the reasons why TTM is chronic.

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Update - January 2002 - John Kender