Be sure to read this great article published by Dr. Michael Lewis in Inform: The business and scientific magazine of the American Oil Chemists’ Society (AOCS).
Not my typical subject for posts, but a well written article worth reading.
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One of the most common complications associated with traumatic brain injuries is the risk of dangerous blood clots that can form in the circulatory system elsewhere in the body.
For patients with traumatic injuries, the body forms blood clots which can break loose and travel to the lungs or other areas, causing dangerous complications.
New research shows that using blood-thinning drugs to treat patients with traumatic brain injuries reduces the risk of life-threatening blood clots without increasing the risk of bleeding inside the brain.
DR. LEWIS COMMENTS: This finding is extremely significant to the concept of using omega-3s following brain injury. Potent blood thinners used in this protocol (heparin and Lovenox) completely block the enzymes responsible for allowing the blood to clot, thus preventing deep vein thromboses that can result in worsening of the patient’s condition or death. Omega-3s potentiate the body’s natural anti-clotting abilities rather than blocking enzymatic processes AND add the ability to modulate neuroinflammation, decrease apoptosis (cell death), and start synaptogenesis (building of new neuron synapses).
Ironically, most doctors will not use omega-3s, mostly out of ignorance, but almost always because they cite that high doses of omega-3s decrease the ability of blood to clot and increase a patient’s risk of bleeding – a risk that is theoretical, but never been shown in any clinical study to be a clinical issue. Yet these same doctors almost immediately put their ICU patients on potent pharmaceutical blood thinners that increase the risk far greater than that of omegas. Now here is a study to show that even that risk has been overstated. The major barrier as to why omega-3s couldn’t be used following TBI is no longer valid.
It is always a pleasure when I read the words of an author who eloquently articulates ideas I believe to be important. Even better when it is a patient’s family that leads me there. A couple of days ago, I was led to a brainline.org article published last year, “Fighting the “TBI Wars”: New Alternatives for TBI Survivors,” by Joel Goldstein, based on his book, No Stone Unturned: A Father’s Memoir of His Son’s Encounter with Traumatic Brain Injury. Goldstein expresses his hope that he can pass along lessons learned from his son’s tragic situation, most pointedly, evaluating and experiencing therapies alternative to conventional medicine.
Rather than trying wax poetic about this article, it is easier just to pull a few quotes:
“Conventional medicine only takes survivors of severe TBI so far, often ending at the nursing home door, or heavily medicated at home, facing long empty hours, and overwhelming family resources. Unconventional therapies are not merely a reasonable option, they are a necessity.”
“Should we accept the doctors’ verdict and wait, hope, and pray for the best?”
“Doctors generally offered an editorial opinion, too — suggesting that a therapy, though safe, was a waste of time and money. One trusty “devil’s advocate” was sure that all alternative therapies were bogus, admonishing that, “Not all who rave are divinely inspired.” But here we had the advantage — at least we knew we were ignorant. It seems a truism, but even the best-trained, most skilled, and well-intentioned professionals in the world often suffer a kind of tunnel vision, sticking to familiar, well-trod paths that pioneers once blazed. Before they eventually won universal acceptance, the practices of conducting heart-surgery or of treating peptic ulcers as infections were doggedly opposed and bitterly denounced by the medical establishment.”
Jumping to the bottom line, the Goldsteins put together an informal “board of advisors” to evaluate potential alternative therapies (defined as practices falling outside the standard of medical practice and not covered by health insurance). Through experimentation and experience, they eventually tried several alternative therapies, settling on Hyperbaric Oxygen Therapy (HBOT), Craniosacral, Bolles Sensory Learning, Novavison’s Vision Restoration (VRT), and nutritional supplementation. In Goldtein’s words, “Some successes were breathtaking.” Today, Bart is a “lively, charming young man, living nearly independently in his own apartment near Albany.”
We should be thankful that Joel Goldstein took the time to document his family’s long journey and has the talent to write a powerful story to share with the world.
Pulitzer Prize winning writer Eric Newhouse has been looking into this. “I’ve been deeply troubled about the lack of TBI diagnoses. Five years ago, the Rand Corporation interviewed several thousand soldiers returning from Iraq and Afghanistan and predicted that 18 percent of them would return with PTSD.” Newhouse is on a lecture circuit speaking about Middle East war issues, and health care for Veterans, and he is disturbed that more isn’t being done to help our Veterans.
For instance, there are multiple Centers of Excellence, sponsored by tax dollars that conduct research on Veterans with TBI or TBI symptoms. But they lack a unified approach and don’t share findings… unless the sharing includes publishing a paper in a journal and a free trip to Hawaii to present the paper at a conference full of researchers going in different diagnostic and protocol directions. [emphasis added]
NOTE: I don’t normally include latest news in my blog, but this is a GREAT article, albeit very scary in its truthfulness. Research has become an employment agency rarely concerned with finding cures, lest the funding dry up because the problem has been solved. On a global scale as an example, the success of the Roll Back Malaria program in the 60’s and 70’s led to the elimination of funding due to its “success.” Subsequently, arthropod (mosquito)-borne diseases have skyrocketed over the past 20-30 years. It is almost impossible for a new researcher with a novel idea to get NIH funding. The system doesn’t prize original thinking; it values the known researcher with a lab that just pumps out regurgitated papers.
Obviously, the big news of this past week in the world of omega-3s is a study published claiming that “omega-3s cause prostate cancer.” I have had friends and family call, text, stop me in person, and email their concerns about what is clearly a headline grabbing ploy by the press to make a huge deal out of poorly designed manuscript masquerading as a scientific publication.
First of all, the study did not look at omega-3 supplementation, but was a look at if there is an association between Vitamin E and selenium and cancers (including lung, colorectal, and prostate). The manuscript was done looking retrospectively at people with prostate cancer and what their omega-3 levels were at a single point in time. When I did a study looking at omega-3 levels and documented suicide, I was very careful not to conclude that low omega-3 levels CAUSE suicide because that would not be a true statement. Low omega-3 levels measured were ASSOCIATED with a 62% increase risk they came from a suicide, but there is absolutely NO WAY POSSIBLE to conclude a causal relationship. These researchers and the press that followed obviously did not feel the need to adhere to such ethical parsing of words in order to grab headlines. Come on, the study showed a possible increase of prostate cancer had a confidence interval of 0-192%!!!!
I am always amazed, though I’m not sure why, when the press blow things out of proportion about a study demonstrating their complete lack of understanding of scientific studies. I could go into details for a long time, but let me just say clearly that this case-control study was not designed to look at the question in which the researchers draw their incorrect conclusions. In the worst case, there may be an association between higher omega-3 levels and prostate cancer, but to conclude that omega-3s cause prostate cancer? Really??? Given that the study was a single snapshot looking at if someone has prostate cancer and what their omega-3 blood level was at that moment, it is completely reasonable to state that prostate cancer causes higher omega-3s in the blood. Or that people with prostate cancer increased their fish or supplement intake because it is fairly well known that omega-3s may be helpful in cancer due to their anti-inflammatory properties. But that is not what catches headlines.
Not sure which argument you might want to use, but the biggest one is that it was a study not designed to look at this question and the investigators completely drew conclusions from data that don’t support their conclusions. So which argument do you want? You mean besides that it is a poorly designed evaluation of data from a totally different study never designed to look at prostate cancer and omega-3s and should have never been published? Or the part where countries and societies that have the most fish intake actually have the lowest rates of all cancers including prostate? Or that there is specific research designed to actually look at that question and everyone of those studies shows decreased rates of cancer? Or that this same study also showed that there are higher rates of prostate cancer in nonsmokers and nondrinkers (so should we recommend everyone drink, smoke, and stay away from fish?)?
One rebuttal can be found at: http://www.nutraingredients-usa.com/Research/Experts-slam-omega-3-link-to-prostate-cancer-as-overblown-scaremongering. A more scientific-oriented review can be found at http://examine.com/blog/fish-oil-and-your-prostate .
What we do know is that omega-3s are anti-inflammatory and well known and documented to decrease overall and cardiovascular mortality, the incidence of cancer, heart disease, and have a positive benefit on brain health especially in the absence of brain health. What is really sad is how many people will decrease their intake of fish or stop their supplementation because of ridiculous studies/reporting like this. How much additional suffering will occur because of it?
The horrible events of the Boston Marathon are etched into our psyche that gives America a glimpse into what our military has faced every day for the past eleven years in Iraq and Afghanistan. One thing that worries me as a retired Army physician when I see injured soldiers –or a victim of terrorism—are the wounds I cannot see. If an IED blast was enough to cause the loss of a limb, it probably had enough energy to affect the brain causing a traumatic brain injury or TBI. These are the wounds we don’t see but may lead to personal challenges now or later. Such unseen brain injuries also are now a growing issue on the football and soccer fields around the country.
There are no magic pills or cures for TBI and it is unlikely there ever will be. YET, we must move forward.
Unfortunately, our medical system was formed around successes in fighting infectious diseases – one diagnosis: one drug. It hasn’t changed and adjusted to modern problems. The system does poorly dealing with complex situations such as TBI that present entirely different sets of challenges with a constellation of symptoms. Western medicine’s adaptation has been – one symptom : one drug – rather than addressing the underlying situation. The medical community needs to refocus on the whole patient, not relying on trying to find a single magic cure that will never exist. Instead, we paralyze ourselves waiting for that magical golden randomized clinical trial to prove that one drug will cure TBI. It isn’t going to happen, ever.
If it is essential to have omega-3 fatty acids to make a brain in utero, it reasons that they can be helpful to repair a brain after it has been injured. It is like a brick wall that’s been damaged. Wouldn’t you want to use bricks to repair the wall? Omega-3s, Decosahexanoic Acid (DHA) in particular, are literally the building blocks—the bricks–of the brain neuron cell wall. I’ve spent much of the past couple of years working to get that point across, first to the military, and since I retired, to the general public. I have to say, the progress in educating people, the medical community in particular, has been both slow and frustrating.
It turns out that Americans are generally very deficient in their omega-3 levels because of changes to the food chain that have occurred over the last half century. When Dr. Joe Hibbeln at the NIH and I did a rigorous evaluation of active duty military suicides, we came to two serious conclusions: in the blood samples we evaluated (800 documented suicides plus 800 well matched controls), omega-3 levels were profoundly low in the overwhelming majority of them; and even with the low levels, there was a 62% increased risk of suicide! We have no way of knowing how many of these were the result of a TBI because there are usually many factors involved in a suicide, but I’m sure some were.
There are good reasons to be concerned about low omega-3 levels in such brain injuries. They have a major influence on our immune systems. They keep inflammation under control when there is an injury and nowhere is that more important than in our brains. With the advent of corporate farming and subsidies to produce soybean and corn, our food supply has changed so much since the Second World War that our bodies are swimming in omega-6s, the highly inflammatory cousins of omega-3s.
We have learned there are no easy answers. When the medical system talks about “treatment” for TBI and concussion, this is a misnomer. What is called treatment is diagnostic testing and a “prescription” for rest – to allow time to heal the wounds. But there are other steps that can help. Several therapies including nutrition, omega-3 fatty acids, neuro-cognitive rehab, hyperbaric oxygen, and others, can have enormous impact, not to cure TBI, but to optimize the brain’s opportunity to heal itself and give a patient the best opportunity to regain as much function as possible. We must take these steps now.
Michael Lewis, MD, MPH, MBA, FACPM, is a retired Army Colonel and President of the Brain Health Education and Research Foundation (www.brainhealtheducation.org) which he founded in late 2011 to educate patients, parents, and providers focusing on optimizing health following a TBI. He is in private practice in North Bethesda, Maryland.