New RCT showing ω-3 + B vitamins reduces brain atrophy

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MarcR
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New RCT showing ω-3 + B vitamins reduces brain atrophy

Postby MarcR » Wed May 06, 2015 11:00 am

Brain atrophy in cognitively impaired elderly: the importance of long-chain ω-3 fatty acids and B vitamin status in a randomized controlled trial

Because it's a randomized controlled trial (RCT) rather than an observational study, it's showing causation rather than mere correlation. I imagine the correlations between ω-3 fatty acids (more is better) and homocysteine (less is better) inspired the RCT, but I think the authors do well not to include homocysteine in their conclusions. I love that they avoided fish oil supplementation and simply measured ω-3 fatty acids as it really adds to clarity regarding the value of B vitamin supplementation.

Alas, there's no ε4 breakout.

For my part, I have been betting on the hypothesis that keeping homocysteine below the high end of the reference range with B vitamins, TMG, and NAC; consuming sardines, salmon, grass fed beef, omega-3 eggs, and cod liver oil; and avoiding high omega-6 processed seed oils will be good for me. This paper doesn't prove that my strategy is right, but it certainly bolsters my resolve to continue.

Design: This retrospective analysis included 168 elderly people (≥70 y) with mild cognitive impairment, randomly assigned either to placebo (n = 83) or to daily high-dose B vitamin supplementation (folic acid, 0.8 mg; vitamin B-6, 20 mg; vitamin B-12, 0.5 mg) (n = 85). The subjects underwent cranial magnetic resonance imaging scans at baseline and 2 y later. The effect of the intervention was analyzed according to tertiles of baseline ω-3 fatty acid concentrations.

Results: There was a significant interaction (P = 0.024) between B vitamin treatment and plasma combined ω-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) on brain atrophy rates. In subjects with high baseline ω-3 fatty acids (>590 μmol/L), B vitamin treatment slowed the mean atrophy rate by 40.0% compared with placebo (P = 0.023). B vitamin treatment had no significant effect on the rate of atrophy among subjects with low baseline ω-3 fatty acids (<390 μmol/L). High baseline ω-3 fatty acids were associated with a slower rate of brain atrophy in the B vitamin group but not in the placebo group.

Conclusions: The beneficial effect of B vitamin treatment on brain atrophy was observed only in subjects with high plasma ω-3 fatty acids. It is also suggested that the beneficial effect of ω-3 fatty acids on brain atrophy may be confined to subjects with good B vitamin status.
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Postby Stavia » Wed May 06, 2015 12:10 pm

Great find! This IMO speaks to the synergistic effect of multi faceted interventions.

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Re: New RCT showing ω-3 + B vitamins reduces brain atrophy

Postby Julie G » Wed May 06, 2015 12:54 pm

YES, this concept was brought up at our recent conference. B vitamins only work if your omega-3 fatty acid levels are adequate. Very interesting to see that it works both ways.

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Re: New RCT showing ω-3 + B vitamins reduces brain atrophy

Postby GenePoole0304 » Wed May 06, 2015 12:58 pm

very crude trial yes it is homocysteine but the amount of B vitamins and the type depend on methylation, saw something like that years ago.
b-12 and folate also possibly B-5 are main ones.

just do this to start
http://geneticgenie.org/

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Re: New RCT showing ω-3 + B vitamins reduces brain atrophy

Postby MarcR » Wed May 06, 2015 2:33 pm

Juliegee wrote:YES, this concept was brought up at our recent conference. B vitamins only work if your omega-3 fatty acid levels are adequate. Very interesting to see that it works both ways.

Both ways? Is there research saying that fish oil supplementation only works if homocysteine is low? I don't suppose you have a study at your fingertips?
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Re: New RCT showing ω-3 + B vitamins reduces brain atrophy

Postby Julie G » Wed May 06, 2015 2:55 pm

You're understanding correctly, Merouleau. The presenter was either Dr. David Smith of Oxford or Dr. Helga Refsum, University of Oslo...I'll look for specific papers. They asserted that B vitamins were only effective in those with good Omega-3 profiles. This could have important implications for vegans with persistently high homocysteine.

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Re: New RCT showing ω-3 + B vitamins reduces brain atrophy

Postby MarcR » Wed May 06, 2015 3:16 pm

The concept that "B vitamins were only effective in those with good Omega-3 profiles" is the same as the conclusion of this paper. When you said "both ways" I thought you meant that causality had been demonstrated in both directions. Maybe I understood your "both ways" remark differently than you intended it ... here's what I think of as "two ways" that might apply here:

1. B vitamin supplementation improves health as long as one has plenty of circulating ω-3 fatty acids.
2. ω-3 fatty acid supplementation (e.g. fish oil) improves health as long as one's homocysteine status is good.

I am aware of evidence for (1) but not yet for (2).
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Re: New RCT showing ω-3 + B vitamins reduces brain atrophy

Postby Julie G » Wed May 06, 2015 3:39 pm

Sorry to be confusing. It is understood that healthy vitamin B levels confer low homocysteine.

When I referred to the synergistic effect working both ways; I meant vitamin Bs are only effective in the presence of healthy ω-3 fatty acid levels AND ω-3 fatty acids are only effective in the presence of healthy vitamin B levels.

Conclusions: The beneficial effect of B vitamin treatment on brain atrophy was observed only in subjects with high plasma ω-3 fatty acids. It is also suggested that the beneficial effect of ω-3 fatty acids on brain atrophy may be confined to subjects with good B vitamin status.

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Postby Stavia » Wed May 06, 2015 3:42 pm

Julie, what was said at the conference about this please? It's all new to me.

(small diversion : What does everyone feel is achievable and necessary for a homocysteine level? For instance mine is 8 to 9. I remember someone at the NYC conference mentioned 6 as target (eeek))

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Re: New RCT showing ω-3 + B vitamins reduces brain atrophy

Postby MarcR » Wed May 06, 2015 3:55 pm

Juliegee wrote:
Conclusions: The beneficial effect of B vitamin treatment on brain atrophy was observed only in subjects with high plasma ω-3 fatty acids. It is also suggested that the beneficial effect of ω-3 fatty acids on brain atrophy may be confined to subjects with good B vitamin status.

I read the second sentence as a plausible add-on speculation - "also suggested", "may be" - rather than a true conclusion, so I didn't make the connection to your "both ways" remark. I get it now.
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