Ranger Up Talks Suicide: Nutrition and Suicide – Could the Answer be at Sea?
By Nick Barringer MS, RD, CSSD, CSCS (EIEIO)
I’m sure it is no surprise to the RU readers that the mental health of Soldiers remains a growing concern as rates of depression and suicide have increased. The Department of Veteran affairs report that on average 22, veterans commit suicide per day and 1 in 5 veterans who have returned from OEF or OIF suffer from PTSD. The current focus of treatment options involve counseling and pharmaceuticals, but could our dietary intake also play a role?
The answer appears to be yes.
Dr. Mike Lewis and his colleagues did a novel study in 2011 where they looked at 1600 blood samples from Soldiers dating from 2002-2008. They had 800 samples of Soldiers who committed suicide and 800 samples of Soldiers who did not commit suicide and they tested the samples for levels of Docosahexaenoic acid (DHA) one of the Omega-3 fatty acids most commonly found in fish.
Dr. Lewis found that the odds of a sample being in the suicide group increased by 14% for every standard deviation drop in DHA levels. More importantly, the samples with the lowest DHA levels were 62% more likely to be in the suicide group. The overall association found was that as DHA levels went down the risk of being in the suicide group went up. Dr. Lewis’ research was novel and so powerful that it caused the DoD to invest 10 million dollars in research that essentially treats veterans who have attempted suicide with fish oil.
The problem is waiting until after an attempt to intervene is often too late.
One of the road blocks to suicide is overcoming the fear of lethal injury. As most in the military could have guessed, researchers have shown that Soldiers, by nature of their profession, overcome this more easily than their civilian counterparts.
So although treatment options for veterans who have attempted suicide is extremely valuable, I think we all can agree it is better to be proactive rather than reactive. Which brings us to the question:
Why was Dr. Lewis looking at DHA levels in Soldiers blood to begin with?
The evidence of the link between omega-3 deficiencies and psychiatric disorders is so robust that the American Psychiatric Association (APA) actually has recommendations for the use of omega-3 fatty acids in psychiatric patients dating back to 2006. But the evidence goes beyond America…
The global scale:
The omega-3/depression link has also been demonstrated on the global scale as in 1998 Dr. Joseph Hibbeln, from the National Institute of Public Health (NIH), reported that rates of major depression are 50 times higher in countries with little seafood consumption when compared to countries with higher seafood consumption.
Similar epidemiological research of over 250,000 Japanese subjects followed for 17 years (1966-1982) found fish consumption associated with lower suicide rates. The protective effect of omega-3 fatty acids and depression and suicide has also been demonstrated in Finland and seasonal omega-3 variations has been found to match seasonal violent suicide and suicide markers in Belgium. In China, low omega-3 blood levels have been associated with suicide attempts. So the relationship between omega-3 fatty acids and depression/suicide appears to hold true regardless of the location or nationality of the individual. If low omega-3 levels are associated with depression and suicide what happens when we give depressed patients’ omega-3s?
Luck of the Irish
Dr. Brian Hallahan took 49 patients who reported to the emergency room of Beaumont Hospital in Dublin, Ireland for an act of self-harm and had a history of at least one other act of self-harm and divided them into two groups. One group was treated with 2 grams of fish oil per day and the other group received a placebo. Both treatments were provided in addition to standard psychiatric care that was provided for 12 weeks.
At the end of the study, the fish oil group had a significant reduction in suicidal thinking and depression when compared to the placebo group and also reported a reduction indaily stressors. Now we have evidence that when a suicidal person consumes fish oil along with psychiatric care they have improved outcomes to those who just receive psychiatric care without the fish oil.
So where do Soldiers get Omega-3s?
Raise your hand if you have ever eaten a delicious piece of salmon down range or had a MRE with mackerel as a main entrée. I’m guessing none have since logistics would make the first very difficult and no MRE contains mackerel. My point is omega-3s are probably lacking in most Soldiers diets especially in situations where they cannot fully control the food they consume such as in the field and deployed settings. So we now have a population exposed significant stress with low omega-3 levels and we just saw how the consequences of that situation in research involving civilians who were probably not exposed to the same level of stress.
Is fish oil the solution?
Suicide is a very complicated issue with many confounding variables so in no way am I touting omega-3s as a “cure.” What I am suggesting is that the evidence is strong enough to indicate that having an omega-3 deficiency makes one more susceptible to depression and suicidal thoughts and ingesting omega-3s could ameliorate this risk. Given the established safety concerning the intake of omega-3s and that they are highly beneficial to cardiac health, the downsides are negligible. The most abundant fat in our brain is DHA, yet we have seen a reduction of DHA consumption over the years as it is replaced with other polyunsaturated fatty acids that are found increasingly in a fast food laden diet. These other polyunsaturated fatty acids have not only replaced DHA consumption but also might block the little DHA we do consume as they compete for uptake.
A risk factor we can control.
As stated before, there are many issues and risks that are involved when someone makes the decision to take one’s life. Many times we cannot control the daily stress, your family history, and the traumatic event or events we might have been exposed to.
But we can control what you eat—whether it is what we eat when we are at home or potentially planning to take omega-3 supplementation in environments where we know fish will not be available. The APA recommends at least 1 gram of omega-3s per day with concomitant therapy and Dr. Hibbeln has recommended 3.5 grams per day based on his research. So although I am incapable of offering a solution, it is my sincere hope that I have given the RU readers a tool that might improve resiliency to one of the most tragic problems facing our nation’s great Warfighters.