Omega-3 and brain injury: interview with Dr. Michael Lewis MD

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US military brain injury awareness campaign (photo: Army Medicine via Flickr)

The most exciting example of ‘Nutrition Meets Medicine’ in the 21st Century, so far, has to be the emerging evidence of the role omega-3 fatty acids play in brain health.  A growing body of research links omega-3 fats, particularly EPA and DHA, to dementia, depression, fetal brain development, age-related cognitive decline and other mental disorders.  One of the most promising areas for new research is the effect of omega-3 fatty acids on recovery from traumatic brain injury (TBI).  Leading the charge is Dr. Michael Lewis MD, president of the Brain Health Education and Research Institute, formed last year, with the goal of:

educating providers and the public on the use of omega-3 fatty acids for the prevention, treatment, and rehabilitation of the brain prior to or following injury such as traumatic brain injury or concussion. 

Dr. Lewis didn’t start his medical career with the intent of focusing on omega-3 fatty acids.  He learned about it in the course of his work as an Army physician, and over the past few years has developed his own omega-3 protocol for patients he sees for brain injury.   I spoke with him recently, and a condensed version of our discussion is below ( a podcast is coming).

Radio Nutrition: How did you get interested in this topic?

Lewis:  A number of people were looking at it, as far as different psychiatric situations such as depression, ADHD and dementia.  I came to the conclusion that if it’s good for the heart and good for the brain and necessary for the development of the human brain, why wouldn’t it be helpful to help repair a brain after it’s been injured?  I started looking into it, and asked whether anybody was looking at the use of omega-3 fatty acids to help with recovery from TBI?  The military’s answer back to me was “Good question.  Why don’t you figure it out.”  I was given the green light to start trying to figure it out, mainly because I was the only one asking the question.

Radio Nutrition: Is there a standard of care in the military that uses omega-3 supplements for TBI treatment?

Lewis:  No there is no standard of care in the military for using fish oil.  Literally, the individual provider decides.  I sat in for a day on a TBI clinic at Walter Reed.  One physician came up to me and said she had tried to put patients on omega-3, and the pharmacy at the facility said “We don’t carry it and we’re not going to order it for you”.  She was shocked, because at a previous VA hospital where she worked, everyone was put on it.  I founded BHERI to get the word out, let them know there is something else that can be done besides rest, to allow brain to heal.

Radio Nutrition: Can you clarify what you mean by “concussive” injury.  Do you mean literally a blow to the head?
Lewis:  When we’re talking about TBI, there are two different parts of the event: the primary injury and the secondary phase.  The secondary phase involves biochemical pathways that occur after the injury, the inflammatory situation.   The inflammatory process is very important, because it brings in the things to help repair blood vessels and other damage.  Because of what we eat, with too many omega-6 fats in the typical American diet and not enough omega-3, that inflammatory process is actually a little bit on the out-of-control side, and there’s too much inflammation going on.  So the secondary phase of that injury certainly is open to modulation.  And omega-3s can really do that quite effectively.  In fact, all the research that’s going into TBI is really looking at that secondary phase.  It turns out that omega-3s are very good inflammatory modulators, so they keep things under control
The primary injury can be hitting your head or a penetrating injury.  The one we’re just understanding in the last 10 years is a blast wave, which causes more global damage to the brain.  And there can be combinations of these different injuries as well.
Radio Nutrition: In your article “Neuroprotection for the Warrior” (Mil Med. 2011 Oct;176(10): 1120-7), you mention a mine accident survivor who got a really whopping dose of omega-3.  Later on you mention research using a 40 mg/kg dose that is more modest.  How did you come to that dose?
Lewis:  If you’re using a good concentrated product, 60-70% concentrated formulas, that works out to be 5-6 capsules/day.  That’s quite a bit for most people.  Looking at someone having problems following a concussion or brain injury, I’m more about – if you’ve got a problem you need to address it quickly.  I use a triple dose the first week and a double dose the second week and then get down to a maintenance dose.  What I’ve found is people notice a difference.  I’m working with two retired NFL players, both linemen, in their 50’s.  They’re having difficulty as they get older.  At the higher dose, they both noticed a difference within the first couple of days.  Thinking more clearly, having more energy, just functioning better in their daily life.
Radio Nutrition: Wow, that’s remarkable.  Have you done any testing on them?
Lewis: I’m designing a program to actually be able to do that.  Put together a baseline testing and then re-test people towards the end of the second week.  I’m in the process of designing that and getting it as automated as possible, and show the data back to the person.  Show them what they answered 2 weeks ago and what they answered now, and here’s the improvement.
Radio Nutrition: Will this involve any biochemical testing?
Lewis: We’re in the process of developing a program and one of the things we want to consider is whether or not we’ll do omega-3 levels to know what their omega-3 status is.  It’s important to have that objective measure.  A number of clinicians and researchers are advocating we should know what our omega-3 numbers are.  We can measure it in the blood.  Researchers have given radioactive-labeled omega-3, and documented that from the time someone swallows a fish oil capsule to the time it starts to show up in the brain is 10’s of minutes.  Less than 1/2 hour.
Radio Nutrition: Wow, that’s amazing!  it’s like a magnet for the brain or a guided missile.
Lewis: Well, the brain is made basically of fat, and 30% of the dry weight of the brain is omega-3.  If you’re not taking enough…  It gets back to “you are what you eat”.  For some reason when it comes to the brain we don’t think about that.
Radio Nutrition: In the immediate future, what do you think needs to happen in terms of research?
Lewis: I have one program going on at Walter Reed on a new product to look at what we could do immediately following an event — a blast injury, a car accident.  Somebody has been knocked unconscious.  Can we get some omega-3s on board right away?  See if that helps save more of the brain and brain function.  As far as basic research that would be incredibly helpful, what about the 95% with a concussion who are not knocked unconscious?  Who are going to be taking things orally.  I’m putting together some protocols to look at that triple dose to help people with post concussive symptoms.  One area is those people who, weeks or months down the line, are continuing to have problems with symptoms like headaches, thinking clearly, executive function.  Another area would be whether there is a role in the immediate aftermath of injury, starting in the emergency room or at a football game?  Can we get them back into the game safely the next week?  We’re not talking about curing TBI.  What we’re really talking about is how do we help the brain heal itself?
Radio Nutrition: I’m going to guess that’s ultimately the long range goal of any such research?
Lewis: That’s my goal.  I’m a very practical person.  There’s a lot of very smart researchers out there doing fantastic work, trying to figure out details of biochemical pathways, maybe develop a pharmaceutical to help.  Everything I see and know tells me not only can omega-3s help the brain recover, but if we pre-load people, we can help increase the resilience of the brain to withstand injury in the first place.  More brains will be protected from more injury.
Radio Nutrition: You just gave me the image of omega-3s as some kind of internal helmet.
Lewis: You’re absolutely right, it’s an internal armor.  A good way to visualize it, especially for the person who doesn’t care about the biochemistry behind it, is my brick wall analogy.  If you have a brick wall and it gets damaged, you probably want to use bricks to repair that wall.  It only makes basic sense.  Well, omega-3s are the bricks of the brain.  The brain takes omega-3s to make that cell wall, so why wouldn’t you want to use omega-3 to repair that brick wall?  It’s like a construction site.  Now that the brick wall is damaged, the brain is trying to put the bricks back in place.  It’s going to take some time.  All I’m talking about it backing up a truck onto that construction site and dumping a pile of bricks right there, so the material necessary to rebuild is right there.  That’s why I talk about using fairly substantial amounts of omega-3, to let the brain have the best chance for healing itself.  It frustrates me when I hear researchers talking about biochemical pathways and enzymes, and it’s like “but what about the bricks?”  The real basic substance.
Fascinating and exciting stuff.  Dr. Lewis enthusiasm for his subject matter is obvious.  He’s certainly at the cutting edge of this research.  As more data becomes available, therapeutic doses of omega-3 for brain injury should become the standard, as we get better information about what the optimal doses for recovery actually are.  If you want more information about Dr. Lewis’ protocols, or omega-3 and TBI, visit the Brain Health Education and Research website.
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