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Dietary Lipids for
Healthy Brain Function
Dietary Lipids for
Healthy Brain Function
Claude Leray
Originally published in French by Edition Sauramps Medical, Montpellier, France under the title:
Ces Lipides qui stimulent notre cerveau by C. LERAY, 2016.
CRC Press
Taylor & Francis Group
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v
vi Contents
Index................................................................................................................. 227
Foreword
Claude Leray, a prolific and recognized scientist in lipids research, presents
here his latest book in which he tackles lipids related to the neurosciences. It
is a vast program! Too vast for those who are not medical doctors? No.
Undoubtedly, his scientific mind, rigorous and methodical, allows him to
address neuroscience holistically, covering both neurology and psychiatry.
These two sides of medicine were separated a little more than 40 years
ago, although so closely intertwined by the substrate on which they work
the nervous system. Neuropsychiatric diseases with an aging population
and the increasing stress accompanying a more urban life style are major
public health concerns. The incidence of multiple sclerosis, Alzheimer’s
disease, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and depres-
sion is constantly growing. What is the cause? Possibly aging. Also our life-
styles. Surely our environment. Neuropsychiatric medicine and research are
indeed changing, and the neurosciences represent the second investment
field in the development of new treatments.
A main focus of this book is to emphasize, rightly, the importance of
lipids in brain function both structurally and developmentally by high-
lighting the current understanding and data of their key roles. It is also
necessary to review the most emblematic pathologies in the neuropsychia-
tric field, which Claude performs with erudition and remarkable scientific
caution.
You will not find here provocation, miracle recipes, or magic foods.
However, you will have the most relevant data, such as the important
discoveries about the role of vitamin D in the development of the
nervous system, neuronal homeostasis, and neuropsychiatric diseases,
all derived from fundamental and medical research. Claude stresses
the importance of lipids in diseases ranging from multiple sclerosis
and autism to Alzheimer’s. Beyond the methodical and documented
descriptions, he stresses the importance of nutrition from birth to old
age to create the conditions for optimal maintenance of our neuronal
assets. The key issue here is thus aging well. Clearly, lipids are not a
panacea, and Claude balances the nature of his comments, supports his
arguments, and justifies his conclusions.
ix
x Foreword
xi
chapter one
Introduction
Research on the structure and function of the human brain started very
early in the history of medical science. Greek doctors, in the sixth century
BC, recognized the brain as the center of the highest human activities. At
the time of Galen in the second century AD, brain anatomy was already
known in detail, and the brain’s importance was established as the seat
of intelligence, voluntary movements, and sensations. The composition
of the brain generated a significant interest as early as the time of Plato
(428–348 BC), who considered this body part as equal to the bone marrow,
whereas Aristotle (384–322 BC) compared the brain to a fat deposit com-
parable to the spermaceti found in the brain of the sperm whale.
The first observations on the fatty nature of the brain were made in
the seventeenth century by the Danish physician Thomas Bartholin
(1616–1680), discoverer of the lymph system and of the glands present
in women that were given his name (Bartholin glands), and by the Dutch
inventor of the microscope and discoverer of the spermatozoids, Antoni
van Leeuwenhoek (1632–1723). But it was the early work of the French
chemist Michel Eugène Chevreul (1786–1889), the founder of lipid chem-
istry, that led the way for other researchers in the nineteenth century to
provide new knowledge about the composition of brain lipids: Nicolas
Vauquelin, Jean-Pierre Couerbe, Nicolas Gobley (all in France), and
Johann Thudichum (in Britain). All of these researchers described the nat-
ure of brain phospholipids, and Gobley and Thudichum also revealed the
presence of few simple acids (stearic, palmitic, and oleic acids).
In the 1960s, with the advent of more efficient analytical techniques,
many researchers focused on the richness of the brain and retina in doco-
sahexaenoic acid (DHA [22:6 ω-3]), a fatty acid found in 1942 in Japanese
fish (see Section 7.1). This fatty acid, called “marine fatty acid,” likely
appeared during the Cambrian explosion, about 600 million years ago,
when its synthesis became possible because of the rising atmospheric oxy-
gen levels above the Pasteur point responsible for aerobic life. In parallel,
complex cell types also appeared that were characterized by the presence
of a nucleus and several mitochondria, structures known to be common to
all cellular organisms called eukaryotes.
Among the discoverers of the biochemical features characteristic of
all nervous tissues, mention should also be made of John S. O’Brien
(University of California–San Diego). In 1965, he was one of the first to
1
2 Dietary lipids for healthy brain function
because all of the nervous disorders described in this book could poten-
tially be diminished without risk by a moderate dietary change or by a
simple supply of an appropriate supplementation. Although this cognitive
impairment approach in no way excludes modern medical therapy,
patients should be aware that any alternative or at least complementary
treatment already exists. This topic should be mentioned in the interview
between doctor and patient, especially after taking into account the docu-
ments related to the involved problems.
These encouraging results offer the potential for a new and important
treatment of many mental conditions that are currently a heavy burden on
social budgets. Indeed, the World Health Organization (WHO) found that
more than 450 million people suffer from behavioral or mental disorders
worldwide. In the European Union, a recent analysis has shown that 27%
of individuals aged 18–65 years suffered from psychiatric troubles during
the past year. In France, 1 in 5 people currently suffers from a mental dis-
order (12 million for the whole country), compared with 1 in 10 for cancer.
The Montaigne Institute and the “FondaMental Foundation” in France
estimated that in 2014 the costs associated with mental illness would reach
nearly 110 billion euros per year or 5.8% of the gross domestic product. In
comparison, the cost of cancer for the society was estimated at 60 billion
euros and that of cardiovascular diseases at 30 billion euros. As emphasized
in the Montaigne Institute report, only 2% of the budget of biomedical
research is actually devoted to these problems. It is thus time to make the
fight against mental diseases a public health priority. Taking into account
the steady lengthening of the “total” life expectancy and the incidence of
mental diseases related to old age, the main challenge of medicine in this
twenty-first century is to increase the “healthy” life expectancy. Failure to
achieve this ambitious goal will lead to formidable economic challenges
for all nations in the management of an increasing number of frail or depen-
dent older people.
The purpose of this book is to focus on the most important and recent
work on food lipids and human health, placing the work in a historical
context. Such research has provided some indisputable evidence of the
beneficial effects, even for a moderate intake, of some specific lipids, some-
times absent or introduced at too low amounts in the normal diet. It is
hoped that this information could be propagated widely to more easily
preserve and improve brain development in young people and mental
health of some adults, with only slight dietary modifications. Further-
more, these improvements involve only natural products that are much
cheaper than the current traditional drugs. Despite the lack of support
by pharmaceutical companies, the advances of these “nutritional treat-
ments” as highlighted in this book may be immediately applied by health-
care personnel for the greatest benefit of patients and the global health
budget.
6 Dietary lipids for healthy brain function
It is regrettable that the basic rules of nutrition and dietetics are not
part of the general culture, a likely consequence of the absence of educa-
tion in these matters at all levels of schooling. Hopefully, the recent rela-
tionships noted between mental or neurological troubles and food lipids
will spur people to take responsibility for their health status. The informa-
tion in this book details how to live to old age in good health and in full
autonomy, particularly by slowing the inevitable decline of the upper
brain functions and by trying to avoid the development of the most
disabling nervous disorders.
References
Anderson, R.E., Maude, M.B. 1971. Lipids of ocular tissues – The effects of essen-
tial fatty acid deficiency on the phospholipids of the photoreceptor mem-
branes of rat retina. Arch. Biochem. Biophys. 151:270–6.
Bernsohn, J., Stephanides, L.M. 1967. Aetiology of multiple sclerosis. Nature
215:821–3.
Bourre, J.M., Francois, M., Youyou, A., et al. 1989. The effects of dietary
alpha-linolenic acid on the composition of nerve membranes, enzymatic
activity, amplitude of electrophysiological parameters, resistance to poi-
sons and performance of learning tasks in rats. J. Nutr. 119:1880–92.
Caldwell, D.F., Churchill, J.A. 1966. Learning impairment in rats administered a
lipid free diet during pregnancy. Psych. Rep. 19:99–102.
Delion, S., Chalon, S., Hérault, J., et al. 1994. Chronic dietary alpha-linolenic acid
deficiency alters dopaminergic and serotoninergic neurotransmission in rats.
J. Nutr. 124:2466–76.
Fiennes, R.N., Sinclair, A.J., Crawford, M.A. 1973. Essential fatty acid studies in
primates linolenic acid requirements of capuchins. J. Med. Primatol. 2:155–69.
Horrobin, D.F. 1998. Schizophrenia: the illness that made us human. Med. Hypoth-
eses 50:269–88.
Lamptey, M.S., Walker, B.L. 1976. A possible essential role for dietary linolenic
acid in the development of the young rat. J. Nutr. 106:86–93.
Nielsen, N.C., Fleischer, S., McConnell, D.G. 1979. Lipid composition of bovine ret-
inal outer segment fragments. Biochim. Biophys. Acta 211:10–19.
O’Brien, J.S., Sampson, E.L. 1965. Fatty acid and fatty aldehyde composition of
the major brain lipids in normal human gray matter, white matter, and myelin.
J. Lipid Res. 6:545–51.
Wheeler, T.G., Benolken, R.M., Anderson, R.E. 1975. Visual membranes: specificity
of fatty acid precursors for the electrical response to illumination. Science
188:1312–14.
Yonekubo, A., Honda, S., Okano, M., et al. 1994. Effects of dietary fish oil during
the fetal and postnatal periods on the learning ability of postnatal rats. Biosci.
Biotech. Biochem. 58:799–801.
chapter two
Brain development
It has long been known that low-weight newborns (less than 2500 g) are
more common in environments with the lowest socioeconomic status.
After examining the dietary habits of mothers, it became clear that mater-
nal nutrition plays a key role. For example, a rigorous study in East
London found that mothers of such children had a dietary energy defi-
ciency, but that deficit could be mostly attributed to lipids, a relationship
implying logically a deficiency in essential fatty acids as well as lipidic
vitamins such as vitamin D and E (Crawford et al. 1986). Although the
hypothesis of essential fatty acid involvement was quickly confirmed by
the analysis of maternal blood, the intervention of vitamins, in particular
vitamin D, has still to be confirmed.
The benefits of breastfeeding in child survival were recognized long
ago in that breast milk had a role in preventing the sometimes fatal effects
of bacterial infections. It is now certain that it guarantees the development
of intelligence, higher performance in school, and even social level in
adults (Victora et al. 2015).
The influence of nutrition on brain development is in short a manifes-
tation of neuronal plasticity as mentioned by neurologists when put at the
service of rehabilitation or functional repair of brain damage. The harmo-
nious development of the brain and cognitive performance in children as in
adults is conditioned by several lipid nutrients. Unfortunately, only three
of these lipids have been the subject of specific research: ω-3 fatty acids,
vitamin D, and vitamin E. The effects of vitamin A are not well known
because experimental research used global supplementation of various
micronutrients, thereby masking the specific effects of that vitamin.
7
8 Dietary lipids for healthy brain function
animals, but not by higher plants. Notably, these two “noble” fatty acids,
DHA and EPA, are absent from vegetable oils and seeds and are found at
very low concentrations in fats of mammalian or poultry meat and in milk
and eggs. The most generous sources are marine fish (or fish oil) and some
other marine animals (molluscs, shellfish) (Section 7.2). Humans may
directly absorb these fatty acids from food, and they also can synthesize
them, albeit slowly, from linolenic acid (18:3 ω-3) that is present in plants
and mainly in some vegetal oils (walnut, soybean, linseed). That biosynth-
esis, the exact efficiency of which is still controversial, is complex and
involves a cascade of enzymes that sequentially elongate, desaturate, and
oxidize the carbon chain (Section 7.1).
EPA and DHA biosynthesis efficiency appears to be higher in
women than in men, but it has been shown that a dietary supplementa-
tion of linolenic acid in pregnant women has no effect on the DHA levels
in maternal blood (de Groot et al. 2004). So, a strict vegan diet (excluding
products and by-products of animal origin) could not be compatible with
normal fetal development, although several observations suggest that an
intake of only linolenic acid would be sufficient to maintain suitable
brain DHA levels. This important issue deserves further epidemiological
research. Importantly, throughout pregnancy, the placenta facilitates the
transfer of DHA from the mother’s body to the fetus, with its supply
being ensured to the newborn through milk (breast or formula). Because
DHA level in milk depends on the maternal diet, it is recommended that
nursing women continue to consume foods rich in marine products.
Indeed, it has been shown that even in Denmark, where fish is frequently
consumed, breast milk provides only one fifth of the recommended vita-
min D intake to the newborn (Streym et al. 2016).
For ethical reasons, experiments using dietary restriction of ω-3 fatty
acids could be performed only in animals. Despite the usual objection
for their transposition in humans, it has been established that an ω-3 fatty
acid deficiency in developing animals produced a DHA depletion in the
brain and that this depletion was associated with lower learning abilities.
Many studies have confirmed that lower DHA levels in nerve cell mem-
branes always induced a slowdown in neurogenesis, the formation of neu-
ronal connections, and cell migration, with these events having negative
consequences for brain growth and function.
It seems now clear that DHA deficiency in humans as in animals is cri-
tical for brain development, but details and importance of the effects are not
fully understood. The impossibility to perform experiments in humans, as
in rats, explains the lag time for our knowledge in this area. Moreover,
in mammals the main fact that emerges is the very different timing of
the brain growth spurt in relation to birth in different species (Figure 2.1).
These features are at the origin of the concept of vulnerability during a
so-called critical period when fast changes in function and structure occur.
Chapter two: Brain development 9
Human
6
Monkey Rat
Weight, %
Figure 2.1 Evolution of brain growth in human, monkey, and rat. Weight increase
is expressed in percentage of the brain weight in adults. The time unit has been
adapted for each species: 1 day in rat, 4 days in rhesus monkey, and 1 month in
human. (Modified from Dobbing, J., and Sands, J., Early Hum. Dev., 311, 74–83,
1979. With permission.)
Thus, unlike in monkeys, rats are born very immature, with this feature
being advantageous for the investigator. In contrast, the central nervous sys-
tem of humans grows very rapidly in the perinatal period. Therefore, we
must remain cautious about the conclusions drawn from experiments done
in different animal species focusing on the central nervous system as well as
for other physiological situations that may vary during body development.
The studies of human brain development have suggested that incor-
poration of DHA is essential at the end of the gestation period and imme-
diately after birth (Clandinin et al. 1980). Indeed, it has been found that
nearly 80% of the sum of embryonic arachidonic acid (20:4 ω-6) and
DHA are deposited in the last 3 months of gestation. During these 3 months,
the fetus has accumulated about 67 mg of DHA per day and about 75 mg
during breastfeeding (Makrides and Gibson 2000). The whole amount
should come from the lipid deposit of the mother, with these stocks being
recovered during several months after birth. Considering these data, it is
easier to appreciate the maternal needs of ω-3 and ω-6 fatty acids during
pregnancy and later, especially in the case of a long-lasting breastfeeding.
Through animal studies, it can be assumed that intake of polyunsatu-
rated fatty acids guarantees harmonious development of brain functions
in the early childhood, after 2 years, and toward the final period of brain
maturation.
10 Dietary lipids for healthy brain function
age and at least up to 4 months age for health benefits” (Hercberg et al.
2008). In addition, to the increase in the breastfeeding frequency from
birth, that program recommended to increase its duration, if possible over
6 months, even during food diversification, a time when foods and bev-
erages other than milk are introduced. Similarly, WHO recommended that
breastfeeding be initiated within the first hour of birth and be exclusive for
6 months, with the introduction of complementary food after 6 months
and continued breastfeeding up until 2 years or beyond.
Despite these common sense recommendations that are also based on
corresponding findings in a multitude of scientific work, postnatal feed-
ing, although improving in all countries, is still far from matching recom-
mendations of the official texts.
In the United States, according to the Department of Health and Human
Services, breastfeeding rates continue to rise. In 2011, 79% of newborn infants
started to breastfeed, but breastfeeding did not continue for as long as recom-
mended. Of infants born in 2011, only 49% were breastfeeding at 6 months
and 27% at 12 months.
In Europe, WHO has estimated that only 25% of infants were exclu-
sively breastfed for the first 6 months during a 2006–2012 study, compared
with 43% in South East Asia. WHO has recommended that breastfeeding be
initiated within the first hour of birth and be exclusive for 6 months, with
the introduction of complementary food after 6 months and continued
breastfeeding up until 2 years or beyond. In Europe, the country with the
highest rate of breastfed babies is Norway: 99% of new mothers initiate
breastfeeding at the hospital and 80% still do it after 6 months.
In France, the Epifane 2012–2013 study (Perinatal and Nutritional
Monitoring Unit, Institute of Health Monitoring, Uspen) revealed that at
birth 59% of infants are breastfed. However, 3 months later, no more than
39% were breastfed, with only 10% exclusively. After 6 months, 23% of
children were still breastfed, but only 1.5% exclusively. Thus, the median
value of breastfeeding is 15 weeks and that of the exclusive breastfeeding
is only 24 days. As noted by the authors of that report, it seems imperative
to better spread and adapt the messages on infant feeding during the first
year of life.
To avoid the problems associated with analytical costs, and lengthy
and cumbersome food surveys, other investigators have used an “ecologi-
cal” approach, already adopted in various epidemiological studies such
as those aiming at the determination of the incidence of disease in differ-
ent geographical regions. This compelling approach was adopted by
Dr. W. D. Lassek at the University of Pittsburgh, Pennsylvania. This work
(Lassek and Gaulin 2014) has taken into account the national data pub-
lished in 28 countries worldwide on the fatty acid composition of breast
milk and the intellectual scores of students at the end of the compulsory
education (at the age of 15 years) (Figure 2.2). These data were measured
16 Dietary lipids for healthy brain function
China
Hong Kong
550 Singapore
Korea
Finland Japan
Canada
The Netherlands Taiwan
Germany
Australia
Average PISA score
Israel
Turkey
450
Chile
Thailand
Mexico
400 Brazil
Argentina
Figure 2.2 Relationship between the PISA test score in 15-year-old children and
the docosahexaenoic/linoleic acid (DHA/LA) ratio in breast milk for 28 countries.
1: Argentina, 2: Australia, 3: Brazil, 4: Canada, 5: Chili, 6: China, 7: Denmark,
8: Finland, 9: France, 10: Germany, 11: Hong Kong, 12: Hungary, 13: Israel,
14: Italy, 15: Japan, 16: Korea, 17: Mexico, 18: The Netherlands, 19: Norway,
20: Portugal, 21: Singapore, 22: Spain, 23: Sweden, 24: Taiwan, 25: Thailand,
26: Turkey, 27: United Kingdom, 28: United States. (Modified from Lassek
W.D., and Gaulin, S.J., Prostaglandins Leukot. Essent. Fatty Acids, 9, 195–201,
2014. With permission.)