Medical Hypotheses- Volume 64, Issue 6, 2005, Pages 1188-1191
Alan C. Logan and Francois Lesperance,
Primary nocturnal enuresis: omega-3 fatty acids may be of therapeutic value
1) Children with bed-wetting have increased levels of prostaglandin E2 and nitric oxide.
2) Omega-3 fatty acids are known to inhibit the synthesis of prostaglandin E2 and renal nitric oxide.
3) Bed-wetting children have an underdeveloped region of the brain that controls nighttime micturition (as noted by their inappropriate startle response).
4) Omega-3 fatty acids play a critical role in the development and function of the central nervous system including micturition control and startle response.
5) Nations with the lowest prevalence of bed-wetting children consume more than double the fish/seafood as compared to the nations with the highest prevalence of bedwetting children.
6) “Given the current excess of omega-6 rich oils in Western countries, all health professionals should at least ensure adequate intake of omega-3 fatty acids in children with” nighttime bed-wetting.
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Primary nocturnal enuresis (PNE), or bed-wetting, is a distressing urinary condition, which can persist through childhood and beyond.
Altered prostaglandin and nitric oxide production have been observed in children with PNE, and prostaglandin inhibitors are known to be of therapeutic value.
Omega-3 fatty acids have the potential to influence the symptoms of PNE by inhibition of prostaglandin and renal nitric oxide production.
In addition, children with PNE have an inappropriate startle response and an apparent maturational delay of the central nervous system.
Research clearly shows that omega-3 fatty acids play a critical role in the development and function of the central nervous system.
It is our contention that inadequate omega-3 intake may play a role in the lack of inhibitory input to the startle and micturition centers in PNE.
THESE AUTHORS ALSO NOTE:
“Primary nocturnal enuresis (PNE) is a condition where the involuntary voiding of urine occurs beyond the age of anticipated nocturnal bladder control.”
Important: “Recent research has uncovered physiological abnormalities in children with PNE, including altered prostaglandin and nitric oxide production.”
There are deficits within the central nervous system (CNS) of those with PNE.
Very Important: “Omega-3 fatty acids, long chain polyunsaturated fatty acids of plant and marine origin, are known to influence these abnormalities described in PNE.”
Omega-3 fatty acids may have therapeutic value in PNE.
Prostaglandins in PNE
Children with PNE have a significant increase in nocturnal sodium and magnesium excretion. Prostaglandin E2 (PGE2) is known to increase nocturnal sodium and magnesium excretion.
“Children with PNE have been shown to have mean serum and urine PGE2 levels that are twice that of healthy controls.” A number of studies have shown that non-steroidal anti-inflammatory drugs that inhibit PGE2 reduce the frequency of bed-wetting.
Nitric oxide in PNE
Low transient levels of nitric oxide (NO) are beneficial. However, high
concentrations of NO decreases anti-diuretic hormone production, [which increases nocturnal urine production]. Children with PNE have more than 11 times greater NO than healthy controls. PGE2 increases NO production.
Startle response in PNE
“It has been suggested that PNE represents a functional immaturity of the CNS, with a lack of normal inhibition of the micturition reflex.” “PNE may reflect a slower CNS maturity.”
“Patients with PNE have well-documented deficits in the brain center which normally inhibits the startle response.” “The startle response consists of a contraction of the skeletal and facial muscles, and an eyeblink in response to a sudden, relatively intense stimulus.
If, however, an additional weak stimulus (prepulse) is presented
immediately before the startle stimulus, there is normally an inhibition of the startle response.
The PPI should normally reach maturity between 5 and 8 years old.” The prepulse inhibition of startle (PPI) is significantly decreased in PNE, which means that this area of the brain had not developed appropriately. This area of the brain also controls micturition and PNE.
“The deficiency of inhibitory signal processing within the brain, perhaps mediated by dopamine, appears to be a common thread between PNE and diminished PPI.”
This suggests that children with PNE do not develop regions of their brain appropriately or timely (and brain development requires adequate omega-3 fatty acids).
Omega-3 and PNE
“Omega-3 fatty acids may influence PNE by regulation of PGE2, NO synthesis and brain signaling.”
“The ability of omega-3 fatty acids to inhibit PGE2 synthesis is well-documented.”
Omega-3 fatty acids from fish markedly lower nitric oxide synthesis.
Potentially, omega-3 administration can be used therapeutically to lower the PGE2 and NO influence on nocturnal diuresis.
Very Important: “Omega-3 fatty acids are well-documented to play a critical role in the normal development of the CNS.”
“Inadequate omega-3 intake may therefore prolong the delay in normal inhibitory CNS function, including a delayed inhibition of micturition.”
There is a lower prevalence of PNE in Malaysia, Korea and Taiwan, vs. the United States, United Kingdom, Ireland, Turkey and Australia. “The former nations consume at least more than double the fish/seafood (kg/capita/year) vs. the latter nations. Perhaps nutrition, in the form of omega-3 fatty acids, can influence the genetics of PNE.”
Omega-3 fatty acids may have therapeutic value in treating PNE because of its ability to decrease PGE2 and NO production.
Omega-3 therapy “may address a possible root cause of some cases of PNE, namely the delayed development of inhibitory brain pathways.”
“Omega-3 supplements are generally inexpensive and well-tolerated, making them and attractive option to access alone or as an adjuvant to standard care.”
Very Important: “Given the current excess of omega-6 rich oils in Western countries, all health professionals should at least ensure adequate intake of omega-3 fatty acids in children with PNE.”