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Meyer JH, Wang Z, Santhirakumar A, Dowlati Y, Docteur N, Shoaib A, Purnava J, Wang Y, Wang W, Chen S, Husain MI, de Silva Wijeyeratne R, Reeyaz H, Baena-Tan C, Koshimori Y, Nasser Z, Sit V. Dietary supplement for mood symptoms in early postpartum: a double-blind randomized placebo controlled trial. EClinicalMedicine 2024; 71:102593. [PMID: 38813444 PMCID: PMC11133796 DOI: 10.1016/j.eclinm.2024.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 05/31/2024] Open
Abstract
Background Postpartum blues (PPB) is a frequent syndrome of sad mood, crying spells, anxiety, restlessness, reduced appetite, and irritability, typically peaking day 5 postpartum. When severe, it greatly increases risk for later postpartum depression. This trial compared a dietary supplement to placebo on PPB severity. The supplement was designed to counter downstream effects of elevated monoamine oxidase A level, implicated in causing PPB. Methods Participants recruited by advertisement from the Toronto region completed procedures at CAMH, Canada and/or participants' homes. Oral supplement or identical appearing relatively inert placebo were administered in randomised, double-blind fashion. Supplement was blueberry juice and extract given four times between nighttime day 3 and morning day 5 postpartum; tryptophan 2 g nighttime day 4 postpartum, and tyrosine 10 g morning day 5 postpartum. On day 5, depressed mood induction procedure (MIP) and postpartum blues were assessed. All data is presented (NCT03296956 closed, clinicaltrials.gov). Findings Between January 2019 and December 2022, participants took supplement (n = 51) or placebo (n = 52). There was no significant effect on primary outcome MIP on visual analogue scale for depressed mood (mean difference = -0.39 mm, 95% CI: -6.42 to 5.65 mm). Stein Maternity Blues scores, exploratory PPB measure, was lower in the active group (effect size 0.62; median, interquartile range (IQR): active 2.00 (IQR 1, 4); placebo 4.00 (IQR 1.5, 6); regression with general linear model, supplement effect, β coefficient = -1.50 (95%: CI -2.60, -0.40), p = 0.008; effect of CES-D crying category before supplement, p = 0.03-0.00000023). Twenty-six and 40 different adverse events occurred within 25% and 42% of supplement and placebo cases respectively (Chi-Square, p = 0.06). Interpretation The primary outcome was negative for effect on depressed mood induction, however the supplement moderately reduced PPB. Funding CAMH/Exeltis.
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Affiliation(s)
- Jeffrey H. Meyer
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - ZhaoHui Wang
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Apitharani Santhirakumar
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Yekta Dowlati
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Natalia Docteur
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Aqsa Shoaib
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Jareeat Purnava
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Yanqi Wang
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Wei Wang
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Sheng Chen
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Muhammad I. Husain
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Rashmi de Silva Wijeyeratne
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Heba Reeyaz
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Catalina Baena-Tan
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Yuko Koshimori
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Zahra Nasser
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
| | - Valery Sit
- Brain Health Imaging Centre, Azrieli Centre for Neuro-Radiochemistry, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, M5T 1R8, Canada
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Takakura M, Nagamachi S, Nishigawa T, Takahashi Y, Furuse M. Supplementation of L-Ornithine Could Increase Sleep-like Behavior in the Mouse Pups. Metabolites 2022; 12:metabo12121241. [PMID: 36557279 PMCID: PMC9785801 DOI: 10.3390/metabo12121241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Along the maternal-fetal-neonatal axis, one of the problems relating to the maternal-neonatal axis is infant sleep problems including nighttime crying. One possible solution could be to provide the newborn with sleep-promoting ingredients through breast milk or formula. So far, it has been reported that L-ornithine has a sleep-related effect. Therefore, we investigated the effect of dietary L-ornithine on maternal mouse plasma and milk L-ornithine levels in Experiment 1. In Experiment 2, a single dose of L-ornithine was applied to know the time-course changes in plasma, mammary gland and milk L-ornithine levels. Experiment 3 was conducted to confirm sleep behavior as well as changes in polyamine levels in milk. L-Ornithine levels in maternal plasma significantly increased by both dietary regimen and single oral administration in Experiments 1 and 2. Both L-ornithine treatments also increased its levels in milk, although not to a concentration as high as in plasma. In Experiment 3, the level of polyamines, which are metabolized from L-ornithine, did not significantly differ after L-ornithine administration. In sleep-like behavior observations, the average concentration of L-ornithine in milk did not increase the sleep-like behavior of mouse pups. However, more concentrated L-ornithine solutions can significantly increase sleep-like behavior. These results revealed that even if mothers ingested L-ornithine to increase L-ornithine levels in breast milk, it is difficult to promote sleep in newborns. Because it is difficult to raise L-ornithine in breast milk to sleep-inducing levels, L-ornithine added formula may partially improve infant sleep and has the potential for preventing infant sleep problems such as nighttime crying.
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Affiliation(s)
- Mayumi Takakura
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka 819-0395, Japan
| | - Satsuki Nagamachi
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka 819-0395, Japan
| | - Takuma Nishigawa
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka 819-0395, Japan
| | | | - Mitsuhiro Furuse
- Laboratory of Regulation in Metabolism and Behavior, Faculty of Agriculture, Kyushu University, Fukuoka 819-0395, Japan
- Correspondence:
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Dowlati Y, Maheux M, Meyer JH. The Effect of Oral L-cysteine on Breast Milk and Plasma Cysteine Concentrations. Neuropsychiatr Dis Treat 2020; 16:3163-3172. [PMID: 33376332 PMCID: PMC7762443 DOI: 10.2147/ndt.s255205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Greater oxidative signaling is implicated in major depressive disorder; hence, there is considerable interest in developing oral supplements with anti-oxidant properties to prevent or treat mood disorders, such as postpartum depression. L-cysteine is a precursor for glutathione, an important antioxidant in the brain. So, developing L-cysteine as a dietary supplement may be useful, provided oral supplementation substantially raises its concentration in blood plasma yet does not affect its total concentration in breast milk. This study assessed the effect of oral L-cysteine on its concentration in breast milk and blood plasma of breastfeeding mothers. PARTICIPANTS AND METHODS Twenty-four health breastfeeding women were randomly assigned to 0, 1.5, or 3 g of oral L-cysteine. Free and total cysteine in breast milk; and free cysteine in plasma were measured. While breast milk is the gold standard, measurement of infant formulas provides indices of nutritional intake considered safe. Therefore, free cysteine was also measured in six different formulas. RESULTS Total cysteine in breast milk was not affected by oral L-cysteine (Repeated Measures of ANOVA (rANOVA), intervention effect: p=0.75). Free cysteine levels in breast milk did rise (rANOVA, intervention effect: p=0.017), but were within the range of common infant formulas. There was no significant effect of L-cysteine supplementation on free cysteine levels in plasma (rANOVA, intervention effect: p=0.25), although a post hoc analysis found a trend towards greater plasma cysteine 30 minutes after oral supplementation (t(14)=-1.69, p=0.11, 3g versus no-dose). CONCLUSION The negligible effect of oral cysteine administration on its total concentration in breast milk was favorable, but the minimal effect on its blood plasma concentration more strongly argues against further development of oral L-cysteine in postpartum, as well as other conditions.
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Affiliation(s)
- Yekta Dowlati
- CAMH Research Imaging Centre and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | | | - Jeffrey H Meyer
- CAMH Research Imaging Centre and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
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Friedman M. Analysis, Nutrition, and Health Benefits of Tryptophan. Int J Tryptophan Res 2018; 11:1178646918802282. [PMID: 30275700 PMCID: PMC6158605 DOI: 10.1177/1178646918802282] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/15/2022] Open
Abstract
Tryptophan is an essential plant-derived amino acid that is needed for the in vivo biosynthesis of proteins. After consumption, it is metabolically transformed to bioactive metabolites, including serotonin, melatonin, kynurenine, and the vitamin niacin (nicotinamide). This brief integrated overview surveys and interprets our current knowledge of the reported multiple analytical methods for free and protein-bound tryptophan in pure proteins, protein-containing foods, and in human fluids and tissues, the nutritional significance of l-tryptophan and its isomer d-tryptophan in fortified infant foods and corn tortillas as well the possible function of tryptophan in the diagnosis and mitigation of multiple human diseases. Analytical methods include the use of acid ninhydrin, near-infrared reflectance spectroscopy, colorimetry, basic hydrolysis; acid hydrolysis of S-pyridylethylated proteins, and high-performance liquid and gas chromatography-mass spectrometry. Also covered are the nutritional values of tryptophan-fortified infant formulas and corn-based tortillas, safety of tryptophan for human consumption and the analysis of maize (corn), rice, and soybean plants that have been successfully genetically engineered to produce increasing tryptophan. Dietary tryptophan and its metabolites seem to have the potential to contribute to the therapy of autism, cardiovascular disease, cognitive function, chronic kidney disease, depression, inflammatory bowel disease, multiple sclerosis, sleep, social function, and microbial infections. Tryptophan can also facilitate the diagnosis of certain conditions such as human cataracts, colon neoplasms, renal cell carcinoma, and the prognosis of diabetic nephropathy. The described findings are not only of fundamental scientific interest but also have practical implications for agriculture, food processing, food safety, nutrition, and animal and human health. The collated information and suggested research need will hopefully facilitate and guide further studies needed to optimize the use of free and protein-bound tryptophan and metabolites to help improve animal and human nutrition and health.
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Affiliation(s)
- Mendel Friedman
- Healthy Processed Foods Research and Western Regional Research Center, Agricultural Research Service, United States Department of Agriculture, Albany, CA, USA
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O'Rourke L, Clarke G, Nolan A, Watkins C, Dinan TG, Stanton C, Ross RP, Ryan CA. Tryptophan metabolic profile in term and preterm breast milk: implications for health. J Nutr Sci 2018; 7:e13. [PMID: 29686862 PMCID: PMC5906556 DOI: 10.1017/jns.2017.69] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 10/19/2017] [Accepted: 11/13/2017] [Indexed: 02/06/2023] Open
Abstract
Breast milk is the only source of the essential amino acid tryptophan (TRP) in breast-fed infants. Low levels of TRP could have implications for infant neurodevelopment. The objectives of the present study were to compare the relationship of TRP and its neuroactive pathway metabolites kynurenine (Kyn) and kynurenic acid (KynA) in preterm and term expressed breast milk (EBM) in the first 14 d following birth, and the relationship of TRP metabolism to maternal stress and immune status. A total of twenty-four mothers were recruited from Cork University Maternity Hospital: twelve term (>38 weeks) and twelve preterm (<35 weeks). EBM samples were collected on days 7 and 14. Free TRP, Kyn and KynA were measured using HPLC, total TRP using MS, cytokines using the Meso Scale Discovery (MSD) assay system, and cortisol using a cortisol ELISA kit. Although total TRP was higher in preterm EBM in comparison with term EBM (P < 0·05), free TRP levels were lower (P < 0·05). Kyn, KynA and the Kyn:TRP ratio increased significantly in term EBM from day 7 to day 14 (P < 0·05), but not in preterm EBM. TNF-α, IL-6 and IL-8 were higher in day 7 preterm and term EBM in comparison with day 14. There were no significant differences between term and preterm EBM cortisol levels. Increased availability of total TRP, lower levels of free TRP and alterations in the temporal dynamics of TRP metabolism in preterm compared with term EBM, coupled with higher EBM inflammatory markers on day 7, may have implications for the neurological development of exclusively breast-fed preterm infants.
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Key Words
- Cortisol
- Cytokines
- EBM, expressed breast milk
- Human milk
- IDO, indoleamine 2,3-dioxygenase
- IFN-γ, interferon-γ
- Kyn, kynurenine
- KynA, kynurenic acid
- Kynurenic acid
- Kynurenine
- MSD, Meso Scale Discovery
- QC, quality control
- TDO, tryptophan 2,3-dioxygenase
- TRP, tryptophan
- Tryptophan
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Affiliation(s)
- Louise O'Rourke
- Graduate Entry Medical School, University of Limerick, Limerick, Republic of Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Republic of Ireland
| | - Gerard Clarke
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Republic of Ireland
- APC Microbiome Ireland, University College Cork, Cork, Republic of Ireland
| | - Aoife Nolan
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Republic of Ireland
- APC Microbiome Ireland, University College Cork, Cork, Republic of Ireland
| | - Claire Watkins
- APC Microbiome Ireland, University College Cork, Cork, Republic of Ireland
- Teagasc, Food Research Centre, Moorepark, Fermoy, Co. Cork, Republic of Ireland
| | - Timothy G. Dinan
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Republic of Ireland
- APC Microbiome Ireland, University College Cork, Cork, Republic of Ireland
| | - Catherine Stanton
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Republic of Ireland
- APC Microbiome Ireland, University College Cork, Cork, Republic of Ireland
- Teagasc, Food Research Centre, Moorepark, Fermoy, Co. Cork, Republic of Ireland
| | - R. Paul Ross
- APC Microbiome Ireland, University College Cork, Cork, Republic of Ireland
- College of Science, Engineering and Food Science, University College Cork, Cork, Republic of Ireland
| | - Cornelius Anthony Ryan
- Department of Neonatology, Cork University Maternity Hospital, Cork, Republic of Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Republic of Ireland
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