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New Science Links Food and Happiness
Joe Hibbeln, M.D., believes our diet is making us depressed, addicted and violent. He thinks he’s found a simple solution.
By Rachael Moeller Gorman, EatingWell.com

Joe Hibbeln maneuvers his small blue Mazda 626 around traffic on a wide boulevard in Bethesda, Md.
"How many people," he shouts over the noise from the open window, "even Miss America, say ‘I want to make the world a happier place’?" He turns the wheel sharply to the left. "Well, I’m doin’ it! I’m zeroing in on a nutritional deficiency that makes the world an unhappy place."
Hibbeln,a captain in the United States Public Health Service, one of the country’s seven uniformed services ("army of the Surgeon General," saysHibbeln), is talking about omega-3 fatty acids. He has, in fact,devoted his entire career to studying the long-chain polyunsaturatedf atty acids that are best known for their heart-health benefits. Heloves them. He loves the fish they come from.
Hibbeln,49, is average height, with dark, graying hair slightly longer on topand matching bushy eyebrows. His love affair with fats began simply. Ina musty autopsy suite at the University of Illinois-Chicago medical school more than 25 years ago, Hibbeln, an aspiring psychiatrist, helda brain for the first time. It was jiggly and white, not what one would expect of a computing juggernaut. "What the heck is this thing madeof?" Hibbeln asked. Mostly fat, his instructor replied.

Fascinatedby the idea that the most complex organ in our bodies was, in largepart, a type of tissue most of us want to get rid of, Hibbeln beganscouring the scientific literature to learn more about how the fatcomprising the brain influenced its function. He kept encountering thework of Norman Salem, Jr., Ph.D., a neurobiologist who studieddocosahexaenoic acid (DHA), a particular type of omega-3 fat prevalentin the brain—and in fish. (Fish often consume a lot of omega-3-richalgae or eat other, smaller fish that do.)
Duringhis last year of medical school, Hibbeln reached out to Salem, who toldhim something that forever changed his career path: Our bodies do notproduce DHA or other omega-3s from scratch; we have to get them fromfood. These words opened up a whole new avenue of inquiry for Hibbeln,and he jumped into researching how the fats we eat (or don’t eat) mightchange our brain.
Hewas especially interested in mental illness. He has a family memberwith mental illness and in 1985, his parents, Raymond and Shirley,helped found the first national support group for families dealing withmental illness, what’s now called the Depression and Bipolar SupportAlliance.
Wecareen through the streets of Bethesda and finally pull up to a guardstation at the National Naval Medical Center, where we are meeting Col.Mike Lewis, M.D., M.P.H., one of Hibbeln’s collaborators, to talk aboutsome new studies. A soldier in dusty fatigues salutes and waves us in."Sir, very good sir." Hibbeln returns the salute. Hibbeln tells me thatpost-traumatic stress disorder (PTSD) and depression in the U.S.military are affecting 20 percent of those who have been deployed. Hepoints to construction vehicles and men in hard hats who swarm aroundthe medical center. "They’re building new treatment facilities tocapture this flood of psychiatric distress," he says. "If I can get themilitary to change their diet, show that it works to reduce depressionand suicide there, then there’s a great potential for societal change."
Aftera few hair-raising attempts to secure parking, we find Lewis in thewaiting area for Pulmonary Medicine. He and Hibbeln recently receivedDepartment of Defense funds to compare blood samples from 800servicepeople who committed suicide between 2002 and 2008 to those of800 healthy people in the military (matched by age, sex and rank) tosee if low omega-3 levels are linked with likelihood of suicide. Noresults yet.
Inaddition, the U.S. Army recently awarded the duo almost $1 million tostudy the effects of giving omega-3 supplements to a special-operationsunit that spends a third of the year in combat. They will give half theunit the omega-3 supplements and the other half a placebo, every dayfor a year, and then follow them for a couple of months to see if theomega-3s might prevent occurrences of depression and suicidal thinking.Hibbeln calls it giving "nutritional armor to the war fighter." They’realso looking at whether it might protect a soldier should he or shesuffer traumatic brain injury—not an unlikely occurrence forspecial-ops persons who jump from planes and engage in combat.
Hibbelndoesn’t fight wars in the traditional sense, but as an officer in thepublic health service, he’s been serving on the front lines ofmental-health research for the last 17 years. "Joe truly wants to helppeople with his science," says Norman Salem, Hibbeln’s former boss andmentor. "And he’s got a lot of great ideas and great data."
Whatdrives him? "I am motivated by a very strong sense of duty," saysHibbeln. (He mentions finding role models in his mother, a librarian;his father, a World War II vet who fought in Okinawa for 63 daysstraight; and his scoutmaster, Herb Wittenborn, also a WWII vet.)"Since I have the ability to do it, it is my duty to create the bestscience," says Hibbeln. "That’s why I wear this uniform."
Hisgovernment-issued dress, he tells me, is a daily reminder of the peoplehe’s committed to serving: veterans with PTSD, violent alcoholics,people with depression, underprivileged mothers who need access tofoods that will maximize their children’s potential. He points out thewindow to a man on the island of a busy intersection, holding a signasking for money. "That’s my boss. That’s the guy I’m working for."
Diet-induced epidemic of distress?
In 1995, Hibbeln and Salem published the paper that launched Hibbeln’s career in this field, an article in the American Journal of Clinical Nutritionpresenting the theory he had been working out ever since he first heldthat lump of brain in his hands: mental illness could very well be aresult of omega-3 deficiency.
Hisreasoning is this: The modern American diet is vastly different fromthe one upon which our ancestors evolved. Our ancestors consumed aboutequal amounts of omega-3 fats and omega-6 fats, the otherpolyunsaturated fats (found in vegetable oils) that compete withomega-3s for space in the brain. Today, Americans get 10 to 25 timesmore omega-6s than omega-3s, partly because we don’t eat as manyomega-3-rich fish, such as salmon and sardines (or wild animals, whichare also higher in omega-3s), but mostly because our diets now containprocessed foods that are packed with omega-6-rich oils, including oilsmade from soybeans, safflower and corn.
Hibbelnpresented the possibility that this dramatic shift could have changedthe way our brains function—sort of as if a car designed to run onunleaded gas suddenly started using diesel. Might it even trigger orperpetuate psychiatric illnesses? Hibbeln offers an interestingcorrelation: statistics suggest that depression and homicide rates haverisen steadily over the past century—the same time period during whichAmericans’ annual per capita intake of omega-6-rich oils increased bynearly 500 percent, from 11 pounds to 64 pounds.
"Whenthe brain becomes deficient in nutrients, the first things to go aremood, the expression of emotion and concentration," Hibbeln explains.Though the idea of a nutritional deficiency affecting mood isn’texclusive to omega-3s (the Institute of Medicine mentions depressionand irritability as symptoms of numerous nutrient deficiencies,including iodine and vitamin B12), Hibbeln’s theory is unique in thatit proposes too few omega-3s—or too many omega-6s—may be at leastpartly responsible for a national epidemic of psychiatric illness.
Fifteenyears after the publication of that first paper, Hibbeln, who is nowActing Chief, Section on Nutritional Neurosciences at the NationalInstitute on Alcohol Abuse and Alcoholism, is even more passionateabout his hypothesis. Now, he has a growing body of scientific researchto support it.
Hibbelnstarted building his case with broad observational studies and in 1998,he compared fish consumption to the prevalence of major depression innine countries. He found that in countries with higher fishconsumption, like Japan, the prevalence of major depression was lowerthan in countries with lower fish consumption, like the U.S. In 2001,he showed that among 3,204 Finnish people, those who rarely ate seafoodwere more likely to suffer symptoms of depression than those who ate itall the time. Later, Hibbeln showed that low fish consumption was alsoassociated with bipolar disorder in 11 countries and schizophrenia in14 countries. Furthermore, countries where people ate less fish tendedto also have higher rates of homicide.
Hibbelnand others soon started testing the theory in clinical trials. Theresults were compelling enough to prompt the American PsychiatricAssociation (APA), in 2006, to recommend that people with majordepression consume a daily omega-3 supplement in addition to theirregular medications. (Recommended daily dose: 1 gram of DHA+EPA,eicosapentaenoic acid, another omega-3 fat in fish. That’s theequivalent of what you would get eating 1 pound of oily fish, such assalmon, every week.) Additionally, the APA suggested that people withother mental-health conditions, including schizophrenia, bipolardisorder and ADHD, might also benefit from this complementary treatment.
Hibbelnlikes these recommendations. He mentions them often. He also mentionsthe people who call, thanking him for his dedicated work. He played mea voicemail from a colleague whose sister’s severe, treatment-resistantdepression improved significantly after she began taking omega-3supplements at the suggestion of her psychopharmacologist, who happenedto be a big follower of Hibbeln’s work.
Iasked if he gets that a lot. "There are certainly people who havesuffered from debilitating depression for 20 years, despite having gonethrough every reasonable pharmacological therapy," he says, leaningforward. "They take the omega-3s at high levels (2 to 3 grams per day),and suddenly their brain is freed."
Healthy fats make happy brain chemicals
Hibbelnexplains that omega-3 fats help keep the membranes surrounding braincells supple. This flexibility is important because the proteins thatstick in the membrane need to twist to do their jobs, which includehelping brain cells communicate. Studies suggest that omega-3s also mayimprove mental health by altering concentrations of brain chemicalscalled neurotransmitters—specifically dopamine and serotonin—perhaps byswitching "on" or "off" genes that regulate these chemicals. Low levelsof serotonin are linked with depression, aggression and suicidaltendencies, while dopamine is a "reward" chemical that the brainreleases in response to pleasurable experiences, such as eating orhaving sex—or taking drugs like cocaine. Depletion of dopamine as aresult of low omega-3 levels could cause an addict to seek more andmore drugs to get high, worsening the addiction, says Hibbeln.
In2003, Hibbeln and colleagues looked at omega-3 levels in 38 cocaineaddicts in a rehabilitation clinic. Some kicked their addiction; othersrelapsed after discharge. Hibbeln found that those who relapsed hadlower levels of omega-3s in their blood. Whether they recovered orrelapsed, addicts with aggressive tendencies also had lower omega-3s.Hibbeln followed up with a controlled trial in 2008, and found thatgiving omega-3s to substance abusers made them less angry and anxious.
NowHibbeln and some colleagues are looking at whether the same thing mayhold true for alcoholics. (Alcohol breaks down omega-3 fats, depletingthe body’s supply.) To find out, Hibbeln and his team recruited 90aggressive alcoholics. The volunteers underwent 30 days of in-patientrehabilitation, followed by 90 days of out-patient therapy with orwithout DHA+EPA supplements (the "without" group got placebo pills). Bychanging levels of neurotransmitters, omega-3s might help remedy issuesunderlying these subjects’ alcoholism, namely depression, says Hibbeln,noting that it might also make them less violent. "If you treat theirunderlying depression and irritability and restore their brain DHA,"Hibbeln asks, "will that assist them in reducing their drinking?"
Hibbelncan’t say yet, as he’s still analyzing the results of the study. Hedoes, however, offer up an anecdotal account of one man for whom theomega-3 doses seemed to make a profound, positive impact.
When"Mr. D.," in his early 60s, was referred to Hibbeln’s study by ahomeless shelter, he’d been living on the streets or in prison for 25years and had a long history of arrests for physical violence andmultiple assault convictions. Basically, says Hibbeln, his dailyroutine consisted of "panhandling enough money to buy the booze heneeded to get really drunk and go to sleep."
After"drying out" for 30 days, Mr. D. underwent baseline tests that foundthe omega-3 levels in his body to be "profoundly low," says Hibbeln. Hewas randomly assigned to the group that got the omega-3 supplements.The first thing the nurses and staff noted was that he looked healthierand happier.
Hegot a job for the first time in 20 years—at a car wash—and he showed upto work every day, says Hibbeln, who recalls: "He came in at one pointin the study and pulled $650 out of a sock and says, ‘Doc, this is themost money I’ve had at one time in 25 years. I used to spend all of mypanhandling money at the liquor store. I still go there to buycigarettes and lottery tickets, but I don’t crave any of the booze inthe store.’" (This never happened the other times Mr. D. went throughdetox without omega-3s, says Hibbeln.)
Asfor Mr. D.’s aggression issues: "Here was a guy who’d had an impossiblylong record for drunk and disorderly conduct transformed," saysHibbeln, into "a complete pussycat."
Diet of evolution
It’smidday and we’re standing in one of the medical center’s public waitingareas, when Hibbeln suddenly gets a smile on his face and announcesit’s time for lunch. "EatingWell Magazine offers to take meout to lunch. Most people are smart enough to go to the fanciestrestaurant in Bethesda. I have a twisted sense of humor, so we’re goingto eat what the military eats." He laughs.
Wetake the elevator to the basement, walk down a long hallway to thegalley. It looks like any hospital cafeteria. There’s fish on the menutoday—cod.
But all that’s left of the fish is a steaming tray of broth.
"Ten minutes till it’s ready," the lady tells us.
"Glad to see it’s popular," says Hibbeln.
"Yeah, it is," she says. "It’s healthy."
"It’s healthy, there you go," Hibbeln replies.
Hibbelnchooses pepper steak with rice instead. (His normal lunch is "hardtack[Scandinavian flatbread] and a can of tuna.") I have the same. MikeLewis, who has joined us for lunch, selects a salad with soup.
Aftertalking about Lewis’ ideas for providing omega-3s to protect soldiers’brains from traumatic injury, Hibbeln reveals his grandest plan, onethat applies all his research toward helping people in the "realworld." Hibbeln wants to create what he calls a modern-day "Diet ofEvolution." He is designing this diet—which he plans to somedayintroduce into the Naval hospital’s cafeteria—to boost the ratio ofomega-3s to omega-6s in the brain, not so much by increasing omega-3sbut rather by dramatically reducing omega-6 fats—from about 10 percentto 1 percent of total calories. (On 2,000 calories a day, that’s 2 to2.5 grams versus the 17 to 20 that a typical Western diet delivers.)
Foryears, Hibbeln and others have advocated eating lots of omega-3-richfish to restore the omega balance in the brain. But they haven’t lostsight of the fact that animal studies suggest slashing the omega-6s maywork just as well. "We don’t need to increase the world’s fisheriesproduction tenfold to achieve the same goal," says Hibbeln. Eating atraditional Mediterranean-style diet that’s centered on vegetables andfruits, legumes and olive oil, provides plenty of seafood and islimited in meat, will help to lower omega-6 intake dramatically, saysHibbeln. (Vegetables, fruits, legumes and olive oil don’t containsignificant amounts of omega-6s or omega-3s; seafood provides plenty ofomega-3s; and meat tends to deliver more 6s than 3s. The diet as awhole is low in omega-6-rich processed foods. But overhauling aninstitutional menu is expensive, he says, "so the question is how do wemake the same menus, backing off the omega-6 fatty acids?"
Answer:Replace the inexpensive high-omega-6 oils the military currently uses,such as soybean oil, with lower-omega-6 oils, such as high-oleicsafflower and high-oleic sunflower oil (which have been bred orengineered to have more monounsaturated fats and fewer omega-6s).
IfHibbeln can show that balancing the omega-3/omega-6 equation in themedical center cafeteria can reduce risks of depression and suicide, itmight convince the entire military to switch to lower-omega-6 oils(which cost a little more than, say, soy oil, but far less than theexpense of changing the entire military diet). This could open the doorto wider-reaching changes—like commercial product reformulations.Hibbeln is already preparing for that. His research team is figuringout how many omega-3s and omega-6s are in foods on supermarket shelves:Different brands of salad dressings. Mayo. Peanut butter. Chicken.Pork. "Pretty much everything," says Hibbeln.
What if he’s wrong?
Nearthe end of our long day together, Hibbeln’s conviction of the extremeimportance of his work had not waned. After saying good-bye to Lewisand ending up in another of Hibbeln’s several offices, this one at theNIH main campus, I asked: What would it take for him to discard histheory that a lack of omega-3s causes mental illness? He sat quietlyfor a few seconds, then said steadily, "I could ask Jeremy [the studentsitting with us] to find all of the published scientific studies onomega-3s in humans—I think the total is somewhere between three andfour thousand. So you’re asking me to override the published data onseveral thousand studies?"
But,I say, most of the studies are not gold-standard randomized controlledtrials (and they’re not all in psychiatric illness; many are incardiovascular disease).
"You have to take every piece of science for what it’s worth," he says.
OK—butthere are quite a few pieces of science, and researchers, who don’tsupport Hibbeln’s theories. Critics argue that Hibbeln’s initialobservational studies simply show associations and note there could beplenty of other reasons why—besides high fish consumption. For example,people in Japan seem less prone to depression than those in the UnitedStates. They also argue that the clinical science is equivocal: of thehandful of controlled trials examining the effects of omega-3s onpeople with major depression, the most well-studied of thesepsychiatric illnesses, only about half suggest they help. In studies ofpeople with milder depression, omega-3 supplementation has worked evenless well. The same is true for mentally healthy people, though therehave been even fewer studies.
PeterRogers, Ph.D., an experimental psychologist who specializes in food andnutrition at the University of Bristol in the UK, is one of theskeptics. "I was very excited by this field, when I read the very firststudies nearly 10 years ago now," says Rogers. "But the more I’ve beeninvolved in this, the less I’m convinced about the impact" of omega-3son mental illness. In a 2008 study, Rogers found omega-3 supplementsdid not improve the moods of people with mild to moderate depression.Rogers also reviewed hundreds of studies on omega-3s and various mentalconditions, including depression, anxiety, aggression, ADHD andschizophrenia. That paper, published in Nutrition Research Reviews in2008, concluded that, while early observational studies were promising,clinical trials have produced inconsistent and inconclusive resultsoverall; much more evidence is needed to recommend omega-3 fats as away to boost mental health.
Hibbelnwaves all this off, acknowledging that the field is still young. What’simportant, he says, is finding the conditions under which omega-3s dowork. Michel Lucas, Ph.D., M.P.H., a research fellow in the departmentof nutrition at the Harvard School of Public Health, agrees. "Evenantidepressant drugs do not work for everybody," says Lucas, who thinksthat, for people with mild to moderate depression, omega-3s might workabout as well as antidepressants. Hibbeln, Lucas and Rogers all see thesame data but come to different conclusions. Hibbeln’s are the rosiest.
Weget back into Hibbeln’s Mazda, which has an ichthys (one of thosereligious fish tags) on the back—only this one says "sushi"—and driveback to my rental car. Hibbeln draws me a shortcut on my notepad—whiledriving—so that I can avoid D.C. rush-hour traffic and make my flight.We talk about his hobbies: serving as Cub Scout master, taking hisschool-age kids to historic presidential homes on vacation, cooking inhis open-fire brick oven.
Aswe circle the garage looking for my car, he starts speaking almost outof nowhere, as if in response to the naysayers I would talk to later."I think my role is not to provide definitive answers, although I dothat on some level," he says, a bit more subdued than he’d beenearlier. "My bigger contribution has been to ask the best questions.Open up new fields for inquiry. I’m a psychiatrist. If I only practicemedicine, I can only affect hundreds, maybe thousands, of people. Butif I do research that shifts the paradigm of treatment, I can createuseful therapies that could impact millions."