The BRAVO Study

Why: An estimated 20 percent of all suicides in the United States are committed by military veterans. In 2010, the Department of Veterans Affairs estimated that a veteran dies by suicide every 80 minutes.

What: BRAVO (Better Resiliency Among Veterans with Omega-3s) is a voluntary dietary research study at MUSC to learn if Omega-3 fatty acids can reduce self-harm behaviors, negative thoughts, and problems that put veterans at risk of suicide. It is double-blind, randomized controlled dietary intervention trial, paid for

When: The study started in late March and will last three years. The study seeks veterans who live in the Charleston area. Vets sign up for six months. Participation is voluntary, will not in any way affect veterans' access to health care or benefits, and will not interfere with any existing treatments.

Where: The study is held at Medical University of South Carolina.

Requirements:

Requires vets to continue all existing medical treatments as normal.

Consume three all-natural fruit juice smoothies, containing either Omega-3 Fatty Acids or macadamia nut oil, daily for six months.

Visit an outpatient office seven times over six months. Each visit may require up to four hour hours per visit.

Complete questionnaires, computer-based assessments and blood draws.

Consent to allowing investigators to consult with your healthcare providers.

How vets sign up: Call the BRAVO information line at 888-322-6884 or email BRAVO@musc.edu to learn whether they qualify. Veterans in the study will be provided compensation and free parking.

More: Go to facebook.com/BRAVOStudy and watch the video for more information.

New hope for lowering suicide rates in military veterans may lie not in a new drug but in a promising super food supplement: omega-3 fatty acids.

As Friday's Pentagon report showed that suicide rates among veterans are higher than originally calculated, a team of specialists at the Medical University of South Carolina's Department of Medicine is already combining multidisciplinary resources in a study that is part of the Department of Defense's suicide research.

Experts in psychiatry, substance abuse, post-traumatic stress disorder, pain and brain imaging, among others - have just embarked on a three-year study of 300 local veterans. Half of the veterans in the study will be asked to consume a fruit smoothie, either containing omega-3s or a placebo containing macadamia nut oil, three times a day for six months, according to the study's lead principal investigator Bernadette Marriott.

"With a veteran dying by suicide an estimated every 80 minutes in the U.S., we are hoping to show that dietary intervention with omega-3 fatty acids will reduce suicide risk," said Marriott, adding that this is the only study of its kind currently underway.

The hypothesis

Marriott has proposed that a daily supplement of omega-3 fatty acids, which are building blocks that play important roles in neuronal structure and function, will reduce the risks of mental illness and suicide among military veterans with increased risk of suicidal behaviors.

She said previous studies indicate that omega-3s reduce symptoms of severe depression, improve mood, and reduce impulsive behavior. Depression, impulsivity and excessive alcohol use can increase the risk for suicide, which has been linked to low levels of omega-3.

Marriott said omega-3s cannot be made naturally by our bodies but are found in a variety of foods - especially seafood.

An associated pilot sub-study will investigate the impact of Omega-3 dietary supplementation on alcohol consumption in suicidal veterans with alcohol use disorders.

Marriott said if the study provides evidence for improvements in curbing suicide in veterans, it could likewise apply to civilians suffering from similar problems.

The team is in the process of recruiting volunteers now from the Charleston area. According to the U.S. Census Bureau, 66,555 veterans live in Berkeley, Charleston and Dorchester counties. The study is being paid for with a $9.8 million grant from the Department of Defense's Military Operational Medicine Joint Program Committee.

Carl Castro, chairman of the joint committee, said the study emphasizes the contributions of military veterans while recognizing and attempting to treat their pain.

"Suicide prevention is one of the most important goals in the U.S. Army," Castro said. "Our veterans have sacrificed in so many ways in service to their country, and we owe it to them to provide the best preventive and treatment options. This research is crucial to the well-being of future military veterans."

The study is being integrated with the joint program committee's suicide research portfolio that includes more than $100 million in research.

Time for changes

Col. Zeb Williams, who has served in the S.C. Army National Guard, has seen a dramatic change in the way the military handles the issue of suicide in his 28 years of service.

Williams served in Operation Desert Storm in 1991, as well as three tours of duty in Afghanistan, including two year-long, "boots-on-the-ground" stints in 2007-08 and 2013-14. He personally knew three of his comrades during those tours who killed themselves.

"It (soldiers and veterans committing suicide) is a concern of mine and other servicemen because of firsthand knowledge of it," says Williams, a Columbia resident who serves on the Patriots Point Development Authority. "I don't know anyone who has served in Afghanistan once or twice who doesn't know someone who has committed suicide."

But Williams says the changes the military has made in response to spiking suicide rates have been dramatic. "Asking for help won't create a black mark on your record like it used to," says Williams.

Retired Air Force Col. Mary Martin, who served 24 years in the Army Reserve and in the Air Force active duty and reserves, isn't convinced that the stigma of recognizing and seeking help has faded.

Martin, also a psychiatric registered nurse and owner of Echo Healthcare Group, has studied suicide as part of a task force after Admiral Jeremy Boorda killed himself in 1996. She thinks a decade or two must pass and new leadership take over before the stigma will fade.

"The social pressure in the military not to seek help with suicide is normal," says Martin. "You're not going to solve this problem with a direct order (seek help if you need it) or with drugs."

Martin applauds any effort to look at nutrition, such as the omega-3 study, as a way to improve brain function and hopefully curb the suicide rate.

"The typical Western medical approaches have been either from a behavioral therapy or to throw drugs at it, but look at 'Maslow's Hierarchy of Needs' - food and water is at its foundation," says Martin, pointing to the fact that medicine has drawn the connection between diet and heart disease.

Curbing the trend

Meanwhile, Friday's news about suicide rates among soldiers had to do with the way the Defense Department calculated numbers.

Defense officials said that their old rates for suicide were flawed because officials did the math using only a percentage of National Guard and reservists - and not the actual number - who were serving on active-duty status.

"It wasn't precise," said Army Lt. Gen. Michael Linnington, the military deputy to the undersecretary of defense for personnel and readiness.

"Having a better picture of what's going on ... helps better align and focus the efforts" to reduce suicide, he said.

According to the four military services, there were 289 suicides among active-duty troops in 2013, down from 343 in 2012. The vast majority were in the Army, the nation's largest military service. The Navy saw a 25 percent decline, from 59 in 2012 to 44 in 2013. The Marines went from 48 to 45, while the Air Force went from 51 to 49.

Due to the accounting changes and other updates, the Pentagon numbers are generally a bit lower and reflect a larger decline in overall active-duty suicides of about 18 percent from 2012 to 2013. In some cases, the services are counting National Guard and Reserve members who have been called to active duty as part of the active duty total, while the Pentagon did not.

The old calculations drew criticisms from elected officials on the Veterans Affairs Committee.

"It's jaw-dropping that the Pentagon would use this kind of crass calculation to measure the impact of the suicide epidemic within their ranks," said Sen. Patty Murray, D-Wash., a senior committee member, adding that the Pentagon must address a problem that clearly is worse than elected officials had been led to believe."

Reach David Quick at 937-5516.