Hi, I have read some of Peskins work, not much yet but I hope to even though I way too busy.
I have been involved in using essential fatty acids to treat CFS (not an ME diagnosis back then) since 1993.
I was probably the first person to promote and try the use of high dose short chain natural omega 3s for CFS back in 1993. I was one of a number of patients this was tried on. There was also experimentation with fat restriction and higher dose omega-6s. This was the work of Dr Andriya Martinovic, whose practice was maybe 100m from my unit.
Not much Peskin is saying is new, at least nothing I have read yet so I need to read more. The knowledge of natural fats versus fats is from the 80s. I was aware of it back then. The knowledge of essential fatty acid ratios (though with disagreement) took off in the early 90s. I am not sure what date the science is from though.
A lot of what Peskin has said that I have read so for is trivially correct and highly misleading. Its a case of so what? Its a case of why is he over-generalizing?
Evening primrose oil wil indeed help many with CFS. So does fish oil. Some of us get worse from fish oil, and the reasons we currently understand about this are complex. Most of us get worse from evening primrose oil, at least in my experience.
Initially we experience a euphoria or high, we feel better. Over time this stabilizes. Then the decline begins. Dr Barry Sears found the same thing with athletes - an inital boost then a long term decline. Its not a reliable method to supplement omega-6s.
Here is my interpretation of the science. Most of us have a functional deficiency of omega-6 fatty acids. Simple then, take more! Not so.
Our underlying physiology has two major problems. First, we have problems converting short chain essential fatty acids to long chain ones. The primary problem that induces this is a decrease in reduced glutathione. The primary cause of low glutathione is oxidative stress, with an additional driver of problems in the methylation cycle for many of us.
We have a second problem. We over-utilize essential fatty acids to make hormones called eicosanoids. These can be made from omega-6 or omega-3 fats. In general the omega-3 fats are less inflammatory, give less of a push to the immune system. As a result they calm the immune system. This is not a suppression, its a reduction in the strength of the immune boost. EPA on the other hand suppresses omega-6 conversion to eicosanoids, in a manner not dissimilar to NSAIDs.
Three things, at least, push this increase used of essential fatty acids. The first is pro-inflammatory cytokines like NFkB. The second is increased NO. The third is decreased cortisol. A fourth thing will push it if you are not carefull: alcohol induces a massive and sudden increase in this pathway.
So when we are deficient and take evening primrose oil, we feel better. A side path, that is very beneficial and leads to series one prostaglandins, is also boosted. The path leading to series 2 prostaglandins is boosted even more though. These are essential hormones. We need them too live. Once we boost this path we start making way too many of them though. So the initial euporia fades and we very slowly decline. Crashes become more common.
We are all individuals. A one size fits all approach can be dangerous. You might be someone who does much better on evening primrose oil. Just be aware of the warning signs. If you get an increase in aches and pains, headache, and flu-like symptoms, you may be pushing this path way too hard.
Having said that I do know that some patients who take evening primrose oil improve. I did too. Then I got worse. Then I got a LOT worse. I didn't turn that around till I stopped taking the evening primrose oil.
Since adopting a policy of limiting my omega-6 intake:
1. My pain levels went from extreme to very mild.
2. My flu-like symptoms went from all day every day to a few days several times a year.
3. My headaches went from many times a week verging on all the time to very very rarely, once or twice a year.
Now all the these outcomes could be just coincidence. During this period I was also learning how to pace myself. There is also a downside in that a reduction in omega-6 essential fatty acids may be depriving me of important hormones and have long term negative consequences. Its certain that if I stopped eating meat and vegetables then I would become seriously deficient ... but to do that you would have to be living on almost nothing but grains.
A few years ago I gave in on a bad day and walked to my corner takeaway. It had changed hands. I think I ordered a burger and fries. I had barely enough energy to get there and back, and not enough coordination to cook for myself. I came home and ate. Some tens of minutes later my pain skyrocketed. I was forced to lie down and was in so much pain I could not move for six hours - primarily chest pain. This is a long familiar symptom, not provably related to heart issues. My pain levels then declined.
Several days later I went to the corner store and asked about cooking oil. They had switched to a new product - rendered animal fat. This has a high concentration of arachidonic acid, the primary fat that makes pro-inflammatory eicosanoids. Do you ever take aspirin or paracetamol? NSAIDs effectively work for pain and fever by preventing the conversion of arachidonic acid to inflammatory eicosanoids, although the mechanism varies depending on the drug. Even Vioxx did this, just more selectively and powerfully (thereby shutting down essential hormone synthesis almost completely). Adding more arachidonic acid is equivalent to taking anti-aspirin.
The essential fatty acid story in ME and CFS is complex. It will be complex for anyone with a range of primary and secondary health issues. There is no one size fits all. Do be careful.
So when would you want to boost omega-6 fats, including evening primrose oil? For short term use only during a primary infection it can boost immunity. In the long term though this will cause a lot of harm if you get the dose wrong, and the optimal dose varies highly day by day.
Bye, Alex
PS Borage oil is a more concentrated form of the active ingredient than evening primrose oil. Hence it is more cost effective. Anecdotally however the common experience is that it is less effective and causes more problems. I do recall reading that this has to do with the other ingredients in borage oil, but this was so long ago that I forget the details.
