those fatty acids....
Hi, all; I have done a bit of checking and thinking, and remain less than totally convinced by this 3:1 or 4:1 ratio stuff, though there are real issues here. I am going to begin with what may look like a diversion, but I hope is relevant.
Caldwell Esselstyn (Prevent and Reverse Heart Disease, 2007) has been working for many years with a group of cardiac patients in bad shape, using a very low fat totally vegetarian diet based on the work of Colin Campbell (The China Study, 2005), and his patients are doing very well still, after many many years. They use no fatty acid supplements, but do take a low dose of statins. He advises against fish or fish oil. Dean Ornish has also been working with a group of cardiac patients in bad shape for many years, using a very low fat diet that does allow no-fat yogurt and egg whites, but is othewise strictly vegetarian; no statins, but 3g fish oil, plus moderate exercise and stress reduction through yoga and meditation. His patients also are doing very well, and in his most recent book (Spectrum) he gives evidence that his methods are helping reverse prostate cancer too, with further speculation that they would probably be effective in breast cancer as well, since it too is a hormonally driven cancer, though ethics prohibits the kind of control group trial used for the prostate patients. Both these doctors have documented their results with high tech imaging methods, and have published their results.
So for many, including those facing serious threat, a healthy life is possible long term without fatty acid supplements, and also with substantial omega 3 supplements. Campbell, followed by Esselstyn, are confident that the human need for both EFAs is met by vegetables. Heart disease can be partially reversed by several versions of one common theme, a low fat basically vegetarian diet; round this centre, variations are possible–a bit of non fat animal protein, a low dose of statin, fish oil supplementation, exercise or stress reduction techniques–these can be used or not as long as the basic theme is respected. The path is pretty straight but not too narrow.
I am trying to establish a paradigm based on well documented territory I know well and have lived for some five years now. Heart disease is not CFS, but Cheney has proved beyond any doubt the major role that cardiac issues play in CFS, so it is not irrelevant. Cheney said (2005, “The Heart of the Matter”) that we are all in heart failure; that term seems too dramatic–diastolic dysfunction would seem more appropriate–but it may be relevant that a recent good study (GISSI-HF) showed that while statins were of no help in heart failure, fish oil was. Since at least 50% of patients with heart failure over the age of 60 are now classified as in diastolic, i.e. they have an ejection fraction of over 50%, their condition overlaps substantially with that of most of us, including myself. Fish oil also has a long history of research showing that it helps with arrhythmias, and decreases the chances of developing atrial fibrillation (Cheney mentions in “The Heart of the Matter” and elsewhere that many CFSers have arrhythmias, and I had heart surgery, which often triggers AF, and have never developed it; I have long taken fish oil and have developed a lot of respect for it.
Another basic preliminary point: the body sees the total sum of omega 3 and omega 6 presented to it, and does not distinguish between food and supplements; discussion of fatty acid supplements should remember this.
Cheney and Patricia Kane now want us to reduce our intake of omega 3s and increase that of omega 6s. Cheney depends on his echocardiogram measurements of the quick response of the heart (specifically the IVRT interval, which measures diastolic function, and which he takes as a measure of available energy–which sounds reasonable to me) to the skin application of various substances. But this quick response test has been questioned by Rich van Konynenburg, and the results make me think that Rich probably has a point, though I have seen no detailed critique, and am not capable of mounting one myself. On these grounds, and these only as far as I know, Cheney states that omega 3s, especially fish oil, generate uniformly negative responses in CFS but not in controls (though there were only 3 of those). It is true that 3s may be more easily oxidized, a possible explanation for this result.
In Cheney’s tests Omega 6s bring a better result, and a mix of 3, 6 and 9 even better. His results show that a ratio of 3:1 of 6 to 3 brings the best results, and suggests high grade olive oil as the closest approximation to this ratio. Fish oil generates a more strongly negative response than does flax oil among the available sources of 3s. Cheney has not yet offered evidence from patient outcomes of this shift in the prevailing opinion that the DHA and EPA found in fish oil are of strong benefit to the heart in reducing atrial fibrillation and clotting, the latter of some concern to CFS, since it seems that our blood is liable to clotting. In addition, there is evidence that the reduced incidence of atrial fibrillation may be due to the way that fish oil modulates autonomic tone, which can initiate such fibrillation. It all sounds good.
Can anything account for what Cheney claims to find? I am really not up to dealing with this, but I have found one possible clue. In a study published Sept. 1992 in Cardiovasc Res, P.L. McLennan et al., using marmosets, “Dietary fat modulation of left ventricular ejection fraction in the marmoset due to enhanced filling,” both fish oil and sunflower seed oil “enhanced ventricular filling, thus providing an energy sparing promotion of diastolic relaxation.” This in comparison to groups fed either sheep fat or a low fat reference diet. We humans should respond in much the same way–marmosets are close cousins. Fish oil should improve our diastolic function.
But another study, A. O. Verkerk et al., Fish oil curtails the human action potential dome in a heterogeneous manner, published Feb 2009 in Int J Cardiology, shows that in ventricular myocites taken from explanted (i.e. removed!) hearts from patients undergoing transplantation because of cardiomyopathy (Cheney!) “Fish oil shortens the cardiac potential and may cause a loss of the dome of action potential (AP). Under conditions of increased preexisting heterogeneity in repolarization this may aggravate dispersion in action potential duration.” I don’t know exactly what this means–maybe someone could enlighten me–but it suggests that in recently dead and severely cardiomyopathic hearts fish oil can have a negative effect, diminishing available energy and increasing the chaotic and therefore energy wasting response–the irregular wall motion noted by Cheney as typical, and registered in my two most recent echocardiograms, though not present a year after my surgery (i.e. not a result of that, as the cardiologists here assumed, but a result of CFS.)
There may thus be a cause for Cheney’s finding based on the assumption that our CFS hearts really are cardiomyopathic, as Cheney insists, and as most cardiologists deny, including the two I have consulted here, as they focus on the good ejection fractions–my own was over 70% and Cheney in his recent DVD states that 80% can be found, usually coupled with irregular wall motion, also my case, due perhaps to the “heterogeneity in repolarization.” It may be the case that our cardiomyopathic hearts do respond differently to fish oil supplementation, and after discovering this study my response is shifting a bit–my first one was “no way am I going to give up the well proved benefits of EPA and DHA on this slim evidence.” Like Cort, I wish that Cheney would publish a full account of his findings, since his DVD recordings, though remarkable performances, do leave many key questions unanswered.
There is another basic thing to consider. Fish and krill oils have a well documented anti-inflammatory power, which I have used myself (fish oil in the presence of aspirin generates resolvins–there is a biotech company, Resolvyx, working on creating resolvins, and one day I suspect they will revolutionize the pharmaceutical treatment of inflammation–unfortunately, it is a privately held company–if they ever go public, I shall be buying!); this is something I have used to control occasional episodes of scleritis. It works. But that anti-inflammatory power implies also that these oils downregulate the immune system–you seldom get anything for free! So you can suppress inflammation, but.... Again, one must make a choice, and the picture is not yet totally clear–fish oil seems helpful in some autoimmune conditions.
I am not sure what I shall do about this. Remembering my first principle–look at the total food + supplement intake-- I did a quick check on a few of my regular foods (
www.whfoods.com is a useful website for this), and discovered that millet has, per cup of 240 gr, about .06 gr of Omega 3, and 1.16gr Omega 6. I eat about 1/3 cup, so get .02 gr of 3 and .4 gr of 6. Oats have .05 gr omega 3 and .84 gr omega 6 per cup of 234 gr, and I guess I have about that for breakfast. So just with those I am getting 1.24 gr of omega 6. The other vegetables I eat must add some more.
I am getting very little omega 3 other than what I take as fish (only once or twice a week) and fish and krill oil. So I doubt that I am actually getting more 3 than 6 overall, and I am not going to be railroaded into switching to olive oil (sorry, Sushi!) for severa reasons: olive oil contains a fair percentage of saturated fats, and reached the big time through its participation in the “Mediterranean diet” that was given a big push by the Lyon Diet Heart Study. This took 605 subjects who had survived a first heart attack and split them into two groups; half consumed the American Heart Association version of the Mediterranean diet, with olive oil as an important source of monounsatured fat, and the other half was asked to simply eat prudently, which apparently meant that they ate a diet “comparable to what is typically consumed in the US.”
After four years those on the Med diet were 50-70% less likely to experience a further cardiac ailments. This made fish, olive oil, and other foods “heart healthy.” But there is a catch. Though they did much better than the other group, after four years 25% had “either died or experienced some new cardiovascular event.” (I take this account from Esselstyn, one of my proved heart gurus). Esselstyn does not allow any oil, and Ornish only allows fish oil supplements.
So until I get further insight or information–and I shall keep looking, since this touches me nearly at several key points-- I think I shall reduce my intake of fish and fish oil, but maintain my input of krill oil, since it includes modest amounts of omega 6 and 9 along with the EPA and DHA that seem so useful, all packaged in phospholipids and protected by astaxanthin, a very powerful antioxidant inhering in krill (OK, I am sold on the stuff, and I do own a few shares in the company that makes it!) And maybe I shall add a bit of GLA–I shall decide that when I have thought more about the Kane doctrine, which I am too fatigued to think about seriously now.
I am not suggesting this as a universal response, just my own, since I have demonstrated susceptibility to CAD despite eating and living very sensibly, and have those periodic bouts of scleritis to deal with. I am also older than most of you, I would guess–76–and that makes a difference. Part of that difference lies in two facts; there is now good and solid research showing that we humans, unlike rats or mice, do a lousy job of converting alpha-linolenic, your basic Omega 3 fatty acid, into DHA and EPA, the Omega 3s characteristic of fish and krill oil. These fishy fatty acids have clear and well researched power in improving brains and eyes and other functions, and alas the basic human weakness in producing them from vegetable forms of Omega 3–basically the alpha-linolenic found in say flax and hemp–gets worse as we age.
So as an elderly person with documented CAD I am going to stick mostly with what Ornstein has proved works, and continue taking my fish and krill, though I may add a bit of GLA (the best Omega 6, it seems). But I want to make it clear that this is not a one size fits all kind of recommendation; it depends on my particular medical history, and on my age.
More generally, it might be useful in considering how to trim one’s sails into this new breeze to step back and think about just how Cheney derived this new suggestion, and how much trust one is prepared to put upon this very individual and not fully tested methodology, and how the suggested results fit into the context of all of one’s health concerns and the totality of one’s diet. We are not made only of CFS, nor do we consume only supplements, and we all eat individually chosen diets that will contain varying amounts of those fatty acids. One size does not fit all, and in trimming our sails we should not lose sight of the goal–we are all trying to get somewhere, not sail around in circles. But Cheney is a great doc anyway.
Best wishes, Chris.
