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Food as medicine: essential fatty acids
The document discusses the importance of essential fatty acids (EFAs) like omega-6 and omega-3 for human health, detailing their roles in cell membrane structure, brain development, and inflammatory response. It outlines the historical discovery of EFAs, their dietary sources, the health consequences of deficiencies, and the ideal ratios of omega-6 to omega-3 intake. Additionally, it highlights the need for adequate consumption of these fatty acids to prevent various diseases associated with high omega-6 and low omega-3 levels in modern diets.
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Food as medicine: essential fatty acids
- 1. FOOD AS MEDICINE: ESSENTIALFATTY ACID By Kevin KF Ng, MD, PhD Former Associate Professor of Medicine Division of Clinical Pharmacology University of Miami, FL. USA Email: [email protected] Slide presentations delivered to health-care providers in 2017
- 2. What is Foodand What is Medicine? ▪ Food: a nourishing substance that is taken into the body to sustain life, provide energy and promote growth. ▪ Medicine: the science or practice of the diagnosis, treatment and prevention of disease.
- 3. What is inthe Food? Food Nutrients Macronutrients Carbohydrate Protein Fat Fiber Micronutrients Minerals Vitamins Phytochemicals Fatty acids Water
- 4. What are EssentialFatty Acids (EFA) Essential fatty acids (EFA) are fatty acids that humans and other animals must ingest because the body requires them for good health but cannot synthesize them
- 5. Essential fatty acidsALA, EPA, DHA, LA, AA
- 6. History of EssentialFatty Acids In 1929 George and Mildred Burr found that if essential fatty acids were missing in the diet, a deficiency syndrome ensued and often led to death. The Burrs subsequently identified linoleic acid (omega-6 PUFA) and linolenic acid (omega-3 PUFA) as essential substances in the diet and coined the phrase “essential fatty acid” Essential fatty acids are also known as Vitamin F.
- 7. Milestones on thediscovery of essential fatty acids, eicosanoids and specialized pro-resolvin mediators Kevin Ng’s mentor
- 8. An outline ofFats and Fatty acids
- 9. Source of polyunsaturatedfatty acids Polyunsaturated fatty acids Omega-6 fatty acid Omega-3 fatty acid Plant derived Plant derived Marine derived linoleic acid (LA) α-linolenic acid(ALA) eicosapentaenoic acid(EPA) docosahexaenoic acid(DHA)
- 10. Examples of Fatsand Essential fatty acids
- 11. ANATOMICAL LOCALIZATION OFFATTY ACIDS IN THE BODY
- 12. Proportions of variousspecies of fatty acids in rat whole body. categorized fatty acids major n-3 PUFA as % of total n-3 PUFA major n-6 PUFA as % of total n-6 PUFA https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555191/ Ratio: 1:6 LA AA ALA DHA EPA
- 13. Descending order ofconcentration of PUFA in organs of rat Phospholipid Fatty Acid Organ Omega-6 LA_Linoleic acid Skin, liver, stomach Omega-6 AA_Arachidonic acid Liver, kidney, pancreas Omega-3 ALA_α-linolenic acid Skin, stomach, liver Omega-3 EPA_eicosapentaenoic acid Pancreas, liver, salivary gland Omega-3 DHA_docohexaenoic acid Brain, liver, spinal cors Adapted from Prostaglandins, Leukotrienes, and Essential Fatty Acids, 2015,100, 13–20.
- 14. Omega-3 phospholipid andcell membrane lipid structure http://www.alamy.com/stock-photo-omega-3-phospholipid-and-skin-cell-membrane-lipid-layer-structure-81535164.html
- 15. Omega-3 phospholipid andcell membrane lipid structure Adapted from alamy.com/stock-photo-omega-3-phospholipid-and-skin-cell-membrane-lipid-layer-structure
- 16. Cell membrane andphospholipid molecule Image modified from OpenStax Biology. Unsaturated fatty acidSaturated fatty acid
- 17. Functions of EssentialFatty Acids ▪ Structure of healthy cell membranes ▪ Development of brain and nervous system ▪ Support healthy skin and hair ▪ Maintain healthy endothelial function ▪ Precursors of pro-inflammatory mediators Prostaglandins Leukotrienes Thromboxanes ▪ Precursors of pro-resolving mediators Lipoxins Resolvins Protectins Maresins Cell membrane
- 18. Phospholipds: release andmetabolism of linoleic acid and α-linolenic acid PLA₂ Saturated fatty acid Unsaturated fatty acid
- 19. Actions of inflammatorymediators produced by Arachidonic acid ▪ Pain Prostaglandins ▪ Swelling Inflammation caused by lipid mediators Leukotrienes ▪ Redness Thromboxanes ▪ Heat
- 20. Actions of SpecializedPro-resolving Mediators (SPM) produced by EPA and DHA ▪ Act as “stop signals” to turn off inflammation ▪ Initiate resolution, repair and regeneration ▪ Facilitate macrophage to clear apoptotic cells (efferocytosis) ▪ Facilitate macrophage to migrate to peripheral lymph nodes (efflux)
- 21. Health benefits ofomega-6 fatty acid ▪ Growth and development ▪ Brain and retina function ▪ Skin and hair growth ▪ Maintain bone health ▪ Regulate metabolism ▪ Maintain reproductive system
- 22. Health benefits ofomega-3 fatty acid http://www.prweb.com/releases/health-benefits-omega-3/natural-omega-3-health/prweb11741699.htm
- 23. Functional differences betweenessential fatty acids Omega-3 fatty acid ▪ Movement of calcium across cell membrane ▪ Relaxation and contraction of muscles ▪ Cell division ▪ Growth ▪ Blood clotting ▪ Lower triglyceride ▪ Fertility ▪ Reduce risks of heart disease, cancer and diabetes ▪ Precursor to pro-resolving mediators Omega-6 fatty acid ▪ Growth and development ▪ Brain and retina development ▪ Stimulate skin health ▪ Stimulate hair growth ▪ Maintain healthy bone ▪ Regulate metabolism ▪ Lower cholesterol and triglyceride ▪ Maintain healthy reproductive system ▪ Precursor to inflammatory mediators
- 24. DISORDERS DUE TO ESSENTIALACID DEFICIENCY
- 25. Disorders due toessential fatty acid deficiency ▪ Dermatitis ▪ Increase water permeability of the skin ▪ Increased susceptibility to infection ▪ Impaired wound healing https://www.mayomedicallaboratories.com/test-catalog/Clinical+and.../82426
- 26. Disorders due toessential fatty acid deficiency: “Disease of civilization” ▪ Hear disease ▪ Hyperlipidemia ▪ Diabetes mellitus ▪ Rheumatoid arthritis ▪ Brain dysfunction ▪ Visual disorder ▪ Skin disease
- 27. Signs and symptomsdue to essential fatty acid deficiency Omega-3 fatty acid deficiency ▪ Poor memory ▪ Mood disorder ▪ Depression ▪ Poor circulation ▪ Heart problems ▪ Fatigue ▪ Dry scaly skin ▪ Arthritis Omega-6 fatty acid deficiency ▪ Skin eruption ▪ Slow wound healing ▪ Behavioral problem ▪ Heart problem ▪ Circulation problem ▪ Sterility in man ▪ Miscarriage in pregnant woman
- 28. LABORATORY TESTS FOR ESSENTIALFATTY ACID DEFICIENCY
- 29. Laboratory tests foressential fatty acid deficiency ▪ Diminished level of linoleic acid (ω-6) ▪ Diminished level of α-linoleic acid (ω-3) ▪ Abnormal red blood cell fatty acid profile ▪ Omega-3 index: (desirable range 8-12%) ▪ Omega-6 to omega-3 ratio: (desirable range 2:1-10:1) ▪ Arachidonic acid to EPA ratio (desirable range: 2:1-71:1)
- 32. The importance ofthe ratio of omega-6/omega-3 essential fatty acids ▪ Excessive amounts of omega-6 PUFA and a ▪ very high omega-6/omega-3 ratio (20:1 in Western diet) Inflammatory disease Cardiovascular disease Cancer Autoimmune disease Neurodegenerative disease Obesity
- 33. The importance ofthe ratio of omega-6/omega-3 essential fatty acids ▪ Excessive amounts of omega-6 PUFA and a ▪ very high omega-6/omega-3 ratio (20:1 in Western diet) Inflammatory disease Cardiovascular disease Cancer Autoimmune disease Neurodegenerative disease Obesity
- 34. omega-3 FA: omega-6FA ratio in USA http://www.smarternootropics.com/omega-3/ http://www.aqua.stir.ac.uk/nas/blood-spot-test/
- 35. Omega 6 fattyacid overload
- 36. Population omega-3 fattyacid in select countries http://suppversity.blogspot.com/2013/10/sesame-powered-high-omega-6-diet-boosts.html
- 37. CHD Mortality andTissue HUFA http://lipidlab.com/services/
- 38.
- 39. What is thecause of high concentration of omega-6 fatty acid in US population? ▪ Dietary vegetable oil ▪ Red meat 96% of oils consumed in US include Soybean oil, cottonseed oi Corn oil, canola oil
- 40.
- 41. Increase in adiposetissue LA concentration over time, buttocks and abdominal subcutaneous only https://www.ncbi.nlm.nih.gov/pmc/articles/PMC46424
- 42. ESSENTIAL FATTY ACIDSIN VEGETABLE OILS AND FOODS
- 43. Omega-6 and omega-3content of various vegetable oils and foods Adapted from https://chriskresser.com/
- 44. Composition of omega-3FA and mercury in fishes http://www.1vigor.com/article/omega-3-fatty-acids-health-benefits/
- 45. Fatty acid content:omega-6/omega-3ratio in Fats & Fatty Acids (grams per tablespoon) http://www.gbhealthwatch.com/Science-Omega3-Omega6.php
- 46. CAN THE PLANTDERIVED ALPHA-LINOLENIC ACID (ALA) BE CONVERTED TO EPA & DHA?
- 47. Metabolic pathways ofpolyunsaturated fatty acid by same enzymes https://www.researchgate.net/publication/25870110 Anti-inflammatory Inflammatory
- 48. Conversion of ALAto EPA and DHA With saturated FA meal EPA ALA DHA With n-6 PUFA meal EPA ALA DHA 6% 3.8% 3% 1.9% https://www.ncbi.nlm.nih.gov/pubmed/9637947
- 49. Metabolic pathways ofpolyunsaturated fatty acid https://openi.nlm.nih.gov/detailedresult.php?img=PMC4418048_13058_2015_571_Fig1_HTML&req=4
- 51. Generation of Specializedpro-resolving mediators from EPA & DHA EPA=eicosapentaenoic acidALA=α-linolenic acid DHA=docosahexaenoic acid
- 52. Functions of SpecializedPro-resolving Mediators (SPM) ▪ Act as “stop signals” to turn off inflammation ▪ Initiate resolution, repair and regeneration ▪ Facilitate macrophage to clear apoptotic cells (efferocytosis) ▪ Facilitate macrophage to migrate to peripheral lymph nodes (efflux)
- 53. How much essentialfatty acids (EPA+DHA) is required for optimal health? ▪ No adequate intake (AI) or Dietary Reference Intake (DRI) has been established in the United States yet. ▪ Expert health organizations and health professionals recommend ● 250 mg to 1000 mg EPA+DHA per day or ● 2 servings of salmon 4 oz a day twice weekly
- 54. CAUSES OF ESSENTIALFATTY ACID DEFICIENCY
- 55. Causes of essentialfatty acid deficiency (rare) ▪ Unbalanced Diet : excessive omega-6 fatty acid deficiency in omega-3 fatty acid ▪ Medical causes ▪ Surgical causes
- 56. Causes of essentialfatty acid deficiency (cont.) Medical ▪ Inflammatory bowel disease ▪ Cystic fibrosis ▪ Pancreatic insufficiency ▪ Carnitine deficiency ▪ Enteral fat restrition Surgical ▪ Massive bowel resection ▪ Enterocutaneous fistula ▪ Bariatric surgery ▪ TPN with no emulsion
- 57. Dietary sources ofomega-6 fatty acids ▪ poultry ▪ eggs ▪ nuts ▪ hulled sesame seeds ▪ cereals ▪ durum wheat ▪ whole-grain breads ▪ most vegetable oils ▪ grape seed oil ▪ evening primrose oil ▪ borage oil ▪ blackcurrant seed oil ▪ flax/linseed oil ▪ rapeseed or canola oil ▪ hemp oil ▪ soybean oil ▪ cottonseed oil ▪ sunflower seed oil ▪ corn oil ▪ safflower oil ▪ pumpkin seeds https://en.wikipedia.org/wiki/Omega-6_fatty_acid
- 58. Sources of preformedEPA and DHA
- 59. Prevention and treatmentof essential fatty acid deficiency Prevention ▪ Provide at least 10% of total calories from fat ▪ Provide at least 2%-4% of calories from linoleic acid ▪ Assure adequate provision of carnitine in at- risk patients ▪ Cystic fibrosis patients ▪ Council patients taking an oral diet to increase intake of foods rich in essential fatty acids. Treatment ▪ For PN-dependent patients, increase LA delivery from lipid injectable emulsion ▪ Evaluate for carnitine deficiency and treat if deficient ▪ For patients taking an oral diet, encourage vegetable oils, condiments, nuts and nut butters rich in EFA ▪ Consider lipid injectable emulsion infusion periodically either while inpatient or at an outpatient infusion site.
- 60. Recommended intakes ofseafood/fish and marine-derived essential fatty acids https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067287/table/Tab2/
- 61. Dose response ofEPA+DHA after clinical events http://coachmikeblogs.com/eat-fish-or-take-fish-oil/
- 62. Side effects ofessential fatty acids Common (1% to 10%): Eructation, dyspepsia, nausea, gastrointestinal disorders (including abdominal distension, abdominal pain, constipation, diarrhea, flatulence, gastroesophageal reflux disease, vomiting) Uncommon (0.1% to 1%): Gastrointestinal hemorrhage, gastroenteritis Rare (less than 0.1%): Gastrointestinal pain Very rare (less than 0.01%): Lower gastrointestinal hemorrhage https://www.drugs.com/sfx/omega-3-polyunsaturated-fatty-acids-side-effects.html
- 63. Possible drug andomega-3 fatty acid interactions ▪ Increase effect of blood thinning medications ▪ Increase effect of non-steroidal anti-inflammatory drugs ▪ Increase effect of blood sugar lowering medications ▪ Increase effect of cholesterol lowering medications ▪ Reduce side effects of cyclosporine during chemotherapy ▪ Improve symptoms of psoriasis with Etretinate and topical steroids http://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000971
- 64. Conclusions ▪ Essential fattyacids (EFA) are essential because they cannot be synthesized by the human body and they must be ingested from external sources. ▪ There are only two EFA : ω-6 linoleic acid (LA) and ω-3 α-linolenic acid (ALA). ALA is converted to ecosapentaenoic acid (EPA) thence to docosahexaenoic acid (DHA) ▪ The functions of EFA include growth and development, regulation of permeability and fluidity of cell membrane, source of precursors for eicosanoids and specialized pro-resolving mediators, influence on membrane enzymes, cellular transduction, neurotransmission and transport activity. ▪ A high ration of ω-6/ω-3 (>4:1) leads to an inflammatory state which underlies the disease of civilization: heart disease, hyperlipidemia, diabetes mellitus, auto-immune disease, brain dysfunction, visual disorder and skin disease. ▪ Deficiency of EFA and a high ω-6/ω-3 ratio can be corrected by adjusting the intake of plant derived linoleic acid and marine derived EPA and DHA
- 65. ANY QUESTION? Contact Kevin KFNg, MD, PhD Email: [email protected]