HMCL223 Clinical Diagnostic Techniques
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1 HMCL223 Clinical Diagnostic Techniques Session 11: Essential Fatty Acid Profiles Hair Mineral Analysis Endeavour College of Natural Health endeavour.edu.au 1
2 Student Feedback Surveys Your feedback is important to us! In the first fifteen minutes of the next class for this subject you will be provided with the opportunity to complete the Student Feedback Survey for HMCL223 Please bring your laptop, tablet, or smart phone to your next class so that you can complete the survey in class time. Endeavour College of Natural Health endeavour.edu.au 2
3 Session Objectives Essential fatty acid profiles o Omega-3-DPA,DHA, EPA, ALA o Omega 6- LA, DGLA, AA Hair mineral analysis o Deficiencies and excesses Endeavour College of Natural Health endeavour.edu.au 3
4 Essential Fatty Acid Profile Endeavour College of Natural Health endeavour.edu.au 4
5 Essential Fatty Acids Profile o Fatty acids influence all aspects of health and disease o They play a diverse role as: - structural lipids in every cell - signalling precursors - major component of oily secretions on the skin etc (Paxton, 2015) Endeavour College of Natural Health endeavour.edu.au 5
6 Essential Fatty Acid Profiles Clinical Manifestations of Deficiency include: - increased thirst & excessive perspiration - atherosclerosis, heart disease - chronic inflammation - auto-immune disease - dry hair, skin, skin rashes, weak fingernails (Paxton, 2015) Endeavour College of Natural Health endeavour.edu.au 6
7 Essential Fatty Acid Profiles o Clinical presentations of EFA deficiency: - hormonal dysregulation - chronic inflammation - inflammatory skin disorders - asthma - diabetes mellitus - cardiovascular disease (Mainali, 2017) Endeavour College of Natural Health endeavour.edu.au 7
8 Essential Fatty Acids Profile o Increased need/deficiency manifestation: - maternal health (foetal neurological development) - neurological dysfunction - depression - mood disorders - attention deficit hyperactivity disorder (Paxton, 2015) Endeavour College of Natural Health endeavour.edu.au 8
9 Essential Fatty Acid Profile o The EFA profile measures the levels of: - Total Saturated fats & Saturated fat fractions - Total monounsaturated fats & Monounsaturated fat fractions - Total omega 3 & Omega 3 fractions - Total omega 6 & Omega 6 fractions - Omega 3:6 ratio (Lab Tests Online, 2018) Endeavour College of Natural Health endeavour.edu.au 9
10 Essential Fatty Acid Profile o Several factors may influence the results of EFA testing including: - increased intestinal permeability: IBD, coeliac disorder - compromised liver function alters EFA metabolism - alcoholism - renal disease (Mainali, 2017) Endeavour College of Natural Health endeavour.edu.au 10
11 Essential Fatty Acid Profiles o Functional Essential Fatty Acid (EFA) profile explores: - plasma levels (fasting dietary intake of over 3 days) - red cell levels (inclusion into cellular bilayer; 120 day assessment) - plasma phospholipids (usage over 120 days) - within the blood, chylomicrons transport dietary lipids to the liver and lipoproteins transport lipids to the cells. o Standard pathology cholesterol panel test explores: - the overall transport of lipids within serum to and from the liver but not cellular function. (Lab Tests Online, 2018) Endeavour College of Natural Health endeavour.edu.au 11
12 Essential Fatty Acid Profiles Hepatocyte s regulate blood lipids in 3 main ways: A: post prandial fatty acids in the blood cleared by hepatocyte receptor binding chylomicron remnants B: fasting state blood levels of lipoproteins are sustained by fatty acid synthesis & export from the endoplasmic reticulum. C: before entering the mitochondria, very long chain fatty acids first undergo chain-shortening in peroxisomes or via the mitochondrial inner membrane cycle (Lord & Bralley, 2010, p. 277 Fig. 5.2) Endeavour College of Natural Health endeavour.edu.au 12
13 (Lord & Bralley, 2010, p. 277 Fig. 5.2) Endeavour College of Natural Health endeavour.edu.au 13
14 (Lord & Bralley, 2010, Fig. 5.9, p. 284) Endeavour College of Natural Health endeavour.edu.au 14
15 Essential Fatty Acid Profiles o Essential fatty acids (EFAs) are Polyunsaturated Fatty Acids (PUFAs) n-3 and n-6 that cannot be synthesised but can be metabolized if eaten within the diet. o The membrane fluidity of the bilayer of cell membranes (phosphatides) is altered according to the presence of these specific fatty acids. o The subsequent metabolic effects are implicated in the maintenance of health or the pathogenesis of disease. (Lord & Bralley, 2010, p , 276, 278) Endeavour College of Natural Health endeavour.edu.au 15
16 Essential Fatty Acid Profiles Functions of EFAs o Membrane structure: AA, DGLA, EPA, DHA main PUFAs in cell membranes including mitochondria &intracellular organelles. Provide fluidity, flexibility (DHA specifically), support structure & function. o Lipid digestion, transport & metabolism: emulsify fats & cholesterol for transport, regulate lipid transport, lipid synthesis & FA oxidation genes. o Cell division: maintain chromosome stability, regulate cell division gene expression. (Paxton, 2015, p. 85-6) Endeavour College of Natural Health endeavour.edu.au 16
17 Essential Fatty Acid Profiles Functions of EFAs o Brain & nerve function: structure of the brain & myelin sheath, generate electrical potentials for nerve transmission. Important in infant brain development & vision o Lung surfactant: EFA & protein form lung surfactant. o Skin permeability: reduce permeability & water loss. o Calcium & bone metabolism: increase calcium absorption, urinary excretion, bone deposition & aid bone strength (Paxton, 2015, p.86) Endeavour College of Natural Health endeavour.edu.au 17
18 Essential Fatty Acid Profiles Functions of EFAs o Eicosanoid synthesis: EFAs substrate for eicosanoids (prostaglandins, prostacyclin's, thromboxane's, leukotrienes, resolvins, protectins): regulation of inflammatory conditions Arachidonic acid & EPA derived. Localized, short-acting chemicals that regulate cell activity, cell function & body homeostasis. o Affect most body functions: circulation, blood clotting, immunity, reproduction, inflammatory responses. (Whitney, Rolfes, Crowe, Cameron-Smith & Walsh, 2014, p. 140; Paxton, 2015, p. 86) Endeavour College of Natural Health endeavour.edu.au 18
19 Fatty Acid Metabolism (Clinical Laboratories, 2011, p. 133) Endeavour College of Natural Health endeavour.edu.au 19
20 Essential Fatty Acid Profiles Fatty Acid Metabolism o Fatty Acid synthesis is inhibited by glucagon, adrenal hormones, high levels of free FA (plasma) dietary PUFAs (n-3 especially) & diets high in fat (+10%) o Fatty Acid synthesis is increased by insulin, high carbohydrate & low fat diets, high glucose (stimulates insulin release), fructose (bypasses rate limiting step in carbohydrate metabolism & loads fat-synthesis pathways) or sucrose intake. (Paxton, 2015, p. 85) Endeavour College of Natural Health endeavour.edu.au 20
21 Essential Fatty Acid Profiles (Lord & Bralley, 2010, p. 272) Endeavour College of Natural Health endeavour.edu.au 21
22 EFA: Interpreting the Results Interpretation of EFA Profiles: o Profiles of low plasma n-3 require dietary & / or supplementary modification o Interpretation of laboratory results considers clinical conditions rather than the repletion of specific profile components. o Concentrating on the abnormalities or patterns including general EFA deficiency, n-3 deficiency, n-6 deficiency, excessive hydrogenated oil, micronutrient deficiency, metabolic or genetic disorder, fatty acid ratio (Lord & Bralley, 2010, p. 292) Endeavour College of Natural Health endeavour.edu.au 22
23 EFA: Interpreting the Results Endeavour College of Natural Health endeavour.edu.au 23 (Lord & Bralley, 2010, p. 292)
24 EFA: Interpreting the Results (Lord & Bralley, 2010, p ) Endeavour College of Natural Health endeavour.edu.au 24
25 EFA: Abnormal Signs & Symptoms (Lord & Bralley, 2010, p. 294) Endeavour College of Natural Health endeavour.edu.au 25
26 Hair Mineral Analysis (HMA) Endeavour College of Natural Health endeavour.edu.au 26
27 Hair Mineral Analysis Hair Mineral Analysis o Measures the levels and ratios of nutrients & toxic metals deposited in the cells & interstitial spaces of the hair over a 2-3 month period. Macro Minerals Micro Minerals Toxic Metals Calcium Chromium, Copper Aluminum, Arsenic Magnesium Iron Cadmium Phosphorus, potassium Manganese Lead Sodium Selenium, Silicon Mercury Zinc Nickel (Nutripath, 2016; Healthscope, 2011, p. 167) Endeavour College of Natural Health endeavour.edu.au 27
28 Hair Mineral Analysis o Hair is composed of keratin (sulfur containing cysteine residue = greater affinity for multivalent metals). o Hair growth has high metabolic activity and blood minerals bind quickly to keratin. o Poor diet, impaired digestion or absorption can lead to element deficiencies. o Element-deficient state can lead to up-regulation of GIT transport proteins which in turn can allow for increased toxic element exposure. o Elements can compete for absorption while having greater or less affinity for transport protein binding. (Lord & Bralley, 2010, p. 75) Endeavour College of Natural Health endeavour.edu.au 28
29 Hair Mineral Analysis o Elements can compete for absorption while having greater or less affinity for transport protein binding. o When elements are either deficient or in excess this has a knock-on effect. o Due to this deficiencies tend to occur in multiples. o Element-deficient state can lead to up-regulation of GIT transport proteins which in turn can allow for increased toxic element exposure. (Lord & Bralley, 2010, p. 73) Endeavour College of Natural Health endeavour.edu.au 29
30 Hair Mineral Analysis o Clinical symptomatology due to chronic low-grade essential element deficient & toxic element burden is difficult to identify. o Multiple organ systems are involved. o Genetic predisposition, nutritional deficiencies, exposure to environmental toxins can also impact on & contribute to elemental deficiency signs. (Lord & Bralley, 2010, p. 73) Endeavour College of Natural Health endeavour.edu.au 30
31 HMA: Essential Element Deficiency & Toxicity (Lord & Bralley, 2010, p. 70) Endeavour College of Natural Health endeavour.edu.au 31
32 HMA: Essential Element Deficiency & Toxicity (Lord & Bralley, 2010, p. 70) Endeavour College of Natural Health endeavour.edu.au 32
33 o o o o o o References Bryant, B and Knights, K, 2011, Pharmacology for Health Professionals,3 rd edn, Mosby Elsevier, Sydney. Clinical Laboratories Pty Ltd, 2011, Healthscope Functional Pathology Manual, Australia Lord RS & Bralley JA (eds) Laboratory evaluations for integrative and functional medicine, 2 nd edn, Genova Diagnostics, Duluth, Georgia. Mainali, S., Davis, S. R., & Krasowski, M. D. (2017). Frequency and causes of lipemia interference of clinical chemistry laboratory tests. Practical Laboratory Medicine, 8, Pagana, K and Pagana, T 2014, Mosby s Manual of Diagnostic and Laboratory Tests, 5edn, Elsevier, Missouri Paxton F, 2015, Foundations of naturopathic nutrition, Allen & Unwin, Crows Nest, NSW. o Whitney E, Rolfes SR, Crowe T, Cameron-Smith D & Welsh A, 2014, Understanding nutrition: Australian & New Zealand edition, 2 nd edn, Cengage learning Australia, South Melbourne, Victoria. Endeavour College of Natural Health endeavour.edu.au 33
34 Recommended Reading Lord RS & Bralley JA (eds) Laboratory evaluations for integrative and functional medicine, 2nd edn, Genova Diagnostics, Duluth, Georgia. Chapter 3: Nutrients & Toxic Elements (p ) Chapter 5: Fatty Acids (p ) Endeavour College of Natural Health endeavour.edu.au 34
35 Endeavour College of Natural Health endeavour.edu.au 35
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