Dr. Dicken Weatherby's "Foundations of Functional Diagnosis" Training INSIDER S GUIDE. Dicken Weatherby, N.D.

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1 Dr. Dicken Weatherby's "Foundations of Functional Diagnosis" Training INSIDER S GUIDE Functional Diagnosis of Essential fatty acids By Limits of Liability & Disclaimer of Warranty I have designed this book to provide information in regard to the subject matter covered. It is made available with the understanding that the authors are not liable for the misconception or misuse of information provided. The purpose of this book is to educate. It is not meant to be a comprehensive source for the topic covered, and is not intended as a substitute for medical diagnosis or treatment, or intended as a substitute for medical counseling. Information contained in this book should not be construed as a claim or representation that any treatment, process or interpretation mentioned constitutes a cure, palliative, or ameliorative. The information covered is intended to supplement the practitioner s knowledge of their patient. It should be considered as adjunctive support to other diagnostic medical procedures. This material contains elements protected under International and Federal Copyright laws and treaties. Any unauthorized reprint or use of this material is prohibited. Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 1 of 20

2 Contents Contents... 2 Introduction... 4 Review... 4 The Role of Essential Fatty Acids in Health and Disease... 4 Low Delta-6 Desaturase Activity... 4 Insulin Dysregulation... 5 Clinical Applications... 5 Autoimmune Diseases... 5 Cell Membrane Structure... 6 Inflammation... 6 Signs and Symptoms Associated with Fatty Acid Abnormalities... 7 Fatty Acid Analysis... 8 Why Test Fatty Acids?... 8 Identify and correct underlying EFA deficiencies... 8 Gauge the effectiveness of supplementation... 8 Correcting inflammatory balance... 8 Monitoring inflammation in patients taking statin drugs... 8 Monitoring for increased free radical activity... 8 Avoid immune suppression... 9 Who does the testing?... 9 What does it involve?... 9 What Fatty Acids are tested?... 9 Variations of the EFA Test Plasma Fatty Acid Testing (Metametrix Only) Red blood cell membrane levels (Metametrix and Genova) Blood Spot (Metametrix only) The AA/EPA Ratio (Metametrix Only) Sample Reports Metametrix: Fatty Acids Erythrocyte Genova Diagnostics: Essential and Metabolic Fatty Acids Analysis (RBC) Interpretation of the Fatty Acid Profile Low alpha-linolenic acid (ALA) Consider supplementation with Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 2 of 20

3 Low eicosapentaenoic acid (EPA) or Low docosahexaenoic acid (DHA) Eicosapentaenoic acid (EPA) Docosahexaenoic Acid Consider supplementation with EPA low and ALA normal or high Consider supplementation with Elevated linoleic acid (LA) and/or arachidonic acid (omega 6 fatty acids) Linoleic acid (18:2n6) Arachadonic Acid Consider Low Arachadonic Acid Consider Delta-6 desaturase deficiency High linoleic acid (LA) AND Low di-homo-gamma linolenic acid (DGLA) High Trans Fatty Acids Recommendations High trans fats Elaidic acid (18:1n9t) Consider High Odd Chain Saturated Fatty Acids Recommendations Low EPA Consider supplementation with High or normal EPA and low DHA Consider supplementation with Dysglycemia and Hyperinsulinemia Low DGLA and High AA Recommendations High oleic acid (18:2n-9) and Low stearic acid (18:0) Elevated levels of saturated fats Consider Resources Genova Diagnostics MetaMetrix Clinical Laboratory Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 3 of 20

4 Introduction Fatty acid levels can have a dramatic impact on the inflammatory responses associated with inflammatory conditions and all of the auto-immune diseases, which have a strong inflammatory component. For instance, the joint pain in rheumatoid arthritis can be directly triggered by the release of inflammatory mediators like leukotrienes, whose production is dependant upon the body's balance of essential and metabolic fatty acids. Review Essential fatty acids (EFAs) exercise a powerful influence on overall health because of their pivotal role in how cell membranes function. EFAs are transformed by the body into critical local hormones, called "eicosanoids," that completely regulate all stages of the process of inflammation, controlling initiation, propagation, and termination of this process that is so vital to the body's ability to repair and to protect itself immunologically. Many of the chronic inflammatory conditions that accompany an EFA imbalance are currently treated with symptom-specific pharmaceutical drugs such as steroids, Prednisone, aspirin and other NSAIDs, sulfasalazine, and colchicine. The problem with such drug therapies is that they prevent the formation of "good" anti-inflammatory eicosanoids as well as the "bad" pro-inflammatory eicosanoids, or they shift production of one type of eicosanoid to another. For effective, long-term management, eicosanoid production should be modified through dietary changes (balancing dietary intake of specific fats, as indicated by testing) and by controlling insulin levels in the circulation prior to EFA testing. Without testing you are shooting in the dark and supplementing according to what you think is going on rather than what is actually present in the body. The Role of Essential Fatty Acids in Health and Disease Over the last century there has been a dramatic shift in the diet of Western Developed countries. The net result of this shift in the diet has been to provide ample substrate for producing arachidonic acid (an omega 6 FA) and very little substrate for producing eicosapentaenoic acid (an omega-3 FA), since both n-6 and n-3 fats use the same enzymes for elongation and desaturation. Consequently, the body makes many more pro-inflammatory eicosanoid hormones. Chronic inflammatory diseases have reached near epidemic proportions in our society. Low Delta-6 Desaturase Activity Delta-6 desaturase is the rate-limiting step for transforming linoleic or linolenic acid into the longer EFA metabolites, GLA and EPA, respectively. Many of our patients have less than optimal delta-6 activity. Infants have no appreciable delta-6 activity until about 6 months of age and must get DGLA, AA, EPA and DHA from breast milk and the diet. As we age, delta-6 activity declines progressively. Dietary factors, including alcohol, trans- Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 4 of 20

5 fats, and saturated fats will each inhibit delta 6 and, interestingly, so too will excessive dietary linolenic acid. Epstein Barr virus and HIV inhibit the desaturase enzymes, and other viruses likely do the same. People experiencing post-viral fatigue syndrome have much lower levels of EFAs than controls. Low delta-6 activity can be identified by low levels of membrane DGLA, especially if the linoleic acid content is relatively higher. This scenario results in low levels of the series- 1, anti-inflammatory prostaglandins, such as PGE1, made from DGLA. Insulin Dysregulation Too little or too much insulin in circulation can have profound effects on eicosanoid formation, contributing to chronic inflammatory processes. Insulin resistance or absolutely low levels of insulin have been shown to impair delta-6 activity, and can lead to all of the problems associated with reduced delta-6 activity above. Insulin surges or general blood sugar dysregulation, commonly found in people who eat large amounts of refined grains and simple sugars (in other words, the standard American diet), will result in greatly increased activity of both delta-6 and delta-5 desaturase. While this means that more LA will be converted into DGLA, it unfortunately also means that the DGLA is available to be converted into arachidonic acid, thereby markedly increasing the body's tendency toward inflammation. Elevated membrane AA levels may indicate this scenario. People with exaggerated insulin response after eating carbohydrates (about 25% of the population) would be especially prone to overproduce AA under the influence of hyperinsulinemia. And there is a growing consensus in the research community that insulin dysregulation may be the common mediator for the cluster of conditions known as Syndrome X, including elevated cholesterol and triglycerides, hypertension, obesity, and diabetes. The mechanism of action of insulin in these pathologies may be due, in large part, to its effects on eicosanoid metabolism. Clinical Applications Autoimmune Diseases Prostaglandins are known to regulate immune response and fibrous tissue formation. Deficiency of PGE1 and/or of TXA2 and excess PGE2 appear to induce hyperactivity of B-cells, possibly due to loss of regulatory control by T-cells, and to enhance fibrosis. Drugs that induce auto-immune diseases also tend to inhibit PGE1 and/or TXA2 production, as does EBV infection and possibly other viruses. In both cases, excess auto-antibody production may result. Using DGLA and EPA supplementation to enhance PGE1 production and reduce cytokine production may be therapeutically useful in treating vasculitis, amyloidosis, and scleroderma. Indeed, EPA/DHA supplementation has induced prolonged remission of systemic lupus erythematosus (SLE) in test subjects. Diets containing both EPA and DHA were more effective than either fatty acid alone in alleviating the severity of renal Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 5 of 20

6 disease in an animal model for SLE. In human studies with SLE, fish oils improved inflammatory markers but did not affect either immune complex or anti-dna antibody titer. Cell Membrane Structure As we have already mentioned, EFAs are an important part of the cell membrane and along with cholesterol help to keep cell membrane fluidity in balance. Improper cell membrane function leads to leaky membranes (i.e. unwanted substances flow into the cell and needed substances flow out) and altered cell membrane receptor function (seen most significantly in cellular resistance to insulin). DHA is an EFA that contributes to the maintenance of the cell membrane function. DHA deficiencies, especially in infancy are associated with inappropriate cell signaling and permeable membranes leading to cell dysfunction and disease. Balancing the EFAs that are present in the cell membrane is an important step in bringing your patients back to a state of health and wellness. Especially those with the following conditions: 1. Behavioral disorders 2. ADD/ADHD (boys diagnosed with ADD/ADHD have significantly lower levels of ALA, DGLA, AA, EPA and DHA than controls. 3. Autism 4. Depression Inflammation There are many causes of inflammation, but the final mediator of the inflammation in the body falls upon the molecules of inflammation, the cytokines, the lymphokines and the eicosanioids. The EFAs in the cell membrane play a significant role in the balance between the proinflammatory and the anti-inflammatory eicosanoids. Knowing the balance of these in terms of the EFAs present in the cell membrane is essential, especially for people suffering from inflammatory disorders such as: 1. Crohn s disease 2. Colitis 3. Cardiovascular disease a. Patients at risk for MI b. Atherosclerosis c. Stroke d. Hypertension 4. Metabolic syndrome 5. Insulin resistance and hyperinsulinemia Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 6 of 20

7 6. Diabetes Signs and Symptoms Associated with Fatty Acid Abnormalities This table lists the most common signs and symptoms associated with fatty acid problems and gives you a sense of what the symptom means in terms of FA ratios and what actions you can take. SIGNS & SYMPTOMS FATTY ACID ASSOCIATION ACTION Emaciation, weakness, disorientation Caloric deprivation Add food balanced in fat, protein, and carbohydrate. Reduced growth, renal dysplasia, Classic essential fatty acid Add good quality fats and oils reproductive deficiency, scaly deficiency Eczema-like ki skin eruptions, loss Linoleic acid insufficiency Add corn or safflower oils of hair, liver degradation, behavioral disturbances, kidney degeneration, increased thirst, frequent infections, poor wound healing, sterility, miscarriage, Growth retardation, weakness, impairment of vision, learning disability, poor coordination, tingling in arms/legs, behavioral changes, mental disturbances, low metabolic rate, high blood Depression, anxiety, learning, behavioral and visual development, cardiovascular Alpha or gamma linolenic acid insufficiency Long chain PUFA-dependent neuron-membrane function, imbalanced prostanoids Low stearic/oleic ratio, loss of prostanoid cell controls (RBC only) Increased odd numbered FAs Add flax, primrose, or black currant oil Add fish oils di Cancer i k Add omega 3 PUFAs Use omega 6 PUFAs with caution Vitamin B12 and/or carnitine Add vitamin B12 and carnitine dmyelinated fi i i nerve degeneration Increased very long chain FAs Add high-erucate rape oil, mustard seed oils Fatty liver Saturated and omega 9 family Restrict alcohol consumption, and accumulation in hepatic cells increase lecithin and methionine Accelerated aging High polyunsaturated acid intake iincrease t k vitamins E and C and the with- out increased antioxidants minerals Se, Mn, and Zn Obesity Various imbalances resulting from Re-establish proper fat-to-protein using processed oils (high elaidic balance using foods like nuts, with low GLA) seeds, and fresh whole grains. Table prepared by Metametrix, Clinical Laboratory Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 7 of 20

8 Fatty Acid Analysis Why Test Fatty Acids? Identify and correct underlying EFA deficiencies The Essential and Metabolic Fatty Acids Analysis uncovers fatty acid imbalances and deficiencies that may be aggravating inflammatory conditions. Gauge the effectiveness of supplementation Testing for EFAs is crucial for gauging the effectiveness of fatty acid supplementation your patients may already be on. It s not enough for your patients to be just taking EFAs, you must get the answers to these questions: 1. Are they taking too little to be clinically effective? 2. Are they taking too much, which is throwing the delicate ratios out of balance, or worse causing immune suppression (see below)? 3. Are they taking the right kind of EFAs? Testing can reveal inborn metabolic conversion errors that may be preventing a patient from achieving optimal levels, even with adequate dietary amounts. Testing reveals this. Correcting inflammatory balance Improper fatty acid intake affects the balance of anti- and pro-inflammatory eicsanoids, which increases health risks associated with inflammation. Monitoring inflammation in patients taking statin drugs Statin medications are among the most popularly prescribed drugs in Western developed countries. We know that statin drugs block the enzyme HMG-CoA Reductase, which is the enzyme responsible for cholesterol synthesis in the body, and this has a detrimental effect on CoEnzyme CoA levels. What is not so well known is that recent research has shown that HMG-CoA reductase inhibitors can increase the relative amounts of Arachadonic Acid in the blood. This causes and increase in the AA:EPA ratio, which is a marker for inflammation in the body. So, EFA testing is very important in patients taking Statin drugs. Monitoring for increased free radical activity EFAs are polyunsaturated fatty acids (PUFAs) and we know that increasing the consumption of PUFAs without increasing antioxidants can cause an increased production of free radicals. By testing EFAs you can clinically manage fatty acid and antioxidant supplementation in your patients. Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 8 of 20

9 Avoid immune suppression We know about the health benefits of fish oils, what we may not be aware of is that excessive consumption of omega-3 fatty acids can suppress immune function, leading to infections and poor wound healing. Many patients are taking excessive levels of Omega 3 oils leading to imbalances of these oils, which can be dangerous. This occurs because the anti-inflammatory effects of omega-3 fatty acids can actually suppress immune function, leading to increased infections, poor wound healing, and possible tumor growth. Who does the testing? Fatty Acid testing is currently done by Metametrix Clinical Laboratories and Genova Diagnostics What does it involve? The test involves 5 ml of whole blood via a simple blood draw (lavender top). You can either do it in the office or send it out to a lab. What Fatty Acids are tested? Metametrix and Genova test for different fatty acid markers and report different ratios. The following is a list of the analytes tested by both companies. METAMETRIX POLYUNSATURATED OMEGA-3 Alpha Linolenic Acid (ALA) Eicosapentaenoic Acid (EPA) Docosapentaenoic Acid Docosahexaenoic Acid (DHA) POLYUNSATURATED OMEGA-6 Linoleic Acid Gamma Linolenic Acid (GLA) Eicosadienoic Acid Dihomogamma Linolenic Acid (DGLA) Arachidonic Acid Docasadienoic Acid Docosatetraenoic Acid POLYUNSATURATED OMEGA-9 Mead Acid (Plasma Test Only) GENOVA POLYUNSATURATED OMEGA-3 Alpha Linolenic Acid (ALA) Eicosapentaenoic Acid (EPA) Docosapentaenoic Acid Docosahexaenoic Acid (DHA) POLYUNSATURATED OMEGA-6 Linoleic Acid Gamma Linolenic Acid (GLA) Eicosadienoic Acid Dihomogamma Linolenic Acid (DGLA) Arachidonic Acid Docasadienoic Acid Docosatetraenoic Acid POLYUNSATURATED OMEGA-9 Oleic Gondoic Nervonic Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 9 of 20

10 METAMETRIX MONOUNSATURATED Myristoleic Acid Palmitoleic Acid Vaccenic Acid Oleic Acid 11-Eicosenoic Acid Erucic Acid Nervonic Acid SATURATED Even Chain Capric Acid Lauric Acid Myristic Acid Palmitic Acid Stearic Acid Arachidic Acid Behenic Acid Lignoceric Acid Hexacosanoic Acid SATURATED - Odd Chain Pentadecanoic Acid Heptadecanoic Acid Nonadecanoic Acid Heneicosanoic Acid Tricosanoic Acid TRANS Palmitelaidic Acid Total C:18 Trans GENOVA SATURATED Even Chain Tricosanoic Pentadecanoic SATURATED - Odd Chain Arachidic Behenic Linoleic Margaric Palmitic Stearic Nervonic Lignoceric TRANS Elaidic Palmitoleic Vaccenic Variations of the EFA Test There are 4 main ways to test EFAs: Plasma Fatty Acid Testing (Metametrix Only) The plasma fatty acid test checks for levels of EFAs in the plasma. Plasma levels reflect body stores as influenced by recent dietary intake and are useful for monitoring response to supplementation and dietary modifications. Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 10 of 20

11 Red blood cell membrane levels (Metametrix and Genova) This test evaluates the level of red cell membrane fatty acids, imbalances of which significantly affect inflammatory and other disorders. Red blood cell membrane levels of fatty acids reveal metabolic effects and long-term balance in the tissues. This test is preferred to assess nutritional status of the eicosanoid precursors and long chain fatty acids necessary for membrane stabilization. It s the preferred test is the one we will describe below. Blood Spot (Metametrix only) This test measures key omega-3 and omega-6 fatty acids and calculates key indicators to establish your optimal balance from a simple finger stick. It also gives a measurement of trans fatty acids. This test is easy to implement in the clinic, does not require venipuncture and is easy enough that a patient can do it at home. This would be a good pre-screening test to assess for the need for detailed testing. The analytes measured include the following: 1. Arachidonic Acid (AA), 2. Eicosapentaenoic Acid (EPA), 3. Docosahexanoic Acid (DHA) 4. AA/EPA Ratio 5. Index of Omega-3 Fatty Acids (EPA + DHA%) The AA/EPA Ratio (Metametrix Only) This test measures the ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA) in plasma. This ratio of the principle omega-3 and omega-6 fatty acids is a measure of the body s eicosanoid balance. Balancing these eicosanoids in the body is an excellent way for managing heart disease and other chronic and inflammatory processes. Recently, a great deal of interest has been paid to the ratio of the fatty acids arachidonic acid (AA) to eicosapentaenoic acid (EPA). According to Dr. Sears, a lower AA/EPA ratio indicates a better balance of "good" and "bad" eicosanoids in your body. An AA/EPA ratio of 1.5 is considered to be ideal, since this is the ratio found in the Japanese population having the greatest longevity and the lowest incidence of cardiovascular disease. The average AA/EPA of Americans is approximately 11, and for patients with inflammatory conditions and neurological disorders, the AA/EPA ratio will be in excess of 20. Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 11 of 20

12 Sample Reports Metametrix: Fatty Acids Erythrocyte Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 12 of 20

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14 Genova Diagnostics: Essential and Metabolic Fatty Acids Analysis (RBC) Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 14 of 20

15 Interpretation of the Fatty Acid Profile Low alpha-linolenic acid (ALA) One of the most common essential fatty acid deficiencies is that of alpha linolenic acid (18:3n3), abbreviated as ALA or LNA. Consider supplementation with Flax seeds and oil, Walnuts and oil, Unroasted nuts and seeds, Dark leafy greens. Low eicosapentaenoic acid (EPA) or Low docosahexaenoic acid (DHA) Eicosapentaenoic acid (EPA) EPA is anti- inflammatory and should balance the levels of pro-inflammatory arachidonic acid. Although EPA can be produced from the essential fatty acid, ALA, dietary intakes of this fatty acid are generally poor. The conversion also requires the action of the delta- 6 desaturase enzyme that may be low due to inadequate Zn, Mg, or vitamins B3, B6, and C. Such an enzyme impairment would be indicated if EPA is low and ALA is normal or high. High levels of saturated, monounsaturated, trans fatty acids, and cholesterol also slow the conversion of ALA to EPA (as well as GLA to DGLA). Docosahexaenoic Acid The growth and development of the central nervous system is particularly dependent upon the presence of an adequate amount of the very long chain, highly unsaturated fatty acids, docosapentaenoic (22:5n3) and docosahexaenoic acids (22:6n3) (1,2). A deficiency in DHA is associated with attention deficit hyperactivity disorder and failures in the development of the visual system. DHA is essential for the early development of the nervous system in the infant so be sure to check DHA levels in your pregnant and lactating patients. You may also want to consider getting a base level in women who are interested in conceiving since breast milk is a rich source of DHA. Low DHA levels may also be a cause of high blood pressure. Consider supplementation with Cold water fatty fish, Salmon, Sardines, Wild trout, Herring, Anchovies, Tuna, Mackerel. Fish oils (EPA/DHA) are available in a variety of supplemental forms, from bulk oil to nitrogen-sealed capsules. An algae-derived DHA is available for vegetarians and pregnant women. EPA low and ALA normal or high This is an indication of delta 6 desaturase impairment. Delta-6 desaturas e enzyme may be low due to inadequate Zn, Mg, or vitamins B3, B6, and C. High levels Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 15 of 20

16 of saturated, monounsaturated, trans fatty acids, and cholesterol also slow the conversion of ALA to EPA (as well as GLA to DGLA). Consider supplementation with Cold water fatty fish, Salmon, Sardines, Wild trout, Herring, Anchovies, Tuna, Mackerel. Fish oils (EPA/DHA) are available in a variety of supplemental forms, from bulk oil to nitrogen-sealed capsules. An algae-derived DHA is available for vegetarians and pregnant women. Elevated linoleic acid (LA) and/or arachidonic acid (omega 6 fatty acids) Linoleic acid (18:2n6) LA is by far the most abundant polyunsaturated fatty acid in most human tissues. Low levels indicate dietary insufficiency. Since dietary sources (especially corn oil) are usually abundant in the human diet it is more common to find LA levels above normal. Excessive LA can contribute to inflammation. Arachadonic Acid Arachidonic acid (AA) is a 20-carbon or fatty acid that serves as the principal proinflammatory fatty acid. Its synthesis is inhibited by non-steroidal anti-inflammatory drugs (NSAIDs). Consider Use only olive oil or high-oleic canola or high-oleic safflower oil for cooking. Avoid all other vegetable oils. Avoid all margarine and shortening. Low Arachadonic Acid AA is essential for cell membrane structure, especially in nerve and brain cells. AA is also the main precursor for pro-inflammatory eicosanoid synthesis. However, low levels of AA can lead to impaired cell membrane function that may manifest as neurological deficits. Low AA has been observed in children with attention deficit hyperactivity disorder and in patients with severe psychiatric illness. Low AA might also predispose a person to inadequate immune and inflammatory response, leading possibly to frequent infections or delayed wound healing. Arachidonic acid is found pre-formed in egg yolks, bone marrow, and fatty (grain-fed) meats. Ordinarily, AA can be made from linoleic acid found in vegetable oils. However, high or even normal levels of linoleic acid along with low AA would suggest reduced delta-6 desaturase activity. Consider Organic egg yolks, bone marrow and fatty red meat Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 16 of 20

17 Delta-6 desaturase deficiency As much as 20% of the population may have impaired delta-6 desaturase (delta-6d) activity. And delta-6d activity decreases dramatically in people as they age. This enzyme is used several times to desaturate the growing EFA chains, although the first conversion [or desaturation] is usually the most tell-tale, when LA is converted into GLA (and subsequently into DGLA). Appropriate therapy is always to give the pre-formed oil that bypasses the action of delta-6 desaturase. Vitamin and mineral cofactors for optimum delta-6 desaturase activity: Niacin (B3), Pyridoxal-5-phosphate (B6), Vitamin C, Zinc, Magnesium High linoleic acid (LA) AND Low di-homo-gamma linolenic acid (DGLA) If AA is also low, the problem is more severe. High Trans Fatty Acids The trans fatty acids are prevalent in most diets because of the widespread use of hydrogenated oils used by manufacturers of margarines, bakery products, and peanut butters. The main trans fatty acid markers are elaidic acid, petro selaidic, and transvaccenic acids. The presence of these eighteen-carbon long trans fatty acids in human tissue can disrupt or impair cell membrane function. A patient with high levels of total C18 trans isomers should be told to avoid hydrogenated oils. Trans fats also mimic unsaturated fats that bind to desaturase enzymes and antagonize the normal production of the downstream metabolites. The net effect is to raise plasma LDL cholesterol and lower HDL. Trans fatty acids are also produced by the bacteria in the gut of ruminant animals which is the reason that beef and milk contain small amounts (13%) of elaidic acid. Moderate use of these foods is unlikely to provide trans fatty acids at levels that are of concern. Recommendations Eliminate all sources of Trans and hydrogenated oils High trans fats Elaidic acid (18:1n9t) This is a strong indication of increased oxidative stress levels and a need for additional anti-oxidant protection. Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 17 of 20

18 Consider Vitamin E and the carotenes are particularly indicated. Avoid all margarine, shortening and dairy products. You may want to think about up-regulating beta-oxidation in order to enhance the burning of these trans fats as fuel. Using Acetyl-l-carnitine would be very helpful. High Odd Chain Saturated Fatty Acids Pentadecanoic acid and/or Tricosanoic acid are odd chain fatty acids, which are produced when endogenous fatty acid synthesis begins with propionic acid (3-carbon fatty acid) as substrate rather than acetic acid (2-carbon). Propionate is found in high quantities in butter and other dairy products. Propionate is also one of the short chain fatty acids produced by our gut bacteria in the fermentation (digestion) of water-soluble fiber. With adequate B12 and biotin, propionate can be converted into succinate for use in the citric acid cycle and energy production. High levels of odd chain fatty acids in cell membranes may indicate an increased need for B12 and biotin, or may result from an exceptionally high water-soluble fiber diet. Recommendations Consider B12 and carnitine if high Low EPA Consider supplementation with EPA (from fish oils) High or normal EPA and low DHA Consider supplementation with DHA (from fish oils or vegetarian derived DHA called Neuromins) Dysglycemia and Hyperinsulinemia One of the many effects of elevated insulin is the upregulation of the enzyme delta-5 desaturase, which converts DGLA into AA. DGLA is the most potent anti-inflammatory EFA, while AA is the most potent pro-inflammatory EFA. Thus, a major effect of high insulin levels is to put the body into a heightened pro-inflammatory state, with disastrous long-term consequences for health. People who eat a diet high in carbohydrates, especially simple sugars, experience surges in insulin levels resulting in high levels of AA. Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 18 of 20

19 Low DGLA and High AA A high DGLA:AA ratio indicates an impaired delta-5 desaturase activity. This may be seen in people who are insulin resistant or diabetic. A high DGLA/AA ratio may also be seen in people taking exogenous GLA oils found in evening primrose, borage and black currant seed oils. Vitamins B2, B3, B6, C, and the minerals zinc and magnesium are cofactors for delta-5 desaturase and their supplementation may be indicated, especially if other desaturase enzymes are also impaired. The EPA/DGLA ratio will be low when DGLA is elevated relative to EPA, indicating a need for EPA sources like fish oils. Recommendations Use only olive or high-oleic oils for cooking. Reduce the use of omega-6 vegetable oils. Supplement EPA, which slows the activity of delta-5 desaturase. Eat a diet free of simple sugars, with a relatively high percentage of protein and complex carbohydrates (beans, whole vegetables and fruits). Run a Metabolic Dysglycemia Profile to rule out diabetes, dysglycemia, insulin resistance, or hyperinsulinemia. High oleic acid (18:2n-9) and Low stearic acid (18:0) The stearic acid/oleic acid ratio from red blood cells is a marker for the presence of malignant tissue, particularly with prostate cancer. In tumors, the net result of changes in fatty acid metabolism is low stearic acid and high oleic acid, causing a profound shift in the ratio of stearic to oleic acids. One likely outcome of this shift is increased fluidity of the tumor cell membrane, resulting in more rapid movement of nutrients and waste products and allowing for faster metabolic rate. The stearic/oleic ratio can used to monitor the effectiveness of cancer therapy. Elevated levels of saturated fats This results in more rigid cell membranes, especially with longer-chain saturated fats. Increased rigidity and/or decreased fluidity decreases membrane receptor function. This can lead to hormone dysfunction or cell-cell communication difficulties. Consider Reduce saturated fats in the diet (meats, chicken, dairy). Use olive oil as main cooking oil. Supplement polyunsaturated fats as indicated by report. Promote increased metabolic rates through aerobic exercise. A note on EFA Supplementation It is likely that you will be supplementing your patients with fish oils when it is indicated by the testing. Please be aware that fish oils can be high in mercury and other undesirable fat soluble toxins such as PCBs. Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 19 of 20

20 Please only use fish oils from reputable companies that can provide you with an assay that has been done on their oils that prove it is clear of all mercury and PCBs. The majority of the companies on our recommended supplement company list have good EFAs. Resources These are the well known labs who do this test. Genova Diagnostics 63 Zillicoa Street Asheville, NC USA Telephone: (800) Fax: (828) MetaMetrix Clinical Laboratory 3425 Corporate Way Duluth, GA USA Telephone: (770) Insider s Guide Functional Diagnosis of Essential Fatty Acids Page 20 of 20