Lipids, fats and essential fatty acids
Fats, Membranes, the Healthy Brain and Mitochondria
The vast majority of cell metabolism takes place on, in, or around cell membranes. If you took all the cell membranes in one person and spread them out flat they would cover 100 square kilometres and if you were to run round this, then you would be running a marathon! The structure of cell membranes is identical throughout the animal kingdom. They are made up of fatty molecules which have a water loving end and a fat loving end - these combine in a sandwich so that the fat loving end forms the core of the membrane and the water loving end forms the outside of the membrane. The structure of the membrane and how liquid it is depends on the fats that are in it. If the composition of membranes change, then they will either become more stiff or more liquid.
There are a great many effects which result from a change in the composition of membranes, for example increased irritability and sensitivity. These effects could, in turn, explain many symptoms such as intolerance of chemicals and foods, intolerance of heat, light and touch, low pain threshold, cardiac dysarrhythmias and so on. Indeed, a great many drugs work because of their effects on changing membrane structure. Drugs such as general anaesthetics, tranquillisers, pain killers and anti-inflammatories work in this way.
Mitochondrial membranes are different from cell membranes because they have to be a little stiffer in order to hold still the bundles of enzymes, called cristae, on which oxidative phosphorylation takes place. They have an additional fat namely cardiolipin to create this extra stiffness.
Acumen laboratories can look directly at mitochondrial membranes to see how they function - Translocator protein studies.
Having the correct oils in the diet is essential for energy supply to the brain. Poor energy supply means foggy brain. See Brain fog - poor memory, difficulty thinking clearly etc.
What are these lipids and where do we get them?
1. The body cannot make many of these lipids and so they have to be taken in through the correct diet. Membranes are largely made up of phosphatidylcholine (they also require phosphatidylserene, phosphatidylethanolamine and phophatidylinositol) and these are present in foods which are made up from other animal cells i.e. meat, fish and eggs. They are present in non-meat foods for example lecithin (present in soya) is a particularly concentrated form of phosphatidylcholine. Furthermore,for all these fats to be available we need a good digestive system. See Digestive enzymes are necessary to digest food and Malabsorption - failure to get the goodness from food.
2. We then have "specials" which have special functions within these membranes. These are, namely, omega 6 and omega 3 essential fatty acids. Omega 6 essential fatty acids come from evening primrose oil, borage oil, star flower, blackcurrant and other such foods.
3. Omega 3 oils. These come from fish, nut seed and vegetable oils especially linseed oil. See VegEPA.
This partly explains the importance of doing a Stone Age Diet** in which lots of different oils are consumed. There is great argument about the correct ratio of Omega 6 to Omega 3 essential fatty acids but the general feeling is that they should roughly be in the ratio of four parts Omega 6 to one part Omega 3. Please see The essential fatty acids omega-6 and omega-3: from their discovery to their use in therapy and in particular the comment "a 4:1 ratio of omega-6 acids to omega-3 acids is generally considered the optimum". Flaxseed oil and rapeseed oil contain Omegas 6 to 3 in the proportion one to six (ie the other way round) and so need to be balanced up with some extra omega 6.
What healthy cell membranes require
1. Healthy cell membranes need the correct fats from the above diet.
2. They also need freedom from toxins from the outside world such as heavy metals, pesticides and other such volatile organic compounds. These fat soluble toxins get into cell membranes where they disrupt normal membrane fluidity with multitudinous effects.
3. Freedom from endogenous toxins (substances that originate from within the organism) - these are largely produced as a result of normal cell metabolism, from the fermenting gut Fermentation in the gut and CFS and from immune overactivity Inflammation and are mopped up by antioxidants Antioxidants. Having a good antioxidant status is, therefore, essential for the maintenance of normal membranes.
4. Stabilisation of membranes. This is largely carried out by methylation. The methylation cycle needs essential B vitamins such as B12 folic acid and pyridoxal-5-phosphate. See CFS - The Methylation Cycle.
All the above factors are necessary for the maintenance of healthy cell membranes.
What happens when problems arise?
When problems develop, this almost always results from toxins building up in membranes (which could be toxins from the outside world or toxins from normal metabolism), and this can result in the build up of very long chain fatty acids called ceramides which again disrupt normal membrane fluidity. Indeed this happens as part of the normal ageing process.
Blockage of the delta-6-desaturase enzymes occurs very easily and again may well be a feature of the normal ageing process. This blocks the availability of certain essential fatty acids and we may have to get round this by tweaking the diet or taking supplements for the essential fatty acids. One example of this is blockage of delta-6-desaturase by viruses or toxins which may trigger a chronic fatigue syndrome. The most difficult to make essential fatty acid in this case is DHA which is at the end of the metabolic line - please see VegEPA.
When things get complicated it is essential to measure the different fatty acids in order that the correct supplement or diet can be put in place.
Implications for Treatment
This page was motivated as a result of a day of lectures organised by the British Society for Ecological Medicine at which Dr Patricia Kane spoke. She is a leading advocate of lipid therapy and largely uses this in the treatment of diseases involving the brain. She presented a stunning array of case histories in which patients with incurable diseases such as motor neurone disease, Parkinson's disease, multiple sclerosis and Alzheimer's had shown improvements, often dramatic. In addition there were case histories of treating children with autism or severe hyper-activity or developmental delay who had gone on to make substantial improvements as a result of her lipid therapy. Of course it is not just lipids that can bring about these changes - there are many ways to skin a cat! We all have different approaches to disease but essentially the basic package is the same. All patients need to pay attention to eating a stone age diet**, essential micronutrients, sleep, the correct balance between pacing and exercise and detox. Patricia Kane's regimes reflect much of this but what she is advocating is:
1. Providing the correct balance of fats for normal membrane structure - she uses a pure preparation of phosphatidylcholine which can be given intravenously (very difficult in the UK because the authorities won't allow it into the country), or with supplements (which work just as well but take longer) to normalise membrane fluidity. We can mimic this by taking the oral supplements and eating high quality animal protein, fish protein and egg (the egg yolk must not be hard - it must be eaten soft). Using high dose phosphatidylcholine also prevents and dissolves away ceramides. She also uses intravenous sodium phenylbutyrate to dissolve ceramides (lipid rafts) and improve detoxification . A rich source of phosphatidylcholine is lecithin, but there is some debate about how this is broken down in the gut and I am currently looking for answers to this question!
2. Supplements to support the methylation cycle to stabilise phospholipids in cellular membrane - see CFS - The Methylation Cycle.
3. Improving detox of toxins by the sulphuration group via glutathione. Glutathione is necessary to make glutathione peroxidase (an antioxidant) as well as for detoxifying xenobiotics (foreign chemical substances). It is easy for the body to run short of this essential nutrient because we live in an increasingly toxic world. Glutathione is a very common if not universal deficiency!
Patricia Kane advocates high dose lipids which literally "wash out" the dirty lipids, which have toxins stuck onto them, and which are present in the diseased cell membrane. These dirty lipids are washed out and discharged via the bile ducts. The problem with fats that come out in the bile ducts is that many are then re-absorbed by gut. Therefore, it is vital to avoid constipation and again eating a high vegetable stone age diet** helps here. She also advocates colonic irrigation to keep the large bowel empty. Taking high dose probiotics is also helpful in detoxifying and washing away these damaging lipids.
A great many conditions could be further improved by attention to lipids. How I see this affecting my practice is that I need to pay more attention to the exact fats that are present in the blood. Initially one can work on a best guess policy since common things are common, but if we are not getting results then the next thing to consider is tests of fatty acid profiles in order to make the correct dietary and supplement adjustments. Please see Essential fatty acid profile. It is very likely that vegetarians and vegans are going to be short in phosphatidylcholine.
Patients with fatigue syndromes will benefit from using VegEPA which contains the correct Omega 6 and 3 fatty acids in the right ratios. Vegetarians need to ensure high intakes of polyunsaturated fatty acids from egg yolk, nuts and seeds. Taking high dose lipids also facilitates detoxification and should be done in addition to improving nutritional status and saunaing regimes.
THE MOST IMPORTANT CONCLUSION IS THAT WE SHOULD BE EATING HIGH FAT DIETS BUT THAT THESE SHOULD BE GOOD FATS, FREE FROM TOXINS.
The problem is that many toxins are fat soluble and bio-accumulate in fat - so oils should be organic.
Be mindful that many fish oils will be high in mercury and pesticides.
- Translocator protein studies
- Brain fog - poor memory, difficulty thinking clearly etc
- Fermentation in the gut and CFS
- CFS - The Methylation Cycle
** FOOTNOTE - RE DIET - More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
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