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Excerpts from
"EFAs in Health and Disease": |
On essential fats
The essential fats (also known as polyunsaturated fatty acids) are a group of fatty acids that humans cannot make or synthesize. Thus they must be obtained from the diet, in a manner similar to vitamins, but in far greater quantities.
There are two families of essential fats, the omega-3 (w3) family and the omega-6 (w6) family. The w3s are made from linolenic acid; the w6s are made from linoleic acid. Eating both linolenic and linoleic fatty acids allows the body to make all the essential fats it needs.
Linolenic and linoleic acids, combined, constitute the Essential Fatty Acids (EFAs). They are the precursors (parents) of all the essential fats. Most people can eat vegetables to obtain all the EFAs they need.
Some people have lost their ability to derive some essential fats from linoleic and linolenic acids, and therefore need to eat more of the derivatives found in fish, in a few plants, and in animal fat.
Many people have deficiencies of linolenic (w3) fatty acids and should eat a mixture of oils including both parents and derivatives. Insufficient intake of essential fats is a more significant cause of heart disease than eating too much saturated fat or cholesterol.
People should eat more EFAs
Many nutrition and medical textbooks report that a deficiency of EFAs in adults is extraordinarily rare. This is also the view of the US Surgeon General, who stated that EFA deficiencies are rarely found in the United States (p. 58). Based on the number of cases reported in the medical literature between 1990 and 1993 (other than deficiencies which I reported), the prevailing "wisdom" is that EFA deficiencies affect less than 1 in 100,000 people, or less than 2,000 people in the USA.
There are a few researchers who, like myself, think that EFA deficiency is very common. Unfortunately, our findings are not yet taught in medical schools. In my review of medical textbooks, courses and conferences, yet to find one which teaches the extent of EFA abnormalities in the USA, let alone how to correct them.
My research indicates that at least 25,000,000 people suffer from significant EFA abnormalities, and the true number is probably much higher. I have found evidence that deficiency of EFAs (both w3 and w6) is one of the most common deficiencies in the adult population. These deficiencies are likely to be the primary nutritional factor that causes cardiovascular disease, hypertension, and the cardiovascular complications of diabetes. Many children also have significant w3 deficiencies that affect their mental abilities. Therefore it is very important to learn to eat a balanced mixture of w3 and w6 fatty acids, starting in childhood.
Oil Effects: what EFAs do
Many important functions of essential fats are still under investigation. The best known functions are:
1. w3 fatty acids decrease cholesterol and triglycerides, lower high blood pressure, make it more difficult to... (Explains effects on immune system, eye function)
2. w6 fatty acids decrease cholesterol and triglycerides, lower high blood pressure, modify the immune system, improve...
3. Increased ratio of w3/w6 causes a decrease in platelet aggregation, and an increase in bleeding time (a special test to measure platelet aggregation). A very high value of w3/w6 can cause an increase in bleeding. A very low value can cause harmful clotting…
Heart disease affects everyone, young and old, rich and poor, people without a high school education, and those with PhDs and MDs. Many of us feel immortal and believe that disease will bypass us. Many health professionals behave as if prevention and treatment were necessary only for patients, and that doctors never get ill. But everyone is at risk for heart disease.
Examples of people with heart disease
Mr. G. was a Latin American worker in his early forties. He had had two heart attacks, suffered from diabetes and hypertension, was overweight and smoked. Mr. G had all the factors that indicate a high risk for heart disease ("risk factors").
Mr. G. was also extremely uncooperative. He refused to do anything to treat his diabetes, to give up smoking or to lose weight. His diet was the worst imaginable for his condition: he loved beef & pork (fried), alcohol, pizza, cheese, sweets and other unhealthy foods which make up the bulk of the standard American diet. He thought he was strong and would never die- "an immortal man."
A lost cause. When Mr. G. was discharged from the Intensive Care Unit after his second heart attack, the doctors decided that he was a lost cause: he refused to follow medical advice, and even if he did, given his medical condition, there was little hope that he would live much longer. He would soon have either a stroke or another heart attack which would kill him. Given the weakened condition of his heart and his oversized body, it was very likely that his heart would soon fail because of the strain put on it.
Traditional care had failed. I was assigned to treat Mr. G because I spoke Spanish, and because Mr. G was such a lost cause that no other physician wanted to take care of him. Perhaps my superiors wanted me to try out my "unusual" ideas about nutrition, cholesterol and how to treat heart disease on a hopeless case. And when he died, would it not confirm established wisdom and leave me to face the consequences?
To kill yourself. I went to visit Mr. G in his room, and found there a classic example of what a person suffering from heart disease should NOT do. He was sitting up in bed eating a hearty breakfast of sausages, eggs, pancakes and butter. His scheduled lunch included meat, a fatty dessert, and coffee. The coffee was ordered with sugar and artificial creamer (after all, you can't expect a grown man to drink bitter coffee!). The one concession to dietary sanity was an instruction that everything be low in salt; however this seemed like a bad joke considering the rest of the menu. Mr. G was also smoking, even though patients are usually not allowed to smoke in their rooms.
The dream. I sat down and spoke to Mr. G. He told me that he wanted to get better and go back to work. BUT...
Case Study: One of my friends, a
world-renowned scientist whom I met in medical school
… We spent many hours together learning to survive and cope with the medical system while he recalled his adventures in Africa or lunch with the Queen of England. He told me that he had an apparently slight problem: he was in his late thirties and had what is called "very mild" hypertension. I took the liberty of raising my concern about his condition. He didn't see any cause for concern. After all, he played tennis regularly, had a strong complexion, and appeared to be in good health.
I was less confident, however. I had seen many men like him with strong complexions who were apparently in good health. In fact, my first cadaver in anatomy was a man whose appearance was similar to my colleague's: he was very strong, healthy-looking, and muscular, but his arteries were almost closed due to atherosclerosis. Thus, in spite of appearances he had really been quite sick.
I believed that my friend should drastically change his diet, lose weight and, of course, eat more EFAs. He thought this was ridiculous. He had been seen by the most famous physicians at the hospital, world known specialists in hypertension and heart disease. According to their evaluations, his blood pressure values were within the "normal range", and he was therefore a normal, healthy man with nothing to worry about. I disagreed. I felt he should not have any hypertension at all. Being normal was not satisfactory if by normal we mean "average". He should try to be better than average in order to beat the odds and live longer than the average man.
My advice went unheeded. Several years went by and I heard that he died of an apparent heart attack while playing tennis. He was in his early 40's.
Comparison of recommendations
Most health organizations agree on the following recommendations:
Less than 30% of all calories should come
from fat.
People should eat 10% of total calories (or
1/3 of calories from fat) as SFA, 10% as MUFA and 10% as PUFA. In other words,
most health organizations recommend that you eat approximately equal proportions
of each type of fat, with the calories from fat not exceeding 1/3 of your total
calories. For example, if you eat 2,000 calories per day, you should eat less
than 600 calories as fat, with 200 as SFA, 200 as MUFA and 200 as PUFA. If you
can, eating even less SFA per day is recommended.
Total daily cholesterol should be below 300
mg.
People should eat about 25 to 30 grams of
fiber daily.
People should eat foods rich in carotene,
vitamins and minerals, such as cruciferous vegetables and fruits, every day.
Many public health groups now recommend that people eat more calories from MUFAs and eat more carbohydrates instead of fat. The way that most public health recommendations are written, it seems that calories from fat should be replaced with calories from carbohydrates. Because the emphasis is on avoiding SFA rather than eating fewer calories, many people replace their fat with carbohydrates, but eat so many carbohydrates than their total caloric intake increases. Because excess calories are converted to SFAs, their bodies still make too many SFAs.
My recommendations are different. I agree that people should eat more natural foods, and avoid processed foods rich in fat. I also agree that people should eat less food high in animal fat. However, my research indicates that the two most important factors in a healthy diet are total calories and calories from essential fats. As long as a person is slim and eats a balanced diet which consists of many different natural foods, he/she does not need to be too concerned about keeping track of total fat, saturated fat, or cholesterol. Most natural foods do not contain too much cholesterol.
The key is to maintain ideal weight. If a person gains weight, he/she is eating too much. It does not matter where the calories come from. Saturated fat, monounsaturated fat, carbohydrates, and protein contribute calories which, in excess, will be converted to the same thing in the body: saturated fat. It is usually easier to maintain ideal weight if one avoids foods high in fat and eats more natural foods high in carbohydrates and fiber.
In addition, a person should eat a minimum amount of essential fats every day. This minimum amount depends on the size of the body, that is, how many cells the body has. This minimum amount increases when one has to compensate for many years of bad eating (especially eating foods low in essential fats), or one has a disease that requires supplements of essential fats.
If you are slim and otherwise eating a healthy diet, a pizza is often as healthy as bread or pasta. It depends on the amounts of EFAs and TFAs rather than SFAs in the food, which vary from one brand to another.
About Siguel's diagnosis method
Even when I was in medical school, I developed a dependable ability to predict death. My first patient had deteriorating kidney function. In my ignorance, I plotted the test results and predicted that he would die within one week. My classmates, interns and professors scoffed at my crude charts and told me that test results often varied and could not be used to make predictions about death. They were generally right, but in my ignorance I continued.
Given my background, I could not help it. Before going to medical school, I was trained as a physicist-mathematician, and my expertise was in developing predictive models. With some ups and downs, the trend in this patient's tests was downwards. Eventually I told my "medical team" that it was time for drastic treatment measures because I predicted death within 2 days. The team had a good laugh and ordered gastrointestinal X-rays to identify the cause of abdominal pain, further renal tests, and various other diagnostic procedures scheduled over a period of 4 days. (At that time, patients went to the hospital and spent their days waiting for diagnostic tests to be done.) The patient died before all diagnostic tests were completed. The team criticized me for making predictions.
The second event involved a patient with inflammatory bowel disease. He was earning about $1,000,000 per year. When I saw him he was lying flat on a bed and told me that he could not get up because of muscular weakness and other problems. I evaluated his test results, requested several additional ones, and diagnosed him as suffering from severe "selected" nutritional deficiencies caused by huge imbalances in the absorption of nutrients. In simpler words, he had too much of some nutrients, and not enough of others. He was deficient in potassium, other minerals and several vitamins, and deficient in EFAs.
I recommended that he eat a specially formulated diet that provided the needed supplements. I presented my case in front of my team and a famous "guest" speaker who discussed his approach and my approach. Being already well known and quite talented himself, he was not afraid to recognize the value of my suggestions...
The third event began one day during morning rounds, when the team evaluated a 40+ y.o. overweight woman with adult-onset diabetes. The team found her diabetes under control and recommended that she be discharged that morning. I told the team that I believed that she was going to die soon, probably that same day, and that she should not be discharged. The students, interns, residents and professor took me aside in the hall and gave me a "lecture" for about 15 minutes. I was told that I should stop making unsound predictions, and that I should study more and learn more. I was told to depend more on X-rays, EKGs, and conventional tests rather than blood or nutritional tests. Just as the team leader was preparing to propose his "punishment" for my silly sayings, the patient went into cardiac arrest. The team attempted to resuscitate her but failed. The patient was declared dead about 30 minutes later.
While the team stood in the hall, one classmate who had seen me make accurate predictions before asked me how I did it. Was it pure luck? I told the team that I had examined the patient early that morning, as was my duty before rounds. I had seen that the patient had several risk factors for hardening of the arteries and increased risk of clot formation. The patient was overweight and had a dietary history of very low intake of EFAs. Each morning diabetic patients have blood drawn for analysis. At the site of blood drawing, the tiny wound had not healed well. When I touched it, it started to bleed again. In a healthy person, the small hole from the needle used for blood drawing closes up very quickly and does not bleed again. When patients have a disorder of blood clotting called "disseminated intravascular coagulation," the blood forms clots inside most of the vessels and exhausts the supply of platelets. As a result, some parts of the body cannot form clots and bleed. This is a life-threatening condition which can be treated if properly diagnosed. A common sign is bleeding at the site where blood was recently drawn.
The autopsy revealed multiple clots in the body. The team could not dispute the facts, but attributed them to my luck. However, after that incident, the team never disputed anything I said. From then on they ordered tests or treatment I suggested.
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© 1998 Edward Siguel. All rights reserved |
modified 9/1/98 |