Results The fatty acid profile EFA-SRÔ

What can I expect my test results to tell me?

The fatty acid profile EFA-SRä will measure the amount of about 30 key fatty acids in your blood, selected from more than 200 chemicals and fats found in blood or tissues. Selecting the proper fatty acids and knowing how to interpret fluctuations is one of the most difficult issues in diagnosis.

In cases like this, more is not better. Reporting more substances would not help but rather would confuse your results. There are millions of substances in the body. The trick is to select the important ones.

It is like news about stocks: there are millions of news items, but you only want to know the relevant ones or else you will waste your life reading and miss the opportunities to make money.

The fatty acid profile EFA-SRä provides those key fatty acids that are needed to make decisions about treatment which have been described by Dr. Siguel. Other fatty acids can be measured for research purposes.

A series of complex evaluations will allow us to determine whether some levels of fatty acids are too high or too low, and whether your body stores of these fats are also likely too high or too low. We will compare several key ratios and determine whether or not you have a fatty acid metabolic block, and exactly which fatty acids you need to eat or avoid.

The Fatty Acid Profile EFA-SRä has several distinguishing features.

The fatty acid profile EFA-SRÔ provides percentages, ratios, and concentrations for fatty acids. The use of percentages and concentrations as reported in the fatty acid profile EFA-SRä has been deemed unique and useful and awarded US Patent No. 5075101, "Method And Apparatus for Diagnosis of Fatty Acid or Lipid Abnormalities." These numbers are critical to the proper diagnosis of abnormalities caused by a Relative vs. an Absolute deficiency of EFAs.
Relative deficiencies are in part caused by excessive amounts of saturated and monounsaturated fatty acids (SFAs and MUFAs). Such deficiencies can often be corrected with appropriate weight loss and PUFA supplements. Absolute deficiencies require taking large quantities of EFAs, to bring adipose tissue stores up to healthy levels. Sometimes intravenous lipids are needed.
For guidelines about the diagnosis of these abnormalities in patients with elevated plasma lipids, see Siguel and Lerman, "Fatty Acid Patterns in Patients with Angiographically Documented Coronary Artery Disease. Metabolism 1994; 43:982-993." For the diagnosis of these abnormalities in patients with low plasma lipids caused by fat malabsorption, such as Inflammatory Bowel Disease and Cystic Fibrosis, see Siguel and Lerman, "Fatty Acid Patterns in Patients with chronic intestinal disease". Metabolism 1996.

For many years, textbooks of medicine have acknowledged the trienoic/tetraenoic (also known as 20:3w9/20:4w6, Mead/Arachidonic acid, or "T/T") ratio as a test for EFA deficiency. Using older and less sensitive technologies, researchers established that T/T values above 0.2 or 0.4 are indicators of EFA deficiency (as still reported in many medical publications). Using modern technology, Siguel reported that levels of T/T above 0.02 are indicative of insufficient EFA levels. In recent years, other markers of EFA status have been developed. The fatty acid profile EFA-SRä uses highly sophisticated technology to achieve narrow ranges for healthy reference levels, and therefore is able to detect the biochemical changes that characterize the early onset of EFA deficiency. It is desirable to diagnose and treat an EFA abnormality before it becomes severe and causes cell damage.

Fatty acids are analyzed using High Resolution Capillary Column Gas Liquid Chromatography (GLC). The method quantifies plasma levels of fatty acids from chain length C14 up to C24, including the EFAs, arachidonic acid, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), the eicosanoid precursors and key trans fatty acids. Similar methods can be used with red cells or adipose tissue.
Several profiles are available to include major saturated and monounsaturated (w7 and w9) fatty acids, the EFAs (linoleic and linolenic), EFA derivatives, total w6 and w3, including 20:5w3 (EPA), 22:5w3 and 22:6w3 (DHA). In addition, different types of trans fatty acids associated with hydrogenated oils or other processed fats can be measured. Usually a physician orders a profile with about 25-30 major cis fatty acids, or one with the cis and several trans fatty acids.

The methods used to prepare the fatty acid profile EFA-SRä have been called "state of the art" by the review committees of the National Institute of Health that examined them. A laboratory technician spends many hours analyzing each sample to obtain adequate peak identification. It takes more than 5 hours to prepare chemical extracts from the blood of each sample, and more than 3 hours to have each sample analyzed by GLC (compared with minutes needed for the analysis of other substances). Additional time is required to review the chromatogram and insure that each peak is properly integrated (i.e., that the amount of each substance is properly calculated). Considerable time is spent on quality control.

The Fatty Acid Profile EFA-SRä compares the patient’s results to results from other patients and from healthy subjects and compares the relative % of each fatty acid (its proportion of total fatty acids) and its concentration. This allows us to identify relative vs. absolute deficiencies, a classification of fatty acid abnormalities described in Dr. Siguel’s patent and in several peer-reviewed publications. This classification is critical to optimal diagnosis and treatment. The report includes charts and tables, designed using software developed by Dr. Siguel, that illustrate whether a patient is considered to have a relative or absolute deficiency. These graphs, needed to diagnose these abnormalities, constitute some of the aspects of US Patent No. 5075101.

In addition to an absolute or relative deficiency of EFAs, most patients have an imbalance of w3 vs. w6 fatty acids, and an imbalance of EFA derivatives. Our experience analyzing hundreds of patients and research subjects has revealed that imbalances of w3 vs. w6 fatty acids or fatty acid excesses require special analytical methods.

Relative excesses or deficiencies of one fatty acid alter the metabolism of the others. The fatty acid profile EFA-SRä can help to diagnose metabolic blocks and provides guidelines for further diagnostic testing of defects in the metabolic conversion of EFA precursors to derivatives. A metabolic block in the formation of EFA derivatives requires treatment with specific supplements to bypass the block. This aspect of the test is in part described in US Patent No. 5075101 and is critical for the treatment of several disorders.
Metabolic blocks have been found in patients with various conditions, including diabetes mellitus, alcoholism, and abnormal lipids. The movie "Lorenzo’s oil" explained the use of special fatty acids to prevent the formation of long chain SFAs which lead to neurological damage in some patients. In those patients, excessive levels of very long chain saturated fatty acids and low levels of EFAs are characteristic of the disease.
See a physician’s guide to the diagnosis of EFA abnormalities by Siguel: "Essential and Trans Fatty Acid Metabolism in Health and Disease." Nutrition Issue. Contemporary Therapy, 1994; 20(9): 500-510.

The fatty acid profile EFA-SRä relies on an extensive database of test results on research subjects as well as patients with unusual metabolic problems. To our knowledge, nobody else has access to a similar database.

The fatty acid profile EFA-SRä is based on reference values developed from samples from subjects without known disease, as well as samples from a population group with "normal" lipid levels. These reference levels provide 5, 10, 25, 50, 75, 90 and 95 percentiles for cis and trans fatty acids, values which help physicians compare a patient with other subjects.

Our research has identified the fatty acid profiles associated with abnormal TC/HDLC, high TG, low HDL, diabetes mellitus, and various other health conditions. Depending on the results of your profile, we can provide specific guidelines on a mixture of fatty acids likely to bring your TC/HDLC ratio towards a value associated with reduced risk of heart disease.

Individualized reports are prepared for each patient, leading to specific treatment recommendations by the health provider.

What can I do with the results?

We will be able to present you with a diet suited to your individual needs. This diet will bring your fatty acid profile closer to ideal levels. As a "side effect," you may lose weight, have more energy, feel more "alert," reduce your chances for cancer and heart disease, and improve allergies and asthma! Most important, you will have the satisfaction of knowing you are doing what is the best for your body and giving your body the nutrients it really needs to reach its ideal-- you are literally taking your life into your own hands.

10 reasons why nutritional therapy with oils may not increase TC/HDLC

Doctors and patients who seek to correct an imbalance or deficiency of EFs by using oil supplements and foods rich in EFAs may experience differing results. They may find that their TC or TG increase, that their TC/HDLC ratio rises, or that a low HDL does not increase.

To find the reasons for individual failure, it would be necessary to spend millions of dollars to analyze thousands of substances in the body, because each person has a very different body chemistry. Obviously, this approach is not practical. Instead, we seek to identify the most likely reasons for failure, which can be one of many factors discussed here.

In my experience, the most likely reason for lack of improvement is that body fat composition has not been changed significantly enough to create a healthy fatty acid profile. Most people have many pounds of fat in their body. At the rate of a few tablespoons of oil per day, it can take years to substantially change the mixture of fats in all parts of the body.

It is possible to correct iron or other vitamin deficiencies in a few weeks by taking a few pills. However, unlike a single vitamin capsule that can contain the mineral dosage required by the body for an entire month, fatty acid supplements cannot fix the problem quickly. One cannot consume a gallon of oil a day.

Before you give up, consider one of the following possibilities:

1. Normal physiological changes. There are normal physiological variations in plasma levels of TC, HDLC and TG. Variations occur due to changes in diet, weight, season (temperature and humidity), etc. There are also "normal" or common laboratory errors, arising from evaporation of water, errors in preparing the blood sample, calibration errors, and variable factors (such as how long the patient was seated before the blood was drawn, how the blood was drawn, and more). These factors can produce a change of 10-30% in the test results.
   For example, if your HDL is 40, it could vary from 25 to 55 because of common laboratory variability even if you did not change your diet!
   This is why we don't rely on one value, but instead look at a trend over a period of many months (preferably at least 12 months).
2. Changes in medication. Some patients anticipate that the treatment will be successful, and stop taking their medications. Patients change the foods they eat or the amount of medications they take for a variety of reasons, including travel, holidays, and "forgetting." Patients and doctors should remember that changes will occur slowly, and that alterations in medications or other therapy should be made only after cholesterol or blood pressure values have changed. A common problem is losing weight very slowly. My father, for example, took soybean oil while he lost weight. It took more than 5 years before major changes occurred in his cholesterol and blood pressure values. Only after several years were we able to decrease the medication he was taking for high blood pressure.
3. Occasional departures from your diet upset the balance of EFAs. Many patients think that if they follow their required treatment plan 6 out of 7 days, it is OK. They think that, because they are being treated by a doctor and following a treatment plan, they may deviate from it. Erroneously, they think that 6 out of 7 "correct" days are plenty and that the skipped day will not hurt them.
   Unfortunately, "cheating" even once a week may be too much for a patient with highly abnormal amounts of cholesterol and premature heart disease. That "single" doughnut, combined with that "occasional" cake or cookie, supplemented by that "small" piece of pizza or pie and that "rare" weekly beer are more than enough to upset the body and cause more harm than the good caused by 6 days on a good diet.
   Remember: all excess calories from carbohydrates and protein are converted into saturated fat. It is possible to gain weight on a low-fat diet. If someone eats plenty of breads, pasta, cereals and a "rare" dessert, they may feel virtuous, but their diet consists of almost pure carbohydrates. If there are any excess calories consumed, the body will store them as saturated fat even if the food has no fat!
   Some people who eat oils rich in PUFAs stop eating other sources of PUFAs (such as fish or chicken). They think that, because they are taking oils, they can eat more low fat processed foods which are mostly carbohydrates. What happens is that the body converts the extra calories from carbohydrates into fat. This "fat" from the carbohydrates counteracts the good effects of the EFs from the oils. Their cholesterol ratios will likely deteriorate because of decreased PUFA/NoPUFA ratios.
4. You are not achieving your ideal weight. We define ideal weight as the lowest weight consistent with good health. Forget tables. There is no need for you to carry extra fat in your body, so keep the extra food in the refrigerator in case of nuclear attack. Most Americans will not go hungry or die of starvation if all the supermarkets go on strike. On the contrary-- the slimmer you are, the less likely you will die of heart disease. A slim body allows your organs (heart, kidneys, etc.) to work more effectively and allows you to live longer.
5. Oils are fat and fats are calories. Taking the oils can make you gain weight. Even a few extra pounds can substantially lower your HDL or increase your TG or TC. Unless you cut out processed foods or significantly increase your amount of exercise, you will gain weight from the oil supplements. At first, people do not pay much attention to this fact, and by the time they realize it, they have gained several pounds. It is very hard for them to lose those extra pounds because they are eating many more calories (about 120 Kcal/tablespoon of oil). Thus, it is very important that, from the beginning, you eliminate some food intake and exercise more to compensate for the extra calories from the oils.
6. You may not be eating enough w6 or w3 fatty acids. Your fatty acid profile will help you determine whether or not you need more w3 or w6, or both. Patients usually start with soybean oil rich in EFAs (no derivatives) for 3-6 months and have another fatty acid profile EFA-SRä before moving to the next step. The next step can be an individually designed mixture of EFAs (no derivatives), or a mixture of EFAs and EFA derivatives for anyone whose body does not make EFA derivatives.
7. Your balance of w3 vs. w6 may be far from optimal, or the oil may not be effective. Not all brands of oil are of the same quality. To verify your results, try a different brand or even buy a fresher bottle of the same brand. You may need to change the type of oil to modify your balance of w3s or w6s.
8. Some people may not be forming derivatives from the EFAs. This may be due to genetic factors, age, unknown nutritional deficiencies, drugs, disease, or other factors. These people must take EFA derivatives such as GLA (from evening primrose, borage or similar seeds) and EPA (from fish oils). A critical issue here is the type of oil used. Some people respond to one type of oil and not to another. Each food has different mixtures of the essential fats which can be more or less effective for a particular person.
9. You may have highly unusual genes (less than 10% of the population). Some people have very unusual genes that cause highly abnormal cholesterol or triglyceride values. My research indicates that these individuals require large amounts of EFAs and EFA derivatives (some of these EFA derivatives are not yet commercially available). Unfortunately, eating large amounts of oils means eating many calories. Their diet becomes highly distorted and very difficult to follow, because they must eat very little to compensate for the extra calories from the oils. Often, these patients have heart disease and cannot exercise. They may be overweight, which means that they must reduce their caloric intake even further. It is very difficult to resolve these difficulties and requires that the patient be willing to follow a strict diet.
   I am doing research to develop new oils and foods to help these individuals. Unfortunately, this research is expensive and we are in need of funding.
10. There are many nutrients and hormones that affect fatty acids and lipids. You may be eating the right amount of oils, exercising, and maintaining your ideal weight, but still experience abnormal TC levels or high TG. We only know a few of the reasons; many are yet to be discovered.
    We know that if the thyroid gland does not work properly, then your lipids can be abnormal. The thyroid hormones affect the way the body uses the essential fats. Deficiencies or excesses of zinc, selenium, iron, copper, and many other vitamins and minerals can influence your lipid levels and the effective use of your essential fats. For that reason, your physician will give you a precise diet to follow with explicit values for vitamins and mineral supplements. Not following the diet exactly will upset the carefully considered balance, which he based on a comprehensive review of hundreds of published medical articles.

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© 1998 Edward N. Siguel. All rights reserved	modified 9/16/98