However, it would appear that the story is not quite so black and white; it wasn’t too long ago that I commented on a Daily Mail story highlighting the worrying side effects associated with the use of statins for reducing cholesterol. Not only do statins come with side effects that include muscle pain and damage to the liver and kidneys, it is becoming apparent that they may also cause memory loss and depression.

Strange, then, that these drugs are so commonly prescribed when there are natural ways of keeping cholesterol levels in check. Given the overwhelming evidence for the protective role that long-chain omega-3s play in cardiovascular health, it amazes me that this information is not passed on more readily by GPs to their patients. With the huge costs to the NHS for treating cardiovascular disease in secondary care, wouldn’t it be more cost efficient to educate people on preventative methods?

Omega-3 fatty acids not only reduce cholesterol, but can lower triglyceride levels, blood pressure, improve blood flow and reduce the risk of arrhythmia (the abnormal heartbeat that can increase risk of heart failure). Whilst eating oily fish is a good way of increasing omega-3 levels for heart health, supplementation with purified oils is a convenient way of achieving the therapeutic doses needed (which are often as much as 2-4g) to treat specific conditions such as hypercholesterolaemia (very high cholesterol) or hypertriglyceridaemia (very high trigycerides).

The type of fat in our diets needs to be addressed. Dietary fat plays a huge role in the development of cardiovascular disease. Our increased intake of junk food and heavily processed foods means that we consume amounts of saturated and trans fats that are detrimental to our health and these limited food choices are becoming normal for the next generation, as parents are making fewer food choices for their children. Making relatively simple dietary changes can have profound effects on our health and the habits we adopt now will be reflected in those we pass to our children. Choosing fat wisely, moderating saturated fat intake and increasing polyunsaturated fat at an early age may well help our own and our children’s passage to good health long-term, without the risk of side effects from prescribed drugs.

Long-term exposure to toxins, a decreased ability to metabolise toxins and therefore neutralise them within the liver, or simply an inability to clear toxins from the body can result in toxic overload that can contribute to the many symptoms associated with ME/CFS/fibromyalgia.

The symptoms of toxic overload, such as fatigue, dizziness and nausea, headaches, brain fog, and so on, are frequently misdiagnosed and pharmaceuticals prescribed, which may exacerbate symptoms and the patient enters a vicious cycle of treatment that has little or no benefit in alleviating symptoms.

So what does the toxic patient do?  It is not possible to remove ourselves from all exposures to toxins, but what we can do is to provide the best possible protection from the effect these toxins have on our health.  We have a complex internal system, involving multiple enzyme families that act, within the liver, to modify and detoxify agents from external sources, as well as those created internally – as a product of digestion, for example.

These enzymes depend on many dietary nutrients including essential vitamins, essential minerals, proteins and essential fats.   Deficiencies of any of these nutrients can contribute not only to the disruption of this important detoxification system, but to all physiological and biochemical pathways that contribute to normal functioning of the cells, tissues and organs that make up the human body.  It is no wonder that diet is so important to our overall health.

By modifying our diet we can therefore protect the organs and systems involved in detoxifying and eliminating toxins and manipulate the endogenous systems that protect the body from the effects of toxins.

Broadly, the ME/CFS/fibromyalgia diet should comprise simple, healthy and unadulterated foods that nourish the body and provide the raw nutrients needed to ensure detoxification pathways are provided with the key co-factors to perform optimally.  ‘Junk’ foods, and foods that are processed and highly refined (such as white sugar and flour) should all be eliminated, as they offer little nutritional value and are most likely to trigger symptoms, as well as being high in artificial additives and chemicals.  Eating a good variety of foods that incorporate organic products will help to eliminate pesticides and other toxins, whilst increasing essential vitamins, minerals, proteins and important fats such as omega-3s.  It is also important to eat small portions at regular intervals to ensure that the body’s nutritional requirements are continuously met.

A very important element of the diet relates to the types of fat that we eat, which can have a significant effect on how we feel. Saturated fats and trans fats, found in animal products and processed foods, have a negative effect on our health. In contrast, polyunsaturated fats (omega-6 and omega-3) have a major positive effect on our health because they are converted in the body to powerful hormone-like substances called ‘eicosanoids’. It is these eicosanoids that regulate physiological functions, with major roles in cardiovascular health, inflammation, immunity and mood.

Consuming a diet that is balanced in these types of fat can help to ensure that our bodies work most efficiently, right down to the cellular level. Consuming too much omega-6 fatty acids, however, can have negative effects. Omega-6s are found in plant oils such as vegetable oil and corn oil, or non-organic meat (these animals are fed on grains rich in omega-6), and while omega-6 fats are essential for good health, too much can result in the over-production of eicosanoids, triggering pain-processing pathways and increasing production of inflammatory products, as well as over-stimulating the immune system.

In contrast, omega-3 fatty acids (specifically those found in oily fish) have the opposite effect.  Generally, Western diets are high in omega-6 and low in omega-3.  Increasing omega-3 fatty acids, especially one known as EPA (eicosapentaenoic acid) and found in oily fish, can help reduce the production of specific proteins which trigger pain and inflammation, at the same time stimulating the production of neurotransmitters – brain chemicals involved in electrical signalling, mood and sleep.

Unfortunately, however, it’s not as simple as merely increasing fish intake. The polluted state of our oceans means that the benefits of consuming fish, as a rich source of omega-3, may be offset by the presence of contaminants, such as methylmercury (MeHg), dioxins, polychlorinated biphenyls (PCBs), and should be limited to twice weekly.   Highly purified omega-3 oils such as Vegepa – a product of choice for many practitioners – offer a safe and convenient method of increasing EPA levels without the risk of consuming hazardous contaminants – a consequence which can be associated with eating too much fish.

Incorporating organic fruit and vegetable produce into the diet, where possible, will also help to ensure that contaminants such as pesticides, herbicides and fertilizers are avoided.  Organic produce is also much higher in important vitamins and minerals – micronutrients that are essential in every biochemical pathway in the body.  Organic meat is also lower in omega-6, higher in omega-3 and, importantly, is free of the steroids and hormones associated with intensive farming methods.

Sugar is also an important element in the ME/CFS/fibromyalgia diet, since the brain and body need energy supplied at an even rate in order to function optimally. Sudden peaks, followed by troughs, in blood sugar can result in low energy and fatigue. The glycaemic index (GI) ranks carbohydrates according to their effect on blood glucose levels and is a good guide to informing us which foods to include as part of a healthy diet, and indeed which foods to limit. White sugar and other refined (simple) carbohydrates have a high GI value, and can be found in processed white bread and white pasta, white rice and most convenience foods. Avoiding these simple carbohydrates and consuming foods with a low GI value, will help to keep blood sugar levels even, and help to stabilise mood too. Good low GI foods include high fibre cereals, whole grain products, beans, pulses, brown rice, whole wheat pasta, fruit and vegetables. Not only are these foods far better for stabilising our blood sugar levels, but these foods also tend to be high in fibre, as well as vitamins and minerals which are needed for good immune function and maintaining energy levels.

Choice of protein is also key when considering the FM diet, since it is needed by the body for growth and repair, and our requirements increase when our body is in a hypercatabolic state (such as fighting infection, during illness, inflammation etc). Ensuring that we get the right amount and type of protein is extremely important for people with M.E./CFS/fibromyalgia.  Amino acids, which are the building blocks of protein, are essential for our health; animal produce is actually the best source of protein as it contains all eight essential amino acids. But we shouldn’t forget that organic meat far outweighs non-organic for nutritional value.  It’s sensible to avoid eating too much red meat, and fish is an excellent source of protein, as well as omega-3 good fats. Fish is low in saturated fat and particularly rich in arginine and glutamine – amino acids known to have a regulatory role in both cardiovascular health and immunity. Remember, though – due to contamination issues, fish should be limited to twice weekly, and smaller, short-lived species tend to be safer to eat than larger, long-lived fish such as tuna.  Vegetarians, on the other hand, need to eat a good combination of cereals and pulses to ensure that all the essential amino acids are included in the diet.  A great plant source of all 8 essential amino acids is quinoa, which can be sprouted or treated in the same way as couscous or rice.

To summarise, these simple guidelines will help people with M.E./CFS/ fibromyalgia to gradually modify their diet towards greater well-being, and a body that is stronger and more resilient to the obstacles it faces with M.E./CFS/fibromyalgia:

Eat small meals and try to eat regularly throughout the day

Include:

• Complex carbohydrates (whole grain/wholemeal)
• Organic ‘5-a day’
• Fibre
• Healthy plant fats – replace vegetable oil/corn oil with olive oil
• Fish up to twice weekly – a good source of omega-3 fatty acids
• Omega-3 EPA purified Vegepa capsules
• Lean animal protein and vegetable protein
• 8 glasses of purified water/day

Avoid

• Junk food and fast food
• Trans fats
• Too much saturated fat
• Processed and refined food (white sugar, white flour, white pasta, white rice)
• Too much alcohol and caffeine
• Artificial ingredients, additives, and chemicals

As well as the above plan for eating well, avoiding stress is also important in managing symptoms.  Try to take regular exercise, outdoor walks, perhaps join a support group and spend time with close friends or family – sharing experiences and advice can all help.

The accumulation of mercury within the body can have profound long-term effects on the nervous system, and has been linked to a variety of conditions including Alzheimer’s disease where it is believed to play a part in nerve cell death. Lipoproteins, such as high density lipoprotein (HDL) and low density lipoprotein (LDL), are combinations of lipids (fat) and proteins that function to transport fat around via the blood, a function that is generally associated with cholesterol, and therefore cardiovascular health. However, approximately 1 in 7 people carry a gene that causes their body to produce a particular lipoprotein called apoE4, known to play a significant role in the development of Alzheimer’s disease. Those who inherit the apoE4 gene from one parent are three times more likely than average to develop Alzheimer’s disease, with those who inherit the gene from both parents having a tenfold risk of developing the disease (Donix et al, 2010). There are multiple hypotheses as to why those carrying the apoE4 gene are more likely to develop Alzheimer’s than those who carry the apoE3 or apoE2 genes; one such hypothesis regards the role that these lipoproteins play in mercury transport within the body, as mercury accumulation in the brain hasbeen linked to the progression of Alzheimer’s. Like all proteins, apolipoprotein is made of chains of amino acids. Cysteine is of particular relevance, as this amino acid contains sulphur, a member of a class of substances called ‘mercaptans,’ the Latin name for “mercury capture.” Because apoE2, the protective form of apoE, contains two cysteine amino acids, it is particularly efficient at removing mercury from the system. In contrast, apoE3 has only one cysteine, and apoE4 none, making it the most ineffective at removing excess mercury from the body.

Given that fish oils are thought to offer protection against neuronal death and therefore the onset of dementia, it seems that ingesting them in high doses may negate any beneficial therapeutic effects unless they are highly purified to ensure all heavy metals are removed. The growing omega-3 market means there are more products of differing qualities and strengths, and the processes used to isolate and purify oils can also differ quite significantly. It would certainly be advisable to choose fish oil supplements that have been purified under pharmaceutical grade conditions to ensure the product not only offers the best possible health benefits, but can also guarantee to be contaminant free.

Refrences

Albert I, Villeret G, Paris A, Verger P. Integrating variability in half-lives and dietary intakes to predict mercury concentration in hair. Regul Toxicol Pharmacol. 2010 Aug 27. [Epub ahead of print]

For many years, baby formula manufacturers have been fortifying and reformulating their products in an effort to produce variations that are ‘equal’ to that of natural breast milk. Formula milk now comes in 3 forms: ready-made, concentrate and powder. Each has its advantages and disadvantages and these generally condense down to convenience and cost. Baby formulas are derived from either cow’s milk or soybean, and are fortified with iron and Vitamin D (which can be lacking in breast milk) and contain a form of sugar called lactose (although lactose free varieties are available). Different brands will generally contain different levels of sugar and protein and some will be fortified with docosahexaenoic acid (DHA) and arachidonic acid (AA), long chain omega fatty acids that are vital for normal growth and development.

The ongoing debate associated with the benefits of breastfeeding over that of bottle feeding centres, in part, on observational findings that link breast milk to higher scores on cognitive tests. These scores are related to head size; it has therefore been hypothesised that breast milk mediates cognitive effects by promoting brain development, particularly that of white matter growth. The two most abundant long-chain polyunsaturated fatty acids in the brain are DHA and AA, where they have a functional and structural role in infant development. DHA is concentrated in the prefrontal cortex of the brain, an area important for association and short-term memory, and in some retinal cells. Concentrations of these fatty acids in human breast milk are relatively consistent during the first year of life, and studies have shown that breast-fed infants have a greater mean weight percentage of DHA and a greater proportion of DHA in their red blood cells and brain cortex than formula-fed infants. Furthermore, cortex DHA in breast-fed infants increases with age, probably due to the length of feeding.

However, human milk is also rich in EPA, another long chain omega-3 that, whilst present in white and gray matter at relatively low levels when compared with DHA, actually plays an important and significant role in myelination and brain function. EPA also plays an important immunomodulatory role by expressing potent virucidal activity, thereby reducing the risk of mother-to-child transmission of infections.

Given the importance that EPA plays in the structure and stabilisation of nerves and brain function as well as its predominant role in the immune system, it is surprising to me that formula milk development has not progressed to include this fatty acid. The rational for this is that EPA competes with AA and that this may cause displacement of AA within membranes. However the research behind individual physiological roles of each fatty acid has developed immensely in the last few years alone and given the presence of EPA within breast milk would suggest to me that there is a role in the development and welfare of the infant. The importance of DHA and AA for brain development is certainly acknowledged by milk formulation companies who have begun in the last few years to add these important fats to their milk products. The Expert Panel recommended that the maximum concentration of AA be 0.6% of total fatty acids, that the maximum concentration of DHA in preterm infant formulas be 0.35% of total fatty acids, and that the maximum concentration of EPA be 30% of the concentration of DHA.

However, commonly available formulas such as Cow & Gate and SMA only include AA and DHA and therefore the only source of EPA for the newborn baby is via its mother’s breast milk, so fully supporting the concept that breast really is best.

Le Huërou-Luron I, Blat S, Boudry G. (2010) Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects. Nutr Res Rev. 23:23-36.

Puri BK, Stannard JP. (2006). The essentiality of eicosapentaenoic acid in breast milk during human lactation: implications to formula milk manufacturers. AGRO FOOD IND HI TEC. 17:7-8.

What consumers really need to understand is that not all omega-3s are created equal, particularly when it comes to such things as heart health and brain function. In fact, it is well established that dietary omega-3 polyunsaturated fatty acids are involved in health promotion and disease prevention, but specifically and uniquely those omega-3s that are derived from fish. It is these omega-3s and these omega-3s only that are needed for proper growth and development in foetuses, infants and children, and for the regulation of immune function, inflammatory function and cardiovascular regulation at all ages.

The difficulty with adding marine derived omega-3s to everyday food items is that these long chain fatty acids are prone to rancidity when exposed to air, raising issues with both taste and the product’s shelf life. However, fortifying food items with the short chain omega-3 alpha-linolenic acid (ALA) derived from plants does not pose with the same problems, as ALA is significantly more stable than the long chain fatty acids eicosapentaenoic acid (EPA) and docosahexanoeic acid (DHA). However, whilst ALA is an omega-3 fatty acid, is does not offer the same health benefits as that of EPA or DHA, as it is simply a precursor to these longer chain fats. Indeed, consumed sources of ALA (such as flaxseeds and hemp seeds) must be physically modified before offering any significant health benefits, a process that is extremely inefficient in humans. In fact, the conversion of ALA to EPA and DHA is consistently low in most people; less than 8% of ALA is metabolised to EPA and only between 0.02% and 4% is metabolised to DHA. Although there is currently no Recommended Daily Allowance (RDA) for omega-3 fats in the UK, the government do suggest a daily intake of 450mg a day for adults and 200mg for children. However, these figures are specifically for long chain omega-3s. Consumers may still be under the false impression that they’re getting sufficient quantities of omega-3 simply by using a fortified spread or breads when the reality is that many fortified foods often contain fairly insignificant levels of omega-3, or are fortified with short chain ALA, and they would need to eat huge amounts to achieve any significant health benefits.

So if you are under the impression that you are boosting your intake of beneficial fats as you place your ‘omega-3 laced’ loaf of bread into your trolley, you may have to think again. Make sure you read the label as this will give a clear indication as to the source, and if it doesn’t state EPA or DHA then you might want to head for the fish counter. The alternative is, of course, to supplement your diet with a quality fish oil (I recommend omega 3 fish oil Vegepa) and, if you really are not a fish lover, try supplementing with echium oil; Echiomega may not be a fish oil but it’s certainly superior to other plant sources of omega-3.