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]

Indeed, several studies have highlighted that abnormal cell membrane fatty acid composition is related to risk and incidence of major depression, and that supplementation with omega-3, and specifically with EPA, appears to normalize fatty acid levels and reduce the symptoms associated with this condition. However different studies can report different findings, and whilst several studies may appear to give varied and often conflicting results, performing a meta-analysis gives an indication of general findings by ‘pooling’ the data from several studies to give an overall picture and therefore adding clarity to a concept.

A recent meta-analysis of 14 studies comparing the levels of polyunsaturated fatty acids between depressive patients and control subjects found that omega-3 polyunsaturated fatty acid levels were significantly lower in those individuals suffering from depression (Lin et al, 2010). Because the primary sources of these long-chain omega-3 fats are fish and shellfish, it is not surprising that those individuals with the highest consumption are the least likely to suffer from depression (Suominen-Taipale et al, 2010). Treating people who suffer with depression using fish oils is therefore a viable method for alleviating symptoms whilst restoring omega-3 levels. Given that low levels of omega-3 are also associated with increased risk of cardiovascular disease, as well as several other chronic disorders and conditions, the overall health benefits of raising omega-3 levels reach out much further as a nutritional approach to improving health.

Encouragingly, improvements in depressive symptoms can be seen as quickly as 8 weeks after commencing treatment. Indeed, a group of Montreal researchers have recently confirmed that taking omega 3 fish oil supplements, at doses higher than that normally consumed in an average diet, is superior to placebo in treating symptoms and that results can be observed within a two month time period (Lespérance et al, 2010). The results of this particular study also confirm EPA to be the predominant active ingredient responsible for the benefits of omega-3.

A meta-analysis of 28 trials investigating as to whether either EPA or docosahexanoeic acid (DHA) or both are responsible for the reported benefits showed that those trials in which EPA was the predominant or only fatty acid used, gave the most significant findings. Furthermore, it was suggested that the effects of 1g daily of EPA could be enhanced and prolonged by the addition of gamma-linolenic acid (GLA), an omega-6 fatty acid found in evening primrose oil (Martins 2009). Given that 1 in 4 individuals will suffer from depression at some point in their life, it is encouraging to know that there is a safe and natural way not only to treat depression but also as a method that could reduce the possibility of developing the condition in the first place.

Suominen-Taipale AL, Partonen T, Turunen AW, Männistö S, Jula A, Verkasalo PK.Fish consumption and omega-3 polyunsaturated Fatty acids in relation to depressive episodes: a cross-sectional analysis. PLoS One. 2010 May 7;5:e10530.

I’m giving a talk in a couple of weeks at the Bristol Eco Veggie Fayre on plant based sources of Essential Fatty Acids, focusing mainly on echium oil. If you want to find out more about how echium seed oil compares with other oils such as flax and hemp, check out this new website which has some really good comparisons www.vegetarian-omega3.com. It would be great to see some of you at the Veggie fayre; my talk is being held in the Veggie Nutritional Room on Sunday 30th at 2pm. It’s a fun day out for all the family, with lots of good veggie food and free samples of vegetarian friendly products to take home!

The human brain is a complex organ that controls our senses, our movements, receives information, analyses information, and stores this information as memories. Dementia, simply put, means ‘deprived of the mind’ and, contrary to what many of us consider an acceptable part of growing old, memory loss and dementia are not a natural part of the ageing process. Scientists are now suggesting that the omega-3 EPA, found in fish oil, can help. Like any organ, the brain needs nurturing, and if we provide our brain with the correct nutrients then we can help to ensure the function of our brain remains at its most efficient.

For those of you interested in finding out more about how EPA helps preventing memory loss, offering help for Alzheimer’s sufferers, the full article is available here: EPA fish oil and its role in Alzheimer’s disease risk

I’ve recently published an article on Omega 3s and fatty liver disease and the study led by Dr Gail Masterton and I would be very interested to hear your feed back!

So why is it that pharmaceutical drugs, with such well documented findings in terms of their negative health effects, continue to be prescribed? It certainly appears that they are offered as a ‘quick fix’ regardless of the long term consequences. Originally discovered in the 1950s, anti-psychotics were found to block receptors in the dopamine pathway and used quite successfully in the treatment of schizophrenia and bi-polar disorder before being introduced as treatment for dementia where their actions serve as nothing other than “chemical restraints”. It seems shameful that pharmaceutical companies can benefit in such situations whilst nutraceutical companies struggle to get clearance for health claims from the Medicines and Healthcare products Regulatory Agency (MHRA). This government agency is responsible for ensuring that medicines and medical devices work and are acceptably safe, and consistently rejects claims for many well-known safe and commonly used nutritional products.

The benefits of fish oil and the role of long-chain fatty acids in brain chemistry and in dementia are generally accepted but not endorsed. Ironically the side effects of consuming fish oils include only relatively minor complications (gastrointestinal upset, nausea, headaches) when compared with the potentially very serious sides effects of some pharmaceutical products. Given that long-chain fatty acids are involved in the dopamine pathway influencing dopamine concentration, number of vesicles and D2 receptors, and have been beneficial in studies where the dopamine pathway is known to be involved such as schizophrenia and attention deficit hyperactivity disorder (ADHD), would it not be prudent to suggest a role of fatty acids as a regular or add-on treatment in individuals with dementia? The recent positive findings of the role of eicosapentaenoic acid EPA in reducing cerebral atrophy in Huntington’s disease is certainly indicative that non-pharmaceutical products need to be investigated and that their role in dementia, not only in the treatment but in the prevention of the condition, is sadly underrated at the expense of the patient.

Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu LM, Jacoby R; DART-AD investigators. (2009) The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol. 2009 8:151-7.

Puri BK, Bydder GM, Manku MS, Clarke A, Waldman AD, Beckmann CF. (2008) Reduction in cerebral atrophy associated with ethyl-eicosapentaenoic acid treatment in patients with Huntington’s disease. J Int Med Res. 36:896-905

The Glycemic Index

The brain needs energy supplied at an even rate in order to function optimally. Sudden peaks in blood sugar will adversely affect behaviour, anxiety, depression, and fatigue, so it is particularly important for people with depression to keep their blood glucose levels even. Although commonly known for its diabetes and weight loss benefits, the glycemic index (most commonly referred to as GI index), which ranks carbohydrates according to their effect on blood glucose levels, is a good guide to informing us which foods to include as part of a healthy diet, and indeed which foods to limit.

While all carbohydrate foods are eventually broken down into glucose, quick-release simple carbohydrates (such as high sugar foods, glucose and fructose) are broken down more quickly into glucose than complex carbohydrates (such as wholemeal grains), releasing glucose rapidly into the bloodstream. Repeated ‘spikes’ of glucose can decrease insulin sensitivity, increasing the risk of type 2 diabetes, as well as promoting oxidative stress in the veins and arteries – a cause of coronary heart disease. After the highs come the energy-sapping blood sugar lows and, frequently, strong urges to reach for another sugary carbohydrate snack to perk us up. Indeed individuals who suffer from atypical depression (a subtype of depression) often overeat and report an almost irresistible craving for carbohydrates.

White sugar and other refined carbohydrates, such as those found in processed white bread and white pasta, white rice and most convenience foods, supply few nutrients to the body but use up important B vitamins, which are essential for our nervous and immune systems, as well as healthy digestion. Avoiding refined foods and sugar, as well as consuming foods with a low GI value, will help to keep blood sugar levels even. Perhaps a more accurate reference guide to prevent blood sugar spikes is the Glycemic Load(GL) ranking system, which is based on a food’s GI value and average portion size. For example, whilst an apple is not low GI, it has a low GL and will barely influence blood sugar levels.

Micronutrient deficiencies

It is extemely common for depression sufferers to have low levels of B vitamins and essential minerals such as zinc, selenium and magnesium. These water-soluble vitamins and minerals must be consumed daily to avoid depletion. Deficiency can, in turn, hinder the body’s ability to utilise specific omega-3 fatty acids, which are known to lift our mood by elevating serotonin and regulating levels of this important neurotransmitter.

EPA, a long-chain omega-3 fatty acid found in fish oil, not only influences serotonin and dopamine in the brain, but is also converted to powerful anti-inlammatories via a series of enzyme-mediated steps. It is these enzymes that rely on the presence of B vitamins and essential minerals in order to function, without which the body’s production of natural anti-inflammatories is minimal, and can even result in the production of inflammatory substances. Combining a good nutritional vitamin and mineral supplement with 1 gram EPA daily (or 4 capsules Vegepa) can help to balance serotonin levels and alleviate the symptoms of depression.

Carbohydrate cravings are also linked with low levels of chromium, which helps to regulate blood sugar levels and reduce cravings. This is because for blood sugar to provide energy, it must be escorted into each of our cells where the energy conversion takes place. Insulin then ‘unlocks’ the cell, allowing glucose to pass in. But there is a missing link. Insulin doesn’t work properly unless biologically active chromium is present as a cofactor (much like a catalyst).

With many modern food processing methods, up to 80% of chromium is lost – particularly with whole wheat and raw sugar when they are processed to white flour and refined sugar. If we regularly opt for these refined foods over their healthy wholegrain relatives, chromium levels within the body can easily become depleted.

Whilst it is likely a low priority during episodes of low mood to concentrate on our eating habits, following a few general guidelines can help to restore healthy brain chemistry and minimise sugar-induced mood swings.

- Avoid processed foods.

- Keep red meat to a minimum or eat organic (red meat is high in inflammatory omega-6 unless animals are fed on natural grass).

- Drink plenty of water, as the brain needs to be hydrated to function at its best.

– Don’t forget your ‘five a day’. Make sure you get plenty of vitamins and minerals by eating a wide variety of fresh fruit and vegetables. If you eat them raw they’ll supply even more nutrients.

– Eat two portions of oily fish weekly to top up on omega-3, containing the natural antidepressant EPA, or take 2 capsules of Vegepa morning and night.

If you found this article interesting, you might like to read more about anti depression foods.

Our understanding of the significant health benefits associated with fish oil supplementation has come a long, long way since scientists’ original discovery, back in the 1950s, that cod liver oil was a rich source of fatty acids. Researchers have since then progressed far beyond the basic understanding that fish oil is a promoter of general good health, and moved onto the next phase of innovation – investigating which particular elements within this oil are biologically active and whether a physical deficiency in this bioactive element results in some degree of physical deterioration. Indeed, fish oil contains two major fatty acids EPA and DHA and it is only really in recent years that these important fatty acids have been investigated individually rather than dumping them in the same boat with the generic label of omega-3.

DHA is the most abundant omega-3 fatty acid in cell membranes, present in all organs and most abundant in the brain and retina. In contrast, EPA is present in minute quantities. It could be easily assumed that DHA is the more dominant of the two fatty acids and put all of our focus here. However whilst DHA has a primarily structural role, EPA plays an important functional role. In actual fact whist EPA and DHA are both considered to be important regulators of immunity, platelet aggregation and inflammation, their influencing bi-products arise from very different pathways and it is therefore not surprising that their mechanism of action will differ.

So what is my problem with the latest headline? Well what’s very misleading with this is the loose use of the word “fish”. The study didn’t even have a vague whiff of fish about it but was conducted using a DHA supplement and a dummy placebo. The importance of this is that the information put forward to eager ears gives the impression that all that mackerel eating is a waste of time. But hear me out. This study took but one of the major fatty acids associated with fish oil, showed no benefit, but happily used the word fish to summarise the findings. If we recall, fish oil contains two important fatty acids, DHA and EPA. It is becoming increasingly clear that the marked differences between the effects of EPA and DHA mean that we can no longer generalise the effects of ‘fish oil’ as a reservoir of omega-3. EPA not only plays a major role in cell signalling but also contributes to the compaction and stabilisation of neurones. Indeed previous studies have shown that high plasma EPA concentration may decrease the risk of dementia and that EPA can actually reduce the atrophy associated with the shrinking brain. I’m not objecting to their findings that DHA is not the fatty acid which plays a role in dementia, rather it’s the fact that the message implies that it we should now question or even rule out the protective role of fish altogether. But when we dig deeper and unravel the scientific evidence and put that on our plates to eat, we see that things are a little more convoluted than we initially thought – well, if you read the recent headlines, that is. Just because the bigwigs are now telling us that DHA won’t save our brains (this week at least) it doesn’t mean that we should now disregard our efforts to include fish as part of our diets in our bid to prevent age-related mental decline. I, for one, shall be continuing to get my twice weekly portions in and I hope you will too. Do remember that once again, it’s not black or white, to fish or not to fish.

So far so good, until I open up the paper to page two where I am met with the words “although side effects are rare, they can include muscle pain and damage to the liver and kidneys.” I guess this is what infuriates me. With the majority of pharmaceuticals there will be the downside list of side effects or contraindications that steal some of the glamour from a treatment programme. Take NSAIDs, for example; these are common over-the-counter anti-inflammatory drugs, like Ibubrofen.

Whilst one of the most common over-the-counter drugs and used by millions, NSAIDs are associated with several side effects, of which many are probably not known by the common user. Whilst the frequency of side effects varies among NSAIDs, the most common side effects are nausea, vomiting, diarrhoea, constipation, rash, dizziness and headache (interesting that we often take them when we have a headache!). NSAIDs may also cause fluid retention, leading to oedema. The most serious side effects are kidney failure, liver failure, ulcers, an increased risk of heart attack and prolonged bleeding after an injury or surgery.

So why is it that if there is a natural alternative which we can take for both of these drugs and without the associated side effects, that we are not advised? Let me speak firstly about cholesterol. In the 1970s Danish researchers discovered that in spite of their high-cholesterol, high-fat, diet Greenland Eskimos had an astonishingly low incidence of cardiovascular disease (as well as arthritis and other chronic inflammatory diseases). When analysing blood samples it was discovered that they had low levels of LDL (bad cholesterol) and low levels of VLDL (triglyceride), but high levels of HDL (good cholesterol). It appeared that their high intake of omega-3 was responsible for this low risk of heart disease. Since this research emerged, much focus has been centred on the role of omega-3 fatty acids and, more recently, specifically the role of EPA in lowering cholesterol levels. EPA reduces cholesterol production by inhibiting the activity of another enzyme called acyl-CoA but without the side effects associated with statins. EPA also acts as an anti-inflammatory in a similar mechanism to that of NSAIDs, but again without the side effects. So my message today is to boost your EPA levels on a long-term basis and you may well lower the possibilities of having to resort to pharmaceuticals with all sorts of side effects.

Increase your fish intake and adopt a more Eskimo-like diet! For those who don’t like fish, you can opt for a high-EPA supplement. Purified fish oils actually are a useful alternative to oily fish consumption and, unlike most oily fish, are contamination-free.