E-EPA reduces inflammation in recurrent depression

Approximately 40–50% of people who experience depression suffer from more than one episode and are therefore categorised as experiencing the recurrent type of this disorder.   Identifying predictors for recurrence in these patients is important for a better understanding of its course and for providing opportunities to improve preventive interventions (1).

The link between diet and depression is one that is gaining considerable interest and it has recently been hypothesised that an unhealthy dietary pattern, one that is low in vegetables, fruits, whole grains and fish, and high in refined grains, fast food, meat and sugar, leads to chronic inflammation which, in turn, could raise the risk for depression and depressive disorders (2).  The products of an inflammatory response, known as cytokines, are produced by a specific type of dietary fat known as the omega−3 and omega-6 polyunsaturated fatty acids.  Importantly, cytokines produced by the omega-6 fatty acid AA are considered pro-inflammatory whilst those from omega-3 EPA are anti-inflammatory.   These polyunsaturated fats are present in our cell membranes where they have important structural and functional roles. The ratio of AA to EPA in the diet therefore influences the composition of cells which, in turn, influences the regulation of inflammation within the body and brain.

Depression is associated with low intake of fish (rich in omega-3), low EPA levels and an imbalance between omega−3 and omega-6 polyunsaturated fatty acids, leading to increased levels of pro-inflammatory products that are linked to many of the somatic symptoms linked to depression, such as gastrointestinal disturbances, complaints of chronic pain, fatigue, and/or other unexplained medical illness3.  Pro-inflammatory cytokines are also known to reduce the availability of the amino acid tryptophan – needed for the production of the mood-enhancing neurotransmitter, serotonin.  Serotonin production and lowered omega-3 fatty acid status are related to dysregulation of the serotonin pathway that is related to mood and cognitive dysfunction in depression.

Low levels of omega-3, and specifically deficiencies in EPA, are consistently observed in patients with depression and recurrent depression.  However, many supplementation studies have given rise to conflicting results and it appears that the efficacy of a ‘fish-oil’ intervention in treating depression is dictated by the EPA content of the oil.  Only oils containing pure EPA appear to offer consistent therapeutic effects on symptoms, with a 1g daily dose of EPA over a period of 3 months providing break-through benefits for depression sufferers (4,5,6).  Whilst there are several hypotheses about the success of pure EPA supplements over conventional oils – which has been shown to be as effective as Prozac in its therapeutic effects (7), – it is believed that just 2 capsules daily of E-EPA 90 (= 1g) may reduce depressive symptoms, in part via regulation of the key components of the inflammatory cascade that are known to affect the production of serotonin (8).

E-EPA 90 is the purest ethyl-EPA concentrate available without prescription, suitable for counteracting omega-3 deficiencies and restoring a healthy omega-6 to omega-3 ratio. This product provides the ideal loading dose for three months, prior to a ‘maintenance’ dose of  Vegepa E-EPA 70, which combines the benefits of 70% ethyl-EPA concentrate extracted from marine anchovy oil with GLA and triterpene antioxidants from organic evening primrose oil.  This unique formulation is designed to balance and maintain healthy omega-3 and omega-6 levels, making it the ideal follow-on treatment once a healthy omega-6 to omega-3 ratio has been restored by the therapeutic actions of E-EPA 90.

1.  Lok A, Assies J, Koeter MW, Bockting CL, Wouters LF, Mocking RJ, Schene AH. (2012) Sustained medically unexplained physical symptoms in euthymic patients with recurrent depression: predictive value for recurrence and associations with omega 3- and 6 fatty acids and 5-HTTLPR? J Affect Disord. 136:604-11.

2. Ekmekcioglu C. (2012) Are proinflammatory cytokines involved in an increased risk for depression by unhealthy diets? Med Hypotheses. 78:337-40.

3.  Hoffmire CABlock RCThevenet-Morrison Kvan Wijngaarden E. (2012) Associations between omega-3 poly-unsaturated fatty acids from fish consumption and severity of depressive symptoms: An analysis of the 2005-2008 National Health and Nutrition Examination Survey.  Prostaglandins Leukot Essent Fatty Acids. [Epub ahead of print]

4.  Martins JG, Bentsen H, Puri BK. (2012) Eicosapentaenoic acid appears to be the key omega-3 fatty acid component associated with efficacy in major depressive disorder: a critique of Bloch and Hannestad and updated meta-analysis. Mol Psychiatry. 2012 Apr

5.  Sublette ME, Ellis SP, Geant AL, Mann JJ. (2011) Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry. 72:1577-84.

6.  Martins JG. (2009) EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 28:525-42. Review.

7.  Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, Peet M. (2008) Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry. 42:192-8.

8.  Jazayeri S, Keshavarz SA, Tehrani-Doost M, Djalali M, Hosseini M, Amini H, Chamari M, Djazayery A. (2010) Effects of eicosapentaenoic acid and fluoxetine on plasma cortisol, serum interleukin-1beta and interleukin-6 concentrations in patients with major depressive disorder. Psychiatry Res. 178:112-5.


Echium seed oil superior to algae EPA/DHA for vegetarian heart health

Within the UK, dietary intakes of long chain omega-3 fatty acids are well below current recommended levels for optimal cardiovascular health.   Whilst adequate intake of the long chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acids (DHA) can be achieved by eating fatty fish at least 1–2 times per week, (equivalent to 250–500mg/d of EPA and DHA) the majority of us fail to achieve such intake.   The cardiovascular health properties of fish oil are attributed to its enrichment in EPA and DHA but for vegetarians and vegans, for whom marine sources of omega-3 are not an option, sourcing effective amounts of omega-3 can be challenging.

Many vegetarians and vegans turn to algae sources of preformed EPA and DHA;  when it comes to heart health, however, it seems that algae oil may not be the best option.  The majority of algae oils are high in DHA with little or no EPA content.  Several studies have recently shown that oils that are high in DHA can increase the amount of LDL or ‘bad’ cholesterol within our blood and that, as such, pure EPA oils may fair significantly better when attempting to lower both triglyceride and cholesterol levels (Bays et al, 2011). When LDL cholesterol levels are too high, the LDL lipoprotein can stick to the lining of the blood vessels and in time can lead to atherosclerosis – the development of sticky plaques that can build up and obstruct the normal blood flow   In contrast, another type of cholesterol HDL lipoprotein ’scours’ the walls of blood vessels, removing excess cholesterol.  What is becoming clear is that whilst EPA and DHA lower triglyceride levels (high triglycerides can lead to type II diabetes and raise the risk of heart disease), only EPA increases good HDL cholesterol and lowers bad LDL cholesterol.  Ideally, vegetarians and vegans who are seeking to supplement with omega-3 for optimal heart health should therefore seek oils containing EPA but which are free from DHA.  Flaxseed oil contains significant amounts of alpha-linolenic acid (ALA), the precursor to EPA.  Our ability to modify and convert ALA to EPA, however, is significantly restricted with less than 8% of ALA metabolised to EPA.

In contrast, echium seed oil, unlike flaxseed or algae oil has the potential to significantly reduce plasma triglyceride and cholesterol levels, and the risk of atherosclerosis (Forrest et al, 2011). Echium oil, derived from the seeds of Echium plantagineum, contains 12–14% of total fatty acids as stearidonic acid (SDA) the immediate product of ALA and the direct precursor to EPA.  Recent findings suggest that even a low daily intake of SDA, easily achievable through dietary means, has the potential to raise tissue membrane levels of EPA (Krul et al, 2011).

Echium seed oil is, not surprisingly, generating a lot of interest as a ‘fish-oil alternative’ for vegetarians and vegans.  Offering known benefits for health and the cardiovascular system, echium seed oil, with its unique fatty acid composition, offers a myriad of health benefits (Whelan et al, 2011; Chilton et al, 2008) making it a superior choice of omega-3 for those who choose not to consume fish or fish oils.

1. Bays HE, Ballantyne CM, Kastelein JJ, Isaacsohn JL, Braeckman RA, Soni PN. Eicosapentaenoic acid ethyl ester (AMR101) therapy in patients with very high triglyceride levels (from the Multi-center, plAcebo-controlled, Randomized, double-blINd, 12-week study with an open-label Extension [MARINE] trial). Am J Cardiol 2011;108(5):682-90.

2. Forrest LM, Boudyguina E, Wilson MD, Parks JS. Echium oil reduces atherosclerosis in apoB100-only LDLrKO mice. Atherosclerosis 2011.

3. Krul ES, Lemke SL, Mukherjea R, Taylor ML, Goldstein DA, Su H, et al. Effects of duration of treatment and dosage of eicosapentaenoic acid and stearidonic acid on red blood cell eicosapentaenoic acid content. Prostaglandins Leukot Essent Fatty Acids 2011.

4. Whelan J. Dietary stearidonic acid is a long chain (n-3) polyunsaturated fatty acid with potential health benefits. J Nutr 2009;139(1):5-10.

5. Chilton FH, Rudel LL, Parks JS, Arm JP, Seeds MC. Mechanisms by which botanical lipids affect inflammatory disorders. Am J Clin Nutr 2008;87(2):498S-503S.




Avoiding depression; is it really possible?

Whilst many forms of depression can be easily treated in primary care, many people chose not to undertake, or are certainly reluctant to begin, the journey that takes them on this route of self-help. Whilst there is a high prevalence of mental health problems and disorders that develop in adolescence and early adulthood, pharmaceutical intervention is not necessarily the key to all treatments. In fact diet, as well as alternative therapies, can be key players in recovery. Most foods, if not all, bring about chemical reactions in the body and have an impact on how we feel. Some make us feel energetic, alert and happy, yet others can make us fatigued, irritable, angry and even depressed. Indeed, food can directly influence our mood, and our diet is even more fundamental when we’re feeling low.

Long term fish consumption is one way to directly affect a person’s tendency to develop depression due to the mood-stabilising effects of omega-3 fatty acids, particularly the long-chain omega-3 EPA (eicosapentaenoic acid). Similarly, antioxidants also have a role in mood, and it is likely a combination of these factors which affects risk. Furthermore, those people whose diets include a high intake of whole foods, fruit, vegetables, whole grains and fish, are less likely to report depression symptoms. Those people who are more susceptible to depression generally haver a higher intake of processed meat, sweets, chocolate, fried foods, refined grains and dairy than people who don’t suffer from depression. Possible explanations for this outcome include the high levels of folate in cruciferous and leafy vegetables, beans and pulses, in line with studies which link low levels of folate with altered brain chemistry. The link between diet and depression using data from observational and clinical studies is giving a clear message: we need to change our dietary patterns.

It is important to consume as many vitamins and minerals as possible, in order to create the foundations for a healthy body and mind. Try eating at least the recommended 5 portions of fruit and vegetables per day, but make sure you eat a variety of them. The omega-3 fatty acid EPA, which occurs naturally in oily fish such as salmon, anchovies, mackerel and tuna, is crucial for brain health and function. EPA moderates mood in two ways: firstly, it regulates the mood-influencing hormones serotonin and dopamine; secondly, it addresses the inflammatory element of depression by switching off inflammation pathways, as well as EPA itself being converted to anti-inflammatory substances. It is also responsible for a range of other health benefits, from combating heart disease to improving the appearance of your skin, nails and hair. With the government recommendation not to exceed 3 portions of fish weekly, it is not advisable to obtain high a dosage of EPA by way of eating fish. Most people eat just a fifth of the amount recommended for good health. The fact of the matter is that most people do not consume enough oily fish to reap the benefits of fatty acids, so supplementation with fish oils is a more viable option for most. In choosing a fish oil supplement, be sure to avoid liver oils. As well as being less sustainable, oils sourced from larger species of fish tend also to be less clean. A good way to overcome this is to take a highly purified fish oil supplement which has undergone a filtration process of molecular distillation to eliminate heavy metals, PCBs and dioxins. Quite as important as eating the right type of food is the process of eliminating the ‘bad’ foods; where possible, reduce intake of caffeine, alcohol and foods high in sugar and ‘bad’ fats, because they de-stabilise blood sugar levels and create mood slumps, which only aggravate symptoms of depression. Unfortunately, many comfort foods fall into this category, but try to resist the temptation as it is likely your mood will worsen soon after.

There is so much information on the internet on self-help and advice for people with depression that it can be quite overwhelming! That’s why I’ve formulated a nice, easy to read, info pack that people can download, read online or print. It covers depression facts and various treatments, including conventional treatments, dietary changes that are known to help, as well as alternative treatments to pharmaceutical drugs. You can download a Depression Pack by clicking here.

Going back to the 50s; why we need to increase our children’s omega-3 intake to secure their long term health.

The message that we need to ‘increase our omega-3 intake’ is one that most of us are aware of. We regularly hear how fish oils, or EPA, can help protect our heart and reduce cardiovascular disease, offer hope to dementia patients, or in some cases even propose the possibility of a future treatment for cancer. These are however, related to conditions that are well established and, in some cases, take years to develop; rather a case of ‘shutting the barn door after the horse has bolted’. Indeed, as adults we focus on repair, but by introducing omega-3 into the diets of our children before these conditions develop and take hold, we can offer them better protection against the risk of developing many chronic diseases. Given that intakes of polyunsaturated fatty acids, especially long chain omega-3, in children and adolescents do not currently meet nutrient intake goals recommended by the World Heath Organisation (WHO) for prevention of chronic diseases (WHO/FAO, 2003), we should be taking more responsibility for our children’s health by ensuring their needs are met. One Vegepa Chewable daily would provide the necessary amount of long chain omega-3 to help improve cardiovascular and immune function, and control inflammation whilst also supporting brain health.

Also known as polyunsaturated fatty acids, omega-3 and omega-6 fatty acids play a crucial role in brain function as well as normal growth and development. Both families of fatty acids are considered essential, as they must be consumed in the diet. Infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are known to be at risk for developing vision and nerve problems. Furthermore, if children continuously fail to consume adequate amounts of omega-3 in early years and on through childhood, they stand a significant chance of developing a severe deficiency, with symptoms that include: fatigue, constant infections (coughs/colds) poor memory, attention difficulties, cognitive difficulties, dry skin, frequent urination and difficulty in sleeping, amongst others. In fact, the increasing incidence in a variety of childhood-related neurodevelopmental disorders, including ADHD, autism, dyslexia and dypraxia, are being directly associated with omega-3 status and are indicative of a massive deficiency problem. Research shows that increasing omega-3 fatty acids can help reduce many of these symptoms, as well as the symptoms associated with neurodevelopmental disorders, by normalising fatty acid status.

The concept of supplementing with EPA as a fish oil is far from new. In fact, the idea originated with the introduction of cod liver oil into children’s diets over a hundred years ago. Our knowledge of omega-3, and the importance of the individual fatty acids EPA and DHA has advanced dramatically in this time, with purified EPA acknowledged as far superior in health benefits to those of the unpurified cod liver oil taken previously.
Cod liver oil was first used by the fishing communities of Scotland, Iceland, Norway and Greenland to protect them from the intense cold. During the 1890s, it began to be used to treat malnourished children, with daily doses also advised to relieve rheumatism, aching muscles and stiff joints in adults. During World War II, and through the 1950s, children were routinely given cod liver oil to supplement what was considered to be a meagre diet. However, as rationing ceased, concerns were raised about the high content of vitamins A and D (toxic in high doses) , diets improved and supplementation stopped.
The post-war period saw major changes in our eating habits, with the increasing availability of processed and refined foods, the introduction of concentrates, trans fats, artificial sweeteners, colourants and preservatives, all aimed at improving taste, shelf life and affordability. However, what were considered to be advances in food technology methods have now progressively impacted on the type and quality of the fat consumed, with a severe impact on omega-3 status. Whilst deficiency can occur through the increased consumption of omega-6 (upsetting the balance within the body), the confusion for the consumer about the type and different sources of omega-3 means that many adults are under the misconception that they, and their children, are consuming adequate amounts. Many children do not eat fish regularly, and for those who do, cod (fish and chips/fish fingers) and tinned tuna, whilst common favourites, do not provide as much omega-3 as oily fish such as salmon or sardines. Furthermore, there is often confusion regarding products that claim to be fortified with omega-3. These products, such as milk and bread are not fortified with long-chain omega-3 fatty acids, but with omega-3 derived from seeds and grains, and do not offer the same benefits as EPA. Indeed, not all omega-3 are born equally.

WHO/FAO (2003). Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series No. 916. World Health Organization: Geneva.

Ritalin in the headlines again.

Yet another Ritalin horror story hits the headlines! It seems that every week I can open a newspaper, or magazine, or turn on my PC, and be faced with another story, or article, or news headline, in which I am informed of the the increasing trend in incidence of children with neurodevelopmental disorders (autism, dyslexia, ADHD and dyspraxia). Given the repeated message of the side effects experienced by these children outweighing the benefits, the rise in the number of children routinely taking pharmaceutical drugs, like Ritalin, is both concerning and alarming. Why is it that these pharmaceutical offerings continue to be dished out, and why are parents not informed of alternative treatments that are not only are proven to work, but also come without side effects?

There has been a twelve-fold increase in autism over the last 30 years, and it would be easy to relate this to changes in food processing methods and the corresponding impact on our children’s diets. An association does not, however, necessarily imply cause, and care must be taken when making such statements. Indeed, whilst more research is certainly needed to confirm the dietary link to such conditions, some scientists seem almost reluctant to admit that such a concept is even plausible. For much of its history, autism has been considered a discrete psychological disorder, managed largely with behavioural intervention techniques. However, many studies have outlined, with great interest, its co-morbidity with other neurodevelopmental disorders, such as ADHD, dyslexia and dyspraxia, where pharmaceutical intervention is a given part of the treatment. A common feature existing in children with neurodevelopment disorders is the specific differences and/or deficiencies in the type of fats (phospholipids) that make up their nerve cell membranes. It has been suggested, and shown, in many well structured trials, that supplementation with specific fatty acids can not only rectify deficiencies, but also be used as a safe alternative to drugs such as Ritalin.

Phospholipids are a major component of every cell membrane, including nerves. Made up of a stabilising ‘polar head’ coupled with fatty molecules, the phospholipid content, and in particular the specific type of phospholipid within nerve cell membranes, dictates many cell functions. A dysregulation in phospholipid
metabolism, as has been suggested in neurodevelopmental disorders, would have a profound influence on brain processes, and may account for many of the symptoms. Phospholipids are constantly being synthesised and broken down, and whilst the enzymes responsible for this normal turnover are under genetic control, the key essential fatty acids of neuronal phospholipids must come from the diet.The type of fat consumed, therefore, can have a profound effect on neurone function, and consequently brain function.

The two major polyunsaturated fats with the brain are the omega-6 AA and omega-3 DHA, which account for around 20% of the dry brain weight. DHA is known to be involved in cell signalling and has an important structural role in the brain, whilst AA is crucial for brain growth. EPA, another major omega-3, is present in most cell membranes, though it has little structural role within brain neurones. However, unlike DHA, EPA is considered vital for the regulation of brain function and not only converts to DHA, but also protects membrane DHA from breakdown through influencing the phospholipase enzymes that act like scissors and are involved in the release of DHA from membranes. Overactive phospholipase enzymes can release DHA unnecessarily and therefore sufficient EPA must be present in the diet, not only to protect detrimental loss of DHA from neurones but also to ensure that the brain functions normally.

The dysregulation in phospholipid metabolism believed to occur in children with neurodevelopmental disorders is thought to be two-fold, firstly, through an increased turnover of the phospholipid membrane, and secondly through a reduced capacity to replenish the phospholipid membrane. Either would result in disruption of the membrane’s normal structure, a combination would have more severe consequences. As humans have a low capacity to synthesise long-chain fatty acids, they must rely on dietary sources such as fish, or fish oils, to meet demands. Low dietary intake of long-chain omega-3 will exacerbate the condition and, understandably, supplementation with long-chain omega-3 will be beneficial. There have been numerous trials investigating the use of ‘fish oils’ in neurodevelopmental disorders and, whilst not all results have been favourable, it appears that the lack of clear and decisive results have been due to the choice of oil used, the dose, and the trial length. For example, given that fatty acid supplementation may take up to 3 months to substantially influence fatty acid deficiencies, it may not be appropriate to look for behavioural changes immediately upon commencing supplementation. Dosage is also key; it appears that for a supplement to have both neuroprotective and neuroregulatory actions, the amount of actual long-chain omega-3 needs to be higher than present in most common generic oils, and that the ratio of EPA to DHA needs to be higher than is typical of these oils. Using pure ethyl-EPA at a dose of 0.5-1.0g, for a period of at least three months is currently the most favoured and proven supplementation regime for treating neurodevelopmental disorders: a regime that not only offers other health benefits, but is easy to implement and with no unpleasant side effects. It’s time to open our eyes to the possibility that pharmaceutical drugs are not always the answer and that, as parents, we have the right to choose the best and safest treatment to help our children.

Controlling cholesterol: why statins may not be the answer.

Statins, also known as HMG-CoA reductase inhibitors, work by preventing the pathway to cholesterol production and are generally prescribed for individuals who are at high risk of heart attack or stroke. It seems that, even in healthy people, these drugs can cut the risk of heart attack by around 30%. Good news, you’d think, considering more than six million adults in the UK currently use them to help control cholesterol levels.

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.

Obesity: don’t feed the problem

The National Obesity Forum (NOF) has announced that National Obesity Week (NOW) kicks off on the 23rd January 2011. Originally established by medical practitioners in May 2000, NOF aims to raise awareness of the growing health impact that being overweight or obese is having on patients and the National Health Service (NHS). Given that obesity is linked to a myriad of health conditions, including metabolic syndrome and type II diabetes, educating individuals in the area of prevention is of key interest to practitioners.

Obesity is a growing problem in the UK, and the most recent estimates for England suggest that some 8.5% of 6 year olds and 15% of 15 year olds are obese. Obese children are more likely to become obese adults and consequently will suffer from a range of chronic diseases in adult life. Whilst changes in patterns of physical activity and the adoption of a more sedentary lifestyle are likely to be important factors behind the growing incidence of obesity, food choice is particularly relevant. Certainly, the development of modern food processing and refining methods means that we now eat very differently from how we did around 50 years ago. Processed food, which is made up of heavily refined ingredients and likely to have a higher ratio of calories to other essential nutrients than unprocessed foods, is now commonplace in our diets. However, our love of junk food, which is high in calories, fat, salt and sugar, and low in any real nutritional value, is having a devastating impact on our long term health. An adult’s choice in food is determined by factors including what is available (for example, seasonal vegetables), what is accessible (how close the shops are), and what is affordable (possibly the greatest influence in some cases). However, a child’s food choice is primarily influenced by what is offered to them; in the early years of life, parents and close relatives are the primary influences on a child’s diet. As children reach nursery and primary school, the variety of foods offered to them will change and expand. For this reason, we should encourage our children to develop an appetite for ‘good’ food that offers them the best nutritional value in the first years of life. Certainly, whilst food habits are not rigid during a person’s lifetime, a base for healthy food habits can be created in early childhood. Any parent is probably aware that children often appear fussy, unwilling to try new foods and new flavours. However, early experience of a particular food is a major determinant in developing a child’s food acceptance pattern, with a child’s food habits influenced by their parents’ food habits and choices. Making children aware of ‘good’ foods and ‘bad’ foods and how these impact on health can be incorporated into meal planning and preparation. Eating together, and eating the same food, is an important element of relationships and the relationship that we have with food. We know that the choices made when we are young can impact on our health as adults; teaching our children about the kind of food we eat is incredibly beneficial in encouraging them to choose the right kinds of food to give them the best chance of enjoying good health later in life. Why not start now?

Nutrition and the Toxic Patient

cropped-IMG_7188-1.jpgThe general population is increasingly being exposed to a variety of “toxic” substances and, as a result, our environmentally polluted world is causing a myriad of health problems.   Whilst we generally understand the concept of toxins that come from external sources- for example, car fumes, tobacco smoke, drugs, dental fillings, environmental pollution, etc., we are less aware of the endogenous toxins that we encounter daily.  These toxins include those generated from viral and bacterial sources within the body, or toxins that are created by the body itself due to its own metabolism.

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


  • 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


  • 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.

World Mental Health Day: how tea and talk may be more beneficial than you think!

A ‘nice cup of tea’ has been, for decades, associated with healing; for making things better or just as an excuse to sit down and talk. In fact, ‘tea and talk’ is the theme for this year’s awareness of World Mental Health Day, an international event which is annually held on 10th October. The event aims to bring general awareness to, and about, mental health issues, and this year’s focus surrounds the association between mental health disorders and chronic illness.

If you are participating in an organised tea and talk event this year, you might want to choose your tea wisely. Whilst ‘milk and two sugars’ may well be a common favourite way of drinking your brew, swapping to green tea this Sunday may help the way forward to feeling a little more cheery! Green tea has been, for a long time reported to have various beneficial effects (eg, anti-stress response and anti-inflammatory effects) on human health. It is these functions that are thought, in part to be associated with the development and progression of depressive symptoms. Regular consumption of green tea not only has benefits in reducing stress and therefore and depressive symptoms (Niu et al, 2009), but may even help reduce cognitive impairment by helping to protect from neuronal damage (Kuriyama, et al, 2009). Green tea is a favourite with populations such as the Japanese. Probably best known for their high intake of omega-3 from fish and other seafoods, alongside low intake of red meat, diet and lifestyle within the Japanese population plays a major role in contributing towards their low incidence of depression, as well as chronic diseases.

However, if the green type is not your cup of tea, and you prefer to stick to something more familiar like PG tips, then worry not. Green tea extract, probably more noted for its use in slimming products is widely available in supplement form. As is often the case, supplements can provide a useful alternative when the real deal just simply isn’t on the menu.

Niu K, Hozawa A, Kuriyama S, Ebihara S, Guo H, Nakaya N, Ohmori-Matsuda K, Takahashi H, Masamune Y, Asada M, Sasaki S, Arai H, Awata S, Nagatomi R, Tsuji I. (2009) Green tea consumption is associated with depressive symptoms in the elderly. Am J Clin Nutr. 90:1615-22.

Kuriyama S, Hozawa A, Ohmori K, Shimazu T, Matsui T, Ebihara S, Awata S, Nagatomi R, Arai H, Tsuji I. (2006) Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project 1. Am J Clin Nutr. 83:355-61.

Mercury, genes and the link with Alzheimer’s disease

cropped-IMG_7188-1.jpgMethyl mercury, a pollutant produced by various industrial activities, is a potent neurotoxin that has now caused serious contamination issues within our oceans. As a fat soluble molecule, methyl mercury enters the food chain and accumulates in the flesh of the fish that then may end up in our supermarkets. Consuming larger, longer living fish on a regular basis is now known to pose a serious health hazard, especially for children and pregnant women who are consequently advised to limit (or even avoid) the intake of some species such as fresh tuna or marlin.

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.


Dórea JG. Environmental contaminants as biomarkers of fish intake: a case for hair mercury concentrations. Eur J Clin Nutr. 2010 Sep 1. [Epub ahead of print]

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]

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