What can essential fatty acids do for you?
By Nutritional Therapist Linda Lazarides

In the early 1990s Professor Peter Behan from the Glasgow-based Institute of Neurological Sciences 
carried out a double-blind trial on 63 patients with post-viral fatigue syndrome, to investigate the effects 
of administering four grams a day of the EFA supplement Efamol Marine, compared with an inert dummy 
product. After three months, 85 per cent of the patients on Efamol Marine reported feeling better, compared 
with only 17 per cent of the control patients(i).
But measuring the benefits of supplementation is not always straightforward, and in 1999 another three-month 
study carried out at the University of Sheffield found no significant clinical differences between M.E. patients 
on Efamol Marine compared with a dummy treatment(ii).

What are EFAs?

Essential fatty acids are molecules found in tiny amounts in oils. They come in two distinct 'families'. Nuts, 
sunflower seeds and sesame seeds are good sources of the omega-6 family, while soya beans, flax seeds 
and oily fish (sardines, salmon etc.) are good sources of the omega-3 family. These fatty acids are called 
'essential' because the human body cannot make them. It is essential to obtain them from your diet. Your 
body then metabolises EFAs to make prostaglandins ­ hormone-like regulators of many body functions.
There are far larger amounts of EFAs in nuts and flax oil than you could possibly pack into a small capsule, 
so why give Efamol Marine rather than simple dietary advice? In fact, the special qualities of this product (and 
similar ones) lie not in supplying EFAs but in supplying partly metabolised EFAs known as EPA and GLA (see 
sidebar). Many people with M.E. seem to lack a vital enzyme called D-6-D which allows the body to use EFAs. 
Giving them a pre-metabolised product can partly bypass this enzyme. The resulting health benefits could help 
to prevent a whole range of symptoms. In Professor Behan's study the patients experienced reduced fatigue, 
muscle pain, dizziness and depression, and their concentration improved.

Energy and your mitochondria

Some researchers believe that EFAs can destroy viruses and that viruses accordingly target and destroy the 
D-6-D enzyme to protect themselves. But there is a simpler explanation for the lack of D-6-D in M.E./CFS, 
and this involves the role of the mineral magnesium.
Take a look at Figure 1 on the next page. There is a growing consensus among expert biochemists and cell 
biologists that the primary pathological process behind this illness is 'mitochondrial dysfunction'. Your 
mitochondria are the units within your cells which produce the energy needed for most body processes. 
The name which biochemists give to this energy is ATP, and the description given to processes which require 
energy is 'ATP-driven'.
Many nutrients cannot just passively diffuse from your intestines into your blood and cells. They use ATP-driven
processes to push them across cell membranes. Magnesium in particular needs a big push from ATP to get it 
into your cells where it carries out its vital work, helping to make the electrical charges which operate your nerve 
cells, heart, brain and muscles.Without magnesium, the D-6-D enzyme cannot function. But according to nutritional 
testing experts, magnesium deficiency is common in patients with M.E./CFS(iii). 
When you take partly-metabolised EFA supplements, you are conserving the nutrients normally required to 
metabolise EFAs. This is of major importance if you have a deficiency of any of these nutrients. Magnesium 
conservation alone could account for many benefits derived from taking partly-metabolised EFA supplements, 
in particular the reported reduction in muscle pain and tension; these are classic magnesium deficiency 
symptoms. Your mitochondria also use magnesium to make ATP, so by taking partly-metabolised EFAs you 
could theoretically gain more energy too.

Why not just take magnesium?

Logically, it would seem simpler just to take magnesium supplements to help make D-6-D, to metabolise your 
EFAs and support your mitochondria. The problem is, without the ability to make sufficient ATP you can still 
have a severe magnesium deficiency even if you take a supplement every day.Remember that reduced ATP 
levels mean a reduced ability to absorb and assimilate this nutrient. If you can only absorb 10%, for instance, 
of the magnesium you consume, you would need to take 3,000 mg magnesium per day to get the RDA of 300 mg. 
It is virtually impossible to get 3,000 mg magnesium a day from food. There is also a limit to how much you can 
take as oral supplements, since excessive magnesium causes diarrhoea and unbalances the absorption of other 
nutrients.
Research into M.E. nutrition and biochemistry is painfully scanty, but since the late 1990s a number of scientific 
papers have been pointing to a new discovery which suggests that EPA and GLA supplements could have a 
hitherto unrecognised therapeutic value in the treatment of M.E./CFS. This discovery is the role of cytokines.

Understanding cytokines

Cytokines are chemicals made by the white cells of the immune system. They are produced during inflammation, 
and elevated amounts of them have been found in some patients with M.E., and certain other chronic diseases, 
e.g.forms of arthritis. The long-term presence of excess cytokines is very damaging, and many scientific antennae 
are now tuned into cytokines as the factor which prevents mitochondria from repairing themselves(iv).
Major stimulants of excess cytokine production certainly include viruses and other infections, but once the infection 
has healed, cytokine production should cease. In M.E., arthritis and other chronic diseases for some reason it 
appears that it does not. Candidiasis and other forms of dysbiosis (bacterial overgrowth of the small intestine) are 
of course types of low-grade infection. These plus inflammatory changes encouraged by food intolerances, 
pollutants, dehydration etc. may be able to keep promoting cytokine production indefinitely.

Fish oil ­ leading the fight against cytokines
 
Cytokine promoters must be addressed by means of dietary changes, but researchers have also identified 
supplements with natural anti-inflammatory properties that can fight cytokines. Fish oil is the most widely-researched 
product. Other cytokine-reducing supplements are bromelain, GLA, nettle extract and ginger extractv. If the vicious 
circle of cytokine production can be stopped, this may give the mitochondria the opportunity to repair themselves. 
There is now some new evidence to support this approach. In April 2004 Dr Basant Puri at Hammersmith Hospital 
published the results of a fish oil trial on M.E./CFS patients, and the results look very encouraging(vi).
If you are seriously ill with M.E., I have just one caution. Not all fish oils are the same. Barry Sears, author of The 
Omega Rx Zone, is an author whom I very much respect. Crude fish oil and cod liver oil should be considered the 
sewer of the sea, says Sears. Anything that is water-insoluble, such as PCBs, DDT and organic mercury compounds, 
will be found in it. He recommends only using products whose level of PCBs is guaranteed to be less than 10 parts 
per billion (ppb). And, he says, some products contain oils extracted from krill or tropical fish. These are relatively 
rich in arachidonic acid, which will undo the benefits of consuming the oil(vii).
Sears recommends only highly purified fish oil which he calls 'pharmaceutical grade'. His book contains some really 
interesting case reports, including a rapid reversal of an advanced case of Alzheimer's disease. Dr Basant Puri also 
confirms that since his recent trial was published, he has obtained even better clinical results using a pharmaceutical 
grade product against CFS(viii).


Partly-metabolised EFA products

Gamma-linolenic acid (GLA) is a partly metabolised form of EFAs from theomega-6 family. It is found in the oils of 
evening primrose, blackcurrant and borage seeds.

Eicosapentaenoic acid (EPA) is a partly metabolised form of EFAs from the omega-3 family, and is found in oil from 
the flesh (not the liver) of fish such as salmon, pilchards, sardines, herrings and mackerel. GLA and EPA are found 
together in the combination products Efamol Marine, and in Biocare's Omegaplex (see page opposite ­ Ed).

Pharmaceutical-grade fish oil is available by mail order from the Nutri Centre, who offer a 25% discount to AfME 
members. Tel. 0207 436 5122 or visit www.nutricentre.com. Brand names include VegEPA (used by Dr Basant 
Puri and also incorporating virgin evening primrose oil ­ see www.vegepa.com), Eskimo 3 made by Nutri Ltd, 
and Arctic Omega. Overdosing with any supplement could unbalance your body chemistry, so always follow 
the manufacturer's directions and ideally supplement under expert supervision.

Prescriptions: If your local chemist stocks any of these products, you could try asking your GP for a prescription, 
but you may well get a refusal as local health authorities will make the GP pay if they do not believe the prescription 
is scientifically justified.


Glossary

ATP: Adenosine triphosphate, the name given to raw energy made by the mitochondria 

D-6-D (Delta-6-Desaturase): The enzyme which metabolises EFAs in the body.This enzyme cannot work without 
sufficient magnesium, zinc and vitamin B6

Dysbiosis: Overgrowth of harmful bacteria or fungi (e.g. Candida) in the small intestine

Candidiasis: A type of fungal dysbiosis

Mitochondria: The part of the cell which makes ATP (energy) 

Why do we need EFAs?

The primary role of EFAs is to be turned into prostaglandins which help to regulate our water balance, blood 
pressure, blood clotting and inflammatory processes. Symptoms of severe EFA deficiency include itchy dry 
skin and eyes, excessive thirst and skin rashes. Milder deficiencies may go unnoticed.

Testing for deficiencies
As low magnesium levels are common in M.E. and in turn cause poor EFA metabolism, essential fatty acid 
blood levels would probably also show up as low in many M.E. patients. For this reason tests are of limited 
value in my view. However, if patients did want to get nutritional status checks done privately, Biolab in London 
offer a blood-testing postal kit which you can take to your GP then return to them by special delivery the same 
day for analysis. A test for red blood cell magnesium costs £11 while the EFA panel is £48 and results must be 
sent to your doctor. To find out more, visit www.biolab.co.uk or tel. 020 7636 5959.


InterAction medical advisor Dr Kelly Morris comments:

The theory presented is fascinating, although without good epidemiology research, I cannot share Linda Lazarides' 
certainty that immune activation, mitochondrial dysfunction, or EFA and magnesium deficiencies are common to 
many people with CFS/M.E. But as different lines of evidence converge, I am optimistic that these and other recurring 
themes represent final common pathways of the different triggers for chronic fatigue and related symptoms.
The pattern of dysfunction described here may be particularly relevant to people with an infectious or immunological 
trigger (e.g. vaccination), as these people are most likely to have chronic immune activation. This may explain the 
discrepancy in findings between studies, since Prof Behan's group studied people with post-viral fatigue whereas 
researchers at Sheffield studied CFS, which could lead to large differences between studies in the number of people 
with chronic immune activation. Also, Prof Behan's study found 85% of people had deficient EFAs while the Sheffield 
study did not find any difference between patients and healthy participants.
Together with the research by Dr Puri, these studies suggest that people with an infectious or immune trigger, 
particularly those with proven EFA deficiency, might benefit from a 3-month trial of supplements. The only prescribable 
UK preparations are Omocor and Maxepa, licensed for an indication other than EFA deficiency. Testing for red cell 
EFAs is not widely available though I would guess that a sympathetic doctor is likely to take more notice of a lab 
test indicating deficiency, especially when backed up by the reports of these three trials.


About the author
Linda Lazarides is a nutritional health expert and author of seven books.Her latest: Treat Yourself with Nutritional 
Therapy (ISBN 0953804631) has an informative section on M.E./CFS, plus over 100 recipes for meals to help reduce 
allergies and cytokines. To find out more, visit her website at www.health-diets.net.If you decide to try taking 
pharmaceutical-grade fish oil, Linda would be very interested in a report from you on the results. Write to her 
c/o AfME at Box No. 4041


References:
i    Behan PO et al. Effect of high doses of essential fatty acids on the
postviral fatigue syndrome. Acta Neurol Scand 1990; 82:209-216
ii    Warren G, McKendrick M, Peet M. The role of essential fatty acids in
chronic fatigue syndrome. Acta Neurol Scand 1999 Feb;99 2):112-6
iii    Howard JM et al. Magnesium and chronic fatigue syndrome. Lancet,
August 15 1992;340:426
iv    Patarca R. Cytokines and chronic fatigue syndrome. Ann N Y Acad Sci.
2001 Mar;933: 185-200
v    Arthritis. www.lef.org/protocols/prtcl-013.shtml
vi    Puri BK. The use of eicosapentaenoic acid in the treatment of chronic
fatigue syndrome.Prostaglandins Leukot Essent Fatty Acids. 2004
Apr;70(4):399-401
vii    The Omega Rx Zone by Barry Sears PhD (Regan Books, 2003)
viii     Personal communication, 19/4/2004