Telomere length — What is a telomere and why do I care how long mine are?

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Hello everyone:

 

As promised a few months ago, here is the article on the importance of telomere length in health and aging. I had mentioned that while two decades ago most of the emphasis in natural health was on “boosting the immune system,” now there is more concern about free radicals, cell membrane stability, and telomere length.

 

So – “What’s a telomere and why do I care how long mine is?” are the questions I’ll be answering. There’s a lot of research in this area, lot with rats and mice, and fair amount with humans, but the field is rather new and that means there remain as many questions as answers. I did the research yesterday, and now today I’ll try to sort it into understandable, plain English answers.

 

A telomere is an end cap on each chromosome. They are actually made up of compressed genetic material, but do not replicate when the cell divides. In fact, for the most part, each time a cell divides, the telomere becomes a little bit shorter. They’ve been compared to the plastic tips on shoelaces.  When enough of the plastic tip on your shoelaces wears away, the shoelace begins to unravel. Likewise, when the telomere shortens too much, the chromosomes start to stick to one another, and in fact that cell can no longer divide. Under the microscope, our chromosomes look like this picture, and the bright end caps of highly compressed genetic base pairs (telomeres) are very clearly seen in this picture.

 

Image

 

Cell division is how we repair our organs. The skin cells, the surface tissue of the eye, the cells that line the digestive tract and the bone marrow cells are all particularly rapidly dividing cells. We need them to be able to continue to divide in order to keep those tissues repaired and functioning well.

 

Decades ago a researcher, Dr. Hayflick, noticed that in cell cultures, the cells can only divide so many times, and then they become senescent, or actually die.  A cell culture could go through an average of 50 population doublings, and then the culture would become senescent. This failure to be able to continue to divide apparently has a great deal to do with the quality of the telomeres. Because cells with shortened telomere’s also have DNA that sticks to itself, forming mutations, there is a strong correlation with telomere’s wearing out and the development of cancer.

 

Now that more human studies have been done, primarily looking at the length of the telomeres of white blood cells (leukocytes), we know that there are large differences in telomere length among human individuals, even at birth. They then shorten in the first few years after birth, remain stable through much of later childhood and adolescence, but then begin to shorten dramatically after adolescence.

 

There is a compound called telomerase, which in technical terms is a ribonucleoprotein complex. Telomerase is able to elongate existing telomeres. This substance is very active embryonically, but is suppressed just a few weeks after birth. Skin cells, sperm producing cells, and lymphocytes retain high levels of telomerase, and therefore are able to maintain telomere length well. Curiously, cancer cells whether in the body or in cell culture, produce huge levels of telomerase and thus effectively make themselves immortal, able to continue to divide indefinitely.

 

Stem cells as a rule also retain high telomerase activity, so research in this area involves replacement of senescent cells with deficient telomeres with the telomerase containing stem cells. There is, of course, a concern that keeping telomerase high through some artificial means throughout the body might actually cause runaway growth like a cancer, but so far in what limited experimentation has been done, just increasing telomerase has not produced an increased amount of cancer.

 

Leukocyte telomere length is pretty easy to measure, and while it is only an experimental tool right now, we may find it being used as a regular lab test in the next decade or so.  This is all in the early stages of scientific investigation, but a review article from the NIH states, “A link between telomere length and mortality has been established.”

 

Telomeres are measured in numbers of “base pairs” which is the genetic code.  The exact sequence of these base pairs is known, and is the same in everyone. A healthy young person will have a telomere length of 8,000 base pairs, dropping to more like 3,000 base pairs with aging, and in very elderly people, as low as 1500 base pairs. 

 

While telomeres do not shorten in heart muscle, because it does not divide, people with severe cardiovascular disease with plaque lined arteries have very short telomeres in the rest of their tissues, even in the bone marrow derived stem cells!

 

Other conditions associated with shortening of telomeres are diabetes, and prediabetes with insulin resistance, obesity and smoking, alcoholism, as well as any chronic inflammatory condition. We fight infection with inflammation, so chronic, long-term infection can really shorten telomeres. Chronic infection is also blamed for inflaming the lining cells of the arteries, and causing them to be blocked with plaque.  The cells found in arteriosclerotic plaque have extremely foreshortened telomeres, and many of them are fully senescent, incapable of doing any repair. 

 

A few other curious facts I discovered include that in people with congestive heart failure (and remember, the heart tissue telomeres don’t themselves grow shorter) have extremely short telomeres in the rest of their tissues.

 

High blood pressure is associated with shortened telomeres.

 

People who are born with short telomeres get clinically significant coronary artery and vascular systemic disease and die at a young age. Even the offspring of parents who have coronary artery disease will start off life with shorter telomeres.

 

On the other hand, older fathers tend to have offspring with longer telomeres. Even their grandchildren will have longer than average telomeres. Women, who on the whole life longer than men, have longer telomeres on average than do men.

 

Now, lest you think it is so simple as long telomeres means long life, it is not necessarily so. Mice have very long telomeres, longer than humans, but far shorter life spans. Statistics on likelihood of death in the elderly bear out some factor of telomere length being involved, but probably less than half, with estimates of 37% of the increased mortality of aging being related to telomere length.

 

Nonetheless, despite the unknowns here, there are some takeaway facts.  One is that smoking and alcohol consumption drastically reduce telomere length, which definitely means a shortened life span. These are controllable factors. Prediabetes and obesity are also treatable with proper diet, exercise, and certain specific supplements to aid the metabolism. Chronic infections, especially chronic gum disease has already been associated with increased risk of arteriosclerosis, and no doubt plays a role in telomere shortening. That, too, is treatable. And then, there is our old familiar refrain of “oxidative stress” that we talked about in the newsletter on hydrogen peroxide intravenous treatments.

 

Reducing oxidative stress means avoiding free radicals in things like fried foods, especially in heated polyunsaturated fats. Cigarette smoke is loaded with free radicals. Some of these we can avoid, and for the rest, eating a diet with lots of antioxidants and taking antioxidant vitamins and minerals are important.

 

As you can see, this is fascinating material, and there is much more to learn. Attention is being turned to increased telomerase, perhaps with adult stem cells, or other methods, to protect, or actually restore, telomeres. I predict a great deal of “longevity medicine” or “anti-aging” medicine is going to revolve around this topic of telomeres.

 

Feel free to let me know about topics you might like to explore. There is a recently published retake on an old 1970’s article recently published in British Journal of Medicine that has some interesting re-interpretations about polyunsaturated fats. I could certainly do a newsletter on that. I also want to discuss the much lesser known forms of Vitamin E called tocotrienols, and their association to nonalcoholic fatty liver disease. Also, years ago I published a newsletter on the ORAC values and how they are determined, and which foods have the highest ORAC scores – a high ORAC score means highly anti-oxidant with much protection from free radicals from eating those foods. A repeat review of that information might be timely.

 

Let me know if you have special interests or special questions that I can address. And thank you, so many of you, who have written me to express your appreciation of these newsletters.

 

Alice

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Boosting the Immune System — It’s Not Just that Simple

Hello Everybody:
A couple months ago, in connection with the newsletter on intravenous hydrogen peroxide, I mentioned that years ago emphasis on health was all placed on simply “boosting the immune system.” Now we look at other factors, one of which I mentioned was telomere length.

In this newsletter I’d like to focus on some of the complexities of our immune system. It’s a much more complicated thing than what was known about it when I was in medical school, and much more complicated than I will even try to delve into here. Just “boosting the immune system” is not entirely an accurate way to achieve health. So let’s look at some simple facts.

You know that if you want to avoid infection, you need a strong immune system. It has been proposed for years that fending off cancer also requires a strong immune system, although currently there is a lot of new research showing the situation is MUCH more complicated than simply a “strong immune system.” If you are curious, check into information on the trophoblastic theory of cancer. There are cancers in which the NK (natural killer) cells, one of the main cancer defense cell types, are actually routinely elevated and seem to have no effect on the progression of the cancer. Breast cancer is one of these, where NK cells are frequently elevated. Clearly just boosting the immune system to get more NK cells is not the whole answer.

The immune system and cancer is too complicated for this newsletter, so let’s look at some other facts. What is it that goes haywire in hay fever? It’s the immune system – being over responsive to things that shouldn’t require such a strong response. What is it that goes haywire in auto-immune disease? It’s the immune system, reacting to the body’s own tissues. What is it that is deadly in bird flu? This one may surprise you. It’s the immune system – a much, much too strong inflammatory arm of the immune system destroys not just the virus but also the lung tissue.

The immune system has several branches. The most basic branch is the T-cell immune system as opposed to the B-cell immune system. B cells are responsible for making antibodies to foreign substances, the immunoglobulins. There are four different immunoglobulins that can be studied with laboratory testing. IgG complexes with germs, making them a better target for the attacks of the T-cells. This is the immune globulin that can mistakenly decide certain food proteins are actually germs, and complex with the food fragments in the blood stream, or in the lining of the gut itself, confusing the heck out of the rest of the immune system, and causing a huge variety of health adverse symptoms.

IgM is a very active antibody created by the B cells, and is very good at killing germs. It will rise in the blood stream when there is an acute infection.

IgE is actually supposed to react to and protect against parasites, and will rise enormously when there is parasitic infection. A misguided B cell in the face of pollen and other allergens will create a huge amount of IgE, and create hay fever and the classic allergy symptoms. The amount of IgE goes up in the blood stream of allergic people.

IgA concentrates in saliva, tears, and the mucus that lines the gut, and respiratory system, guarding the gateways to the body with its antibody producing ability.

The other type of white blood cell involved in the immune system is the T-cells, which mature in the thymus. The T-cells react in various ways to the information presented to them by the B-cells, which is what lets them distinguish between what is foreign and worth attacking, and what should be left alone as neutral. This is where the discussion of the immune system gets thoroughly complex. I’m going to keep it relatively simple. The T cells are told by the B-cells what to attack or not, and then they organize a very complex response. That response can be simplified into the Th-1 type of cells, which produce a great deal of inflammation, and produce pro-inflammatory chemicals (including peroxide) to blast the dickens out of the invader.

If the Th-1, pro-inflammatory response gets out of hand, it can produce enormous amounts of damage to our own surrounding cells and tissues. That’s what happens in bird flu. The virus congregates in the lungs and then the Th-1 defense becomes so vicious that it destroys the lung tissue to get at the virus. Sounds like a very bad time in a war-zone where there is a high death toll amongst innocent civilians.

As things should be, after a while of the Th-1 system getting a handle on the “war” then the Th-2 system activates. Our Th-2 immune system is anti-inflammatory. It more or less “puts out the fire” that the Th-1 system left behind. It is still not entirely clear how our innate immune system switches itself over to the Th-2 portion, but it is obviously very important that it do so. For anyone interested in far more detail on balancing the Th-1 and Th2 systems, a presentation from Dr. Cheney, who is a premier researcher on CFIDS and FMS, is available (transcribed from lecture material) at http://www.anapsid.org/cnd/diagnosis/cheneyis.html.

The key word here, as you see, is balance. We don’t want to just “boost the immune system,” we need to have it in balance, with the B-cells feeding the correct information to the T-cells, and the T-cells acting in proper coordination and with Th-1 and Th-2 systems in balance. We don’t want rogue T-cells misreading “self” as if it were an enemy. In a well balanced immune system there is actually a mechanism whereby T cells are intermittently tested in their reactivity to “self” and those which over-react are invited to undergo apoptosis (cell death).

The obvious next question is: What can we do to help balance the immune system?
Modest activity and exercise will increase the Th-2 system. An extremely hard workout actually diminishes the entire immune system for about two hours, which does not make hard workouts wrong, just makes it important to stay away from infected people, wash your hands, and take precautions against infection for about two hours. I remember having done extremely hard exercise in the past, only to be wiped out by some severe bronchial infection the next day. Now I understand what was going on better, and might have been able to take some prevention measures, even to the point of dosing myself with nano-particle silver immediately after, or even before, the strenuous exercise.

Of course diet matters, with alcohol and sugar deactivating the immune system overall for hours after ingestion. Mercury, as a toxic heavy metal, depletes glutathione which actually moves toward a Th-2 dominance (out of balance) making infection more highly possible. Some of the drugs which reduce the pro-inflammatory (Th-1) part of the immune system also increase the risk of infection.

On the other hand, plant sterols, melatonin, progesterone, selenium and zinc promote balance. Omega 3 fatty acids, which are anti-inflammatory, have been tested and their anti-inflammatory mechanism does not involve Th1/Th-2 balance. Probiotics are highly helpful. Bifida in particular, and Lactobacillus to a lesser degree, plus many others that are still being researched actually release into the body small peptide molecules that “talk” to our immune system. These are called second messenger molecules, and while these are very complex and incompletely understood, the overall effect is a balancing of the immune system. When the beneficial bacteria in the gut are disturbed through antibiotic use, stress or any of a huge variety of factors, it is hard for the immune system to be healthy.

Herbal medicine to balance immunity is extremely complex, and most herbs have multiple actions. Astragalus for instance is known as an immune booster, and it is also directly anti-viral. It is known in Traditional Chinese Medicine as making some colds worse, which may be because it actually reduces Th-2 dominance. Therefore, the pro-inflammatory Th-1 activity may make the symptoms of some colds worse. In treating cancer, Th-2 dominance is not a good thing, so astragalus is being tested in cancer treatment. You can see, I hope, just from that paragraph about astragalus how very complicated herbal medicine can be. I still love herbal medicine, however, because most of the time the herbs contain a multiple bunch of active substances that give the herb an overall benefit in a particular arena. Astragalus definitely has an overall benefit in the immune system arena.

Of course, we know about Echinacea, cat’s claw, garlic, ginger, and turmeric. Each of these has its immune system benefits and each is as complex as astragalus in its actions.

Of great interest and new to me is the herb Tinospora cordifolia. It seems to have very few side effects or dangers, so it is one to try, even before all the information is collected. It is a standard in Ayurvedic medicine, where it is used to boost the immune system’s ability to fight disease, malaria and even cancer, but it also reduces hay fever and allergy symptoms, alleviates arthritis, and helps auto-immune diabetes. Tests show that it lowers eosinophils (associated with allergy and parasitic disease), and neutrophils (the white blood cells that fight infection), reduces the incidence of sepsis in certain specifically studied situations. The NK cell response is elevated, as is B-cell activity, and T-cell activity. It is, at the same time, a potent antioxidant. This herb has all the features so far of the perfect immune system balancer. It is known as Guduchi in Ayurvedic medicine. It is available from several sources. I would tend to go with Life Extension Foundation’s product, or with a well established Ayurvedic supply house. I have not found a lot about dose recommendations. To read the complete Life Extension Foundation article on this herb, go to http://www.lef.org and look for the May 2013 issue of their magazine. You do not have to be a member to access this. The article has the words “Boost Immune Function” contained within the title, so you will have no trouble recognizing it.

Well, that’s all for this time. The next email should contain more information about the yoga and tai chi classes, and then next month I’ll tackle the very interesting issue of telomere length and longevity.

Until then, be well.

Alice R. Laule, M.D.

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Is it bergamot, or Bergamot?

On a recent walk through the Missouri woods, I came upon a clump of wild bergamot (Monarda fistulosa) also known as bee balm. This is an herb that is both calming and anti-depressant, so knowing that, I ate a few leaves of it. I also took a photo and posted it on the facebook site for my clinic, Harrison Optimal Health. I wrote a little article on its medicinal uses. I also knew that it was a useful aromatherapy oil, and read that the leaves of it were used to flavor Earl Grey tea. After posting about the herb, I also checked my aromatherapy book, where there was a pen and ink drawing of the bee balm plant next to the section on Bergamot, but in the text it said that the essential oil was made from a citrus fruit. I also checked a package of Earl Grey tea which listed the flavoring agent as Bergamot, a citrus fruit. That’s when I realized I was confused. The clarification below is the result of some further research I did, assisted by Shelli Hart, from the clinic.

Wild bergamot is the term for the lovely clump of plants I found in Missouri. It is a member of the mint family, and has many medicinal uses. The Iroquois used the leaves for a beverage, and the Ojibwe used chewed bergamot leaves wadded into their nostrils as a cure for headaches. The leaves are also known to be useful for colds, and bronchial congestion. The Flambeau Ojibwe actually did process the leaves into a volatile oil, which they used for catarrh and bronchial congestion. In more modern times, the herb is best known as an overall aid to digestion, helping with flatulence, bloating, nausea and vomiting, and colic. It improves digestion and can ease abdominal pain. The occurence of wild bergamot is widespread, from Canada, into the south, as far west as Arizona. It is found in wooded areas, prairies, and upland thickets. There is a red variety, Monarda didyma, that is used as a decorative plant in landscaping and domestic gardens. If you buy bee balm from a plant nursery, it is likely to be this species.

The essential oil that is known as Bergamot is made from the citrus, the Bergamot orange, which is grown in southern Italy and France. It is grown not for eating, but for the flavor of the juice, and/or rind. In Antalya southern Turkey it is used as marmalade. There are fewer medicinal uses for the orange (which is yellow in color, not as sour as lemon but more bitter than grapefruit). It may have some cholesterol lowering properties, and has been used for malaria. Primarily it is the essential oil that has medicinal uses, being used for relaxation and uplifting of the mood, building of confidence. The essential oil also has a long history of use for the skin, especially oily skin. That’s about the only overlap in their usages, the wild bergamot plant being used by one native American group as a treatment for acne.

Since I consider a large part of my job as a doctor to be teaching and educating, whenever I get confused, and then get myself unconfused through research, I like to share it. I hope you find this helpful, or at least, interesting.

Alice

Below — Bergamot orange photo

Bergamot orange

This photo looks so reddish, I think it is likely Monard didyma

Wild bergamot

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Retirement

Retirement by the way did not turn out as anticipated, though I did change focus on 7/1/11, as planned. I am now Medical Director of the clinic which I opened in 2001 as part of Future Visions Foundation, Inc., a nonprofit dedicated to educating people about staying healthy, and staying away from doctors. I had planned to close the clinic, but fate provided me with the means to keep it going. At this point, we have an excellent medically trained naturopathic doctor, an chiropractor with vast experience who didn’t want to fully retire, so works with us part time now. Our team also includes a massage therapist who is very intuitive, and dedicated, and does several types of massage, including Fibro-Ease for fibromyalgia pain. Now fully certified, we also have on board a certified medical support hypnotherapist who can provide help for chronic pain, PTSD, and a nearly endless list of issues for which he has tools to support a person’s healing. At the end of September, or somewhere near about that time we will be joined by a Doctor of Oriental medicine who will be a licensed accupuncturist, and trained in Chinese medical herbs. This is what I dreamed of doing years ago, but could not do while I was the only one seeing patients, exhausted at the end of each day.

I have had very little time for writing, but that will work out eventually. I have opened an art gallery (with a skateboard shop in the back) where I teach Argentine Tango, and also make hand made jewelry. This gallery is on the square, in downtown Harrison, Arkansas.

I will start sharing some of my thoughts, and some of my monthly newsletters here, as I still have an enormous love of information about health. I write a lot about nutrition and biochemical health, but truly have a deep interest in mental, spiritual, emotional, relationship and planet health as well. All are intertwined.

Alice Laule, M.D.

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Hello Everyone: Here is the promised newsletter on dosages of essential omega 3 fatty acids. Actually there is another set of essential fatty acids called omega 6 fatty acids, but I won’t have room to discuss them in this newsletter. Most of the vegetable oils are omega 6 fatty acids, and we usually get enough of them, though often now in the wrong form (hydrogenated, or otherwise tortured into unnatural forms by the food industry). So for now – back to the omega 3 fatty acids. These are the fish oils, and seeds and nuts, such as flax seeds and walnuts which contain the omega 3’s. One must eat quite a lot of cold water ocean fish, seeds and nuts to get enough. Speculation on the diets of healthy populations living near the ocean in the past proposes that those folks probably had about 5 times the omega 6’s as omega 3’s. Now in the US with solid fats like shortening and margarine in heavy use, and questionably informed consumers pushing for a move to vegetable oils instead of lard and animal fats for restaurant frying, the estimate is the average US citizen eats about 30 times the omega 6 fatty acid as omega 3. That’s way too much omega 6. The need for more omega 3 FA’s is known to the health-conscious public, so most people I see as patients are taking an omega 3 supplement. The largest mistake by far that I see is – these people are not taking enough to do any good. Omega 3 FA’s are not a micro- nutrient, where all a person needs is a few milligrams, or even just a few micrograms. The minimum requirement for just mere prevention of heart and vascular problems, cell membrane health, and anti-inflammatory balancing is 1000 mg. a day. Since most capsules of fish oil contain 1000 mg. of fish oil, most people believe they are getting 1000 mg. of omega 3’s from one capsule. I invite you to look at the detailed back label of your fish oil. You will probably see that of that 1000 mg. of fish oil 180 mg. of it is EPA and 120 mg of it is DHA. Those are the only part that is omega 3 oils – the rest is just, well, oil. So each capsule you are taking has only 300 mg of actual omega 3 in it. If you are taking Carlsen’s, or Nordic Naturals, or ProOmega ( or others) these are high potency fish oils, often molecularly distilled to remove some of the fishy taste, often batch tested for mercury (which is somewhat of a danger), and each one of these capsules will contain 400mg. or more of omega 3’s, and be labeled as such. In other words, if you are taking a standard fish oil capsule, your minimum dosage to get any effective amount is 4 capsules daily. If you are using one of the high potency, high quality ones (which I strongly recommend) then you can get by with 3 a day. As to the danger of mercury in the fish oil supplements, a study was done 7-8 years ago in which a large number of brands of fish oil were gleaned off health food store and supermarket shelves, and tested for mercury. The content was quite low in all but the very cheapest of the fish oils. I do still suggest the higher potency, distilled ones because some people find the appropriate dose of fish oil absolutely intolerable because of the after taste that it can have. It does help to take the fish oil, and then eat quite a bit of food afterwards – it seems to help somewhat with the repeating and repeating of the fishy taste., but taking a molecularly distilled brand solves the problem for almost everyone. So far we’ve talked only about preventive dosages, though I think pre-existing arthritis responds quite well to this dose range. (Or at least, mine did.) If someone has glaucoma, and wants a lowering of the pressure from omega 3’s, then it takes 2000 mg., or some articles say up to 6,000 mg. of omega 3 a day. There are articles recommending up to 8,000 mg. a day for heart disease. At these doses, one of fish oils benefits can become a hazard. Fish oil prevents platelets from clumping together, so it prevents abnormal clotting from closing off arteries accidentally. A degree of this is helpful in people with narrowed arteries from advanced cardiovascular disease. However, it is possible to bleed excessively from failure of the platelets to clump when they should. I personally never recommend doses that high in the 6,000 and above range, and even at the 4000 mg. per day range, I warn people about potential bleeding, and sometimes perform a simple test called a “bleeding time” in the office to see how easily the blood clots. The truly effective omega 3 fatty acids in the human system are the EPA and DHA that are in fish oil. However, some people are allergic to fish, or are dedicated vegans and do not want to take an animal by-product of any type. For those folks, there are algae sources of EPA and DHA which work great. There are other sources, but the web site I have memorized is www.vegan-essentials.com. The more I have studied the effects of omega 3’s (EPA and DHA) specifically, the more it appears that the human body was designed to eat either fish or algae, and we don’t fare well without it. The other obvious option to fish would seem to be flax, chia, hemp seed, or walnut oils. These products all contain high amounts of an omega 3 FA called alpha linolenic acid (ALA). Twenty years ago, the nutritional industry was across the board (me included) suggesting that people take flax oil. Chia was not even on the radar screen yet, and hemp is still not suitable for public conversations. A lot of this flax seed excitement came about from animal (mostly rat) experiments showing that (ALA) could be easily converted to EPA and DHA by means of two different enzymes. Well once again rats proved not to be people – the delta 5 and delta 6 desaturase enzymes with which rats come fully equipped to make this essential conversion to EPA and DHA turn out to be scarce and fairly ineffective in humans. We can do some conversion of ALA to EPA, but there is a huge risk of becoming DHA deficient by relying on flax seed alone for omega 3’s. . And it is DHA which makes up a brain. DHA is truly important in children. Concern about DHA needs in babies years ago led most manufacturers of soy based baby formulas to add DHA to their product. Since soy contains no DHA, there was actually a lowering of IQ shown in babies who were being fed DHA deficient soy formula. Though I am not a fan of flax seed as a sole source of omega 3 FA’s, it does have lignans and products that are useful for a healthy gut, and it is not a “bad” food – it is just an inadequate source of usable omega 3 FA’s for humans. This ALA part is the topic that I wanted to research that delayed the production of this newsletter. I know 10 years ago the best understanding out there was that the human body had no known use for ALA as such, but only for the EPA into which we can convert it. That still is the case. The information I found that was new to me was the potential for DHA deficiency. There is still a sad lack of research in this area. I personally have a sense that walnuts may have some intrinsic quality that aids in the conversion process, or another component that is also anti-inflammatory. My own experience with flax seed was that while I was on it, an old broken knee was getting more and more arthritis, and beginning to somewhat cripple my movements. When I switched to an appropriate dose of fish oil, within two weeks, I had almost no pain in the knee, though it does still pop a lot. In the last few years I have experimented a bit with making walnuts a substantial part of my diet, and actually noticed some improvement in my arthritis in one of my fingers, that the fish oil is not helping. So – there are so many questions research has yet to answer. One question I would like to answer is whether fish oil can solve the problem of the “aspirin resistant” people, who can take aspirin or even Plavix in largish doses and not get any reduction in their platelet clumping. There is a new blood test out that may just allow me to do a little research of my own, depending on the cost of the blood test. I lost a friend about 1 ½ years ago to blood clots that were unstoppable by his excellent cardiologist because of aspirin resistance. I didn’t get a chance to try to help him out with fish oil (or other supplements), and at that time there was no blood test available to me to test the effects of the fish oil. Now let me add two more things. Rather than saying “we are what we eat” we should say “we are what we absorb.” For us to absorb any fat, we must have bile, and adequate amounts of it. Some people have poorly functioning gall bladders, or have had their gall bladder removed. Now, if your gall bladder has been removed, you still have a trickle of bile going into the small intestine all the time, straight from the liver. But the way the gall bladder is meant to work is that it stores quantities of bile. Then when we eat a normal diet, containing some protein, and some carbs, and some fats, a hormone trigger in the upper duodenum tells the gall bladder to squeeze all that bile out onto the food. The bile salts turn the fat into tiny particles (micels) that can be absorbed and used. Without adequate bile, we simply do not absorb fatty acids well. So there are some people who take large amounts of good fatty acid supplements, and it does nothing but make their stool float (oil floats on top of water, remember). Their skin will remain dry, their joints tender, and their inflammatory balance off kilter. We have ways of testing this in the office, some by just asking the right questions, some by testing levels of fat soluble vitamins in the blood stream, or the amount of fat in the stool. These people will need to take bile salts with their fatty acid supplement, or fatty meals, or make sure they are properly absorbed. The other additional piece of advice – if you still notice dry skin, and other evidence of fatty acid deficiency despite doing everything else right, you might try taking biotin. It is one of the B vitamins, and one of its jobs is to help the cells themselves absorb the fatty acids. Ordinarily adequate amounts of biotin are made by the healthy bacteria in the gut, but there are some people who need to take an additional 5000-10,000 mcg of it to fully utilize their fatty acids. People who have had gut problems, a colostomy, lots of antibiotic use, or other reason to have inadequate beneficial gut flora probably need to take biotin. It helps the hair and nails too. Well that’s it for May (Yeh,…. I know.) But this fatty acid topic gets so very complicated! And for all of you who’ve checked on me or asked, yes, I am doing much better, getting past that recurrence of chronic fatigue syndrome. Still not 100% but getting close. Thanks for caring! Until next time, Alice

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