Evening primrose oil and borage oil in rheumatologic conditions

Diets rich in arachidonic acid (20:4n-6) lead to the formation of 2-series prostaglandins (PGs) and 4-series leukotrienes (LTs), with proinflammatory effects. Nonsteroidal antiinflammatory drugs are used in rheumatoid arthritis to inhibit cyclooxygenase (prostaglandin-endoperoxide synthase), thereby decreasing production of 2-series PGs. Lipoxygenase activity remains intact, however, allowing LT production (eg, synthesis of LTB(4), a potent inflammatory mediator) to continue. Altering the essential fatty acid (EFA) content of the diet can modify some of these effects. Ingestion of a diet rich in evening primrose oil elevates concentrations of dihomo-gamma-linolenic acid (DGLA; 20:3n-6), which results in the production of 1-series PGs, eg, PGE(1). DGLA itself cannot be converted to LTs but can form a 15-hydroxyl derivative that blocks the transformation of arachidonic acid to LTs. Increasing DGLA intake may allow DGLA to act as a competitive inhibitor of 2-series PGs and 4-series LTs and thus suppress inflammation. The results of in vitro and animal work evaluating EFAs in inflammatory situations are encouraging, which has stimulated clinical workers to evaluate these compounds in rheumatoid arthritis. Several well-controlled, randomized clinical studies have now been completed in which various EFAs were evaluated as treatments. The results of most of these studies suggest some clinical benefit to these treatments; these data are reviewed here.

Prevention of nerve conduction deficit in diabetic rats by polyunsaturated fatty acids

The influence of diets containing gamma-linolenic acid (GLA; 18:3n-6) on sciatic nerve conduction velocity (NCV) was determined in diabetic rats. NCV was lower in diabetic rats fed diets supplemented with olive oil or sunflower seed oil than in nondiabetic rats; rats supplemented with GLA during a 5-wk diabetic period, however, did not exhibit significantly lower NCV. The mean proportion of the phospholipid fatty acid linoleic acid (18:2n-6) was higher in the sciatic nerves of diabetic rats than in the nondiabetic groups irrespective of dietary lipid treatment. Additionally, the proportion of linoleic acid was higher in the diabetic rats fed sunflower oil than in all other groups. Dietary GLA supplementation did not significantly influence the fatty acid composition of nerve membrane phospholipids and there was no obvious correlation between the fatty acid composition of nerve membrane phospholipids and NCV. The content of fructose and glucose in sciatic nerves was higher, whereas that of myo-inositol was lower, in diabetic rats than in nondiabetic rats; however, this was not significantly influenced by dietary GLA. GLA administration did not significantly influence Na(+)-K(+)-exchanging ATPase or ouabain binding activity in sciatic nerve preparations, both of which remained nonsignificantly different in the diabetic and nondiabetic groups. The results suggest that dietary GLA can prevent the deficit in NCV induced by diabetes and that this effect is independent of the nerve phospholipid fatty acid profile, sugar and polyol content, Na(+)-K(+)-exchanging ATPase activity, and ouabain binding. GLA may prevent the deficit in NCV indirectly, possibly by its role as a precursor of vasodilatory prostaglandins. These results confirm that GLA is the active component of evening primrose oil.

Oestrogen and essential fatty acid supplementation corrects bone loss due to ovariectomy in the female Sprague Dawley rat

Essential fatty acid deficient animals develop osteoporosis. Eicosapentaenoic acid and gamma-linoleic acid have been reported to have positive effects on bone metabolism in both the growing male rat and the ovariectomized (OVX) female rat. These effects have been further investigated using a novel gamma-linolenic/eicosapentaenoic acid diester together with an oestrogen implant in the ovariectomized, female Sprague Dawley rat. Rats were sham-operated or ovariectomized at age 11 weeks. Two groups of OVX rats received an oestrogen implant at ovariectomy. Animals received fatty acids, linoleic acid (control) or a diester with gamma-linolenic acid and eicosapentaenoic acid as part of a semi-synthetic diet. Bone calcium content and excretion of deoxypyridinolines as marker of bone degradation were measured at 14 weeks. Oestrogen, as well as diester alone, increased calcium/femur to sham levels. Oestrogen plus diester potentiated the effect of oestrogen on bone calcium (P < 0.05 vs OVX). At the same time, oestrogen alone and the combination of oestrogen plus diester significantly reduced (P < 0.05 vs OVX) urinary deoxypyridinoline and hydroxyproline excretion. Again, the diester potentiated the effect of oestrogen. The effects of the diester alone, together with the potentiated effects of oestrogen by the essential fatty acids on osteoporosis, are novel findings.

Effects of fish oil supplementation on platelet survival and ex vivo platelet function in hypercholesterolemic patients

Little is known about the effects of dietary supplementation on platelet survival with low doses of n-3 and n-6 fatty acids in patients with hypercholesterolemia. The effects of a 6-week intervention with fish oil capsules (daily intake: 216 mg eicosapentaenoic acid, 140 mg docosahexaenoic acid, 390 mg gamma-linolenic acid, and 3480 mg linoleic acid) on in vivo platelet survival (111 In-oxine labeled platelets) and on ex vivo markers of platelet activation were investigated in a placebo-controlled, double-blind study with 26 hypercholesterolemic patients. In vivo platelet survival increased in the fish oil group (T) from a mean of 159+/-14 hours to a mean of 164+/-12 hours (p=0.025), whereas it remained unchanged in the placebo (P) group (T vs. P; p=0.055). Ex vivo, thromboxane B2 decreased from a mean of 225+/-16 to 212+/-21 ng/mL (p=0.003) in T but did not change in P (T vs. P: p=0.002). Malondialdehyde formation was lowered significantly by fish oil supplementation from a mean of 5.49+/-1.3 to 5.12+/-1.05 nM/10(9) platelets, p=0.005, as compared with P (T vs. P; p=0.018). The trendwise decrease in 11-DH-thromboxane B2 plasma levels was not significant nor was the increase in platelet sensitivity to prostaglandin I2 by fish oil. Baseline platelet survival in patients with hyperlipoproteinemia type IIa was not different from those with hyperlipoproteinemia IIb and response to treatment in terms of platelet activation markers was not either. The changes in platelet activation parameters in T were associated with significant reductions in cholesterol (-2.9%), low density lipoprotein cholesterol (-3.5%), and triglycerides (-12.4%). Both ex vivo and in vivo platelet activation parameters exhibited signs of decreased activation by a 6-week diet supplemented with n-3 and n-6 fatty acids, which might be beneficial in reducing atherothrombotic risk, in patients with hyperlipoproteinemia type IIa and IIb.

Essential fatty acids in health and disease

Essential fatty acids (EFAs) form an important component of cell membranes, are eicosanoid precursors and are therefore required for both the structure and function of every cell in the body. EFAs can modulate the activity of protein kinase C, T and B cell response, free radical generation and lipid peroxidation, lymphokine secretion and cell proliferation. EFAs also have anti-mutagenic, anti-bacterial, anti-fungal and anti-viral properties. EFAs and their metabolites lower serum cholesterol, triglycerides and blood pressure. EFAs appear to be of benefit in atopic eczema, premenstrual syndrome, psoriasis, auto-immune disorders especially rheumatoid arthritis and systemic lupus erythematosus, prevention of target organ damage in diabetes mellitus, peptic ulcer disease, ulcerative colitis, coronary heart disease and atherosclerosis. EFAs and their metabolites can selectively kill tumor cells both in vitro and in vivo without harming normal cells. In addition, EFAs seem to play a fundamental role in inflammation and immune response. In view of their actions and relative safety, it is anticipated that EFAs may be useful in the management of several diseases.

Effect of topically applied evening primrose oil on epidermal barrier function in atopic dermatitis as a function of vehicle

The aim of this study was to establish the effect on barrier function in atopic dermatitis of topical evening primrose oil in an amphiphilic and a stable water-in-oil emulsion. The studies were vehicle-controlled in two populations of 20 atopic subjects. Barrier function was assessed in terms of transepidermal water loss and stratum corneum hydration after a 4-week treatment period and a 1-week treatment-free period. A barrier function test with sodium lauryl sulphate (SLS) and nicotinic acid ester was also carried out. Evening primrose oil proved to have a stabilising effect on the stratum corneum barrier, but this was apparent only with the water-in-oil emulsion, not the amphiphilic emulsion. The choice of vehicle is therefore an extremely important factor in the efficacy of topically applied evening primrose oil.

Management of cyclical mastalgia in oriental women: pioneer experience of using gamolenic acid (Efamast) in Asia

BACKGROUND

In most Western countries gamolenic acid is the first-line treatment for women with cyclical mastalgia.

METHODS

A prospective study was carried out in the breast referral clinic of the Department of Surgery, University of Hong Kong to evaluate the treatment of cyclical mastalgia using gamolenic acid provided in evening primrose oil (Efamast, Scotia Pharmaceuticals Ltd, Scotia House, Stirling, Scotland) as a pioneer experience in Asia. In addition, the features of cyclical mastalgia in Oriental women were studied by conducting a survey using anonymous questionnaires.

RESULTS

Sixty-six women with disturbing cyclical mastalgia seen by one breast surgeon were followed up with a breast pain diary. Thirty-four women had persistently disturbing mastalgia and were commenced on Efamast. Responses were measured at 3 and 6 months according to a standardized protocol. An overall useful response rate of 97% was observed at 6 months. Side-effects were found in 12% but all were insignificant.

CONCLUSIONS

Efamast may be recommended as a first-line specific treatment for Oriental women with disturbing cyclical mastalgia.

[Necrolytic migratory erythema]

Necrolytic migratory erythema (NME) is generally associated with glucagonoma. It waxes and wanes by successive relapses and remissions. The clinical and microscopical diagnosis is complex. In addition to glucagonoma treatments, the administration of corticoids, aminoacids, zinc or essential fatty acids can be helpful. There exist several etiological hypotheses for NME. These are based on modifications of pancreatic enzyme activities and on variations of aminoacids, fatty acids, zinc or glucagon concentrations.

Effect of dietary supplementation with evening primrose oil on vascular thrombogenesis in hyperlipemic rabbits

The dietary intake of saturated fatty acids affects arteriosclerosis. We studied the effect of supplementation (15% wt/wt) of a hyperlipemic diet (1.3% cholesterol) with evening primrose oil (Oenothera biennis) in four groups of 10 rabbits each. After 6 weeks the aortic endothelium was analyzed morphologically with scanning electron microscopy, and the arterial wall was studied with morphometric techniques and cell nucleus counts. Endothelial functioning was analyzed by measuring prostacyclin synthesis, and thrombogenicity of the subendothelium was studied by perfusion in a Baumgartner annular chamber. Evening primrose oil reduced hypercholesterolemia (from 29 +/- 3 to 12 +/- 2 nmol/l), increased HDL-cholesterol (from 0.5 +/- 0.06 to 0.8 +/- 0.09 nmol/l) and doubled prostacyclin synthesis (from 2.7 +/- 2 to 6.2 +/- 0.7 ng/mg aorta) in rabbits on the hyperlipemic diet, reduced subendothelial surface occupied by platelets (from 6.9 +/- 0.4 to 4.8 +/- 0.3%), and reduced human platelet adhesion on the subendothelium (from 53.3 +/- 6% to 38 +/- 8%, respect to total occupation). Morphological analyses showed that evening primrose oil diminished endothelial lesions caused by the atherogenic diet, reducing area of the arterial wall (from 6.9 +/- 0.2 to 4.7 +/- 0.2 microm2 x 10(6)) and the degree of neointimal proliferation (from 0.6 +/- 0.02 to 0.4 +/- 0.09 microm2 x 10(6)). We conclude that in our experimental model, this dietary supplement enhanced the antithrombotic capacity of the endothelium, reduced subendothelial thrombogenicity, and diminished the extent of vascular wall lesions caused by the hyperlipemic diet.

Effect of evening primrose and fish oils on two stage skin carcinogenesis in mice

The effect of fish oil (FO, given in the form of MaxEPA) rich in n-3 fatty acids and evening primrose oil (EPO) rich in n-6 fatty acids on two-stage skin carcinogenesis in mice was studied. Both FO and EPO inhibited the papilloma formation to a significant degree only during the promotion stage which was associated with an increase in lipid peroxidation. Both FO and EPO inhibited the binding of benzo(a)-pyrene to skin cell DNA suggesting that this could be one of the mechanism(s) by which these oils could be preventing papilloma development. Neither EPO nor FO influenced epidermal cell proliferation. In the FO group, LA (linoleic acid), AA (arachidonic acid) and DHA (docosahexaenoic acid) were increased, whereas in the EPO group a significant increase in the AA content was noted. No specific changes in the fatty acid pattern were observed in any of the groups that could be attributed to the papilloma incidence. These results suggest that FO and EPO can influence papilloma formation which can be attributed, at least in part, to their ability to prevent benzo(a)pyrene binding to DNA and to an increase the lipid peroxidation process.

Nutrition supplements and the eye

PURPOSE

A review of the role of vitamins, minerals, carotenoids and essential fatty acids in relation to eye health. The mode of action may be directly on the eye or by promoting bodily health on which the eye depends.

RESULTS

The lens and retina suffer oxidative damage and the anti-oxidant vitamins A, C and E are implicated as protective. Studies in man give indifferent support to the role of nutrition in the development of cataract. In the elderly, vitamin intake may be inadequate, so that a vitamin supplement may be reasonable. Zinc has a role in retinal metabolism and may be beneficial in macular degeneration. Selenium has an anti-oxidant role. Other minerals including copper have a less defined role. Carotenoids are concentrated at the macula and have an anti-oxidant role. A reduced risk of macular degeneration is found in relation to a high serum level. The essential fatty acid, gamma-linolenic acid (GLA), is useful in Sjögren's syndrome and may help in other dry eye conditions. Omega-3 fatty acids are important in retinal development and have a role in preventing cardiovascular disease.

CONCLUSION

All persons should be encouraged to maintain healthy nutrition. Middle-aged and elderly patients may benefit from a supplement. An intake in excess of the recommended daily intake may be beneficial, but this is not proven. Further clinical trials are indicated to define the advisability of vitamin, mineral and other supplements. Dosages for recommended intake and for supplements are given.

Nitric oxide deficiency, leukocyte activation, and resultant ischemia are crucial to the pathogenesis of diabetic retinopathy/neuropathy--preventive potential of antioxidants, essential fatty acids, chromium, ginkgolides, and pentoxifylline

Impaired microcirculatory perfusion appears to be crucial to the pathogenesis of both neuropathy and retinopathy in diabetics. This in turn reflects a hyperglycemically mediated perturbation of vascular endothelial function that entails overactivation of protein kinase C, reduced availability of nitric oxide, increased production of superoxide and endothelin, impaired insulin function, diminished synthesis of prostacyclin/PGE1, and increased activation and endothelial adherence of leukocytes. These dysfunctions may be addressed with a supplementation program that includes high-dose antioxidants, fish oil, gamma-linolenic acid, chromium, arginine, carnitine, and ginkgolides. Pharmaceuticals likely to be of benefit in this regard include pentoxifylline, probucol, replacement estrogens, and inhibitors of angiotensin converting enzyme and aldose reductase.

Regulation of cell adhesion, a central mechanism in the anticancer action of essential fatty acids (review)

Certain members of essential fatty acids (EFAs) are known to have anticancer functions. It has been established in recent years that some of these anticancer actions are via the effects of these fatty acids on the adhesive properties of cancer cells, including cell-cell and cell-matrix adhesions. These discoveries have implicated EFAs as a group of novel agents, able to regulate adhesive function of cancer cells and thus bearing clinical importance.

Effect of carnitine and essential fatty acid supplementation on the uptake of 11C-carnitine in muscle of a myopathic carnitine-deficient patient using positron emission scintigraphy

The aim of this study was to demonstrate the pattern of 11C-carnitine uptake after various treatment regimens in a myopathic carnitine-deficient patient and two normal volunteers, using a whole body counter specially adapted for positron emission. One carnitine-deficient patient and two normal volunteers were scanned after an intravenous injection of 11C-carnitine, both while on carnitine therapy and after discontinuation thereof. The third scan was done on the patient following carnitine and fatty acid therapy for 7 days. Both the carnitine-deficient patient and the normal volunteers showed improved 11C-carnitine uptake by thigh muscles after carnitine supplementation, and the carnitine-deficient patient even more so after carnitine and fatty acid supplementation. It is therefore concluded that the scintigraphic findings support the clinical impression that carnitine deficient patients improve after carnitine and essential fatty acid supplementation.

Mastalgia. Tailoring treatment to type of breast pain

Breast pain is a common, often distressing problem among women. After significant disease is ruled out, most patients respond to simple reassurance. Others, however, require treatment because symptoms interfere with their lifestyle. The authors offer practical suggestions for tailoring treatment for these patients according to type of pain--cyclical mastalgia, non-cyclical mastalgia, or chest wall pain.

Premenstrual symptoms in general practice patients. Prevalence and treatment

OBJECTIVE

To examine the rates of premenstrual symptoms in Australian patients, the treatments they had tried for such symptoms, the perceived effectiveness of these treatments, the proportion of women who reported that they had sought help for premenstrual symptoms and whether women perceived the need for additional help in dealing with premenstrual symptoms. Characteristics associated with higher symptom levels and desire for help were examined.

STUDY DESIGN

A cross-sectional survey of 310 general practices patients aged 18-45 years and who had reported having had a menstrual period in the previous three months.

RESULTS

Between 11% and 32% of women reported severe or extreme changes during the premenstrual phase on each of the 10 symptoms in the short Premenstrual Assessment Form, with the highest rates for affective symptoms. Eighty-five percent of women reported that they had tried treatments for premenstrual symptoms, and many reported having tried multiple treatments. The most commonly tried treatments included pain killers rest, drinking more fluid and exercise, which had been tried by at least one-third of women. When women were asked to nominate up to three treatments they had tried and found most effective, the most commonly mentioned were dietary changes, evening primrose oil, vitamins (including B6) and exercise. Approximately 50% of the women had sought help, most commonly from a general practitioner and 45% reported that they would like more help dealing with premenstrual symptoms. Higher overall symptom scores were associated with a history of endometriosis, a lower education level, not taking oral contraceptives, taking evening primrose oil and taking vitamin B6.

CONCLUSION

There is a need to further refine, through evaluation of different approaches, programs and resources, ways to effectively help women who report premenstrual symptoms and would like help to deal with them.

Essential fatty acids in the management of impaired nerve function in diabetes

Impaired conversion of linoleic acid to gamma-linolenic acid (GLA) has been demonstrated in animal diabetes and inferred from blood fatty acid profiles in human diabetes. This impairment could theoretically lead to defective nerve function because metabolites of GLA are known to be important in nerve membrane structure, nerve blood flow, and nerve conduction. Administration of GLA corrects the impaired nerve function in animal models of diabetes. Two multicenter, randomized, placebo-controlled trials in humans with diabetic neuropathy have shown significant benefits of GLA as compared with placebo in neurophysiological parameters, thermal thresholds, and clinical sensory evaluations. Further work is needed to define the place of this therapeutic approach and its interactions with other treatment modalities.

The usefulness of topical application of essential fatty acids (EFA) to prevent pressure ulcers

This study investigated whether the topical application of essential fatty acids improves hydration and elasticity and helps prevent skin breakdown in individuals with poor nutritional status. Between June 1995 and July 1996, 86 patients, equally divided into two groups, underwent double-blind research (mean age = 60; range 26-78). All patients had a Norton Scale score of 9 and were fed orally a high-protein diet and/or received parenteral nutrition (92% were severely malnourished). Pressure ulcer prevention was the same for both groups. Every 8 hours, approximately 20 ml of solution A (1.6 gr EFA with linoleic acid extracted from sunflower oil, 112 UI vitamin A, and 5 UI Vitamin E) or B (1.6 gr mineral oil, 112 UI Vitamin A, and 5 UI Vitamin E) was applied all over the body inclusive of all potential wound sites for a mean of 21 days. In group A, two patients developed ulcers (both Stage I, one per patient); 42 (98%) had hydrated skin and 32 (76%) maintained skin elasticity. In group B, 12 (27%) developed ulcers (all Stage II, ten with 1 ulcer, two with 2 ulcers); 9 (22%) had hydrated skin while 34 (78%) showed scaly skin/deep dehydration; 10 (24%) maintained skin elasticity while 33 (76%) showed a loss of elasticity. These results lead us to believe that essential fatty acids really do make a difference in the skin.

Epogam evening primrose oil treatment in atopic dermatitis and asthma

Essential fatty acids are claimed to have positive effects in atopic diseases. In a double blind, placebo controlled, parallel group study 58 out of 60 children, with atopic dermatitis and the need for regular treatment with topical skin steroids, completed a 16 weeks' treatment period with either Epogam evening primrose oil or placebo capsules. Twenty two of these subjects also had asthma. The parents used diaries to record symptom scores and concomitant medication. Peak expiratory flow was measured and disease activity was monitored by the clinician every four weeks. The plasma concentrations of essential fatty acids increased significantly in the group treated with Epogam capsules. The study demonstrated significant improvements of the eczema symptoms but no significant difference was found between the placebo and the Epogam groups. No therapeutic effect was shown on asthma symptoms or fidget.

Effects of OKY-046 and nifedipine in cyclosporine-induced renal dysfunction in rats

Cyclosporine (CsA) (37.4 mumol/kg per day for 7 days) treated female Wistar rats exhibited significantly decreased creatinine clearance (Ccr) and body weight loss (BWL), but had neither proteinuria (PU) nor alteration in their urine volume (V). Light microscopic (LM) sections of rat kidneys showed that all kidneys were affected by lesions, mainly diffuse vacuolization. These changes were associated with decreased urinary excretion ratios of 6-ketoprostaglandin F1 alpha to thromboxane B2 (6kPGF1 alpha/TXB2) and prostaglandin E2 to TXB2 (PGE2/TXB2). When OKY-046, a TXA2-synthetase inhibitor or nifedipine (NFD), a calcium channel blocker and an antagonist of endotheline (ET), were administered in addition to CsA, they restored Ccr and increased urine V but they did not prevent BWL. LM sections showed that only 5 or 7 out of 9 kidneys of animals were affected, respectively. These changes were associated with prevention of the diminished ratios of urinary PGE2/TXB2 and 6kPGF1 alpha/TXB2 mainly in the OKY-046 treated animals. In conclusion, our results suggest that inhibitors of TXA2 or antagonists and/or inhibitors of endothelin play a protective role in the development of the dysfunction induced by CsA. However, the protection observed using OKY-046 and NFD did not reach that obtained by evening primrose oil (EPO) or Ketanserine (KTS), substances which prevented the fall of Ccr and BWL. Furthermore, with these protective agents only 5 out of 9 kidneys were affected and the lesions were of minor importance.