A new concept of lifestyle-related cardiovascular disease: the importance of interactions between cholesterol, essential fatty acids, prostaglandin E1 and thromboxane A2

Superovulation Induced Changes of Lipid Metabolism in Ovaries and Embryos and Its Probable Mechanism

This research was intended to investigate the fetal origins of changed birth weight of the offspring born through assisted reproductive technology (ART). The association between hormone and lipid metabolism or body weight has been generally accepted, and as the basic and specific treatment in ART procedure, gonadotropin stimulation might have potential effects on intrauterine lipid metabolism. In our studies, the mice were superovulated with two doses of gonadotropin. The cholesterol metabolism in ovaries and the triglyceride metabolism in embryos were analyzed. The results showed gonadotropin probably accelerated luteinization and induced a longer time follicle development and ovulation, which resulted in histological and morphological alteration of ovary, and increased the cholesterol content and the expressions of steroidogenesis-related genes. In embryos, gonadotropin increased lipid accumulation and decreased fatty acid synthesis in a dose-dependent manner. Moreover, the changes of fatty acid composition were also shown in superovulation groups. Our studies firstly provided the evidence that the superovulation might affect the maternal and fetal lipid metabolism. These variations of lipid metabolism in our results may be associated with birth weight of ART infants.

Can the premises of the altered homeostatic theory permit improvement in the prevention of ischemic heart disease?

In this communication, the altered homeostatic theory will be discussed and updated, and evidence will be presented that the premises of the theory might permit improvement of the prevention of ischemic heart disease (IHD). This hypothesis, first described in 1999, argues that IHD is due basically to an inappropriate shift of homeostasis, and the theory includes the position that S-RV directly induces symptoms. In contrast, the standard approach to IHD is based fundamentally on two principles: that atherosclerosis is due fundamentally to lipid abnormalities, and that symptoms in IHD are due to obstructive complications of atherosclerosis in epicardial coronary arteries. Suggestions for prevention stem from the altered homeostatic theory's different basic conceptualization of this disorder, and it seems reasonable that accepted basic pathogenetic mechanisms help shape measures to prevent IHD. Many of the theory's positions for preventing IHD parallel standard views, but the theory's basic premises have resulted in significant differences between the standard and the theory's overall approach to the prevention of IHD. Positions for the prevention of IHD include: the possibility that any preventative factor can improve any risk factor, the use of substitute preventative factors to counter unmodifiable or difficult to correct risk factors, underestimation of the risk of IHD by the standard position in individuals with normal lipid levels but multiple other risk factors, the probable relative overemphasis of the risk factor of cholesterol, the value of a national program to reduce the incidence of multiple disorders with similar risk factors, an alternate approach to the use of statins, and the value of an evolutionary approach to preventing IHD and other disorders.

Modulation of cholesterol concentration in Caco-2 cells by incubation with different n-6 fatty acids

Incorporation of exogenous cholesterol was compared in human adenocarcinoma colon cells (Caco-2) after incubation with 100 microM of either linoleic acid (LA, 18:2n-6), gamma-linolenic acid (GLA, 18:3n-6), arachidonic acid (AA, 20:4n-6) or adrenic acid (or n-6 docosatetraenoic acid, DTA, 22:4n-6). In both cells 7 days after seeding and 14 days after confluency, incubation with LA significantly raised the proportion of 18:2n-6 but not its long-chain metabolites in cellular phospholipid. Incubation with GLA increased the levels of 18:3n-6, 20:3n-6, and 20:4n-6. Incubation with AA increased the levels of 20:4n-6 and 22:4n-6, and incubation with DTA increased the levels of 22:4n-6 as well as its retro-conversion metabolite, 20:4n-6. A subsequent addition of cholesterol (180 microM) to the medium significantly raised the cellular cholesterol level but less so in the cells 7 days after seeding incubated with GLA. The increase in cellular cholesterol level was generally greater in the cells of 7 days after seeding, particularly those incubated with long-chain highly unsaturated n-6 fatty acids, than in those of 14 days after confluency. These findings suggest that the cell growth and the extent of unsaturation in cell membrane phospholipid fatty acids modulate the incorporation of the exogenous cholesterol into the Caco-2 cells.

Role of lipid-induced changes in plasma membrane in the biophysical shunt theory of psychopathology

The existence of a lipid factor that either causes faulty lipid metabolism or directly contributes to the emergence of a biophysical shunt in neuronal membrane ionic flow propagation is proposed. The neuronal membrane contains a remarkable amount of phospholipids, glycolipids and cholesterol. It is assumed that, under certain unfavorable intrinsic states, the plasma membrane's lipid order and composition and, consequently, its cholesterol-to-phospholipid ratio, may change. This, in turn, may significantly modify membrane fluidity, altering the essential physical properties in the affected portions of the membrane and causing a disarray in the adjacent ion channels, leading to the establishment of a biophysical shunt in a loop-like operation, forming the basis for a variety of mental disorders. The present model offers a diet-induced lipid correction for the relief of psychopathological problems.

Endothelium, fibrinolysis, cardiac risk factors, and prostaglandins: a unified model of atherogenesis

A model of atherogenesis is described in which it is proposed that a state of relative impairment of intravascular fibrinolytic function is the primary defect which makes possible both the initiation and the continued progression of arterial plaques. The key mechanism by which impaired fibrinolysis is atherogenic centers on the unique disruptive effect which fibrin has on the contiguous endothelium of the vascular intimal surface. From this perspective, in areas of spontaneous endothelial injury, impaired fibrinolysis maintains and promotes the gradual enlargement of the area of injury by causing persistently increased intimal permeability and by allowing enhanced fibrin and platelet deposition. This hypothesis thus represents a modification of the response-to-injury hypothesis in which the emphasis has been shifted from the initial endothelial injury to a state of interference with the normal process of healing endothelial injuries. Consistent with this viewpoint, it is noted that all positive risk factors for vascular disease are associated with impairment of fibrinolytic function and, conversely, negative cardiac risk factors enhance fibrinolysis. It is further proposed that one or more prostaglandins, or closely related metabolites, represent the mediators of primary physiologic importance with regard to in vivo regulation of fibrinolysis. By this hypothesis, adequate dietary intake of essential fatty acids, as well as maintenance of unimpaired eicosanoid metabolism, become centrally important in both preventing and reversing arteriosclerosis. This two-tiered model can be used to organize and potentially explain the interrelationship between diverse and apparently divergent sets of epidemiological data which previous models have been unable to accommodate.

Natural micronutrients as controlling factors in Western diseases--a lesson in nature-programming

Micronutrients, essential for approximately 65% of all known enzymes, have during this century been considerably reduced in modern Western diets, due to food refinement, canning, refrigeration and additives. This reduction coincided with a phenomenal increase of Western and industrial diseases, many of them with genetic associations. Different basic diets in genetic races over thousands of years have led to a high percentage of enzyme polymorphisms, suggesting different basic diets necessary for different genetic races. These basic diets, with or without micronutrient supplementation, should be a necessary component of Western diseases prevention and therapy.

Fatty acid and prostaglandin metabolism in children with diabetes mellitus. II. The effect of evening primrose oil supplementation on serum fatty acid and plasma prostaglandin levels

Our previous study demonstrated that levels of dihomo-gamma-linolenic acid (DGLA) and arachidonic acid in serum total lipids decreased in association with increased plasma levels of prostaglandins E2 (PGE2) and F2 alpha (PGF2 alpha) in patients with insulin-dependent diabetes mellitus. In this study, 11 children with insulin-dependent diabetes mellitus completed a double-blind, placebo-controlled study to assess the effect of dietary supplementation with gamma-linolenic acid (GLA) on serum essential fatty acid and plasma PGE2 and PGF2 alpha levels. GLA was given as the seed oil from the evening primrose (EPO) and all patients received either EPO capsules (containing 45 mg of GLA and 360 mg of linoleic acid) or indistinguishable placebo capsules for 8 months. Initially patients took 2 capsules daily for 4 months then 4 capsules daily for a further 4 months. All patients were assessed at the start of the study, after 4 months and at the end of the study, by measuring serum essential fatty acid and plasma PGE2 and PGF2 alpha levels. After administration of 4 capsules daily the DGLA levels increased and PGE2 levels decreased significantly (p less than 0.01) in the EPO compared with the placebo group. Neither fatty acid nor PGE2 and PGF2 alpha levels were altered by administration of 2 EPO capsules daily. This suggests that the altered essential fatty acid and PG metabolism in diabetes may be reversed by direct GLA supplementation.

Effect of dietary palm oil on lipoprotein lipases: lipoprotein levels and tissue lipids in rat

The aims of our study were to investigate the effect of dietary palm oil on the levels of lipoprotein lipase, hepatic lipase, fat distribution (in the aorta and liver), and total cholesterol, HDL, LDL, and triacylglycerol levels in young rats (70 g body wt) over a period of 10 weeks. Palm oil-fed rats showed higher growth rate and lower triacylglycerol levels than the control group. Hepatic lipase activity was correlated to the liver fat distribution (correlation coefficient, r = +0.682) as seen by histopathological sections and was similar for both the palm oil and the control diets. Palm oil-fed rats exhibited a significantly higher HDL cholesterol to total plasma cholesterol ratio when compared to animals fed the control diet. The triacylglycerol levels correlated inversely to the HDL cholesterol levels (r = -0.536) while the lipoprotein lipase (LPL) activity correlated directly to the LDL level (r = +0.617) for both groups of animals. The fatty acid profiles of adipose and liver tissues and plasma revealed that saturated fatty acids--palmitic and stearic--were preferentially incorporated in liver and adipose tissues and less in the plasma. This accounts for lack of deposition in the arterial wall and for the antithrombotic tendency of palm oil. Thus, our present findings suggest that dietary palm oil may not contribute to the risk for coronary heart disease.

Changes in serum lipids in rats treated with PGF2 alpha

Serum lipid concentrations were determined in rats treated with PGF2 alpha, PGE1, and controls. Administration of PGF2 alpha in rats influenced only the HDL lipid composition. HDL-cholesterol decreased while HDL-triglycerides increased. No significant difference was observed in the levels of serum total cholesterol, triglycerides, and phospholipids between animals treated with PGF2 alpha and controls. Reduced concentrations of serum lipid levels and especially of HDL-cholesterol, HDL-triglycerides, and HDL-phospholipids were found in the rats treated with PGE1. These results suggest that PGF2 alpha and PGE1 could modify serum lipid levels influencing lipoprotein metabolism.

The response to endotoxin in guinea pigs after intravenous black currant seed oil

The influence on the metabolic response to endotoxin of three days of total parenteral nutrition with lipids high in gammalinolenic acid (18:3 omega 6, GLA) compared to soy oil (SO) was examined in acute operatively stressed guinea pigs. GLA is the precursor of dihomogammalinolenic acid (DHLA), the substrate for synthesis of "1" series prostaglandins such as PGE1, which have previously been shown to be protective in endotoxin lung injury and traumatic shock. Guinea pigs fed an intravenous diet containing black currant seed oil (BCO) emulsion (20% GLA) or soy oil emulsion (0% GLA) for 2.5 days had their arterial pH, pCO2, pO2, and bicarbonate measured at baseline and hourly during a 7-hr infusion of endotoxin (lipopolysaccharide (LPS), 2mg/kg) or saline. Plasma lactate and fatty acid profile analyses were performed at the end of the LPS infusion. Increased levels of GLA and DHLA were present in the plasma phospholipid fraction of animals fed the black currant seed oil diet, while soy-fed animals had only trace amounts of GLA. In addition, the ratio of DHLA to arachidonate was higher in animals receiving the black currant seed oil total parenteral nutrition (TPN). After 2 hr of LPS infusion, all animals exhibited the typical shock response resulting in metabolic acidosis characterized by a significant (p less than 0.05) drop in pH from 7.34 +/- .02 (SO) and 7.39 +/- .02 (BCO) at baseline to 7.14 +/- .05 and 7.22 +/- .04 by 7 hr for SO and BCO groups, respectively. Plasma lactate values at the end of the infusion were significantly elevated compared to saline in both groups (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of gammalinolenic acid on plasma lipoproteins and apolipoproteins

Nineteen hypercholesterolemic patients (10 without and 9 with hypertriglyceridemia) were given evening primrose oil rich in gammalinolenic acid (GLA, 18: 3n - 6), in a placebo controlled cross-over design, over 16 weeks (8 + 8 weeks), with safflower oil as the placebo. During supplementation with evening primrose oil, dihomogammalinolenic acid (20: 3n - 6) increased in plasma lipids and red blood cells, and in subjects without hypertriglyceridemia there was a significant decrease in low density lipoprotein-cholesterol and plasma apolipoprotein B compared with the levels observed during safflower oil administration. Our results confirmed that evening primrose oil is effective in lowering low density lipoprotein in hypercholesterolemic patients.

Lipid composition of liver microsomes in rats fed a high monounsaturated fatty acid diet

The fatty acid and cholesterol contents of tissue membranes are the determinants of membrane stability and functionality. This study was designed to evaluate the influence of a high monounsaturated fatty acid diet on the fatty acid composition of rat liver microsomes and on their cholesterol and lipid phosphorus content. Weanling animals were fed for 5 weeks with high fat diets containing olive oil or corn oil. Saturated fatty acids were increased and oleic acid decreased in microsomal total phospholipids and in the three major phosphoglycerides, phosphatidylcholine (PC), phosphatidylethanolamine (PE) and phosphatidylinositol (PI), of rats fed corn oil as compared to the olive oil group. The percentage of linoleic acid was higher in the corn oil group, but only for total phospholipids and PC. Linoleic and alpha-linolenic metabolites were significantly increased in total phospholipids of olive oil-fed animals with respect to those fed corn oil. These changes were responsible for the low unsaturation index found in microsomal phospholipids of the corn oil group. The diet did not affect the microsome cholesterol or the lipid phosphorus content. These results show that, in olive oil-fed rats, the cholesterol content and the degree of unsaturation of liver microsomes was similar to that observed in weanling animals; this probably suggests an adequate maintenance of functionality of membranes in olive oil-fed animals.

Prostaglandin E1: a review

Work on the structure of prostaglandin E1 (PGE1), isolated from natural sources, was completed 25 years ago (1). Shortly after, methods for the chemical synthesis of PG with their natural configuration were developed in the laboratories of the UpJohn Company (2) and of E. J. Corey (3) and, by the late sixties, PGE1 became widely available. The information since accumulated about its biological and clinical effects is more substantial than for any other PG. This review will draw together some of this information, focusing on recent studies of its mechanisms of action.

The role of linoleic acid and its metabolites in the lowering of plasma cholesterol and the prevention of cardiovascular disease

An increase in linoleic acid intake lowers plasma cholesterol and is one of the safest methods for achieving this end. However, the amounts that must be consumed are large. Linoleic acid is metabolized via several routes and it is probable that a metabolite, rather than linoleic acid itself, is responsible for the cholesterol-lowering effect. If that metabolite could be identified, safe, drug-free, cholesterol-lowering might be achieved with much lower doses. Evidence is reviewed which suggests that a long-chain polyunsaturated fatty acid and/or a prostaglandin metabolite may be responsible for the cholesterol-controlling action of linoleic acid. Such metabolites may be effective also in controlling other risk factors for cardiovascular disease, such as elevated blood pressure and enhanced platelet aggregation. Epidemiological studies suggest that low levels of those metabolites, especially dihomogammalinolenic acid and arachidonic acid, are powerful independent risk factors for development of ischaemic heart disease. Further research in this area is urgently needed now that it is broadly accepted that cholesterol-lowering does indeed reduce the risk of cardiovascular disease.

Low prevalences of coronary heart disease (CHD), psoriasis, asthma and rheumatoid arthritis in Eskimos: are they caused by high dietary intake of eicosapentaenoic acid (EPA), a genetic variation of essential fatty acid (EFA) metabolism or a combination of both?

The low prevalences of CHD, psoriasis, asthma and rheumatoid arthritis in Eskimos have been attribute to the high dietary intake of EPA from fish and marine mammals. However, even on a Western diet, Eskimos have plasma arachidonic acid (AA) levels far below those seen in Europeans while dihomogammalinolenic acid (DGLA) levels are higher in Eskimos. These low AA and high DGLA levels seem to be due to a genetic abnormality in EFA desaturation since they are found even when EPA intakes are low. Since AA is known to be important in the pathogenesis of CHD, asthma, psoriasis and arthritis, while DGLA has properties which make it of likely therapeutic value in these conditions, the genetically high DGLA and low AA are likely to be as important as dietary EPA in determining Eskimo disease patterns.

The influence of dietary marine oil (Polepa) and evening primrose oil (Efamol) on prostaglandin production by the rat mesenteric vasculature

The interactions of n-6 and n-3 fatty acids on prostaglandin metabolism in the isolated rat mesenteric vessels were studied. Sprague-Dawley rats (200-220 g) were fed for two weeks a fat-free semi-synthetic diet supplemented with 10% by weight of different combinations of Evening Primrose Oil (Efamol), a rich source of linoleic acid (LA) and gamma-linolenic acid (GLA), the immediate precursor of dihomo-gamma-linolenic acid (DGLA), and Polepa (POL), a marine oil rich in eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. The combinations of supplement were as follows: 9% Efamol - 1% POL, 8% Efamol - 2% POL, 7% Efamol - 3% POL, 6% Efamol - 4% POL, 5% Efamol - 5% POL. The outflow of thromboxane (TxB2), prostacyclin (6-keto-PGF1 alpha), PGE2, and PGE1 was decreased in relation to the proportion of marine oil in the diet, except for the group which received 8% Efamol - 2% POL, and which showed an increase in 6-keto-PGF1 alpha, PGE2, and PGE1. The decrease in TxB2 was much greater than those of 6-keto-PGF1 alpha or PGE2, while PGE1 followed the same pattern as prostacyclin and PGE2. These results suggest that n-3 fatty acids, at high concentrations, inhibits conversion of both DGLA and AA to eicosanoids. Low concentrations of fish oil may, in contrast, increase formation of desirable 1 and 2 series eicosanoids.

An initial screening of serum lipids and fatty acid profiles of hypertensive and normotensive subjects

Serum lipids and their acyl group profiles from a group of hypertensive patients with elevated systolic and diastolic pressure were compared with normotensive subjects of matched age, body weight and dietary habits. The level of serum triacylglycerols was elevated in the hypertensive subjects, but the cholesterol level remained normal. The acyl groups of serum triacylglycerols and cholesterylesters from hypertensive subjects indicated a higher proportion of the saturated fatty acids (16:0 and 18:0) and a lower proportion of linoleic acid (18:2) as compared to normal controls. There was no obvious change in the level and acyl group composition of serum phosphatidylcholine between the two groups. Since the hypertensive and normotensive subjects indicated similar dietary habits, the resulting differences in serum lipids reflected an abnormality in the lipolytic process in the hypertensive subjects.

Essential fatty acids, prostaglandins, and alcoholism: an overview

Essential fatty acids (EFAs) are major structural components of the brain and through their effects on membrane properties can influence nerve conduction, transmitter release, and transmitter action. Prostaglandins (PGs) derived from EFAs have profound behavioral effects and are also able to modify conduction and transmitter function. Effects of alcohol on EFAs and PGs are therefore good candidates for explaining at least some of the actions of alcohol on brain function. Ethanol has three main known actions on EFA and PG metabolism: it reduces blood linoleic acid levels and induces or exaggerates EFA deficiency states; it blocks metabolism of linoleic acid to EFA metabolites which are known to be important in brain structure; and it enhances conversion of the linoleic acid metabolite, dihomo-gamma-linolenic acid, to PGE1. This review demonstrates that some of the short-term behavioral effects of ethanol and some of its long-term adverse effects on brain, liver, and other tissues may be partly explicable in terms of ethanol actions on EFA and PG metabolism. Modification of such metabolism by dietary and other means has already been shown to influence the effects of alcohol and alcohol withdrawal in both humans and animals. This promises to be a fruitful source of investigation with substantial implications for the understanding and treatment of alcoholism.

The influence of dietary manipulation with n-3 and n-6 fatty acids on liver and plasma phospholipid fatty acids in rats

The interrelations between linoleic acid (LA) metabolites and fish oil fatty acids were studied. Sprague-Dawley rats (200-220 g) were fed a fat-free semisynthetic diet supplemented with 10% (by weight) of different combinations of evening primrose oil (EPO), a rich source of LA and gamma-linolenic acid, and polepa (POL), a marine oil rich in eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. The combinations of supplement were as follows: 9% EPO-1% POL, 8% EPO-2% POL, 7% EPO-3% POL, 6% EPO-4% POL and 5% EPO-5% POL. After two weeks on the respective diets, the animals were killed, and the fatty acid compositions of liver and plasma phospholipids were examined. The results showed that animals fed higher proportions of POL consistently contained higher levels of dihomo-gamma-linolenic acid (DGLA) (p less than 0.05), a metabolite of LA and GLA, and lower levels of arachidonic acid (AA) (p less than 0.01), a metabolite of DGLA through delta-5-desaturation. Thus, an inverse relationship between AA/DGLA ratio and EPA levels was found to exist (r = -0.765 in plasma and -0.792 in liver). However, there was no such relationship between AA/DGLA ratio and DHA levels. This result suggested that EPA but not DHA in fish oil exerts an inhibitory effect on the conversion of DGLA to AA.

Influence of prostaglandin E1 on high density lipoprotein-fraction lipid levels in rats

Serum lipid concentrations were determined in rats treated with PGE1 and in controls. Reduced concentrations of total lipids (P less than 0.001), cholesterol (P less than 0.001), triglycerides (P less than 0.05), and phospholipids (P less than 0.002) were found in the treated rats. Furthermore, decreased concentrations of HDL-cholesterol (P less than 0.001), HDL-triglycerides (P less than 0.02), and HDL-phospholipids (P less than 0.02) were observed in the treated rats. These lipid changes could be related to the antilipolytic action of PGE1. Furthermore, these results suggest that PGE1 may exert an antiatherogenic effect modifying serum lipid levels.

Cardiovascular actions of dietary polyunsaturates and related mechanisms. A state-of-the-art-review

A survey of the effects of dietary polyunsaturates on the function of the cardiovascular system is given. In isolated hearts of rats dietary linoleate supply increases both coronary flow and heart muscle function. Hearts of rats fed high amounts of linoleic acid are protected against catecholamine (over)-stimulation. Polyunsaturate rich vegetable oils are effective in lowering blood pressure in several murine hypertension models. This effect seems to be closely related to antihypertensive changes in kidney function and in the function of the arterial vessel wall. Dietary polyunsaturates augment the hypotensive effect of antihypertensive drugs. Cardiovascular effects of dietary polyunsaturates are at least partly mediated via changes in the prostanoid metabolism as well as a reduction of the sympathetic activity. Evidence has been accumulated that cardiovascular effects of dietary polyunsaturates in animal and man are comparable. The observed effects are discussed against the background of a reduced risk of cardiovascular disease after a polyunsaturate rich diet in man.

Plasma essential fatty acids in pure and mixed race American Indians on and off a diet exceptionally rich in salmon

Eskimos on a traditional diet have unusually low prevalences of cardiovascular disease and cancer. One possible reason is the high intake of eicosapentaenoic acid (EPA) which is thought to account for the high EPA and low arachidonic acid (AA) levels in Eskimo plasma. People who also consume a traditional diet exceptionally rich in EPA are the Indians of the west coast of Vancouver Island. There are about 12,000 of these people and their traditional diet has been affected much less than that of the Eskimos. When on their traditional diet the Vancouver Island Indians, like the Eskimos, have high EPA and low AA levels in plasma. When eating European food, EPA levels are in the European range, but AA levels are still exceptionally low, a finding also reported from Eskimos living in Denmark. In a small mixed race group, AA levels were intermediate between those in pure Indians and in Europeans. The high EPA levels in Eskimos and West Coast Indians are related to diet. The low AA levels, in contrast, are probably genetically determined. Unusual disease patterns in these populations cannot be entirely attributed to diet.

The combined role of atheroma, cholesterol, platelets, the endothelium and fibrin in heart attacks and strokes

In 1920 the typical American diet was rich in cholesterol and fat, especially saturated animal fat, with one-third the polyunsaturated vegetable fat as now; yet in that year, death from myocardial infarction (MI) in the United States was so rare that it had no name or medical recognition. In 1960, when MI deaths in the United States had soared to an alarming rate of 600,000, orthodox medicine concluded that cholesterol and saturated animal fat in food caused elevated cholesterol in blood, which caused cholesterol in atheroma, which in turn caused death from MI and strokes. It is suggested that human atheroma is made up mostly of fibers of either collagen or fibrin, smooth-muscle cells or dead smooth-muscle cells, that it contains but little cholesterol, and that it is present in both men and women and in populations having little or no MI as well as in those where MI is the greatest cause of death. It is suggested that MI is largely caused by coronary blood clots formed at the site of a break in the coronary artery endothelium; that the introduction of a new, unnatural dietary fatty acid--trans-trans linoleic acid--in margarine and refined vegetable oils in the 1920s, by inducing a deficiency of beneficial prostaglandin E1 (PGE1) while greatly increasing harmful thromboxane A2 (TXA2), caused vasoconstriction while the clumping of platelets was greatly increased, giving rise to the coronary blood clots that either cause or are part of the fatal process of MI. It is suggested that in fostering the increase of dietary trans-trans linoleic acid in polyunsaturated vegetable fats at the expense of saturated animal fat, orthodox medicine is fostering a principle cause of MI as the cure.

How do polyunsaturated fatty acids lower plasma cholesterol levels?

For 30 years it has been known that linoleic acid can lower elevated cholesterol levels. Large increases in linoleic acid have been widely recommended as a way of reducing the risk of cardiovascular disease. Such recommendations have resulted in major dietary shifts in some countries, including the USA. Yet the precise characteristics of the linoleic acid molecule which confer on it cholesterol-lowering properties are unknown. gamma-Linolenic acid, the first essential fatty acid metabolite of linoleic acid, has been found to have cholesterol-lowering actions ca. 170 times greater than the parent molecule, suggesting that linoleic acid must be converted to gamma-linolenic acid to exert its desirable effects on cholesterol metabolism. Aging, sex, diabetes mellitus, alcohol, catecholamines and trans fatty acids and saturated fats can all modulate the delta-6-desaturase enzyme which converts linoleic acid to gamma-linolenic acid. This provides a possible unifying explanation for the actions of these known risk factors for cardiovascular disease.

Nutritional modulation of mineralocorticoid and prostaglandin production: potential role in prevention and treatment of gastric pathology

Various lines of evidence indicate that aldosterone and prostaglandins may play physiological roles in protecting the gastric mucosa. This would suggest that low-sodium, high-potassium diets, and supplementation with essential fatty acids that are efficient prostaglandin precursors (as in evening primrose oil), may have value in the prevention and treatment of gastric ulcer and gastritis. A low-sodium, high-potassium diet may also reduce the risk of gastric cancer.

Melanin: the organizing molecule

The hypothesis is advanced that (neuro)melanin (in conjunction with other pigment molecules such as the isopentenoids) functions as the major organizational molecule in living systems. Melanin is depicted as an organizational "trigger" capable of using established properties such as photon-(electron)-phonon conversions, free radical-redox mechanisms, ion exchange mechanisms, and semiconductive switching capabilities to direct energy to strategic molecular systems and sensitive hierarchies of protein enzyme cascades. Melanin is held capable of regulating a wide range of molecular interactions and metabolic processes primarily through its effective control of diverse covalent modifications. To support the hypothesis, established and proposed properties of melanin are reviewed (including the possibility that (neuro)melanin is capable of self-synthesis). Two "melanocentric systems"--key molecular systems in which melanin plays a central if not controlling role--are examined: 1) the melanin-purine-pteridine (covalent modification) system and 2) the APUD (or diffuse neuroendocrine) system. Melanin's role in embryological organization and tissue repair/regeneration via sustained or direct current is considered in addition to its possible control of the major homeostatic regulatory systems--autonomic, neuroendocrine, and immunological.

The beriberi analogy to myocardial infarction

Two pandemics of heart attack deaths have plagued the world's population during the past 130 years. The first pandemic, induced by beriberi, was caused by the industrial revolution altering the nutritional composition of rice. By 1892 a simple working knowledge, then at hand, could have terminated the beriberi plague; however, orthodox medicine being then enchanted with the false concept that all disease was caused by germs, permitted millions of Asians to die needlessly of beriberi by refusing to tell them to eat rice bran or to drink rice bran tea. A second pandemic of heart attack deaths, called myocardial infarction (MI), struck the developed nations of the Western World in full force after 1930. As a hypothesis, it is suggested that this MI pandemic, still raging today, was caused by a change in food processing that occurred after 1920, when the new oil seed industry introduced into our food three greatly harmful lipid substances. The unnatural trans-trans isomer of linoleic acid, which had never been in human food prior to 1920 and which entered our food in margarines and refined oils, blocked the conversion of natural cis-cis linoleic acid to prostaglandin E1, which tends to prevent MI, both by acting as a vasodilator and by minimizing platelet aggregation. Harmful lactones were also introduced into our food, increasing the risk of MI by decreasing the fibrinolytic activity of our blood. The oil seed industry also introduced into our diet free radical lipid peroxides that make the myocardium more vulnerable to infarction. It is suggested that except for the one in 500 of us who is afflicted by familial hypercholesterolemia, the cholesterol concept of MI is as false today as was the concept in 1900 that germs caused beriberi. It is further suggested that a working knowledge is at hand today that can make death from MI just as rare as death is now from a beriberi-induced heart attack.

Inverse relationship between linoleic acid in serum and in adipose tissue of patients with essential hypertension

In patients with labile essential hypertension without and with overweight as well as in normotensive controls the fatty acid pattern of serum triglycerides and subcutaneous adipose tissue was estimated by gas liquid chromatography. In serum triglycerides of hypertensives linoleic acid was increased but appeared decreased in depot fat. This inverse relationship could not be found for arachidonic acid. Correspondingly, the C 18:2/C 20:4-ratio was higher in serum triglycerides than in adipose tissue. Only in depot fat of overweight hypertensives the percentage of arachidonic acid was decreased when compared to subjects with normal body weight. Linolenic acid remained unchanged in serum triglycerides but decreased significantly in adipose tissue of hypertensive patients. Eicosapentaenoic acid was increased in serum triglycerides and depot fat of patients with essential hypertension of normal body weight. The results are discussed with respect to the possible pathogenesis of essential hypertension and the hypotensive potency of dietary linoleic acid which has been described in patients with high blood pressure.

Nutritional prevention of pre-eclampsia--a special role for 1 series prostaglandin precursors?

PGE1 appears to act as a physiological regulator of uteroplacental blood flow. Its vasodilatory, anti-vasopressor, and platelet stabilizing effects could be expected to counteract the placental ischemia, hypertension and excessive coagulation that are seen in pre-eclampsia. Supplementation with efficient essential fatty acid precursors of PGE1 reduces platelet aggregation, has been used with success in the treatment of hypertension and arterial vasospasm, and might offer a nutritional means of reducing the incidence and severity of pre-eclampsia. Assurance of adequate general nutrition also appears to be of importance in this regard.

An expanded concept of "insurance" supplementation--broad-spectrum protection from cardiovascular disease

The preventive merits of "nutritional insurance" supplementation can be considerably broadened if meaningful doses of nutrients such as mitochondrial "metavitamins" (coenzyme Q, lipoic acid, carnitine), lipotropes, and key essential fatty acids, are included in insurance supplements. From the standpoint of cardiovascular protection, these nutrients, as well as magnesium, selenium, and GTF-chromium, appear to have particular value. Sophisticated insurance supplementation would likely have a favorable impact on many parameters which govern cardiovascular risk--serum lipid profiles, blood pressure, platelet stability, glucose tolerance, bioenergetics, action potential regulation--and as a life-long preventive health strategy might confer substantial benefit.

Loss of delta-6-desaturase activity as a key factor in aging

Aging is characterized by a wide variety of defects, particularly in the cardiovascular and immune systems. Cyclic AMP levels fall, especially in lymphocytes. Delta-6-desaturase (D6D) levels have been found to fall rapidly in the testes and more slowly in the liver in aging rats. D6D is an enzyme which converts cis-linoleic acid to gamma-linolenic acid (GLA). Other factors which inhibit D6D activity are diabetes, alcohol and radiation, all of which may be associated with accelerated aging. In meat eaters or omnivores which can acquire arachidonic acid from food, the main consequences of D6D loss will be deficiencies of GLA, dihomogamma-linolenic acid (DGLA) and prostaglandin (PG) E1. PGE1 activates T lymphocytes, inhibits smooth muscle proliferation and thrombosis, is important in gonadal function and raises cyclic AMP levels in many tissues. It is a good candidate for a key factor lost in aging. Moderate food restriction, the only manoeuvre which consistently slows aging in homoiotherms, raises D6D activity by 300%. Other factors important in regulating D6D and the conversion of GLA to PGE1 are zinc, pyridoxine, ascorbic acid, the pineal hormone, melatonin, and possibly vitamin B3. GLA administration to humans has been found to lower blood pressure and cholesterol, and to cause clinical improvement in patients with Sjogren's syndrome, scleroderma and alcoholism. These diseases are associated with some features of accelerated aging. The proposition that D6D loss is not only a marker of aging but a cause of some of its major manifestations is amenable to experimental test even in humans. The blocked enzyme can be by-passed by giving GLA directly.

Prospects for nutritional control of hypertension

Sodium restriction is not the only nutritional measure likely to prove valuable in the treatment and prevention of hypertension. The hypotensive effects of central adrenergic stimulation can be promoted by supplementary tyrosine, insulin potentiation (as with GTF), and (possibly) high-dose pyridoxine. Insulin potentiators (GTF) and prostaglandin precursors (essential fatty acids) should have direct relaxant effects on vascular muscle. A high potassium, low sodium diet, coenzyme Q, and prevention of cadmium toxicity (as with dietary selenium) may act to offset renally-mediated pressor influences. Functional combinations of these measures might prove to be substantially effective, in which case they would offer considerable advantages over potentially toxic drug therapies.

Point of view--a role for "nutritional insurance" supplementation in preventive medicine

While macronutrient dietary profile is receiving increasing attention as a determinant of disease risk, the potential of micronutrient supplementation as a public health tool has received little serious attention within orthodox medical circles. In light of the fact that the biochemical effects of many nutrients vary as a function of dose within and beyond "adequate" intake levels, and in light of individual differences in nutrient requirements, it is evident that micronutrient dietary profile--even under the assumption that all nutrient intakes are at least "adequate" or "normal"--plays a major role in determining long-term disease risk. Intelligently planned "nutritional insurance" supplementation could be expected to prevent or delay the onset of many degenerative diseases, while helping to satisfy idiosyncratically high requirements and preventing nutrient deficiency disease.

Decreased prostacyclin sensitivity of human platelets after jogging and squash

8 healthy male volunteers performed jogging (as an example of an aerobic metabolic condition) and squash (as an example of an intermittently anaerobic metabolic condition). The platelets sensitivity to prostacyclin (PGI2) decreased after jogging. After squash, a statistically significant (p 0,001) decrease in the sensitivity of the platelets could be seen. Our findings suggest that an early alteration of platelet sensitivity might play a key role in maintaining the hemostatic balance and could be of greater importance than the vascular wall PGI2-synthesis, as the sensitivity changes immediately, whereas the PGI2-formation change is a long-term process.

Dietary modification of the vascular effect of prostacyclin in hypertensive rats

Hypertension increased the responsiveness of spontaneously hypertensive rats (SHR) to exogenously infused prostacyclin (PGI2) at rates of 300 ng/kg/min and 1 microgram/kg/min. This did not occur for angiotensin infusion. Substitution of a diet containing alpha-linolenic acid for the control diet to SHR abolished this increased responsiveness to PGI2. Accompanying the abolition of the increased responsiveness to PGI2 was a significant increase in specific activity of two lysosomal hydrolases (N-acetylglucosaminadase and cathepsin D) within the aorta of SHR. These changes may reflect compensatory responses of the vasculature to protect the animal.

A biochemical basis for alcoholism and alcohol-induced damage including the fetal alcohol syndrome and cirrhosis: interference with essential fatty acid and prostaglandin metabolism

Alcohol has at least two actions on essential fatty acid (EFA) and Prostaglandin (PG) metabolism. It enhances the conversion of dihomogammalinolenic acid (DGLA) to PGE1 but it blocks the activity of the delta-6-desaturase, an enzyme necessary for replenishment of DGLA stores from dietary precursors. The acute effect of ethanol is therefore an increased production of PGE1 but chronic consumption will lead to depletion of DGLA and PGE1. Withdrawal from alcohol will lead to a precipitous fall in PGE1. PGE1 is known to have profound effects on the nervous system and behaviour. Patients with mania produce more PGE1 than normal while those with depression make less. Alcoholics may drink to maintain a normal PGE1 level, something which will require more and more ethanol as DGLA is depleted. In both animals and humans PGE1 or its precursor, gamma-linolenic acid (GLA) have been shown to attenuate the acute withdrawal syndrome. PGE1 injections prevent the development of fatty liver in alcohol-treated animals. Defective EFA and PGE1 metabolism are known to lead to increased fibrosis, reproductive failure, cardiomyopathy, cardiovascular disorders, gastritis and pancreatitis and could therefore be the basis for these disorders in alcoholics. A PGE1 deficiency could also be responsible for the fetal alcohol syndrome. Three other agents are known to produce constellations of fetal defects very similar to those found in the alcohol syndrome. These other factors are dihphenylhydantoin, lithium, and a deficiency of zinc. These three factors and excessive alcohol consumption all lead to PGE1 deficiency by different routes. If this concept is correct, the key to the management of alcoholism and its medical complications lies in the provision of GLA or DGLA, fatty acids which by-pass the alcohol blocked step and which are unfortunately unlikely to be present in any normal diet. Unlike many concepts of alcoholism and alcohol damage, the EFA/PGE1 idea is very readily testable and already has considerable experimental support.