Chronic Fatigue Syndrome

Fatty Acids & Chronic Fatigue Syndrome
The Dr Basant Puri Interview

'...by taking a high-EPA fatty acid supplement, one could encourage both processes: namely, increasing the availability of the precursors from which the phospholipid molecules are created, and inhibiting the action of ... the enzyme that strips them out. '

The study by Dr Basant Puri (1) and colleagues, showing some abnormalities in the metabolism of fatty acids of a group of patients with Chronic Fatigue Syndrome (CFS), has generated a lot of interest. In this interview, Dr Puri gives a more detailed explanation of their research (2), and why, in his opinion, fatty acid supplementation could be of benefit.

What does the study you have just published show?

It's the first study to look directly at the chemistry of the brain in relation to CFS. Normally, the chemical choline has a gradient in the brain, with more being found in the front of the brain and less in the back. In the CFS patients whom we scanned, this gradient did not exist. In fact, the concentration of choline in the back of the brain was as high as in the front. In contrast, we found that the age- and sex-matched control patients, whom we also scanned, did show the spatial variation that we would normally expect.

So what does this increase in choline mean?

We believe that the increased choline levels are related to abnormal metabolism in membrane phospholipids, the building blocks of all cell membranes in the brain(3). The study indicates that there is increased loss of fatty acids in the brain in people with CFS. To explain: choline is actually part of some phospholipid molecules. If there is an excess of free choline in the brain then this may indicate that the membrane phospholipids are being broken down faster than they are being created.

What can one do to address this?

If this explanation is correct, then phospholipids are being broken down faster than they are being created in the brain. An important component of the phospholipids is the highly unsaturated fatty acids (HUFA). So there are two mechanisms by which we could try to shift the equilibrium in favour of increased biosynthesis of the phospholipids within the membranes.

First, we could increase the availability of the key ingredients of the phospholipids themselves. And second, we could try to inhibit the processes that break down the phospholipids. In respect of the first possibility, we have already found that increased levels of one key ingredient - choline - is present in the occipital cortex of the brain. So it might make sense to increase the availability of another key component of the molecule, namely HUFA. In respect of the second possibility, namely inhibiting the processes that break down membrane phospholipids, we could try actively to inhibit the action of some of the enzymes responsible for this.

So how would you increase the presence of HUFA?

Simple. Fatty acid supplementation. People might try incorporating higher levels of essential fatty acids in their diet by eating oily fish, but in order to bypass various blocks in the body's ability to utilise specific dietary fatty acids, it might be prudent to supplement with specific fatty acids.

And what can one do to inhibit the action of the enzymes which break down the phospholipids?

It turns out that one of the key groups of enzymes that remove HUFA from phosophilipid molecules in brain cell membranes - cPLA2 - is actively inhibited by the omega-3 fatty acid EPA. Fortunately, the body can easily convert EPA into another omega-3 fatty acid, DHA, which is also important in phospholipid molecules. So by taking a high-EPA fatty acid supplement, one could encourage both processes: namely, increasing the availability of the precursors from which the phospholipid molecules are created, and inhibiting the action of cPLA2, the enzyme that strips them out.

Are there any other studies to support this?

Interestingly, back in 1990, Professor Peter Behan from Glasgow University, and Professor David Horrobin, published a study in which 63 adults with what was then called 'post viral fatigue syndrome', were entered into a double-blind, placebo-controlled study. The active treatment was a combination of fatty acids including GLA, EPA and DHA, and this was given to 39 of the patients randomly selected from the group. The remaining 24 patients received a placebo. The trial lasted three months, at the end of which, 17% of the placebo group showed some improvements. But in the fatty acid supplementation group, a much higher figure - 85% of the group - had shown improvement on a range of conditions.

So what symptoms improved?

Fatigue, myalgia (muscle pain), dizziness, poor concentration and depression. Also, the essential fatty acid levels in red blood cell membranes - which are believed to index the levels in brain cell membranes - had been found to be abnormal at the start of the trial amongst the participants. However, at the conclusion of the trial, those who had received the supplement were found to have fatty acid levels that had reverted to normal.

So fatty acids cured CFS?

No, I do emphasise that none of the patients in this study was regarded as 'cured'. The authors described the results as 'gratifying' because those who improved felt able to resume work and other activities considered impossible up until then.

So what fatty acids, and how much, should one take?

If this theory is correct, then optimum levels of EPA are required. In the 1990 study, the active treatment consisted of eight 500-milligram capsules per day, with each capsule containing EPA, DHA, GLA and Vitamin E. We have found in other conditions linked to phospholipid metabolism, including depression, that one should get at least 500 mg, and preferably 1 gram of EPA per day. You would have to look at the specific levels of the particular fatty acid supplement to assess this. I would also like to add that anyone on anticoagulant therapy should seek medical advice, as omega-3s actually thin blood and assist circulation.

1. Dr Basant Puri is a Consultant and Senior Lecturer in Imaging and Neuropsychiatry at the MRI Unit, MRC Clinical Sciences Centre, Imperial College School of Medicine, Hammersmith Hospital, London W12 0HS, England.

2. Puri BK et al. Relative increase in choline in the occipital cortex in chronic fatigue syndrome. Acta Psychiatrica Scandinavica 2002.

3. Each cell membrane is made up of phospholipids. Each phospholipid has a carbon backbone, to which are attached two chains of fatty acids (lipids), plus a phosphorus group (which often includes choline).

ABSTRACT (Point 2 above)

Puri BK et al. Relative increase in choline in the occipital cortex in chronic fatigue syndrome. Acta Psychiatrica Scandinavica 2002.

Objective: To test the hypothesis that chronic fatigue syndrome (CFS) is associated with altered cerebral metabolites in the frontal and occipital cortices.

Methods: Cerebral proton magnetic resonance spectroscopy was carried out in eight CFS patients and eight age- and sex-matched healthy control subjects. Spectra were obtained from 20 20 20 mm3 voxels in the dominant motor and occipital cortices using a point-resolved spectroscopy pulse sequence.

Results: The mean ratio of choline to creatine in the occipital cortex in CFS (0.97) was significantly higher than in the controls (0.76; P = 0.008). No other metabolite ratios were significantly different between the two groups in either the frontal or occipital cortex. In addition, there was a loss of the normal spatial variation of choline in CFS.

Conclusion: Our results suggest that there may be an abnormality of phospholipid metabolism in the brain in CFS.

1st Vitality Note:

Professor Puri has written a book "Chronic Fatigue Syndrome: A Natural Way..." which offers a fresh approach to chronic fatigue syndrome or M.E., which covers the use of EPA in the treatment of the debilitating condition - which we'd highly recommend. For more information, please click here.

1st Vitality specialise in high concentration pharmaceutical grade oils including MorEPA (mentioned in Dr Puri's book). For help on choosing the right one for your needs, please contact us