Fuhrman's e-mail on DHA

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Fuhrman's e-mail on DHA

Postby vman » Thu Apr 02, 2009 7:50 pm

Jeff,

I know you've covered various aspects of this before, but Dr. Fuhrman's latest e-mail below about DHA deficiency in vegans sparks all kinds of questions that I can't even begin to answer. Does this bring up any additional thoughts that you may not have covered here previously?

vman

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From Dr. Fuhrman's latest e-mail:

Leaders of the Vegan Movement Develop Parkinson's: Case Studies

Herbert Shelton (1895 - 1985) a naturopath and chiropractor and the influential founder of the American Natural Hygiene Society and Nature Cure movement in America and prolific health writer advocated a natural food vegetarian diet of mostly raw fruits, vegetables and nuts. I read all of his highly motivating books, newsletters and writings in my teens. He lived in Texas, was physically fit, grew lots of his own food and ate carefully and fasted periodically. Of course he did not get cancer, he did not get heart disease, but he died of Parkinson's disease and was so severely affected by the age of 78 that even walking was difficult. In 1973 when I met him he was already severely hunched over and had a difficult time walking and caring for himself. Though he lived many years with this significant disability, the quality of his later years was extremely poor.

Prominent Vegetarian and Health Advocate - this leader in the natural health movement and a personal friend to me also suffered from and eventually died from a fall related to his Parkinson's disease. During his young adult life he embarked on the path of healthy living and vegetarianism. A follower of Shelton's works, he operated a large health food store, one of the first to sell organic fruits and vegetables in America; he became a leader in the health food industry. Of course he was not at risk of cancer or heart disease with his excellent diet, but he developed Parkinson's which limited the quality of his later years.

When he was developing his Parkinsonian tremors, I ordered blood tests and was shocked to see his blood results showing almost a zero DHA level on his fatty acid test, in spite of adequate ALA consumption from nuts and seeds eaten daily. I had never seen a DHA level that low before. Since that time I have drawn DHA blood levels on other patients with Parkinson's and also found very low DHA levels.
Was it a coincidence, that these leaders in the natural food, vegetarian movement, who ate a very healthy vegan diet and no junk food would both develop Parkinson's? I thought to myself--could it be that deficiencies in DHA predispose one to Parkinson's? Do men have worse ability to convert short chain omega-3 into long chain DHA? Is that why Parkinson's affects more men than women? Is there evidence to suggest that DHA deficiencies lead to later life neurologic problems? Are there primate studies to show DHA deficiencies in monkeys leads to Parkinson's? The answer to all of these questions is a resounding, yes.


More than 1 million Americans suffer from Parkinson's Disease (PD), a neurodegenerative disease that is clinically characterized by resting tremor, muscular rigidity, gait problems and impaired ability to initiate movements. Recent scientific findings show diets rich in omega-3 fatty acids, in particular DHA (docosahexaenoic acid), have a protective effect on this type of neurodegenerative disease. Studies in animals clearly show that supplementation of DHA can alter brain DHA concentrations and thereby modify brain functions leading to reduced risk of neurodegenerative diseases like Alzheimer's and Parkinson's.1

A recent study examined mice which were exposed to two diets; one group was fed a diet with DHA and other omega-3 fatty acids; while the other group was given ordinary food, lacking DHA. After a period of time they were given a dose of a chemical that causes the same damage to the brain as Parkinson's disease. The mice on the DHA diet seemed to be immune to the effects of the chemical, whereas the mice that ate ordinary food developed symptoms of the disease.

According to the researchers, among the mice that had been given omega-3 supplementation - in particular DHA - omega-3 fatty acids replaced the omega-6 fatty acids in their brains. Due to the fact that concentrations of other omega-3s (LNA and EPA) had maintained levels in both groups of mice, the researchers suggested that the protective effect against Parkinson's indeed came from DHA.2
Another conclusion drawn from this finding is that a brain containing a lot of omega-6 fatty acids may create a fertile ground for developing Parkinson's disease. These fatty acids, are abundant in foods rich in either vegetable oil or animal fat, which we already know contribute negatively to our health.

Another study observed the effect of DHA on monkeys treated with MPTP, a drug that induces Parkinson's like symptoms, and the results suggested that DHA can reduce the severity of, or delay the development of these drug-induced symptoms and therefore can offer therapeutic benefits in the treatment of Parkinson's. 3

Overall, this research provides evidence that DHA deficiencies can leave us vulnerable to developing diseases like Parkinson's and Alheizmer's. If you are a nutritarian, flexitarain, vegan, or vegetarian and you are not taking DHA or confirming your levels are adequate with blood work you are being negligent, and potentially increasing your risk of such a disease in later life. All the good efforts on proper nutrition can be undone with one deficiency such as Vitamin D, B12, or DHA. I see this every week in my practice.

History Repeats Itself

Some authors, doctors and leaders of the vegan movement today are heavily biased towards the idea of not needing these supplements. They simply give inadequate nutritional advice and in spite of all the science they still pooh-pooh taking long-chain omega-3 DHA. They are risking the quality of their own lives and that of their followers.

Likewise, I have seen so many vegan-promoting doctors and authors negate the need for taking B12, as well as dismiss the need to take vitamin D, stating minimal sunshine is enough. They also deny the need for omega-3 supplementation. There is so much scientific literature available today pointing to the contrary, however, this irresponsible information keeps radiating from the podium of lecture halls.

It reminds me of all the statements in the past, that the need for B12 was exaggerated and that the small amount of bacteria on organic produce or in seaweed was sufficient.

TC Fry (1926 - 1996)- another long-term Natural Hygienist, raw foodest, vegetarian-fruitarian, advocated you did not need supplements as food contained all that we need. He died of an atherosclerotic-related embolism at the age of 70. I saw his hospital record at his death and reviewed his blood work drawn immediately prior to his death. It was quite revealing. He had severe B12, deficiency, so long-standing that his B12 levels were almost undetectable and the lowest I have ever seen. It is kind of interesting reading internet interpretations of why he died, such as "did not practice what he preached," "cheated on his diet," "too much sex," "ozone treatments for his vascular disease". He died prematurely simply because long-standing B12 deficiency leads to extremely high homocysteine levels, which can cause intra-vascular inflammation and cardiovascular disease.

I have seen this over and over again in vegans not supplementing with B12. I even had a patient with extremely severe hyper-homocysteinemia and vascular disease who flew in to see me from Scandinavia. When I diagnosed the problem and discussed how to solve it, she still refused to take the B12 supplements, stating that Dr. Shelton and Dr. Vetrano said that nature provided us with all that we need in natural plant foods. She flew home angry that I disagreed. She died soon after.

Don't be fooled into thinking that by merely eating right you are doing all you can do to protect your health. People must be made aware that by neglecting to take the supplements that are essential to assuring nutritional excellence, they are putting themselves in harm's way. Specifically, not taking DHA, B12 and vitamin D can be potentially dangerous and even life threatening.
Dr. Fuhrman's DHA Purity is a pure, fresh, all vegan, concentrated liquid. This DHA is derived from algae grown under sanitary laboratory conditions.

1Calon F ; Cole G Neuroprotective action of omega-3 polyunsaturated fatty acids against neurodegenerative diseases: evidence from animal studies. Prostaglandins Leukot Essent Fatty Acids. 2007; 77(5-6):287-93
2M. Bousquet, M. Saint-Pierre, C. Julien , N. Salem, Jr., F. Cicchetti and F. Calon Beneficial effects of dietary omega-3 polyunsaturated fatty acid on toxin-induced neuronal degeneration in an animal model of Parkinson's disease
The FASEB Journal. 2008;22:1213-1225.
3 Samadi P ; Grégoire L ; Rouillard C ; Bédard PJ ; Di Paolo T ; Lévesque D Docosahexaenoic acid reduces levodopa-induced dyskinesias in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine monkeys. Ann Neurol. 2006; 59(2):282-8
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Postby Joe927 » Fri Apr 03, 2009 6:53 am

This is why I sometimes have issues with Dr Furhman's take on issues. So he goes on a 3 page long diatribe about how vegans need to supplement or they'll die, and at the very end lets us know that he conveniently sells the supplements on his website. I'm sure he is well intentioned but it makes him look like any other supplement pusher. He appears willing to scare people into buying his products.
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Postby JeffN » Fri Apr 03, 2009 7:27 am

These issues are all addressed in the threads on Fish, Essential Fats, Flax, etc.

This topic was also recently addressed on a professional list-serve made up of all the professionals in vegan/vegetarian health and most did not agree with the above conclusions.

Let me quote one of the responses...

"I think we need good evidence before recommending that vegans consume an expensive supplement of substances (EPA/DHA) that do not naturally occur in any diet of land plants.

The balance of evidence for specific benefits of the longer omega-3s for heart health is rather weak (see for example the BMJ review http://www.bmj.com/cgi/rapidpdf/bmj.38755.366331.2Fv1 ) Those recommending EPA and DHA have, in my opinion, been too quick to dismiss the DART-2 results showing increased risk in angina sufferers.

http://www.ncbi.nlm.nih.gov/pubmed/17343767

Research on omega-3s and adult mental function favours EPA rather than DHA and little DHA is retro-converted to EPA. ALNA is effective in raising EPA levels.

In terms of DHA supply to nervous tissue during pregnancy, ALNA reduces signs of omega-3 deficiency (e.g. elevated levels of Osbond acid) indicating that it acts as a source of DHA even if little conversion is evident in blood samples.

The evidence for adverse effects of ALNA is either sparse (eye) or contradictory (prostate).

I therefore see no need for vegans to consume any omega-3 other than the plant omega-3 alpha-linolenic acid (ALNA).

A good source of ALNA is ground flaxseed. In the UK, organic flaxseed can be purchased for under ÂŁ4 per kilo (ÂŁ1 per 1,000 kcal) making it a not particularly expensive food rather than an expensive supplement. A heaped tablespoon of flaxseed a day (about 10 grams) combined with cutting down high omega-6 oils and seeds will give a good balance between omega-6 and omega-3 (about 4:1) without excessive polyunsaturated fat intake."

There have been a number of recent reviews of omega-3 fatty acids and depression.

For example,

The role of omega-3 fatty acids in mood disorders. http://www.ncbi.nlm.nih.gov/pubmed/18183532 and

Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid?

http://www.pubmedcentral.nih.gov/picren ... id=2071911 <http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2071911&blobtype=pdf> &blobtype=pdf

These reviews provide no basis to recommend the use of pure DHA (as per most veg*n supplements) to combat depression.

I think it is also important to note that a recommendation of EPA and DHA as nutritional supplements for veg*ns would imply that humans are adapted to require dietary components that are not found in plants. If the evidence pointed to such a conclusion, I would go with the evidence but I have no desire to leap beyond the evidence into such problematic territory: if one such adaptation were demonstrated the likelihood that other such adaptations exist would increase. So far, I don’t think the evidence points that way.

In the collaborative analysis of studies comparing vegetarians with other dietary groups, fish-eaters and vegetarians showed very comparable results (Table 7 http://www.ajcn.org/cgi/reprint/70/3/516S ). The fish-eaters will have had higher intakes of EPA and DHA than the vegetarians but this does not seem to have conferred an advantage. Once again, evidence to recommend EPA/DHA seems lacking."


I agree.

In addition, a recent article in the AJCN agreed with this position.

Do vegetarians have to eat fish for optimal cardiovascular protection?1–3
Am J Clin Nutr 2009;89(suppl):1S–5S.

Iqwal Mangat

ABSTRACT
Interest in the cardiovascular protective effects of n–3 (omega-3)
fatty acids has continued to evolve during the past 35 y since the
original research describing the low cardiovascular event rate in
Greenland Inuit was published by Dyerberg et al. Numerous in vitro
experiments have shown that n–3 fatty acids may confer this benefit
by several mechanisms: they are antiinflammatory, antithrombotic,
and antiarrhythmic. The n–3 fatty acids that have received the most
attention are those that are derived from a fish source; namely the
longer-chain n–3 fatty acids eicosapentaenoic acid (EPA; 20:5n–3)
and docosahexaenoic acid (DHA; 22:6n–3). More limited data
are available on the cardiovascular effects of n–3 fatty acids derived
from plants such as a-linolenic acid (ALA; 18:3n–3). Observational
data suggest that diets rich in EPA, DHA, or ALA do reduce cardiovascular
events, including myocardial infarction and sudden cardiac
death; however, randomized controlled trial data are somewhat
less clear. Several recent meta-analyses have suggested that dietary
supplementation with EPA and DHA does not provide additive
cardiovascular protection beyond standard care, but the heterogeneity
of included studies may reduce the validity of their conclusions.
No data exist on the potential therapeutic benefit of EPA, DHA, or
ALA supplementation on those individuals who already consume
a vegetarian diet. Overall, there is insufficient evidence to recommend
n–3 fatty acid supplementation for the purposes of cardiovascular
protection; however, ongoing studies such as the Alpha
Omega Trial may provide further information.

Also...

While I try to keep the discussion/threads on the health issues and the available evidence, the point of having an article end in the sale of the product recommended in the article, take away from the credibility of the article, regardless of who writes the article.

As I have said here many times, supplements can and do play a role, but should only be recommended on an individual basis on an as needed basis, with informed consent. In addition, as a health professional, (and as the ethical guidelines of most all health professions agree) it is a compromise of the doctor/patient relationship for me to directly sell supplements to a patient. My role is to evaluate their health situation and if a supplement (or medication) is necessary, to tell them which one and which brand I may recommend, and/or where to get it the cheapest for the highest quality. And, I should refrain from any sales of promotions of specific brands unless I am fully disclosing all my financial relationships with the brand and making them available at my cost as a added benefit to the patient.

In other words, if I thought someone needed B12, it is my job to discuss the various forms of B12, which I would recommend and why, and where they could get it for the best price. And, if I was to make it available, it would be only to offer it at or below cost as a service to you.

Anecdotal stories of isolated cases of disease and death from an evidence based professional, only makes their position worse, not better.

Personally, I won't even go near the personal sales of these products as I feel it compromises my ethics, integrity and professionalism. After over 5 years of being "in charge" of the supplement program for a former employer, my total commissions equaled "0" because I refused to sell them. However, when they were appropriate, I did recommend them on occasions to specific patients for specific reasons, but I also told them where was the best place for them to buy them.

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thanks Jeff

Postby vman » Fri Apr 03, 2009 8:18 am

Appreciate your detailed response Jeff.
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Postby Suebee » Fri Apr 03, 2009 10:28 am

So then is it possible the problem started with Hygienists eating too many nuts/seeds which are high in omega-6's which threw off the balance? Or is Parkinson's another disease caused by their lack of B12? Any ideas?
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Postby JeffN » Fri Apr 03, 2009 10:48 am

Suebee wrote:So then is it possible the problem started with Hygienists eating too many nuts/seeds which are high in omega-6's which threw off the balance? Or is Parkinson's another disease caused by their lack of B12? Any ideas?


Or hygienists not eating and/or living hygienically.

Dr Shelton was renowned for his lack of adherence which he attributed to his constant life on the road.

http://www.orthopathy.net/shelton.html

"Shelton's diet really wasn't that strict. He was a lactovegetarian; he never could get past the milk products in his diet, including cheese, clabbered milk, and butter."

In addition, we actually see the benefit of a vegan diet in the literature.

1) A vegan diet prevents progression of Parkinsons Med Hypotheses. 2001 Sep;57(3):318-23. Does a vegan diet reduce risk for Parkinson's disease? McCarty MF.

In aggregate, these findings suggest that vegan diets may be notably protective with respect to Parkinson's Disease. However, they offer no insight into whether saturated fat, compounds associated with animal fat, animal protein, or the integrated impact of the components of animal products mediates the risk associated with animal fat consumption. Caloric restriction has recently been shown to protect the central dopaminergic neurons of mice from neurotoxins, at least in part by induction of heat-shock proteins; conceivably, the protection afforded by vegan diets reflects a similar mechanism. The possibility that vegan diets could be therapeutically beneficial in PD, by slowing the loss of surviving dopaminergic neurons, thus retarding progression of the syndrome, may merit examination. Vegan diets could also be helpful to PD patients by promoting vascular health and aiding blood-brain barrier transport of L-dopa. PMID: 11516224

2) Schwartz RH. Parkinson's disease and vegan diet. Med Hypotheses. 2004;63(1):178.

“A 75-year-old man with PD for eight years changed to a vegan diet for two years. During this time his PD did not appear to have advanced, his dosage of PD medications (levadopa) did not increase, and his quality of life was reported to have improved—an atypical course for this disease.”

3) Med Hypotheses. 2001 Sep;57(3):318-23.
Does a vegan diet reduce risk for Parkinson's disease?
McCarty MF.

Abstract
Three recent case-control studies conclude that diets high in animal fat or cholesterol are associated with a substantial increase in risk for Parkinson's disease (PD); in contrast, fat of plant origin does not appear to increase risk. Whereas reported age-adjusted prevalence rates of PD tend to be relatively uniform throughout Europe and the Americas, sub-Saharan black Africans, rural Chinese, and Japanese, groups whose diets tend to be vegan or quasi-vegan, appear to enjoy substantially lower rates. Since current PD prevalence in African-Americans is little different from that in whites, environmental factors are likely to be responsible for the low PD risk in black Africans. In aggregate, these findings suggest that vegan diets may be notably protective with respect to PD. However, they offer no insight into whether saturated fat, compounds associated with animal fat, animal protein, or the integrated impact of the components of animal products mediates the risk associated with animal fat consumption. Caloric restriction has recently been shown to protect the central dopaminergic neurons of mice from neurotoxins, at least in part by induction of heat-shock proteins; conceivably, the protection afforded by vegan diets reflects a similar mechanism. The possibility that vegan diets could be therapeutically beneficial in PD, by slowing the loss of surviving dopaminergic neurons, thus retarding progression of the syndrome, may merit examination. Vegan diets could also be helpful to PD patients by promoting vascular health and aiding blood-brain barrier transport of L-dopa.


While I wish they updated this, I do find this review of Diet and Parkinson's better, which recommends a plant based high carb diet.

http://www.nutritionucanlivewith.com/vegetarian.htm

We just can not make sweeping generalizations as this newsletter did on such relationships. However, these sweeping generalizations and anecdotal information are good for use in marketing and advertising but not in science.

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