Johnathan Kay and Professor Ekins bring up a number of interesting
points (as always), so here is my contribution, which is less concise
than usual because I have had a Bank Holiday weekend to fester over
it.

1)      Medical science doesn’t handle too well diseases for which
there is more than cause. Theories about CHD are, in general, marred
by the assumption that there is a single significant cause (i.e. the
subject of my latest grant application….). It seems to me very
reasonable to suggest that our current diet contains too low a content
of omega-3 fatty acids, but not everybody agrees with this approach to
CHD and the debate has been going on for some time.

In the mid 1980s’ Donald Rudin, an MD from Harvard, had been using flax
oil (which is ~55% ALA) to resolve EFA deficiency in patients, but,
with mixed results. Patients had positive inital response initially
followed by a sharp
deterioration with continued use of flax oil. For 3-4 months, the diet
could provide clinical resolution of psoriasis,
eczema, etc.Unfortunately this lasted for some months, but was
followed by a decline, and a return of symptoms after which he took
them off the flax oil diet. By stopping the flax, the patient gained
relief. When the patients’ original symptoms returned, they were given
flax again and almost always experienced periods of relief of their
symptoms. What was happening was that eventually gross elevation of
the omega-3 EFA's (with ALA from flax) was disrupting omega-6 EFA
metabolism and thus producing symptoms of EFA deficiency rather than
resolving them. It's all about balance.

See Rudin D "The Omega Factor: Our Nutritional Missing Link" and also
Patricia Kane, who has a lot on the web propagandising this point of
view.


2)      Recent studies from Norton Sound, Alaska show that the Inuit
people, who consume a traditional diet very high in marine organisms,
have a spectacular intake of omega-3 fatty acids. However they also
now have a spectacularly high incidence of CHD, probably due to
dietary profligacy and the consumption of manufactured foods (e.g.
Cresco vegetable shortening as “Eskimo ice cream” when out on the
sledge). So increasing omega-3 consumption is not the cure for all
known diseases and does not protect your heart and vascular system
from damage caused by other aspects of diet and lifestyle.

So while an enhanced intake of alpha-linolenic acid might be a good
idea for many of us, but it’s a mistake to believe that it is going to
prevent CHD unless other aspects of the diet are taken into account.
There are many other and diverse factors involved in the development
of CHD - such as inflammation, overall antioxidant intake, selenium
status and chronic heavy metal overload. .


3)      I first visited in Crete in 1961 (on the somewhat dubious
pretext that visiting sites of classical antiquity would be
character-forming), and frankly people were still starving there at
that time from the cumulative effects of 30 years of depression,
wartime occupation and civil war, certainly eating wild plants and
animals (when they could get them). So I was very curious about why
the Cretan diet should be considered so special (there are of course
distinguished academic studies on this subject). Could it be the
effect of caloric restriction ? I later learnt that “weeds” are plants
which are highly resistant to oxidative stress and so able to exploit
ecological niches in which pampered cultivated plants can’t grow. They
thus have in general a higher vitamin C and phenolic content (that's
why they are bitter) than the cultivated plants which we buy in the
supermarket is that they are grown in what amounts to continuous
culture, never even touching the soil (that’s why your lettuce is now
so clean). Under conditions of modern cultivation there is very little
point for the plant in making much vitamin C. Try tasting the
difference, for example, between organic Hampshire water cress and the
stuff that magically gets into those plastic bags in the
supermarkets(highly sulphited to prevent it going off).

So I am sure that wild purslane is good for you, but probably not just
because of its high ALA content.

4)   Iodine -  I am in a commercial lab and an important part of our
work is measuring urinary iodine, as a marker of iodine intake. At the
last count, 65% of the samples submitted (all U.K., mainly adults)
showed iodine deficiency, many quite grossly so. I used to think that
salt here was iodised – but it isn’t - and we are actually living in
an iodine-deficient zone. As Prof Ekins says, the main dietary source
of iodine has in the past been milk, but less so now. I have in front
of me a set of results- 30 year old female, low T4 (dubious free T4,
I’m afraid Roger), high TSH and urinary iodine that is 17% of the
lower end of reference interval given by WHO.

I would be surprised if iodine deficiency wasn’t now a significant
cause of adult hypothyroidism in the UK population.


5)       My collaborators (Dr's Hassan and Al-Awqati) probably read
Prof Ekins’ 1985 Lancet hypothesis more carefully than most – we had
at that time a project in a maternity hospital in Kuwait, looking at
maternal nutrition, following changes in serum hormone binding
proteins and minerals throughout pregnancy. The popular wisdom of the
day was that synthesis of these binding proteins progressively
increases due to an anabolic oestrogen effect. But transthryetin
doesn't increase at all, and the others - SHBG, transcortin, TBG, RBP,
caeruloplasmin, transferrin and albumin - show variable increases at
different points during pregnancy - suggesting that the rise in TBG,
for example, reflects increased nutritional demands by the foetus,
rather than an hepatic steroid effect in the mother. [See: Hassan MAM,
Miller NJ, Hamdi IM, El Adawi SA, Al-Zaid M, Awqati MA. Considerations
on some hormone binding protein patterns during pregnancy. Hormone and
Metabolic Research, 1991;23:85-87].This very much supports Prof Ekins'
hypothesis that TBG is required to support foetal neural growth and
development.

I'd better stop there; interesting discussion.

Nick Miller
London

On 20 April 2011 11:52, Roger Ekins <[log in to unmask]> wrote:
> Johnathan Kay's recent highlighting of two articles - one in the
> Independant; the other by the Health Reporter of BBC news - may have left
> ACB members at a loss concerning  the action they should take relating to
> high cholesterol levels on the one hand, and low dietary iodine  on the
> other  (JK remaining silent regarding  both issues).
> I am a physicist, not a medical doctor, and not qualified to comment
> authoritatively on either of these matters. On the other hand, I've long
> been involved in each for both professional  and personal reasons, and the
> following comments may be of interest.
> With regard to high cholesterol levels, treatment with statins, etc, my
> interest in this area was aroused many years ago by conversations with a
> Belgian biochemist friend  and the international interest being shown at the
> time in the herb purslane, which reputedly contains  more omega 3 fatty
> acids than any other leafy plant. It is eaten as a salad in certain
> Mediterranean countries, particularly the Greek islands such as Crete, whose
> inhabitants are characterized by very low levels of heart disease. I have an
> Italian wife; also a house on the north coast of Sardinia, and purslane
> (known in Italy as portulacca) grows as a weed in our "garden"(mostly
> comprising what the Sards refer to as macchia), though the Sards refuse to
> eat portulacca.  But the wild boar (that bring and play with their
> offspring  in our garden) love it.  The Cretans also use walnut oil in their
> diets which likewise contains high levels of omega 3, though the Italians
> likewise dismiss walnut oil as only good for polishing furniture, and not
> fit for human consumption.
> I have  in this context previously mentioned an interesting  book by Susan
> Allport "The Queen of Fats: Why Omega-3s Were Removed from the Western Diet
> and What We Can Do to Replace Them", published by the University of
> California Press  as one of a series  entitled California Studies in Food
> and Culture. Susan Allport is a science journalist, not a professional
> scientist, but she has thoroughly researched the field, accumulated an
> impressive range of references, and presents some highly convincing
> arguments to support the thesis she passionately promulgates, i.e that the
> high levels of heart disease seen in the US and UK are caused by a gross
> imbalance in western diets between the two essential unsaturated fatty
> acids, omega 3 and omega 6.  In both the US and UK, the omega 6/omega 3
> ratio is in the order of 20-25/1, in part because food manufacturers
> minimize omega 3 in their products because of its relative instability and
> tendency to oxidize, causing rancidity. Moreover omega 6 and omega 3 compete
> with each other in the body, so that simply adding omega 3 to the diet in
> the form of an occasional oily fish may do little to redress the balance and
> be virtually useless. According to Susan Allport, the ratio between the two
> found in the diet of primitive man is closer to 1:1.
> Only two countries in the world (i.e. Denmark and Japan, if I recall
> correctly) have issued government guidelines regarding the omega 6/omega 3
> ratio characterizing a health diet, this being about 3:1.  I once asked the
> Chief Scientific Officer of the Department of Health (Prof Sue Hill) why the
> DoH had not done the same, but received no reply. Perhaps Susan Allport's
> story is bunkum, but if so, I would interested to know the reasons why.
> The following is a typical write-up about her book on Amazon:
> A nutritional whodunit that takes readers from Greenland to Africa to
> Israel, The Queen of Fats gives a fascinating account of how we have become
> deficient in a nutrient that is essential for good health: the fatty acids
> known as omega-3s. Writing with intelligence and passion, Susan Allport
> tells the story of these vital fats, which are abundant in greens and fish,
> among other foods. She describes how scientists came to understand the role
> of omega-3s in our diet, why commercial processing has removed them from the
> food we eat, and what the tremendous consequences have been for our health.
> In many Western countries, epidemics of inflammatory diseases and metabolic
> disorders have been traced to omega-3 deficiencies. The Queen of Fats
> provides information for every consumer who wants to reduce the risk of
> heart disease, cancer, arthritis, and obesity and to improve brain function
> and overall health. This important and compelling investigation into the
> discovery, science, and politics of omega-3s will transform our thinking
> about what we should be eating.
> Susan Allport - like others - dismisses the "cholesterol myth"; also the
> routine treatment with statins.
> OK.  Buy or borrow this book and reach your own opinion on the story it
> tells. It costs a little more than it did when I bought my copy, but it's
> money well spent if it ensures a long and healthy life for you and yours.
> But before you do this,  you can also read some of Susan  Allport's articles
> on the web, such as
> <http://www.vitalchoice.com/shop/pc/articlesView.asp?id=517>, and the
> comments of Nature and other reviewers.
> ---------
> The other issue on which I might usefully comment is dietary iodine.  Some
> years ago - following  investigations with medical and psychologist
> colleagues (Drs  Pharaoh and Connolly) on T3 , T4 , FT3 and FT4 levels
> amongst native inhabitants in the Jimi valley in Papua New Guinea (see
> Pharoah, P., Connolly, K., Hetzel, B. and Ekins, R. Maternal Thyroid
> Function and Motor Competence in the child. Develop. Med Child Neurol 23.
> 76-82, 1981) - I wrote a 'hypothesis' article in the Lancet in 1985
> (attached) suggesting that "maternal T4   plays an important role in fetal
> neurogenesis and that TBG ensures an adequate placental supply of T4
> throughout fetal life".
> This concept totally contradicted the then conventional views that thyroid
> hormones neither cross the placenta in significant amount and are
> unnecessary in the development of the early fetus, i.e. during the first
> trimester (see Fisher, DA et al,  "Ontogenesis of
> hypothalamic-pituitary-thyroid function and metabolism in man, sheep and
> rat" in Recent progress in Hormone Research, Academic Press, 1977;  and
> Nunez J,  "Effects of thyroid hormones during brain differentiation.
> Mol.Cell Endocrinol 37:124 (1984)). Indeedthe rise of TBG was claimed to
> prevent transport of maternal T4 and T3 from the maternal to fetal
> circulations (see  Osorio C and  Myant NB: "The passage of thyroid hormones
> from mother to foetus and its relation to foetal development." Brit Med Bull
> 16:159, 1960).
> But our own theoretical studies on hormone transport from capillaries to
> adjacent cells suggested that high levels of T4 binding proteins
> (accompanied by high levels of T4) increase the delivery rate of
> intracapillary T4 to adjacent tissue (see attached figures taken from
> publication 420, "Analyic Measurements of Free Thyroxin" Clin Lab Med,  13,
> p. 599-630, 1993).
> (I also attach a photograph of a neurological cretin taken by a colleague
> in Papua New Guinea, where a high proportion of children had suffered
> irreversible damaged early in fetal life due to lack of iodine in their
> mothers' diets - caused by the replacement of the salt the native population
> obtained by evaporation of local well-water by rock salt supplied by the
> Australians.)
> These publications and concepts attracted little attention, though a
> distinguished American thyroidologist, Evelyn Man, kindly wrote to me
> applauding the hypothesis paper. She and her colleagues had previously
> reported that children of hypothyroid mothers had significantly reduced IQs.
> This agreed with our own observations (which continued for a further 15
> years or so) that, aside from the neurological cretins born of iodine
> deficient mothers, the remaining children in this group continued to display
> reduced motor performance as measured using bead-thredding tests and other
> such indicators.
> I am therefore glad to see that the importance of dietary iodine has been
> recognized, and that Dr Vanderpump has been recommending  the use of iodized
> salt. Nino Salvatore (the great Neapolitan thyroidologist) pleaded with the
> Italian Government for many years for this to be done, but  - as far as I
> can recall - the  government was reluctant to engage in universal and
> involuntary  medication, though large parts of Italy have been iodine
> deficient.
> But the bottom line is that the main effect of lack of iodine in the diet
> (aside from goitre) is the effect on the children of mothers lacking T4.
> This has been unlikely for some years as a result of modern methods of
> milking cows using of iodine-containing disinfectant in pre- and postmilking
> teat dips and udder washes.  Also iodine is present in certain breads.
> Nevertheless teenage girls may drink little milk and eat little bread, and
> end up with low T4  blood levels. On the other hand this may cause them
> little harm unless they are foolish enough to become pregnant, in which case
> they risk giving  birth to the modern equivalent of the medieval village
> idiot.
>
> --
>
> Roger Ekins, PhD DSc FRS
> Windeyer Institute of Medical Science
> University College London
> London W1T 4JF
>
>
> Phone +44 20 7679 9410
> Fax +44 20 7679 9407
> ------ACB discussion List Information-------- This is an open discussion
> list for the academic and clinical community working in clinical
> biochemistry. Please note, archived messages are public and can be viewed
> via the internet. Views expressed are those of the individual and they are
> responsible for all message content. ACB Web Site http://www.acb.org.uk
> Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives
> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions
> (How to leave etc.) http://www.jiscmail.ac.uk/

------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/