EFAs and Womens Health13.12.2012
by Hudson - Tori
Low fat, no fat, bad fat..." Such is the mantra of today's popular diets. Women, especially, are the disciples of the fat phobic teachings of modern nutrition. Unfortunately, misinformation and confusing labeling often lures the consumer into thinking that no fat pretzels and no fat cookies are healthy foods. To achieve real health, we need to learn a new nutritional term: "good fat". (And, yes, there is such a thing!)
Quality oils and fats are actually essential in maintaining our health and in the prevention of certain chronic diseases. Our bodies need a healthy ratio of saturated, monounsaturated and polyunsaturated fats. Some polyunsaturated fats are as essential as vitamins and minerals for the maintenance of good health - these are the essential fatty acids (EFAs), or good fats.
It is estimated that approximately 80 percent of Americans consume a diet deficient in EFAs. Popular and convenient processed foods, which form such a large part of our diets today, are deliberately stripped of many EFAs to preserve shelf life. At the same time, we tend to consume large amounts of foods heavy in saturated fats (french fries, potato chips, crackers, baked goods, ice cream, and other "quick snack" foods). We also consume a lot of meat and shellfish, which contain a fatty acid called arachidonic acid, which, in excess, has potentially harmful effects. The balance of fats in the typical North American diet is dramatically out of sync with the needs of our bodies.
We know we don't get enough EFAs - but does it matter? EFAs play crucial roles in the body on a minute-by-minute basis. They produce hormone-like compounds; maintain cell membrane function; regulate pain, inflammation and swelling; dilate and constrict blood vessels; mediate immune response; regulate smooth muscle responses; prevent blood clots; regulate blood pressure and nerve transmission; regulate cholesterol levels; and even much more. Deficiencies of EFAs, which are so vital to many of the body's most basic functions, can lead to many health problems for both men and women. Diseases linked to EFA deficiency include rheumatoid arthritis, diabetic neuropathy, cardiovascular disease, mental disorders, and skin conditions such as eczema. For women, however, EFA deficiency can cause some unique problems that may include:
- premenstrual syndrome
- menstrual cramps
- abnormal menstrual bleeding
- breast disease
- some symptoms of menopause
EFAs also have benefits in pregnancy and fetal development. In addition, women may be particularly interested in the benefits of EFAs for reducing the risk of cardiovascular disease - the leading cause of death of women in North America today.
Essential Fatty Acids at work
Our bodies cannot make EFAs - they must be obtained from the diet or through supplementation. That is why they are called "essential fatty acids". The most important fatty acids are linoleic acid (LA) and alpha-linolenic acid (ALA). LA belongs to the "omega-6" family of fatty acids while ALA belongs to the "omega-3" family. We need both omega-6 and omega-3 fatty acids to maintain good health.
Under ideal conditions, the body uses LA to produce GLA (gamma linolenic acid), another fatty acid with numerous health benefits. Likewise, the body uses ALA to produce eicosapentaenoic acid (EPA). In turn, GLA and EPA are used to produce beneficial hormone-like compounds called prostaglandins. Specifically, GLA is used to produce series one prostaglandins such as prostaglandin E1 (PGE1) while EPA is used to produce prostaglandin E3 (PGE3). Prostaglandins affect the function of virtually every system in the body - these molecules are used in the regulation of inflammation, pain, blood pressure, fluid balance, blood clotting, and affect hormone production and function. In order to maintain a proper balance of the antispasmodic and anti-inflammatory prostaglandins (PGE1 and PGE3) with the pro-spasmodic and pro-inflammatory prostaglandins (PGE2), it is critical to have the proper amount of each fatty acid - particularly GLA, ALA, and EPA.
The body has to receive a constant supply of EFAs and a balanced supply of each fatty acid in order to produce the right prostaglandins as they are needed. Without adequate amounts of GLA and EPA, prostaglandin production will be reduced, and problems will result.
EFAs in women's health
Premenstrual syndrome (PMS)
PMS has been linked to excessive and incorrect prostaglandin production. Specifically, women with PMS may have a deficiency of PGE1, at the central nervous system  and in other tissue such as breast tissue. Supplementing with EFAs may raise the body's production of PGE1. The most popular and scientifically documented method is to supplement with GLA in order to increase production of PGE1. Rigorous scientific studies have demonstrated that supplementing with GLA has a significant effect on symptoms of PMS. [2,3,4] The effects of GLA have been shown to improve all symptoms including premenstrual headaches, depression, irritability, and bloating. GLA also dramatically relieves premenstrual breast pain and tenderness, which I will talk about more in the "breast health" section of this article. Oils that contain high quantities of GLA include evening primrose oil, borage oil and black currant oil.
Foods that are high in arachidonic acid (such as meat and shellfish) may be a contributing factor to menstrual cramps. The body uses arachidonic acid to produce the potentially harmful prostaglandin E2 (PGE2). This prostaglandin causes the muscle and uterine contractions of cramping. The best medicinal foods and oil supplements to relieve menstrual cramps are those that increase the antispasmodic prostaglandins E1 and E3. Fish like salmon, tuna, halibut, sardines, mackerel and herring contain EPA, which helps to relax muscles by stimulating the production of these prostaglandins. In one study of fish oil in adolescent girls with menstrual cramps, as many as 73 percent of the patients rated the fish oil supplement as being moderately effective in relieving their menstrual cramps .
Seeds, nuts, and oils that contain ALA may also be beneficial - the body converts the ALA to EPA, which is then used to produce muscle-relaxing prostaglandins.
Supplementing with flax oil, borage oil, black currant oil, and evening primrose oil are additional ways to promote the synthesis of the antispasmodic prostaglandins and reduce the uterine contractions of menstrual cramps.
Abnormal menstrual bleeding
Flax seeds contain a group of compounds called phytoestrogens. Flax seeds are particularly high in a specific type of phytoestrogen called lignans. Flax seed lignans can promote regular ovulation and help to lengthen the menstrual cycle by one to three days. By promoting regular ovulation, fertility improves, progesterone levels are normalized and a more regular bleeding pattern results. Lignans may also reduce the risk of cardiovascular disease and osteoporosis, and have beneficial effects on symptoms of menopause. They are therefore a highly useful dietary addition for all women.
Although essential fatty acids have not been talked about much in relationship to osteoporosis, it appears evident from the research that has been done that we must expand our use of EFAs to maximize calcium metabolism and preserve bone health. There is a growing body of evidence and research to warrant advice about EFAs and calcium metabolism, bone health and the prevention of osteoporosis. EFAs have been shown to increase calcium absorption from the gut (in part by enhancing the effects of vitamin D), reduce urinary excretion of calcium, increase calcium that is deposited in the bone and improve the strength of bone. Adults with osteoporosis who are given fish oil show an increase in calcium levels and an increase in urinary calcium clearance. GLA in particular has been shown to reduce the excretion of calcium, inhibit bone reabsorption and markers of bone turnover while at the same time increasing the levels of calcium content in the bone.
The pain and tenderness of benign breast disease associated with cyclic breast pain and fibrocystic breasts has been alleviated with evening primrose oil in more than one scientific study. , In the course of treatment, it has been detected that women with breast pain have unusually low concentrations of GLA and metabolites from GLA. The concentration of GLA metabolites increases and the concentration of saturated fats in the breast decreases when patients are given supplements of evening primrose oil. Borage oil, which contains more than twice as much GLA as evening primrose oil, would be an additional consideration for use in cyclic breast pain.
Health care practitioners and patients alike may be concerned about the relationship between flaxseed oil and breast cancer. Dietary ALA has been correlated with an increased risk of breast cancer in several studies. A recent study offers comfort however, and actually suggests a protective effect of ALA. More research is needed to determine the effect of dietary ALA on the risk of developing breast cancer. At the present time, it may be advisable for women with breast cancer to avoid consumption of large doses of flax oil, or to use flax oil along with either fish oil, evening primrose oil, or borage oil. However, adding flax seeds to the diet, with their high lignan content and the ability to weakly block the effect of estrogen on the breast and lower estrogen levels, as well as provide fiber, is an excellent breast cancer prevention habit to acquire.
Fish oils also play a role in reducing the risk of breast cancer. The protective effect of omega-3 fatty acids was first observed in Greenland Eskimo women who seemed to have a strikingly low rate of breast cancer. These women have a diet that is probably the highest in omega-3 fats of any population to date. The best diet may be when our diet is a balance of ALA and GLA, with the fish fatty acids EPA and DHA.
Another important oil that has been associated with a lower incidence of breast cancer is olive oil which contains 76% oleic acid. This fatty acid is also found in evening primrose oil (7%), borage oil (15-20%), black currant oil (10%), and canola oil (54%). A study published in 1995 demonstrated that increased olive oil consumption was associated with a 25% lower risk of breast cancer in Greek women.
An exciting new study holds out additional advice for women who have breast cancer and are being treated with the anticancer drug Tamoxifen. In this study, patients took about 3 grams of GLA daily, which resulted in a significant reduction in one parameter used to assess response to the Tamoxifen. This study demonstrated a faster response for patients who took GLA along with Tamoxifen, compared to Tamoxifen treatment alone.
Evening primrose oil and other oils containing GLA are popularly consumed by women to decrease the symptoms of menopause. GLA in the form of evening primrose oil was found to reduce the maximum number of nighttime flushings associated with menopause. However, there was no overall difference between the supplement and the placebo. Many other herbal supplements are available to relieve menopausal symptoms and these may be used in conjunction with EFAs for greater benefit.
Pregnancy and Fetal development
Essential fatty acids have a unique role during pregnancy because of the rapid development of new cell growth, new tissues, and new organ systems in a developing fetus. Fetal development is associated with a high EFA requirement, and this supply is dependent on the amount and availability of EFAs from the mother.
Prostaglandins are also involved in the development and clinical expression of pre-eclampsia (the simultaneous occurrence of the clinical triad of hypertension, edema and protein in the urine at any time during the course of the pregnancy). These prostaglandins are modulators of vascular smooth muscle tone and platelet aggregation (blood platelets sticking together). Pre-eclampsia is characterized by increased vasoconstriction, frequently associated with increased platelet aggregation, reduced uteroplacental blood flow, and premature delivery. In a placebo-controlled clinical trial, a group of pregnant women receiving a combination of evening primrose oil and fish oil had a significantly lower incidence of edema.
Although there is no rigorous clinical research yet in this area, GLA supplementation during pregnancy has been found by practitioners of natural child birth to be an efficacious method to stimulate cervical ripening during labor. Since the ripeness of the cervix determines the length of time until the onset of labor, naturopathic practitioners often use evening primrose oil supplements in pregnant women to decrease the length of labor and the incidence of postdates pregnancies. PGE1 is known to stimulate cervical ripening and hasten the progression of labor.
For the fetus, a deficiency of EFAs, particularly EPA and DHA, may lead to a poorly developed central nervous system. EFA deficiency may also lead to intrauterine growth retardation leading to a lower whole body weight and slower growth of the brain. Supplementation with a daily complex of essential fatty acids and fish oils during pregnancy provides vital nutrients that supply the necessary EFAs for the increased nutritional and metabolic demand throughout the nine months of gestation. Although research clearly shows that moderate EFA supplementation is beneficial and safe for pregnant women, caution should be exercised when consuming large doses.
Although cardiovascular disease affects both sexes, it is the number one killer of women in North America today. Prevention and treatment of cardiovascular disease is therefore a leading health concern for women across the continent. Again, cardiovascular disease has a strong connection to the balance of fats in our diets. Diets that are high in cholesterol and saturated fats contribute to an imbalance of saturated and unsaturated fatty acids that contribute to premature coronary heart disease. Fish oils containing the omega-3 fatty acids EPA and DHA are associated with numerous heart-protective effects and have been found to lower the risk of developing cardiovascular disease. Fish oils prevent clots, inhibit inflammation in the vessel walls, cause vasodilation, and promote a regular heart rhythm. Fish oils may also lower blood pressure and triglycerides. Increasing the amount of omega-3 fatty acids with fish oils and/or flax oil can reduce atherosclerosis and blood clot formation, as well as lower blood pressure. Numerous studies show that omega-3 fatty acids lower cholesterol and triglyceride levels. These results are primarily associated with EPA- and DHA-rich fish oils, but flaxseed oil supplementation can produce some similar benefits. Remember, flaxseed oil contains ALA, an omega-3 fatty acid that the body can use to produce EPA.
GLA has been found to reduce some risk factors for cardiovascular disease, including reducing blood pressure and retarding the development of diet-induced atherosclerosis. Borage oil has been shown to augment the control of vascular resistance as well which can favorably alter blood pressure. Another oil, black currant seed oil, also rich in GLA, was tested in individuals who had borderline hypertension. It had a particularly significant effect in lowering the diastolic blood pressure.
I hope that this short review will serve to increase your awareness about the fundamental role of essential fatty acids in some of the most prominent health concerns women face. Food sources of good fats include high quality vegetable oils such as olive, canola, flax and pumpkin oil in our diets and cold water fish such as tuna, salmon, halibut, sardines, mackerel and herring in addition to whole grains. Essential fatty acid supplementation provides an important addition to a whole foods diet and can be particularly beneficial if you are at higher risk for certain health problems or have a chronic health problem such as the ones that we have discussed. The best supplements include flax oil (containing 50-60% ALA), borage oil (20-24% GLA), evening primrose oil (8-10% GLA), black currant oil (15-17% GLA), and the fish oils rich in EPA and DHA. Borage oil is nature's richest source of GLA - at 20-24% GLA, it contains twice as much GLA as evening primrose oil. Borage oil is therefore a compelling potent alternative to evening primrose worth our increased attention and use. Many reputable manufacturers offer "multi-EFA" combinations that include a blend of borage, fish, and flaxseed oils for convenient daily supplementation.
Good nutrition clearly goes hand-in-hand with good fats. Most women can benefit from increasing the good fats in their diets with daily supplements of essential fatty acids.
About Tori Hudson, ND
Dr. Tori Hudson, ND, is a well-known author and regular contributor to the Journal of Naturopathic Medicine and HealthNotes Online. She has been featured in over 70 magazines including Women's World, McCalls, Redbook, Prevention, Time, and Healthy Living. Her new book "Women's Encyclopedia of Natural Medicine, Alternative Therapies and Integrative Medicine", received a five-star rating at the popular website Amazon.com. She is also a nationally recognized lecturer for both professionals and the general public and has appeared on many local and network radio and TV programs including appearances on "Good Morning America", PBS's "Healthy Living Series", and Lifetime's "New Attitudes." She also serves as "Naturopath on Call" for Prevention Online.
Hudson graduated from the National College of Naturopathic Medicine, in Portland, Ore., in 1984. Since that time Hudson has served as Medical Director, Associate Academic Dean and Interim Academic Dean as well as a professor at the college. In 1999 she was named the "Physician of the Year" by the American Association of Naturopathic Physicians (AANP) and in 1990 Hudson was awarded the President's award for research in the field of women's health by the AANP.
Hudson is also the Medical Director at the Institute of Women's Health & Integrative Medicine and is part owner of A Woman's Time, a Menopause Options and Natural Medicine clinic in Portland.
- Jakubowica D. The significance of prostaglandins in the premenstrual syndrome. In: Taylor R, ed. Premenstrual syndrome. London: Medical New-Tribune, 1983, p.16.
- Puolakka J, et al. Biochemical and clinical effects of treating the premenstrual syndrome with prostaglandin synthesis precursors. J Rep Med 1985;30(3):149-153.
- Ocerman P, et al. Evening primrose oil as a treatment of the premenstrual syndrome. Rec Adv Clin Nutr 1986;2:404-405.
- Casper R, A double blind trial of evening primrose oil in premenstrual syndrome. 2nd International Symposium on PMS, Kiawah Island, Sept. 1987.
- Harel L, et al. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol 1996; 174(4):1335-1338.
- Horrobin K. Calcium metabolism, osteoporosis and essential fatty acids: a review. Prog Lipid Res 1997;36(2-3):131-151
- Papendorp D, Coetzer H, Kruger M. Biochemical profile of osteoporotic patients on essential fatty acid supplementation. Nutrition Research 1995;15(3):325-334.
- Tulloch I, Smellie W, Buck A. Evening primrose oil reduces urinary calcium excretion oin both normal and hypercalciuric rats. Urol Res 1994;22:227-230.
- Claasen N, Potgieter M, Seppa M, et al. Combination of evening primrose oil and fish oil influence bone resorption and bone calcium content. Bone 1995;16(Suppl): 385S-392S.
- Pye J, et al. Clinical experience of drug treatment for mastalgia. Lancet 1985;2:373-377.
- Pashby N, et al. A clinical trial of evening primrose oil in mastalgia. Br J Surg 1981;68:801-824.
- Braden L, Carroll K. Dietary polyunsaturated fat in relation to mammary carcinogenesis in rats. Lipids 1986;21:285-288.
- Wicha M, Liotta L, Kidwell W. Effects of free fatty acids on the growth of normal and neoplastic rat mammary epithelial cells. Cancer Res 1979;39:426-435.
- De Stefani E, Deneo-Pellegrini H, Mendilaharsu M, Ronco A. Essential fatty acids and breast cancer: a case-control study in Uruguay. Int J Cancer 1998;76:491-494.
- Klein V, Chajes V, Germain E, et al. Low alpha-linolenic acid content of adipose breast tissue is associated with an increased risk of breast cancer. European J of Cancer 2000; 36:335-340.
- Bang H, Dyerberg J, Hjorne N. The composition of food consumed by Greenland Eskimos. Acta Med Scand 1976;200:69-73.
- Kromann N, Green A. Epidemiological studies in the Upernavik District, Greenland: Incidence of some chronic diseases 1950-1974. Acta Med Scand 1980;208:401-406.
- Trichopoulou A, et al. Consumption of olive oil and specific food groups in relation to breast cancer in Greece. J Ntl Cancer Inst 1995;87(2):110-116.
- Kenny F, Pinder S, Ellis In, et al. Gamma linolenic acid with tamoxifen as primary therapy in breast cancer. Int J cancer 2000;85:643-648.
- Chenoy R, Hussain S, Tayob Y, O'Brien PM, Moss MY, Morse PF. Effect of oral gamolenic acid from evening primrose oil on menopausal flushing. BMJ 1994 Feb 19; 308(6927):501-503.
- D'Almeida A, Carter J, Anatol A, Prost C. Women and Health, 1992;19(2/3):117-131.
- McFarlin BL, Gibson MH, O'Rear J, Harman P. A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice. J nurse-Midwifery 44(3):2095. 1999.
- Mills D, Mah M, Ward R, Morris B, Floras J. Alteration of baroreflex control of forearm vascular resistance by dietary fatty acids. Amer J Physiology 1990; 259:R1164-1171.
- Deferne J, Leeds A. Resting blood pressure and cardiovascular reactivity to mental arithmetic in mild hypertensive males supplemented with black currant seed oil. J Human Hypertension 1996;10:531-537.