Dr. Tori Hudson, N.D.

Low fat, no fat, bad fat. Such is the mantra of today’s dietary guidelines. No one is making more efforts to comply with this barrage of confusing information than women. For themselves, their children, their parents, their partners, their husbands, women are the disciples of the fat phobic teachings of modern nutrition. Besides misinformation and confusing labeling which lures the consumer into thinking that no fat pretzels and no fat cookies are healthy foods, two important concepts are being sacrificed:

1. a low fat diet of 30% may not be enough for the prevention of certain female cancers;
2. the importance of quality oils and fats in maintaining our health and the prevention of certain diseases.

Estimates have been given that approximately 80% of Americans consume a diet deficient in essential fatty acids. Essential fatty acids play an important role in producing hormones, cell membrane function, regulating pain, inflammation and swelling, dilating or constricting blood vessels, mediating our immune response, regulating smooth muscle responses, preventing blood clots, regulating blood pressure and nerve transmission, regulating cholesterol levels, and much, much more. Deficiencies of essential fatty acids can lead to many health problems for men and women and some that are particular to women.

Essential fatty acids (EFA’s) must be obtained from the diet or supplementation because our bodies cannot make them. It has been reported that 3-4% of the total daily caloric intake of normal adults should be from EFA’s. For children, pregnant and lactating women, the recommendation is 5-6%. Although all fatty acids are the major building blocks of all fats, the most important ones are linoleic acid (LA) and alpha-linolenic acid (ALA). LA is an essential omega-6 fatty acid and ALA is an essential omega-3 fatty acid. We need both omega-6 and omega-3 oils but the balance of omega-6 to omega-3 oils is critical to the proper metabolism of prostaglandins. LA and ALA can be converted to prostaglandins which are important for the regulation of inflammation, pain, blood pressure, fluid balance, blood clotting, steroid production and hormone synthesis, heart, kidney and gut function, and nerve function. Under ideal conditions, the body converts LA into gamma-linolenic acid (GLA) and converts ALA into eicosapentaenoic acid (EPA). GLA and EPA are then converted into the prostaglandins. GLA becomes prostaglandin PGE1 and EPA becomes prostaglandin PGE3. The body has to constantly supply the EFAs so that they can be converted to the prostaglandins that are needed. Without adequate amounts of GLA and EPA, prostaglandin 1 and 3 production will be reduced. With an improper balance between omega-6 oils and omega-3 oils, too much prostaglandin series 2 (PGE2) will be produced which is a pro-inflammatory prostaglandin. Both a reduction in the anti-inflammatory prostaglandins and an increase in the pro-inflammatory prostaglandins lead to problems. For women, these problems may include premenstrual syndrome, menstrual cramps, abnormal menstrual bleeding, pregnancy related problems and fetal development, osteoporosis, cardiovascular disease and breast disease.

Premenstrual syndrome

Women who have PMS typically have dietary habits which are worse than the standard American diet. A nutritional analysis published by Dr. Guy Abraham, reported that PMS patients consumed 62% more refined carbohydrates than women who did not have PMS, 275% more refined sugar, 79% more dairy products, 53% less iron, 77% less manganese and 52% less zinc.1 Diets high in refined carbohydrates, sugar and dairy products are also diets that are high in saturated fats and hydrogenated fats, which means subsequently low amounts of essential fatty acids. Diets high in saturated and hydrogenated fats are also high in omega 6 oils which mean a greater production of PGE2 and a reduced production of PGE1 and PGE3.

Excessive and incorrect prostaglandin (PG) synthesis has been implicated in the pathogenesis of PMS, and a deficiency of PGE1 at the central nervous system has been proposed to be involved in PMS.2 There are many nutrients important for the synthesis of PGE1, not just GLA. These include magnesium, cis-linoleic acid (an essential fatty acid), vitamin B6, zinc, vitamin C, and vitamin B3. Another acid, arachidonic acid, is a precursor to PGE2, which has antagonistic effects with regard to PGE1. Vegetable oils are rich sources of cis-linoleic acid and animal fats are the main dietary sources of arachidonic acid; therefore, patients with PMS would be wise to decrease their consumption of animal fats and increase their consumption of vegetable oils so they have more PGE1. Likewise, a diet high in the other nutrients mentioned would also promote the synthesis of PGE1.

The main strategy of supplementing with essential fatty acids for PMS is an attempt to raise the body’s own formation of PGE1. The most popular method of doing so has been to supplement with evening primrose oil products in order to supply increased levels of gamma linolenic acid. Although there are several studies that show positive results, some of the studies did not include a placebo group and other studies did not show a statistically significant difference between the treatment group and the placebo group. The studies by Puolakka et al, 19853; Ockerman et al, 19864; and Caspar, 19875 were all double-blind crossover controlled trials where evening primrose oil (EPO) demonstrated an effect that was significant over the placebo group. One of these studies used 3 gm per day and three of the studies used 4 gm per day. The effects of EPO have been shown to be best for clumsiness and headaches although all symptoms including depression, irritability, bloating and breast tenderness showed a marked improvement. Other sources of oils that contain gamma linolenic acid and raise PGE1 include borage oil, black currant oil and rape seed oil.

Menstrual cramps

Menstrual cramps are one of the most common problems that women face and indeed it affects over 50% of menstruating women. Foods that are high in arachidonic acid may be a contributing factor to menstrual cramps. Arachidonic acid is the fat our body uses to produce the series-two prostaglandins; the pro-inflammatory and spasmodic prostaglandins. In this case, prostaglandins that can cause uterine contractions and cramping. Dairy products are a main source of arachidonic acid. In addition, many people are allergic to dairy products or lack the enzymes to digest them. Digestive problems such as bloating and gas can intensify with menstrual cramps which adds to the overall discomfort. Reducing or even eliminating the intake of milk, cheese, cottage cheese, butter, ice cream and yogurt may be enough to have a significant impact for as many as one third of women with menstrual cramps. Saturated fats from non-dairy sources can also intensify menstrual cramps by stimulating the prostaglandin two-series. Most of our saturated fats come from animal products although a few are from vegetable sources such as palm oil or coconut oil. Animal foods contain saturated fat and should be reduced or avoided. They include beef, pork, lamb and even chicken and turkey. Even though chicken and turkey are lower in saturated fat, they are actually higher in arachidonic acid than red meats.

The best medicinal foods for menstrual cramps are those foods that increase the antispasmodic prostaglandins, the PGE1 series and the PGE3 series. Certain fish, like salmon, tuna, halibut, and sardines contain linolenic acid, which is a fatty acid that helps to relax muscles by the production of these prostaglandins.6 There are many seeds and nuts that are sources of linoleic acid and linolenic acid, which also then produce these muscle relaxing prostaglandins. The best seed sources of both these fatty acids are flaxseeds and pumpkin seeds. Sesame seeds and sunflower seeds are excellent sources of linoleic acid. The oils from the seeds of flax, pumpkin, sesame and sunflower are then good oils to eat on salad dressings if menstrual cramps are the concern. Flax and pumpkin oils should not be used when heated, but sesame and sunflower are acceptable cooking oils.

In the second half of the menstrual cycle, omega-6 fatty acids, particularly arachidonic acid, are released. Subsequently, an increase in PGE2 occurs, causing uterine contractions leading to a lack of oxygen to the uterine muscles and the subsequent pain. Omega-3 fatty acids, EPA and DHA, compete with omega-6 fatty acids and result in the production of the PGE-1 and 3 series. Based on these observations, the use of essential fatty acid supplementation can be very effective in the prevention and treatment of menstrual cramps.

Supplementation with flax oil (high in omega-3 fatty acids), borage oil (high in LA and GLA), black currant oil (high in LA and GLA), evening primrose oil(high in LA and GLA), and fish oils (high in omega- 3 oils), is one way of favorably altering the synthesis of the beneficial prostaglandins; the end result likely will be less uterine contractions and less menstrual pains.

After the rise of progesterone in the second half of the menstrual cycle followed by its decline right before menstruation – progesterone withdrawal – omega-6 fatty acids, particularly arachidonic acid, are released. Subsequently, an increase in PGF2 alpha and PGE2 occurs, causing uterine contractions leading to ischemia and pain. Instead of inhibiting ovulation and therefore the progesterone effect, or inhibiting the synthesis of prostaglandins with nonsteroidal anti-inflammatory agents, the omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid, compete with omega-6 fatty acids and result in the production of the PGE1 and PGE3 series. Based on these observations, the use of fish oil containing omega-3 fatty acids as a supplement seems logical and attractive. Dietary supplementation with fish oils was tested in 42 adolescent girls with dysmenorrhea.6 The first group of 21 girls received fish oil (1080 mg eicosapentaenoic acid, 720 mg docosahexaenoic acid), and 1.5 mg of vitamin E daily for 2 months followed by a placebo for an additional 2 months. In the second group, 21 girls received placebo for the first 2 months, followed by fish oil for 2 more months. At the conclusion of the study, on a 7-point scale (a score of 4 being moderately effective and a 7 meaning totally effective), 73% of the girls rated the effect of the fish oil and vitamin E greater than or equal to 4.

Many combination EFA products are currently available in the professional and retail market. These include borage oil/flax oil, EPO/flax oil, and EPA/DHA, and are well balanced formulations designed to deliver the optimal balance of EFA’s ideal for the treatment of menstrual pains.

Abnormal menstrual bleeding

Changes in the amount of menstrual blood, duration, and pattern are among the most common of health concerns that women face. Although these changes cause a lot of anxiety for women and do warrant a medical evaluation, most cases of abnormal bleeding are due to benign and easily addressed conditions. Even so, prompt evaluation of abnormal menstrual bleeding is highly recommended.

Flaxseeds stand out as a food that has an ability to regulate the menstrual cycle. Flaxseeds contain a group of phytoestrogens called lignans that have been shown to have weakly estrogenic properties as well as antiestrogenic properties. Two specific lignans, enterodiol and enterolactone, are absorbed after formation in the intestinal tract from plant precursors particularly abundant in flaxseeds. The ingestion of flaxseed powder and their effect on the menstrual cycle was studied in 18 normally cycling women.7 Each woman consumed her usual omnivorous, low fiber diet for 3 cycles and her usual diet supplemented with 10 grams per day of flaxseed for another 3 cycles. All women were instructed to avoid soy foods. The second and third flax cycles were compared to the second and third control diet cycles. Three nonovulatory cycles occurred amongst the 18 women during the control diet (36 total cycles) compared to none during the 36 flaxseed cycles. The ovulatory flax cycles were consistently associated with about one more day in the luteal phase when compared to the ovulatory non flax cycles. This may not seem like much, only one day longer before you bleed and slight increase in the number of ovulations. However, over a period of months and years, the cumulative effect not only has implications for regulating the menstrual cycle, but may in fact play a positive role in reducing the risk of breast and other hormonally dependent cancers.

Supplementing with flax oil, borage oil, or EPO may also help to reduce heavy bleeding by increasing the anti-inflammatory prostaglandins. This anti-inflammatory effect can reduce heavy bleeding about 1/3 of the time.

Some women who have no menses or very infrequent menses in their reproductive years may be suffering from insufficient calories, insufficient dietary fat, and/or low cholesterol. Eating disorders are obviously detrimental to health but even extreme diets low in fat, such as vegan diets or macrobiotic diets, may present problems for some individuals. Adequate EFA’s and cholesterol are needed to make hormones. If no cholesterol is found in the diet, and the liver is not manufacturing adequate cholesterol, then these women may have a lack of menses due to insufficient hormone levels because they have not had enough cholesterol for their body to make the hormones. Supplementing the diet with EFA’s will be important in women with inadequate menstrual cycles that are due to a low fat diet. Using fish oils and the seed oils in combination products would be a well balanced approach in supplying the necessary nutrients in addition to dietary changes.

Summary

This short review hopes to increase awareness about the fundamental role of essential fatty acids in some of the most prominent health problems women face. The next column will address breast diseases, cardiovascular disease, osteoporosis, and pregnancy.

The best oils and fats are those that are found in nature rather than those that have been manipulated and altered by manufacturing. High quality vegetable oils such as olive, canola, flax, sunflower, and pumpkin oil in our diets and cold water fish such as tuna, salmon, halibut, sardines, mackerel and herring in addition to whole grains are the best ways of getting adequate essential fatty acids from the foods we eat. Essential fatty acid supplementation provides an important addition to a whole foods diet and particularly beneficial if you are at higher risks for certain health problems or have a chronic health problem such as the ones that we have discussed. These supplements include flax oil, EPO, borage oil, black currant oil, and the fish oils rich in EPA and DHA. So, it’s not just no fat and low fat, and avoid bad fats, it’s also a matter of increasing and supplementing with the good fats of essential fatty acids.

References

1. Abraham G. Nutritional factors in the etiology of the premenstrual tension syndromes. J Reprod Med 1983; 28:446-464.
2. Jakubowica D. The significance of prostaglandins in the premenstrual syndrome. In: Taylor R, ed. Premenstrual syndrome. London: Medical New-Tribune, 1983, p. 16.
3. 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.
4. Ockerman P, et al. Evening primrose oil as a treatment of the premenstrual syndrome. Rec Adv Clin Nutr 1986;2:404-405.
5. Casper R. A double blind trial of evening primrose oil in premenstrual syndrome. 2nd international symposium on PMS, Kiawah Island, Sept. 1987.
6. 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.
7. Phipps W, Martini M, Lampe J, Slavin J, Kurzer M. Effect of flax seed ingestion on the menstrual cycle. J Clinical Endocrinology and Metabolism 1993; 77(5): 1215-1219.