Published on August 20, 2012
Fats and inflammation New twists in old an old talePage 1
Background• It has been suggested by some, almost bluntly, that omega-6 fatty acids are proinflammatory and hazardous and omega-3 fatty acids are strongly anti-inflammatory (Michel de Lorgeril 2011 & many advocates of paleo and low carb diet)• However, Harvard and many other academic nutrition experts have opposed this view: – ”Adequate intakes of both n-6 and n-3 fatty acids are essential for good health and low rates of cardiovascular disease and type 2 diabetes, but the ratio of these fatty acids is not useful. Reductions of linoleic acid to ”improve” this ratio would likely increase rates of cardiovascular disease and diabetes.” (Willett 2007)”• Major advances have been made during latest years• This slide deck summarizes the key findings that have changed the landscape 2 www.pronutritionist.net
Popular black & white claim amongPaleo & Low Carb ”schools”TFA n-3n-6
1 Claim #1: Arachidonic acid the driver of inflammationPage 4
Arachidonic acid & inflammation.Evidence from clinical trials• Increasing dietary intake • Roberts et al. 2007 (1.2 g AA/day, no change inflammation paramaters of arachidonic acid (AA) except in IL-6, which decreased) by 2-4 times above • Kakutani et al. 2011 (No change in normal intake does NOT inflammation parameters at the AA dose of 0.72 g) increase inflammation in humans (randomized • Calder P. Dietary arachidonic acid: controlled trials lasting harmful, harmless or helpful? Br J some weeks) Nutr. 2007 Sep;98(3):451-3. • Calder P. Polyunsaturated fatty• New mechanisms of anti- acids and inflammatory processes: inflammatory actions of New twists in an old tale. Biochimie 2009;91:791–795 AA have been invented (Calder 2009)
Point # 1 Human RCT evidence: increased intake of arachidonic acid does not lead to increased inflammation (at least in short term).6
2 Claim #2: High intake of linoleic acid increases inflammation in humans due to increased arachidonic acid levelsPage 7
Linoleic acid & inflammation. Evidencefrom clinical trials • Johnson & Fritsche. Effect of• A meta-analysis of 15 Dietary Linoleic Acid on Markers ofclinical studies: When Inflammation in Healthy Persons: Aintake of linoleic acid is Systematic Review of Randomized Controlled Trials. Journal of theincreased by some 20-50 Academy of Nutrition and Dieteticsg/day, no change can be 2012; 112: 1029-1041detected in inflammationmarkers in blood orerythrocytes• The length of the studies:2-9 weeks
Linoleic acid intake & AA responseEvidence from clinical trials • Rett & Whelan. Increasing dietary• A meta-analysis of 32 linoleic acid does not increaseclinical studies: When tissue arachidonic acid content inintake of linoleic acid is adults consuming Western-type diets: a systematic review. Nutrchanged dramatically (10- Metab (Lond). 2011 Jun 10;8:36.300 % vs normal), nosignificant change can bedetected in arachidoniclevels• The length of the studies:some weeks
Point # 2 Human RCT evidence: Increased intake of linoleic acid is NOT linked • increased inflammation • increased arahidonic acid levels10
3 Claim #3: Omega-3 fatty acids are strongly anti-inflammatoryPage 11
Omega-3 FA’s & inflammation.Evidence from clinical trials• A meta-analysis of 26 • Rangel-Huerta et al. Omega-3 long- chain polyunsaturated fatty acidsclinical studies supplementation on inflammatory • Among healthy biomakers: a systematic review of randomised clinical trials. Br J Nutr. individuals, no change 2012;107 Suppl 2:S159-70 in inflammation markers • In cardiovascular and renal diseases n-3 fats decreased moderately inflammation• The length of the studies:2-12 weeks
Point # 3 Human RCT evidence: Marine based omega- 3 fatty acids are likely to be modestly anti- inflammatory among healthy humans and moderately anti-inflammatory in some diseases13
4 Claim#4. Saturated fat is more or less neutral in terms of inflammatonPage 14
Saturated fat (SFA) & inflammation.Evidence from clinical trials• In meal and fat challenge • Warensjö et al. Effects of saturated and studies, high dose SFA unsaturated fatty acids on estimated increases IL-6, LPS and CRP desaturase activities during a controlled levels dietary intervention. Nutr Metab• Cardiovasc Dis. 2008;18(10):683-90 In a clinical study SFA increased • Harte et al. High fat intake leads to inflammation markers whereas acute postprandial exposure to in another it did not (Bjermo et al. 2012, Petersson et al. 2010) circulating endotoxin in type 2 diabetic subjects. Diabetes Care. 2012 ;• Mechanisms: 35(2):375-82 – Increased absorption of LPS • Masson CJ, Mensink RP Exchanging – Decreased conversion of ALA to saturated fatty acids for (n-6) EPA & increased conversion of LA to γ-LA (eventually increase in AA polyunsaturated fatty acids in a mixed concentration) meal may decrease postprandial lipemia – Decrease in the anti-inflammatory and markers of inflammation and action of HDL (even if the endothelial activity in overweight men.. J concentration is increased) Nutr. 2011 May;141(5):816-21.
Point # 4 If anything, SFA is modestly pro-inflammatory as a part of commonly consumed diet. At the doses of > 50 grams/meal is likely to be pro-inflammatory16
5 Claim#5: Extra virgin oil is anti- inflammatoryPage 17
Olive oil & inflammation. Evidencefrom clinical trials• In two clinical trials among • Fito et al. Anti-inflammatory effect of men with atherosclerosis, virgin olive oil in stable coronary disease patients: a randomized, crossover, extra virgin olive oil was controlled trial. Eur J Clin Nutr. 2008 anti-infllammatory Apr;62(4):570-4 • Widemer et al. Beneficial effects of• Refined olive oil is neutral polyphenol-rich olive oil in patients with early atherosclerosis.Eur J Nutr. 2012 in terms of inflammation Aug 8. according to a single meal study and a clinical trial • Tholstrup et al..Dietary cocoa butter or refined olive oil does not alter postprandial hsCRP and IL-6 concentrations in healthy wome. Lipids. 2011 Apr;46(4):365-70.
Point # 5 Extra virgin olive oil seems to be anti- inflammatory among men with atherosclerosis (due to polyphenols?) Refined olive oil (MUFA) seems to be neutral in terms of inflammation19
6 Claim#6: Margarine is bad for your health because it artificial and probably contains trans fatPage 20
Margarin & inflammation. Evidencefrom clinical trials• In a recent single meal • Masson CJ, Mensink RP Exchanging test, margarine was anti- saturated fatty acids for (n-6) polyunsaturated fatty acids in a mixed inflammatory whereas meal may decrease postprandial lipemia butter induced and markers of inflammation and endothelial activity in overweight men.. J inflammatory response Nutr. 2011 May;141(5):816-21.• In a clinical study (12 • Bjermo et al. Effects of n−6 PUFAs compared with SFAs on liver fat, weeks) margarine as the lipoproteins, and inflammation in 2nd vehicle of omega-6 fats abdominal obesity: a randomized controlled trial. American Journal of induced anti-inflammatory Clinical Nutrition Am J Clin Nutr. First properties vs butter published April 4, 2012, doi: 10.3945/ ajcn.111.030114
Point # 6 If anything, modern margarines that are devoid of trans fat, are modestly anti-inflammatory. At least when compared to butter based regimens.22
Conclusions • Omega-3 fatty are somewhat more proinflammatory than previously described / thought • Arachidonic acid poses some anti-inflammatory effects that has not been acknowledged previously • Saturated fat increases AA levels and decreases EPA levels which may be especially harmful in the absence of omega-3 fatty acids • Saturated fat increases absorption of LPS from the gut. LPS is an endotoxin and prone to cause wide spread inflammation in artery walls, liver and adipose tissue • Some argue that high intake linoleic leads to an increase in cancer incidence. According to a large meta-analysis of clinical fat replacement studies and prospective studies this is not the case. (Zock & Katan 1998)Page 23
My conclusion on fatty acids n-6 TFA SFA n-3 MUFA24 www.pronutritionist.net
My conclusion on edible fats. A wholeless dramatic MargarineBMI Butter Refined >30 % >40 Fish oil Weight /cream canola oil&T2D loss Extra virgin Refined olive oil Olive Oil Massive obesity if far more inflammatory than changes in dietary fats Massive weight loss leads to dramatic decrease in inflammation markers in severe obesity
Top 3 readings• Calder Philip. Polyunsaturated fatty acids and inflammatory processes: New twists in an old tale. Biochimie 2009;91:791–795• Johnson & Fritsche. Effect of Dietary Linoleic Acid on Markers of Inflammation in Healthy Persons: A Systematic Review of Randomized Controlled Trials. Journal of the Academy of Nutrition and Dietetics 2012; 112: 1029-1041• Rett & Whelan. Increasing dietary linoleic acid does not increase tissue arachidonic acid content in adults consuming Western-type diets: a systematic review. Nutr Metab (Lond). 2011 Jun 10;8:36.26
Please read the whole papers Just follow the yellow links to the original papersPage 27
Follow me http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist http://www.pronutritionistblog.com Reijo Laatikainen, Authorized Nutritionist, MBA, DietitianPage 28
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