Essential Fatty Acids (Omega-3 & Omega-6) are direct building blocks for the skin's lipid bilayers, reducing transepidermal water loss (TEWL).
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@AlphaZance hi, any picture available of a human hand skin from a person that was label as essential fatty acid deficient in one of these experiments?
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Human essential fatty acid deficiency: treatment by topical application of linoleic acid
Abstract
An essential fatty acid (EFA) deficiency developed in a 19-year-old man who was being maintained on a long-term regimen of fat-free, intravenous hyperalimentation fluids. The EFA deficiency was reversed after 21 days by daily, topical application of linoleic acid to the patient's skin. The ratio of eicosatrienoic acid (20:3, n-9) to eicosatetraenoic acid (20:4, n-6) decreased to normal levels in the skin and serum with clinical improvement of the EFA deficiency syndrome. The cutaneous manifestations (scalp dermatitis, alopecia, and depigmentation of hair) were reversed with continued, topical application of safflower oil, which contains 60% to 70% linoleic acid.
https://pubmed.ncbi.nlm.nih.gov/406855/Essential fatty acid deficiency while a patient receiving fat regimen total parenteral nutrition
Abstract
A 32-year-old man was diagnosed with lymphoma and underwent Billroth’s II operation because of upper gastrointestinal haemorrhage. Although the patient received fat regimen total parenteral nutrition (TPN), the patient developed typical skin rash of essential fatty acid deficiency after 2 weeks of starting TPN. The diagnosis was confirmed by biochemical and histological analyses. After increasing the lipid infusion, the rash was gradually improved with complete resolution after 19 days.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3387468/ -
@AlphaZance i can not open the full text links, could you share the picture of the first link on the thread?
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@thebiooracle
Modern Multivitamins and B-complex put too much pyridoxine, modern foods fortified with it, with many personal reports on the internet stating they have high B6 in blood and symptoms of neuropathy from it, they don't even supplement. Yet lots of acne and other skin problems still on the internet, I've almost never seen B6 reported as solution to skin problems, we already have too much? Ray Peat himself stated he took 100,000 I.U. of Vitamin A and not B vitamins to prevent acne.The Human Reality
Humans: Humans are large, relatively hairless, and have a very low surface-area-to-volume ratio.
Well, if you are going to talk of "Modern" levels of B6 and "The Human Reality" in regards to so called EFA, you should also look at the intake and percentage levels of those EFAs both in diets and modern human fat stores. In both cases, the amounts are extremely high- way higher than diets from the 1960s-1980s, and those levels were much higher than before seed and fish oils started to be produced in the first place. So, the idea of any modern human in a modern country who doesn't have some sort of major digestive disorder ever having "Essential Fatty Acid Deficiency" is pure fantasy.
Remember, when Burr's lab tried to induce EFA deficiency in William Brown back in the 1930s, 6 months of an essentially fat free diet was unable to produce the condition. Meanwhile, Brown saw some major health improvements, like the disappearance of headaches and fatigue and normalization of blood pressure, suggesting that "excess" EFA was more of an issue even at that time than "deficiency." It might take modern people several years of strict fat free dieting to even approach so called "EFA deficiency," and if someone were able to do such a thing, they would probably run into other issues first.
Since EFAs make up roughly 8% of total daily calories, and about 20% of body fat stores on average in the USA, so called "EFA deficiency" simply isn't a real concern for the vast majority of the population. The only possible cases, like the ones you posted, are where part of the GI tract has to be removed and TPN is used for a time. And in those situations, other conditions and deficiencies would also need to be seriously considered.
The is why Ray Peat balked at the idea that Omega 6 and Omega 3 should be labeled "essential." In reality, they are unavoidable.
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@ZackVegas
Did you read the two EFAD studies on human I cited above? They were on Vitamin, Mineral and Amino rich regimen: fat-free, intravenous hyperalimentation fluids and fat regimen total parenteral nutrition (TPN). Yet they developed skin conditions and reversed with EFA. The person (32-year-old man presented with history of anorexia) receiving TPN already having EFA and they had to increase the amount of fat he receives.There's plenty of studies on TPN regimen and EFAD development:
Essential fatty acid deficiency during total parenteral nutrition
Essential fatty acid (EFA) deficiency has become a clinical problem since the advent of fat-free total parenteral nutrition (TPN). The following study was done to determine the minimum fat requirements for patients receiving continuous TPN solution. Seventy-seven patients who had 97 courses of TPN of at least 14 days duration were prospectively studied. The following fat supplementation was given: a) none, b) 10% soybean oil emulsion intravenously at fixed dosage, c) fat from an oral diet, or d) intravenous and oral fat. No patient was EFA deficient before the onset of TPN. EFA deficiency was prevented when at least 3.2% of total calories were given as intravenous fat or at least 15% as oral fat. Lesser amounts of fat decreased the rate of EFA deficiency development but did not prevent it from occurring. The 7.7 g/day of linoleic acid provided in 1000 ml per week of 10% soybean oil emulsion provides adequate fat to prevent EFA deficiency.
https://pubmed.ncbi.nlm.nih.gov/6782957/Essential fatty acid deficiency in adults receiving total parenteral nutrition
In seven adult patients receiving fat-free total parenteral nutrition (TPN) for 4 to 8 weeks, weekly determinations of plasma fatty acids and total plasma tocopherols were made. Four patients were deficient in essential fatty acids, as defined by triene:tetraene ratio >0.4, at the end of the second week of TPN. Six patients were deficient by the end of the third week and all seven were deficient by the end of the fifth week of TPN treatment. One patient who was deficient in both essential fatty acids and zinc developed a scaling, eczemoid dermatitis that disappeared within 3 weeks after cessation of TPN and resumption of oral feedings containing both fat and zinc. After resumption of oral feedings by three patients, the triene:tetraene ratio returned to normal within 2 weeks. The mean of total plasma tocopherols fell over a period of 7 weeks and in three individuals, reached levels generally associated with deficiency. There were not any obvious clinical manifestations of vitamin E deficiency.
https://www.sciencedirect.com/science/article/abs/pii/S0002916523341066Serum lipids and fatty acids composition of tissues in rats on total parenteral nutrition (TPN)
The modulating effect of energy and exogenous triglyceride supply on serum lipids and fatty acid composition of liver, tibialis anterior muscle, subcutaneous and peri-epididymal fat was assessed in rats using Total Parenteral Nutrition (TPN). Nutrients were infused continuously for 10 days through a central vein catheter. Four levels of fat were tested: No fat, Low fat (6% non-protein calories), Medium fat (30%) and High fat (60%), at 2 energy levels (270 kcal and 350 kcal/kg X day). An isonitrogenous supply was given to all groups as 0.9 g N/kg X day. At the highest level of fat intake (20.4 g/kg) at the high energy level triglycerides, cholesterol and phospholipids of serum were elevated. Biochemical signs of essential fatty acid (EFA) deficiency were observed as rising levels of eicosatrienoic acid and lowered concentrations of linoleic and arachidonic acid, mostly in the liver and the muscle in the No fat groups. EFA levels were reduced significantly in the No fat and Low fat groups and more pronounced at the high energy level. In conclusion, our study suggests that when energy intake is increased the EFA status becomes more critical. It seems evident that more EFA is required in absolute values when hypercaloric diets are given.
https://pubmed.ncbi.nlm.nih.gov/6438428/Medium-chain triglyceride supplementation in infants with biliary atresia: a review of the evidence for impacts on fat absorption, growth, nutritional status and clinical outcomes.
Biliary atresia is a rare bile duct disease resulting in intestinal bile salt depletion due to poor bile flow. Medium-chain triglyceride (MCT) supplementation is widely recommended and used as the main dietary management in infants, however evidence for its use is limited and there is uncertainty regarding the optimal percentage (proportion of total fat that is MCT) and dose (grams/kilogram/day, g/kg/d). The aim was to review the evidence for the impact of MCT on fat absorption, growth, nutritional status and clinical outcomes in infants with biliary atresia and the optimal nutrition profile of MCT supplementation. A scoping review found that the mostly observational, historic evidence for MCT supplementation pointed to greater fat absorption during MCT supplementation compared to no supplementation, but also some evidence of a risk of essential fatty acid deficiency with very high MCT percentage. Only six studies have investigated MCT percentages and only three reported MCT dose. One analysis of MCT in the largest cohort of biliary atresia patients ever presented (n = 200), found no association between MCT percentage with growth, nutritional status or clinical outcomes. Counterintuitively, there was an unexpected inverse association between MCT dose and growth. A possible interpretation was that increased MCT was a consequence of poor growth rather than a cause, as infants either drank more or dietitians prescribed more MCT as fat malabsorption worsened. In conclusion, MCT is widely recommended, however, the evidence for its use is lacking and there remains uncertainty about the optimum percentage and dose for infants with biliary atresia.
https://europepmc.org/article/MED/41502374Essential fatty acid deficiency in total parenteral nutrition. Detection by changes in intraocular pressure
Essential fatty acid deficiency (EFAD) has been commonly and readily diagnosed during fat-free total parenteral nutrition (TPN), with only vague awareness of possible functional and clinical derangements secondary to essential fatty acid deficiency. Arachidonic acid is known to be a precursor for prostaglandin (PG) synthesis. Prostaglandins are known to be intermediaries between stimulus and cellular response in a variety of physiologic and pathologic processes; one would suspect therefore that EFAD would result in PG deficiency with resultant multiple derangements in functions regulated by PG. We tested this hypothesis by serially measuring intraocular pressure (IOP) in patients before and during fat-free TPN and after supplementing these patients with fat. In the eye as well as in various other organs PG are believed to act as mediators of adrenergic neurotransmission by a negative feedback mechanism. As catecholamines are potent ocular hypotensive agents, decreased levels of PG due to EFAD will cause increase in catecholamine turnover with a reduction in IOP. Two groups of patients matched as to their age, sex, nutritional status and diseases were studied. One group (control) was receiving a normal diet or fat-containing TPN while the other group was receiving fat-free TPN. IOP in the fat-free TPN group dropped from 13.7 +/- 0.4 mmHg pre-TPN to 9.3 +/- 0.5 mmHg during the first week of fat-free TPN. Within two weeks after supplementation of fat or return to normal oral diet IOP returned to 13.9 +/- 0.3 mmHg. Prostaglandin levels, which were 0.025 +/- 0.004 ng/ml pre-TPN or in control patients decreased to 0.012 +/- 0.002 ng/ml (p < 0.001) during fat-free TPN, to return to normal after fat was added to TPN regime or patients returned to normal oral diet. During fat-free TPN linoleic acid levels decreased to 40% of its initial value with a mild increase upon the addition of fat, while eicosatrienoic acid and the triene:tetraene ratio increased to 6.5 times their initial values. Arachidonic acid levels did not change during fat-free TPN or after repletion with fat. Intraocular pressure determination seem to be a simple, harmless, inexpensive, reliable and sensitive indicator of EFAD. Moreover, IOP determination represent a functional derangement which in a clinical setting lends functional credence to the biochemical changes of EFAD whose entire significance has not yet been determined. Similarly, serial IOP determinations are sensitive in detecting adequate functional repletion of EFAD. As PG are known to act as intermediaries in a variety of physiological processes it seems reasonable to assume that the change in IOP is only one of many different changes and derangements to occur as a result of PG and EFA deficiency.
https://pubmed.ncbi.nlm.nih.gov/223507/Essential fatty acid deficiency and home total parenteral nutrition patients
The requirements for essential fatty acids in patients on home parenteral nutrition are not well described. We therefore studied the needs of 12 patients receiving parenteral nutrition for at least 4 mo (range: 4 mo-17.3 yr; mean 7.0 ± 5.2 yr). Prior to the study, each patient had been receiving intravenous lipids either weekly or biweekly and had a triene to tetraene ratio (TTR) on plasma phospholipids performed at least annually. A TTR ≥ 0.2 was considered diagnostic for essential fatty acid deficiency (EFAD). The purpose of this study was to determine the required intravenous lipid supplementation in patients on home total parenteral nutrition (HTPN). Patients with an initial TTR of <0.2 had their intravenous lipid stopped and changes in their serum phospholipid fatty acids were followed every 3–4 wk. Nine of 12 patients had TTRs > 0.2 at some point in the study. Phase I consisted of patients who at initiation of the study had normal TTRs and were taken off lipid supplementation until their TTR became abnormal. Phases II, III, IV, and V consisted of lipid delivered in total nutrient admixtures in biweekly doses of 0.6, 1.2, 1.8, and 2.4 g of fat/kg bodyweight, respectively. Eight patients normalized their TTRs on the biweekly lipid regimens; one patient expired before his ratio normalized; and three patients could not be made deficient in essential fatty acids after 26 or more wk of fat-free parenteral nutrition. Most patients required 1.2 to 2.4 g of lipid/kg bodyweight/biweekly to correct serologic EFAD. The clinical background, as well as the length of small bowel remaining, did not seem to identify those patients who required lipid supplementation nor the final dose of lipid needed to normalize their TTRs.
https://www.sciencedirect.com/science/article/abs/pii/S0899900796908503 -
@ZackVegas
Did you read the two EFAD studies on human I cited above?Yes, I did. Which is why I made the possible exception for those with "some sort of major digestive disorder." Both of those case studies involved patients who had portions of their GI tract removed.
They were on Vitamin, Mineral and Amino rich regimen: fat-free, intravenous hyperalimentation fluids and fat regimen total parenteral nutrition (TPN).
Yes, they were, after surgery, and after the conditions that lead to the surgeries, and most certainly caused malnutrition and deficiencies of several vitamins, minerals, cofactors, and probably even macronutrient deficiencies.
Yet they developed skin conditions and reversed with EFA.
More like they developed skin conditions that were reversed with additional fats, either in TPN or applied topically. Yes, these fats did contain a high proportion of PUFA, but this does not mean that PUFA was "essential," even in these extreme cases. They might have seen similar improvements, or even better improvements, from fats like Coconut Oil, Beef Tallow, Shea Butter, Cocoa Butter, or even Olive Oil. As these were one person case studies, we don't have those other groups to compare them to.
The person (32-year-old man presented with history of anorexia) receiving TPN already having EFA and they had to increase the amount of fat he receives.
Yes, he did have anorexia. He had lost 30kg (or 66 pounds) in 3 months. He also had lymphoma, and underwent chemotherapy. Then, he underwent Billroth’s II operation, where they removed part of his stomach. Originally, the patient was receiving 340g of carbs, 80g of protein, and 50g of fat daily. This is only 2130 calories a day, basically the minimum you would expect for a sedentary man of 74kg. When you factor in the surgical recovery and this history of anorexia, this itself might already have been too little. Then, after three days, they cut the fat to only 3 days a week, instead of 7. Meaning he was only getting 1600 calories 4 days a week. When they went back to 50g of fat daily, the xerosis healed in 19 days.
So, maybe this could have been "EFA deficiency." Or, it could have been Saturated Fat deficiency. Or Monounsaturated fat deficiency. Or just a general fat deficiency. Or simply an overall calorie deficiency. Or various vitamin and mineral deficiencies. Or multiple of the above. Which is to say this case in no way shows that Omega 6 and Omega 3 are in and of themselves "essential."
There's plenty of studies on TPN regimen and EFAD development:
Yes, there are plenty of studies out there that come to a conclusion that was reached long before the study was ever conducted. Maybe it's showing how Omega 6 and 3 can be "essential" in very extreme cases, or maybe it's confirmation bias. Either way, it doesn't have much application to real world humans that can eat normally.
Essential fatty acid deficiency and home total parenteral nutrition patients
The requirements for essential fatty acids in patients on home parenteral nutrition are not well described. We therefore studied the needs of 12 patients receiving parenteral nutrition for at least 4 mo (range: 4 mo-17.3 yr; mean 7.0 ± 5.2 yr). Prior to the study, each patient had been receiving intravenous lipids either weekly or biweekly and had a triene to tetraene ratio (TTR) on plasma phospholipids performed at least annually. A TTR ≥ 0.2 was considered diagnostic for essential fatty acid deficiency (EFAD). The purpose of this study was to determine the required intravenous lipid supplementation in patients on home total parenteral nutrition (HTPN). Patients with an initial TTR of <0.2 had their intravenous lipid stopped and changes in their serum phospholipid fatty acids were followed every 3–4 wk. Nine of 12 patients had TTRs > 0.2 at some point in the study. Phase I consisted of patients who at initiation of the study had normal TTRs and were taken off lipid supplementation until their TTR became abnormal. Phases II, III, IV, and V consisted of lipid delivered in total nutrient admixtures in biweekly doses of 0.6, 1.2, 1.8, and 2.4 g of fat/kg bodyweight, respectively. Eight patients normalized their TTRs on the biweekly lipid regimens; one patient expired before his ratio normalized; and three patients could not be made deficient in essential fatty acids after 26 or more wk of fat-free parenteral nutrition. Most patients required 1.2 to 2.4 g of lipid/kg bodyweight/biweekly to correct serologic EFAD. The clinical background, as well as the length of small bowel remaining, did not seem to identify those patients who required lipid supplementation nor the final dose of lipid needed to normalize their TTRs.
https://www.sciencedirect.com/science/article/abs/pii/S0899900796908503This one is incredibly interesting. It shows that even in extreme cases of digestive disorders and malnutrition, it's still difficult to induce so called "Essential Fatty Acid Deficiency" in 25% of patients, even after 6 months of fat free feeding.
Basically, this again either leads to two conclusions.... either so called EFAs aren't essential at all, and the general population is consuming them at toxic levels, and should cut back..... or, they are essential in much smaller amounts that are currently consumed in the general population, and the general consumption level is at toxic levels (similar to iron), and levels should be cut back. Extreme cases of digestive disorders and/or chronic malnutrition should of course be considered separately.
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Do you think different people might have different EFA requirements? For some people, trace amounts of EFA are enough, but for others, you get EFA deficiency from going under 6 grams of omega-6 a day or whatever. People who aren't in perfect health might need more EFA to avoid deficiency than healthy people do?
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@ZackVegas
You aren't determining who needs more or less EFA, you're telling everyone to cut back regardless while saying it isn't essential or essential in small amounts in the same sentence. Lack of extreme medical cases also doesn't determine that the individual is replete or having optimal EFA, and this is probably biased because you get fewer clinical studies for non-extreme cases.
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