Chronic Fatigue Syndrome: A Natural Way to Treat M.E. [Paperback]

 

 

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The book has some solid science, an interesting hypothesis, anecdotal
evidence of dramatic improvements, but is marred by a, let us say, over
enthusiastic backing of a single product.

The first half is solid science with an interesting hypothesis which
while quite plausible is not proven. The second half is on more shaky
grounds with many "facts" stated with little, shaky or no support. And
as another reviewer mentioned, it does mention a single product above
all others, and argues strongly for it.

This is not to say his hypothesis is wrong or that the product he
proposes does not have the suggested benefits. But some of the weaker
reasoning later in the book leads to doubt about how strong the earlier
reasoning is. The author is a Professor at Imperial College London and
has published many articles in peer-reviewed journals, so some of this
is slightly surprising. But let us follow the book.

After a brief introduction, there is a history of CFS including the
common criteria for diagnosis. Then we are presented with well
explained evidence from a number of peer reviewed papers showing that
there are physiological differences in those suffering from CFS. These
include lymphocyte activity, levels of omega-3 and omega-6 fatty acids,
and brain biochemistry. His hypothesis to explain this data is that CFS
sufferers have a "pre-existing long term viral infection".

He then introduces the role of omega-3 and omega-6 fatty acids in cells
and the immune system and states that viruses disrupt an enzyme that
enables production of GLA and EPA from linoleic acid and alpha-linoleic
acid. There is evidence from two double blind trials that gave
supplements containing GLA and EPA (or placebos) to CFS sufferers. One
showed a significant improvement in those taking the supplements and one
showed equal improvement for the supplement and the placebo. The second
trial used a placebo containing high levels of linoleic acid and a
little alpha-linoleic acid. He also reports cases of patients of his
having significant improvements when taking very high doses of EPA.

So far so good. All solid science, with an emphasis on the pet theory
of the professor. But the tone of the book changes substantially at
this point. The references to the preferred product increase, caveats
largely disappear, the reasoning becomes lax and the claimed benefits
expand. Did someone else write the second half?

Rather than carefully worded explanations we have "some of the benefits
that have been attributed to [product X] include ...". He refers to
"triterpines" - the only references on google are herbal medicine sites.
He makes DHA sound like a scary cancer causing chemical to be avoided
having just mentioned that they occur naturally in fish.

And chapter 7 - "Other benefits of taking fatty acids" really pushes the
boat out. Apparently his preferred treatment reduces depression,
improves sleep, boosts energy, aids concentration and thinking, helps
joints, reduces body weight and improves skin, hair and nails! There
are a few caveats in there, but mostly it is just stated. This was
where I thought "if it sounds too good to be true then it probably is".

Evidence is given for the depression part of this. However the evidence
is pretty poor. First, high fish consumption (per country) is
correlated with low rates of depression (and vice versa). On a per
country basis many things are correlated, no sort of causal link is even
suggested by this evidence. Next we are told that seasonal rates of
violent suicide are negatively correlated with seasonal variation in the
level of EPA. Are you serious in presenting this?!? More people commit
suicide in winter. This is correlated with so many things as to be
unreal. Have you heard of seasonal affected disorder? Bur we are told

"Taken together, both these sets of studies indicate a link between low
levels of EPA and the occurrence of depression or suicide."

NO THEY DON'T! (Sorry for shouting but this really is ridiculous).

More direct evidence is that depressed people have low levels of EPA.
But maybe you get depressed and then don't eat so well. No causation is
shown here. Finally he mentions some trials that appear to show that
depressed people who take EPA improve significantly. This is evidence
worth looking at, unlike the first two studies.

The second half also contains a sensible chapter on how to ensure a
balanced diet giving you the vitamins and minerals you need, and
a chapter containing practical information on assessing, living with and
basic treatment for CFS.

In conclusion, there is a lot of interesting science in this book, but
keep your sceptical hat around and think about it. I am still
interested in looking into omega-3 and omega-6 fatty acids. But I need
a lot more evidence before I'm willing to take the "one true" EPA
supplement recommended by Professor Puri.

For recommended books about ME/CFS, see
http://www.ahummingbirdsguide.com/bookreviews.htm

In this book Professor Puri argues that people with CFS are deficient in essential fatty acids which exist in two main groups namely Omega-6 and Omega-3. The reason for the deficiency we will look at in a moment. His solution to the problem is a supplement called VegEPA, a combination of evening primrose oil and fish oil. The manufacturers of this product, Igennus Ltd, sponsor some of Prof Puri's research. Although we can only guess at the nature of the financial arrangements, it is has led some commentators to speculate that his research and findings as presented in this book have been compromised by this connection.

VegEPA, a patented formulation, is unique in one respect. One of the essential fatty acids contained in the fish oil, DHA, has been removed. As you might expect, without other competing products available it is very expensive. To justify the cost of around £50 a month at the recommended dosage the need and benefit of removing the DHA has to be shown.

We get a better picture of this book if we look at it in the wider context of the work of the author. First published in 2004 is his book entitled "The Natural Way to Beat Depression". The remedy, again, is VegEPA. However, depression and CFS are entirely different conditions. There are distinct measurable physiological differences including some that are opposite to each other. For example, the level of cortisol, a hormone produced by the adrenal glands, is elevated with depression whereas with CFS it is reduced. If VegEPA is effective for depression, and its not something I have looked at, it is reasonable to suppose that it is unlikely to be particularly effective for CFS as well. It is therefore not surprising that information coming from the main ME/CFS support groups is not showing any clear benefit from supplementing with this product.

The argument put forward in the earlier book is that depression is primarily caused by the lack of a dietary intake of alpha-linolenic acid which the body needs to turn into the series of essential fatty acids in Omega-3 group including EPA and DHA. It was found that EPA was effective in treating depression but that DHA inhibited its action which is why VegEPA is used which contains EPA and no DHA. It is with depression and not CFS that Prof Puri's connection with this product appears to have first begun.

In this book on CFS, Prof Puri again suggests it is lack of essential fatty acids that is responsible for the condition. However, here he doesn't cite a dietary lack but an inhibition by a latent virus of the enzyme, D6D, which is needed to create the various essential fatty acids in both Omega-6 and Omega-3 groups. The claim for VegEPA is that it is effective because it bypasses the need for this enzyme. Evening primrose oil already contains GLA in the Omega-6 group which would otherwise need to be produced by this enzyme from a dietary source of linoleic acid. Similarly, the fish oil already contains EPA in the Omega-3 group which would otherwise need to be produced by this same enzyme from a dietary source of alpha-linolenic acid.

If it is true that this enzyme, D6D, is involved in a lack of essential fatty acids in people with CFS, and research since this book was published suggests it might, the case for supplementing with VegEPA breaks down. Bearing in mind that the main selling point of this product is that is doesn't contain the essential fatty acid, DHA, Prof Puri attempts to justify that by downplaying its importance in the body and also by trying to implicate it with unhelpful and even injurious effects. It is here where the previously well constructed and reasoned way of presenting his arguments is abandoned. He goes on to reassure the reader that if the body does require DHA then it can simply make it from the EPA in the supplement. The enzyme required to do that, at least in part, is D6D. His theory as to why people get CFS depends on the premise that D6D has been inactivated by a virus. Clearly, he hasn't thought it through! A supplement for CFS therefore needs to contain DHA not exclude it!

As far I am aware the only controlled trial to show a positive effect by essential fatty acids on CFS included DHA. I think it is therefore safe to conclude that to use pure fish oil in combination with evening primrose oil is going to be more effective than VegEPA. Another point to consider with VegEPA is that in spite of its high cost, at the recommended dose of eight capsules a day the amount of GLA provided by the evening primrose oil is only approximately 70mg. Most authorities consider a therapeutic dose to be between 150mg and 300mg a day.

If we accept Professor Puri's argument that a person with CFS is likely to be deficient in essential fatty acids, then we need to look beyond his recommendation to use VegEPA. Borage oil would be a better choice than evening primrose oil to provide GLA. This would make the therapy more affordable. Just two 500mg capsules daily will provide 200mg of GLA. Also, because borage contains the enzyme D6D, this could help to compensate for the inhibitory effect that viruses appear to have on it. The benefits of using borage oil to provide GLA combined with pure fish oil to provide EPA may be increased further if dietary measures are included that reduce the intake of linoleic acid, that is, particularly foods cooked with and made from polyunsaturated vegetable oil such as sunflower. It is the relationship between dietary intakes of Omega-6 and Omega-3, not simply amounts, and which has changed dramatically in recent years in favour of Omega-6, that may well be crucial to an understanding in the future of how essential fatty acids play a part in CFS.

This book provided so much information and made so much sense. Prof. Basant Puri has really helped me to understand my condition and in a way come to terms with it. I would recommend this book to anyone who like myself had never heard of this illness before being diagnosed with it. It is full of valuable advise and contacts.

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5.0 out of 5 stars fatigue book
After reading other reviews on this book I decided to give it a chance, once I picked it up I couldn,t put it down. Read more

Published on 5 Jun 2009 by I. R. Fenner

5.0 out of 5 stars finally an effective treatment
As a qualified nurse retired due to this horrible illness I have read much research about ME, everything argument Dr Puri puts forward mirrors my own case, and his research... Read more

Published on 17 Mar 2006 by Mr. At Meynell

2.0 out of 5 stars Excellent for UK research but stale for worldwide
EPA with virgin evening primrose oil[EPA] can be highly effective in the treatment of Chronic Fatigue Syndrome for some patients ONLY. Read more

Published on 10 April 2005

5.0 out of 5 stars The best book ever on M.E.
I have read many popular books and articles on ME. This one is head and shoulders above the others. Professor Puri has carefully developed his argument, backed up by the latest... Read more

Published on 17 Mar 2005 by Jennifer Myers

1.0 out of 5 stars This book is a product advertisement
This book is an extended advert for a product called VegEPA. The testimonials quoted are impressive as are the author's credentials and I have no reason to doubt the accuracy of... Read more

Published on 1 Feb 2005 by kelb_uk

5.0 out of 5 stars Proof: M.E is not all in the mind!
Finally a clear concise reasoning/evidence behind the debilitating illness M.E.
I have suffered from M. Read more

Published on 21 Jan 2005

5.0 out of 5 stars 6 months ago I suffered badly from ME....not any more!!!
I was a long time sufferer of ME and started to take Professor Puri's treatments 6 months ago. As a result I have never felt so well as I do now on VegEPA. Read more

Published on 4 Dec 2004 by sean

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