Elementary Introduction to Essential Fatty Acids (EFAs)

Slides Presented in Part at The First Conference on Therapy for Verbal Apraxia/Dyspraxia "Essential Fatty Acids (EFA) in Verbal Apraxia: A New Potential Therapeutic Intervention"

July 23-24, 2001 Headquarters Plaza Hotel, Morristown, New Jersey, U.S.A.

Robert Katz, Ph.D.

Managing Director, Consortium for Brain Fatty Acids, Omega-3 Research Institute, Inc., and

Director of EFA Research, Cherab Foundation,

	Elementary Introduction to Essential Fatty Acids (EFAs)
	The Omega-6 and Omega-3 EFA Families of PUFA (1)
	The Omega-6 and Omega-3 EFA Families of PUFA (2)
	The Omega-6 and Omega-3 EFA Families of PUFA (3)
	EFAs and Eicosanoids
	EFAs in Inflammation
	Recommended Adequate Intake of EFAs
	Omega-3 PUFA and Their Systemic Presence
	Relevant Books on Omega-3 PUFA

Elementary Introduction to Essential Fatty Acids (EFAs)

The structure of fatty acids is like a long chain with many links and a Carbon atom at each joint between two links and at both ends of the chain. One of the ends of the chain contains the acid moiety, the other has only the carbon atom and hydrogen atoms. A carbon-carbon link can be single (like in saturated fats which are solid at room temperature and are components of red meats) or it can be double or unsaturated. If the fatty acid has one double bond it is called monounsaturated like oleic acid, the main component of olive oil. If it contain two or more double bonds it is called polyunsaturated fatty acid (PUFA) like the omega-6 and omega-3 families. TOP

The Omega-6 and Omega-3 EFA Families of PUFA (1)

There are two main families of polyunsaturated fatty acids (PUFA):
The Omega-6 Family and The Omega-3 Family
Linoleic (LA) Alpha-linolenic (LNA or ALA)
(C18:2 n-6; #C atoms, (C18:3 n-3)
2 Double Bonds)
Gamma-linolenic Stearidonic (SDA)
(GLA), (C18:3 n-6) (C18:4n-3)
Dihomogamma-linoleic Eicosapentaenoic (EPA)
(DGLA), (C20:3 n-6) (C20:5 n-3)
Arachidonic (ARA) Docodapentaenoic (DPA)
(C20:4n-6) (C22:5 n-3)
Docosatetraenoic acid Docosahexaenoic (DHA)
(DTA) (C22:4 n-6) (C22:6 n-3) TOP

The Omega-6 and Omega-3 EFA Families of PUFA (2)

Members of each family are either essential i.e., our body cannot make them (such as LA and ALA) or conditionally essential that is, if we ingest enough LA and ALA in our food (see below for recommended daily intake) our bodies can manufacture all the others. This biochemical-physiological process is however slow and inefficient, especially in the fetus, premature newborn and developing infant. Thus Ara, EPA and DHA are provided by the mother directly through the umbilical cord or breast milk. Very recently the FDA approved supplementation of infant formulas with DHA to satisfy the infant’s needs for appropriate brain and retina development and with Ara to ensure appropriate general development and growth. Direct DHA supplementation is more needed than EPA supplementation. The reasons are not clearly understood yet. It is known however that EPA does not accumulate and persist in the brain like DHA. It is transformed into DHA and hormone-like materials. TOP

The Omega-6 and Omega-3 EFA Families of PUFA (3)

 Omega-6 Oils
LA is abundant in corn oil, safflower oil, sunflower seed oil, cottonseed oil, soybean oil, peanut oil, sesame oil or grape seed oil. GLA is abundant in borage oil and evening primrose oil. Ara is abundant in red meat
Omega-3 Oils
ALA is abundant in flaxseed oil, canola oil, walnut oil and to some extent in soybean oil. EPA and DHA are in fish, other seafood, fish oils and algal oils,

Thus, in the human body: LA goes to GLA>Ara and ALA->EPA->DHA
(Both Ara and EPA are starting materials for cellular, hormone-like molecules called eicosanoids or prostaglandins) TOP

EFAs and Eicosanoids

Omega-6 prostaglandins (PGs) are potent stimulators of muscle contraction and platelet aggregation, e.g., thromboxane.
Omega-3 PGs are vasodilators that regulate blood pressure and inhibit platelet aggregation
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Omega-6 PGs can induce labor by causing contractions of the womb
Omega-3 PGs can relax the myometrium TOP

EFAs in Inflammation

The omega-6 prostaglandin PGE-2 is involved in fever, pain and swelling, menstrual cramps, inflammatory bowel disease, the omega-3 PGE-3 has low inflammatory potential.
The omega-6 leukotriene LTB-4 is involved in asthma, emphysema, bronchitis, dermatitis, psoriasis and ulcerative colitis, while the omega-3 LTB-5 also has low inflammatory potential.
Schematically
PGE-2 PGE-3
Cyclo-oxygenase enzyme (COX)
Ara EPA
Lipo-oxygenase enzyme (LOX)
LTB-4 LTB-5 TOP

Recommended Adequate Intake of EFAs

Fatty Acids Grams/Day %Energy
LA 4.44 2.0
upper limit 6.67 3.0
____LNA 2.22 1.0
 DHA & EPA 0.65 0.3
DHA at least* 0.22 0.1
Trans Fatty Acids<2.00___________
* For pregnant and lactating women 0.3 grams/day of DHA
A ratio of omega-6:omega-3 of 2:1 up to 4:1 is recommended
According to the USDA the average ratio of omega-6:omega-3 consumed by the US population is about 10-1. TOP

Omega-3 PUFA and Their Systemic Presence

Roles in cardiovascular disease: maintain lower levels of serum triglycerides, maintain healthy platelet function and blood coagulation levels, lower the risk of sudden death from stroke or cardiac infarct
Roles in prevention and therapy of cancer: are regulators of cancer cell death (apoptosis) during carcinogenesis (breast, prostate and colon cancers), reduce anticancer drug toxicity and facilitate the therapeutic effect of some anticancer drugs
Roles in the eye and brain: are potential regulators of retinal and neuronal signal transduction, appear to be regulators in mood disorders.
What is their role in verbal apraxia? TOP

Relevant Books on Omega-3 PUFA

To learn about the importance of EFAs and their roles in the Central Nervous System see the following books:
1. B. Jacqueline Stordy, Ph.D., and Malcolm J. Nicholl, “The LCP Solution”, Ballantine Books, New York, NY, 2000 (available from the Cherab Foundation)
2. Andrew L.Stoll, M.D., “The Omega-3 Connection,” Simon and Schuster, New York, NY, 2001
To learn about EFAs in general, and how to integrate them in a healthy everyday diet, please consult the following book:
3. Artemis P. Simopoulos, M.D., and Jo Robinson, “The Omega Plan,” HarperCollins Publishers, New York, NY, 1998 TOP

Cherab Foundation Scientific Programs

The following was from 'the First Apraxia Conference' July 23-24, 2001,Headquarters Plaza Hotel, Morristown, New Jersey USA

and was also presented at the Research Workshop - September 20-21 and on September 22, 2001 'Fatty Acids in Neurodevelopmental Disorders' St Anne’s College, Oxford, UK

Cherab Foundation SCIENTIFIC PROGRAMS

VERBAL APRAXIA/DYSPRAXIA and the THERAPEUTIC ROLE of
ESSENTIAL FATTY ACIDS:

The Perspectives of Speech Pathologists:

The Perspective of a Developmental Pediatrician:

A Time Line of Therapeutic Outcomes in
Speech/Communication

Conclusions:

Cherab Foundation PROFESSIONAL STAFF

Organizers and Scientific Panel Members of the First
Conference on Verbal Apraxia/Dyspraxia

Cherab Foundation SCIENTIFIC PROGRAMS

The first conference for therapy of verbal
apraxia/dyspraxia entitled: "Verbal Apraxia/Dyspraxia
and Essential Fatty Acid (EFA) Supplementation: A New
Potential Therapeutic Intervention," 23-24 July, 2001,
Headquarters Plaza Hotel, Morristown, New Jersey,
U.S.A., was organized under the auspices of the Cherab Foundation and the Consortium for Fatty Acids, Omega-3
Research Institute, Inc. The research findings
described below were presented by Cherab Foundation
professional staff to a panel of participating experts
for their review. The panel recommended the initiation
of clinical trials to validate the potential
therapeutic effects of EFA supplementation in verbal
apraxia and autism. The data was also presented as
three posters at the Conference on "Fatty Acids in
Neurodevelopmental Disorders", September 20-21, 2001
Oxford, United Kingdom.

VERBAL APRAXIA/DYSPRAXIA and the THERAPEUTIC ROLE of
ESSENTIAL FATTY ACIDS:

Official Statement from The First Scientific Conference Dedicated to the Therapy of Verbal Apraxia/Dyspraxia! You may want to explore the archives of our grouplist.

The First Scientific Conference on Therapy for Verbal Apraxia/Dyspraxia

Post conference Statement

The First Scientific Conference on Therapy for Verbal Apraxia/Dyspraxia, held on July 23-24, 2001 at the Headquarters Plaza Hotel, Morristown, New Jersey under the auspices of the Cherab Foundation (http://www.apraxia.cc/), focused on "Essential Fatty Acids (EFAs) and Verbal Apraxia: A New Potential Therapeutic Intervention." A panel of scientific experts discussed the evidence presented at the conference in the form of professional anecdotal case reports on improvement of verbal communication ability with EFA supplementation in this population. The panel unanimously agreed that the existing scientific evidence justifies planning and implementing a comprehensive clinical trial to convincingly validate this new potential therapeutic intervention.

The panel discussed various clinical research alternatives including the following:

A controlled case series trial using currently available standardized speech assessment measures or developing new clinical assessment profiles for baseline and post-EFA testing

A randomized, placebo-controlled multicenter clinical trial of EFA and placebo supplementation to be undertaken as soon as possible. For example, if a randomized, placebo-controlled clinical trial would be undertaken, all diagnosed verbal apraxic children, including those with hypotonia and sensory integration disorder, who have not been supplemented with EFAs, would be eligible for randomization. The panel suggested that all randomized children would be supplemented with EFA or placebo in addition to appropriate speech therapy. This took into consideration the potential cooperative or possibly synergistic effect of the combined therapies in the treatment group. The length of the trial is proposed to be 3 months. Improvement in verbal communication skills, or the lack thereof using an assessment protocol as described above, would be the major therapeutic outcome measured, and plasma, as well as erythrocyte membrane EFA levels would be monitored periodically. The two groups would consist of about 20-30 age-matched subjects. ProEFA would be the therapeutic supplement used in the trial based on preliminary successes attained.

In addition the panel noted the potential availability of electrophysiological measuring instruments that could serve as assessment tools of developmental-behavioral characteristics of a verbal apraxic child, and recommended the exploration of such techniques. While the panel refrained from discussing the etiology and pathophysiology of verbal apraxia, it also expressed great interest in what appears to be a presence of verbal apraxia in a percentage of children on the autistic spectrum and a possible association in other disorders and syndromes, such as: hypotonia, sensory integration disorder, dysarthria, attention deficit hyperactivity disorder, Kabuki Syndrome and cerebral palsy. The panel recommended further exploration of these phenomena.

Although no final decision was reached on the nature of the clinical trial/trials to be undertaken, the workshop ended with a commitment from all members to continue debating this issue in close collaboration with the organizers, and to reach a decision within the shortest timeframe possible.

The organizers thank all panel members for their tireless dedication and enthusiastic participation in the Workshop's deliberations, and thank all parents who contributed to the success of the workshop, by requesting the professionals supervising and treating their children to complete a professional anecdotal case report questionnaire on the outcomes of EFA supplementation. This workshop could not have taken place without their assistance.

The organizers also wish to acknowledge with thanks the assistance of many dedicated parents in helping with the logistic aspects of the workshop.

Last but not least, the organizers are thankful to the Cherab Foundation's president, Ms. Lisa Geng, for her support of this workshop, and her boundless energy and enthusiasm in the service of verbal apraxic children and their parents.

The Scientific Organizers:

Marilyn Agin, M.D., and Robert Katz, Ph.D.,

Scientific Panel Members:

Marilyn Agin, M.D.
Medical Director, Early Intervention, New York City, NY

Susan E. Carlson, Ph.D.
Professor, University of Kansas, Kansas City, Kansas
Member Consortium for Fatty Acids (CFBFA)

Joseph Hibbeln, M.D.
Chief, Outpatient Clinic
National Institute of Alcoholism and Alcohol Abuse
NIH, Bethesda, Maryland

Robert Katz, Ph.D.
Managing Director, Consortium for Brain Fatty Acids (CFBFA) Omega-3 Research Institute, Inc.

Nancy Kaufman, M.A., CCC/SLP
Director, Kaufman Children's Center for
Speech Language and Sensory Disorders,
West Bloomfield, Michigan

Ann Moser
Director, Peroxisomal Diseases
and Fatty Acid Profiles Clinical Laboratory,
Kennedy Krieger Institute, Baltimore, Maryland
Member CFBFA.

Jennifer Hill-Karrer, Ph.D.
Associate Professor,
University of Kansas Medical Centre, Kansas City, Kansas

Lori Roth M.A., CCC/SLP
Speech Pathologist, Cherab Foundation

Andrew Zimmerman, M.D.
Professor, Johns Hopkins University and
Kennedy Krieger Institute, Baltimore, Maryland

Guest Panelist:

Alexandra J. Richardson, MA, DPhil
Senior Research Fellow in Neuroscience, Imperial College School of Medicine, MRI Unit, Hammersmith Hospital, London; and University Lab. of Physiology, Oxford.

Guest Dinner Speaker:

Hugo W. Moser, M.D.
University Professor, Johns Hopkins University School of Medicine Baltimore, MD Director of Neurogenics Department,
Kennedy Krieger Research Institute Baltimore, MD

The Administrative Organizers:

Cherab Foundation

Lisa Geng, President, Suzanne Smolyar, Executive Vice President, and Glenn W. Geng Executive Director, Treasurer

For all information, please contact the Cherab Foundation

How did this Apraxia /EFA Scientific Conference Come About?