Professor Basant K. Puri
Honorary Clinical Research Fellow, Department of Medicine, Imperial College, London, who has published over 150 papers, mainly in imaging, neuropsychiatry, biochemistry, spectroscopy and physics and over 30 books, including textbooks in psychiatry and statistics.
He is acclaimed the world over as one of the leading researches into ME and travels extensively all around the world, lecturing on the subject. He holds the Patent on Vegepa which he himself formulated.
A Review and Summary of the book by Jacqui Footman
In the introductory chapter of this book, Professor Puri describes what he terms a breakthrough in the treatment of ME/CFS following his conclusion that a key component needed for treatment was a combination of ultra-pure EPA (completely free of any DHA) and virgin evening primrose oil. Such a product first became available in April 2004 and within 3 months he was seeing 80% of his ME/CFS patients who followed his recommendation to use this product making clinical improvements, some of which were striking.
He continues in chapters 2 and 3 by first giving an excellent background history and summary about ME/CFS, dismissing very effectively any remaining notion that it be a condition of psychological origin, and surmises that there is a great deal of evidence from a consideration of viral infections, changes in the immune system, blood fatty acid levels and brain biochemistry that persons experiencing the clinical features of M.E, as for example those involved in the Royal Free Hospital outbreak in 1955, are experiencing physical (organic) illness. He concludes that “the best explanation for the pattern of results seen in ME/CFS, with reduced NK cell activity, reduced Th 1 cell activity, increased Th 2 cell activity and increased Tc cell activity, is that there is a pre-existing long-term viral infection, to which the immune system is reacting.” page 30.
Throughout these two chapters, Professor Puri explains in straightforward terms the evidence he is using and why it is significant. He refers in some detail to studies which provide evidence of statistically significant lower values of both omega-3 and omega-6 fatty acids in red blood cells and that these would be representative of levels in brain cells. He also describes two Magnetic Resonance Spectroscopy (Neurospectroscopy) studies, which revealed statistically significant high ratios of choline/creatine and how several experts agree that this reflects a change in the turnover of fatty acids in cell membranes. All the blood, brain biochemistry and immune system findings described in Chapter 3 could be consistently brought together in one model, which provides a strong pointer to natural treatment with fatty acids.
In Chapter 4, Professor Puri explains some of the functions of omega-3 and omega-6 fatty acids in the body, and how the body normally would obtain these fatty acids.
- These fatty acids have extremely important roles in maintaining the correct structure of cell membranes throughout the body. Without sufficient AA and DHA, cell membranes become more rigid and the reduced flexibility is reflected in poorer or abnormal functioning of receptors that lie in the membranes, which in turn means that communication between cells, including brain cells, is impaired.
- AA, DGLA and EPA act as the starting point for the manufacture by the body of eicosanoids. Eicosanoids are special types of hormones, such as, to give but one example, prostaglandins. They are involved in many processes that are important in maintaining the health and well-being of the body and in fighting disease, including: blood-clotting, regulating blood pressure, the response to disease or trauma – including inflammation responses, pain and fever, the secretion of acid by the stomach.
- When sufficient EPA is available to the body it can be converted into natural sleep mediators.
- EPA has a particularly important role in helping the body to combat viral infections. Professor Puri describes the ways in which EPA is both directly and indirectly virucical.
The body normally obtains omega-3 and omega-6 fatty acids from food and subsequent synthesis within the body. The following diagram is crucial to understanding how.
|OMEGA-6 FATTY ACIDS||OMEGA-3 FATTY ACIDS|
At the top of each chain respectively, linoleic acid and alpha-linolenic acid have to be obtained from food; they cannot be manufactured in the body and therefore are known as Essential Fatty Acids, EFAs. As you go down each chain, GLA, DGLA and AA and EPA and DHA are manufactured in the body from the preceding fatty acid in the chain with the help of special enzymes. Delta-6-desaturase is the enzyme that catalyses the chemical reaction that produces both GLA and EPA. Without this enzyme the body is short of all the other fatty acids.
Professor Puri goes on to explain how an invading virus can block delta-6-desaturase from working properly, hence blocking adequate production of GLA and EPA. The virus does this for self preservation, because EPA has anti-viral properties. With reduced EPA and eicosanoids, defences are weakened and the virus is free to reproduce rapidly. “Viruses are able to fuse their cell membranes with those of the host (human) cells they are invading. Once complete fusion is achieved, the viral contents, including viral genetic information (in the form of DNA or RNA), can readily be passed into the host cell. The infected cell is not necessarily killed; it can be parasitized by the virus so that it remains alive but its functions are altered to suit the virus.” page 23.
Professor Puri lists the many other effects of this viral strategy of blocking the enzyme delta-6-desaturase. “Unable to make sufficient quantities of EPA, the human body is no longer able to manufacture sufficient quantities of the EPA-based natural sleep mediators. As a result, the body does not get enough deep refreshing sleep and ends up tired and even less able to resist the viruses. The lack of DGLA, AA and EPA also means that the body cannot produce enough eicosanoids, and so the general health and well-being of the body suffers. The body cannot mount proper immune response measures against the invader, and has to endure long bouts of painful sore throats, and enlarged and tender lymph glands. EPA and certain eicosanoids normally help to keep our joints working properly and ‘well-oiled’; their disappearance means that the body has to endure pains in many different joints.”
“If these consequences were not bad enough, there is even worse to come. Blocking that first enzyme (delta-6-desaturase) also means that cell membranes cannot get enough AA and DHA so that they become more rigid and lose their normal flexibility. The effects on the protein receptor molecules that lie in the cell membranes are profound; the size and shape of these receptors change so that they no longer accept and pass on signals in the right way. Communication between cells is impaired. It would be like an enemy hitting our satellite and radar communications during war. The results of this in the human brain are cognitive defects, such as problems with short-term memory and with concentration.”
“These results will sound familiar to any reader who is suffering from chronic fatigue syndrome. They constitute key symptoms and signs of this disease.” pages 54-55.
If you have followed thus far, you can now see that the logical treatment to compensate for the virus blocking delta-6-desaturase is to supply the body with adequate GLA and EPA. This is the basis of Professor Puri’s recommended treatment and the product that he recommends is Vegepa. He makes it clear that he has no financial connection with the manufacturer but recommends it on the basis of its purity and that it is the only product available providing this particular combination of fatty acids.
The GLA is provided in the form of virgin evening primrose oil. The importance of using virgin oil is explained in the book – vital components of the oil can be compromised in the manufacturing process so not all evening primrose or starflower oils are equal.
The EPA is derived from fish oil, purified to remove all contaminants and the DHA. Bad news for vegetarians who thought they could get their Omega-3 from flax seed oil – flax seed oil provides alpha-linolenic acid, which is no use to the body if delta-6-desaturase is blocked.
[Good news is that since the publication of this book, the manufacturer has brought out a Vegan Vegepa called ECHIOMEGA, which uses Echium seeds instead and can be ordered through the Vegepa Club].
Professor Puri explains that if GLA and EPA are supplemented as well as reducing dietary intake of linoleic acid (which competes with EPA for delta-6-desaturase) there should be sufficient delta-6-desaturase available to synthesise DHA from EPA (see diagram above). Once GLA is provided, there is no problem with the synthesis to DGLA and AA because different enzymes are used which are not blocked.
Professor Puri explains at length why it is important NOT to include DHA in the Omega-3 supplement (most other Omega-3 supplements contain DHA and this is recommended in some quarters). Many ordinary fish oil supplements containing EPA and DHA also contain heavy metal and other contaminants absorbed by fish at the top of the marine food chain from polluted water. People with M.E. can be extra sensitive to such contaminants.
Leading researchers in the field have come to the conclusion that the type of DHA that comes in supplements tends to inhibit many of the beneficial actions of EPA. Studies using different ratios of EPA and DHA are quoted and a recent study in Iceland found a positive correlation between levels of DHA and linoleic acid with DNA breaks in certain white blood cells linked to a risk of cell reprogramming and cancer. If, because you have read papers saying that you need DHA, you are worried about taking a DHA-free supplement, Professor Puri reassures you that the DHA you need for the structure of cell membranes will be synthesised from EPA in your body, provided your intake of linoleic acid is sufficiently low (see below). This is a better source of DHA than that found in most omega-3 supplements.
Dose: the recommended dose of VegEPA capsules for the treatment of ME/CFS is 8 capsules daily, 4 in the morning and 4 in the evening. The dose can be increased during times of stress or infections or a couple of weeks before an important event. In Professor Puri’s first trial of 20 patients with intractable ME/CFS, the first 4 patients took 4 capsules daily. Only one of these improved. The next 16 patients took 8 capsules. All 16 improved. For children aged 8-14 the adult dose should be halved.
Cofactors: there are many enzyme-mediated conversions take place in the body in the processing of fatty acids. In order for these to take place, small amounts of certain vitamins and minerals are essential. The most important cofactors are Folic acid, vitamin B12, vitamin B6, Niacin, Biotin, Vitamin C, Zinc, Selenium and Magnesium. Professor Puri recommends you get these from a diet rich in sources of these vitamins and minerals, as detailed in the book, but says that taking them in supplement form if there are problems with the dietary approach is better than missing out on them altogether.
The intake of linoleic acid in the Western diet has increased exponentially over the past half century. Since this fatty acid competes with EPA for delta-6-desaturase it is important to reduce intake. Virtually all oils contain high amounts (details given on page 118) with two of the worst being sunflower and safflower oils, which we commonly use for cooking. Change to pure virgin olive oil, which has the lowest linoleic acid content, only 9%. Avoid fried food if possible, and if you must fry use olive oil. Another fat it is very important to avoid is trans fat, found in margarine and anything that has ‘hydrogenated vegetable oil’ on the label, such as most pastries, biscuits, cakes, pies, sachets of drinking chocolate. Trans fats not only inhibit the action of delta-6-desaturase, but also are incorporated by body cells into their membranes, making them inflexible and causing problems with signals passing between cells, including brain cells. It is better to use butter than margarine, particularly a brand such as Anchor, produced from grass-fed cows, which means the butter is more likely to contain some EPA.
Long-running stress levels, anxiety or fear can raise the levels of stress hormones such as cortisol, which in turn inhibit the proper functioning of the enzyme delta-6-desaturase. It is important to reduce stress levels, even making major lifestyle changes if necessary. Excess consumption of caffeine and alcohol, as well as any smoking equally can have inhibitory effects on the enzyme. Other forms of stress that can cause increases in cortisol are listed: pain, infection, low blood sugar levels, starvation, haemorrhage (bleeding). Wherever possible, these are to be avoided. Suggested therapies to help reduce stress include CBT, exercise (if you are up to it – Professor Puri suggests walking, slow cycling or swimming), Massage therapy, Aromatherapy, gentle Yoga, Reflexology, Daoyin Tao and The Alexander Technique.
Within the context of the whole treatment protocol, Professor Puri also warns against and explains the deleterious effects of refined sugar consumption and suggests alternatives. One of the ways sugar can cause harm is the way in which it effects energy levels. “After the immediate rush that occurs following a meal or drink that contains added sugar, your energy levels may actually feel as if they have diminished, as your body tries hard to mop up all the extra sugar by pouring out insulin into your blood stream. In order to cope with the feeling of tiredness that this process engenders, you may have another sugar-containing ‘food’ or drink. And so the cycle repeats itself day after day through endless cups of sweet tea and coffee and large numbers of chocolate bars, sweets and biscuits (laden with harmful trans fats)” page 121. Professor Puri strongly recommends three square meals daily and if snacks are necessary, provides suggestions for alternatives that are free from refined sugar and trans fats.
Other benefits: Professor Puri has written similar books about the treatment of both ADHD and depression using fatty acid supplements. Aside from these two other conditions, some further benefits are mentioned. It is explained how taking this combination of evening primrose oil and EPA improves sleep, energy levels, concentration and thinking, the cardiovascular system (there is special mention of help with atrial fibrillation), body weight, skin, hair and nails. The only side effect that might be considered adverse is a possible slight loosening of the bowel contents. Actually though, this is also a beneficial effect since toxins can be cleared more quickly and have less time to be absorbed. Omega-3 fatty acids also have a thinning effect on the blood, again beneficial in that it reduces risk of DVT, heart attack and stroke, but if you are already taking a blood-thinning drug such as warfarin or heparin, you must consult your doctor before starting omega-3 supplementation so the doctor can make any necessary adjustments to your drug prescription.
Full names for the fatty acids mentioned in abbreviated form throughout
AA arachidonic acid, vitally important as a building block for eicosanoids
DGLA dihomo-gamma-linolenic acid, vitally important as a building block for eicosanoids
GLA gamma-linoleic acid
EPA eicosapentaenoic acid, vitally important as a building block for eicosanoids, sleep mediators, interferons
DHA docosahexaenoic acid, important in maintaining the correct structure of cell membranes
I hope you have found this synopsis helpful. I found the book fascinating. Professor Puri clearly has great insight and understanding for this illness and the people who live with it. He does an outstanding job of explaining complex scientific matters in a way that everyone can follow, which greatly added to my enjoyment of the book and allowed me to feel confident writing this summary. I cannot make a strong enough recommendation that you read this book to discover all the detail that is missing here. J.F.
Puri BK. (1 Jul 2006). Neuropsychiatric disorders presenting with antisocial behaviour. INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. 60:760-761.
Puri BK. (1 Oct 2006). The rising tide of aggression and delinquency in adolescent girls. INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. 60:1155-1156.
Puri BK. (1 Dec 2006). Munchausen syndrome by proxy in pregnancy. INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. 60:1527-1529.
Puri BK. (1 Feb 2007). Drug-facilitated sexual assaults. INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. 61:184-185.
Puri BK. (1 Mar 2007). Blood-injection-injury phobias. INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. 61:358-359.
Puri BK. (1 Nov 2010). The clinical application of blood oxygen level-dependent echo planar imaging functional magnetic resonance imaging in the preoperative planning of neurosurgical procedures involving language-related brain regions. NEUROLOGY INDIA. 58:61-62.
Puri BK. (Feb 2007). Long-chain polyunsaturated fatty acids and the pathophysiology of myalgic encephalomyelitis (chronic fatigue syndrome). J Clin Pathol. 60:122-124.
Puri BK; Jakeman PM; Agour M; Gunatilake KD; Fernando KA; Gurusinghe AI; Treasaden IH; Waldman AD; et al. (Jul 2012). Regional grey and white matter volumetric changes in myalgic encephalomyelitis (chronic fatigue syndrome): a voxel-based morphometry 3 T MRI study. Br J Radiol. 85:e270-e273.
Puri BK. (Feb 2012). Indexation of cerebral cell membrane phospholipid catabolism by the non-invasively determined cerebral 31-phosphorus neurospectroscopic phosphodiester peak. Med Hypotheses. 78:312-314.
Puri BK. (Sep 2011). The role of proton neurospectroscopy in the assessment of brain function, estimation of coma duration, and prediction of outcome in severe traumatic brain injury. Neurol India. 59:657-658.
Puri BK. (1 Jul 2011). Brain tissue changes and antipsychotic medication. EXPERT REVIEW OF NEUROTHERAPEUTICS. 11:943-946.