Letter to the editor
What happened to do no harm? The issue of dietary omega-6fatty acids
In 1999, scientists from around the globe gathered to addressdietary recommendations for omega-3 and omega-6 fatty acids. Their recommendation emphasized the importance of redu-cing omega-6 fatty acids in order to reduce adverse health effectsof excesses of arachidonic acid (AA) and its eicosanoid products.Therefore, they set an upper limit for linoleic acid (LA), to no morethan 6.67g/day, based on a 2000kcal diet of 3.0% of energy. Yet,based on the current series of papers published on LA[2–4], onemight be led to believe there has been a substantial body of evidence to refute the recommendation, which is not the case. Theresearch cited is taken outof context and/or is based on verysmallstudies, many of which were published over a decade ago, asdescribed below.
Comments on three papers published in PLEFA September 2008(vol. 79, issue 3)
The health implications of changing linoleic acid intakes by JayWhelan (pp. 165–167).Linoleic acid and coronary heart disease by William S. Harris(pp. 169–171).Too much linoleic acid promotes inﬂammation
doesn’t it? byKevin L. Fritsche (173–175).
: Evelyn Tribole
1100 Quail Street, Suite 111,Newport Beach, CA 92660, USA.Fritschedescribes the CHIANTI study by Ferrucci et al.,
as an example of no adverse impact on inﬂammation from eatingtoo much LA. Subjects with the highest quartile of plasmaarachidonic acid levels had lower pro-inﬂammatory markers andhigher anti-inﬂammatory markers. But an important detail fromthis study is ignored
the subjects from this Mediterraneanregion eat a low LA diet, averaging 7g/day. In this context, it isnot surprising that plasma AA was associated with beneﬁcialinﬂammation biomarkers
because it does so in the presenceof eating a balanced proportion of omega-6 and omega-3 fattyacids. The results of this study support the beneﬁts of eating alower LA diet!Harrisconcludes that, ‘‘Reducing LA intakes to less than 5%energy would be more likely to increase, not decrease, risk forCHD’’. Yet, that is not what the research shows. The Lyon DietHeart Studyput their subjects on a low omega-6 fat diet, witha maximum 7g (
4.6% calories), which resulted in a strikingreduction in all-cause mortality, including sudden cardiac deathand cancer. Notably, studies have demonstrated harm from eatinghigh LA diets on cardiovascular health[7–9].Whelanstates that a number of studies fail to linkenrichment of AA in tissues with deleterious outcomes. Yet fourout of ﬁve of these studies[10–13]were performed on only10 healthy men! He also says that there is no adverse effect fromeating dietary LA intake on breast cancer. Large studies from theUSA, France and Sweden indicate otherwise[14–16]. For example,in a case-control study on nearly 1700 women, researchersdemonstrated that women with a genotype inﬂuencing the LOXenzyme, had a two-fold increase in breast cancer risk if they atehigh levels of LA (
17.4g/day). Yet, this genotype had noinﬂuence on breast cancer risk, if these women ate a lower LA diet.
: At best, these papers[2–4]serve as editorialsreﬂecting opinions of individual scientists. And at worst, thesepapers are disservice to the scientiﬁc process and public health, asthey have been published without counterpoint or a serious reviewof the literature. The issue of an optimal level of dietary omega-6fats is far from settled. But a plethora of papers published in thelast decademerit a serious discussion on the public healthissue of dietary omega-6 fats; the most commonly consumedpolyunsaturated fat in industrialized countries.
 A.P. Simopoulos, A. Leaf, N. Salem, Workshop statement on the essentiality of and recommended dietary intake for omega-6 and omega-3 fatty acids,Prostaglandins Leukot. Essent. Fatty Acids 63 (2000) 119–121. K.L. Fritsche, Too much linoleic acid promotes inﬂammation
doesn’t it?,Prostaglandins Leukot. Essent. Fatty Acids 79 (2008) 173–175. W.S. Harris, Linoleic acid and coronary heart disease, Prostaglandins Leukot.Essent. Fatty Acids 79 (2008) 169–171. J. Whelan, The health implications of changing linoleic acid intakes,Prostaglandins Leukot. Essent. Fatty Acids 79 (2008) 165–167. L. Ferrucci, A. Cherubini, S. Bandinelli, B. Bartali, A. Corsi, F. Lauretani, et al.,Relationship of plasma polyunsaturated fatty acids to circulating inﬂamma-tory markers, J. Clin. Endocrinol. Metab. 91 (2006) 439–446. M. de Lorgeril, P. Salen, J.-L. Martin, I. Monjaud, J. Delaye, N. Mamelle,Mediterranean diet, traditional risk factors, and the rate of cardiovascularcomplications after myocardial infarction: ﬁnal report of The Lyon Diet HeartStudy, Circulation 99 (1999) 779–785. J.H. Dwyer, H. Allayee, K.M. Dwyer, et al., Arachidonate 5-lipoxygenasepromoter genotype, dietary arachidonic acid, and atherosclerosis, N. Engl. J. Med. 350 (2004) 29–37. C.Q. Lai, D. Corella, S. Demissie, et al., Dietary intake of n-6 fatty acidsmodulates effect of apolipoprotein A5 gene on plasma fasting triglycerides,remnant lipoprotein concentrations, and lipoprotein particle size: TheFramingham Heart Study, Circulation 113 (2006) 2062–2070. H. Allayee, A. Baylin, J. Hartiala, et al., Nutrigenetic association of the5-lipoxygenase gene with myocardial infarction, Am. J. Clin. Nutr. 88 (2008)934–940. D.S. Kelley, P.C. Taylor, G.J. Nelson, B.E. Mackey, Arachidonic acid supplemen-tation enhances synthesis of eicosanoids without suppressing immunefunctions in young healthy men, Lipids 33 (1998) 125–130. D.S. Kelley, P.C. Taylor, G.J. Nelson, P.C. Schmidt, B.E. Mackey, D. Kyle, Effects of dietary arachidonic acid on human immune response, Lipids 32 (1997)449–456. G.J. Nelson, P.C. Schmidt, G. Bartolini, D.S. Kelley, S.D. Phinney, D. Kyle, et al.,The effect of dietary arachidonic acid on plasma lipoprotein distributions,apoproteins, blood lipid levels, and tissue fatty acid composition in humans,Lipids 32 (1997) 427–433. G.J. Nelson, P.C. Schmidt, G. Bartolini, D.S. Kelley, D. Kyle, The effect of dietaryarachidonic acid on platelet function, platelet fatty acid composition, andblood coagulation in humans, Lipids 32 (1997) 421–425.
ARTICLE IN PRESS
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Prostaglandins, Leukotrienes andEssential Fatty Acids
0952-3278/$-see front matter
2008 Elsevier Ltd. All rights reserved.doi:10.1016/j.plefa.2008.12.004Prostaglandins, Leukotrienes and Essential Fatty Acids