Medical dogma can be dangerous. Here’s a true story.
A woman who I know well developed brain swelling, cognitive changes, and seizure activity from following her doctor’s orders. She had mildly elevated blood pressure and had been told to take ALL sodium out of her diet, which she did completely. This precipitated a state of hyponatremia—severely low serum sodium– precipitating the symptoms above.
Another patient was instructed to ‘eat no fruits’ because of mild gastritis. She abided by this for years until she developed severe anemia and bone marrow suppression from her vitamin C deficiency. These are both true stories.
But this post is not about hyponatremia or scurvy; it’s about dogma. I am concerned that there have been some dogmatic threads promulgated online that may be doing people a disservice. Human health and biology are far more complex than a reduction to a binary “do” or “don’t do” this.
Two Common Medical Dogmas
The first dogma is that “PUFAs (polyunsaturated fats) are bad”. The second is that “estrogen is bad”. Each of these statements is not quite that cut and dried.
“All PUFAs are bad.” Our body requires these fats to function correctly in the same way that our body requires sodium to maintain electrochemical gradients or vitamin C to support bone marrow health (see above). I submitted a short post recently outlining some scientific facts regarding omega-3 and Omega-6 fats. Comments were suspended by admin., but in the short time it was up I was surprised to see how many of the comments blankety said, “not for me”.
Excessive sodium is unquestionably bad if you have hypertension. Low sodium (and disrupted osmotic gradients) are uniformly dangerous for everybody. As with so many things in biology, there’s a happy medium.
Why We Need Specific Polyunsaturated Fats (PUFAs)
Fully eliminating PUFAs carries similar dangers to our health. We need these fats, and we need both the Omega-3 and -6 forms for our body to run well. We get into trouble when the omega-6’s disproportionally exceed the omega-3 fats, specifically the DHA and EPA forms.
Both sets of fats are moved through a set of enzymatic steps that use enzymes known as the delta 5 and delta 6 desaturase pathways. If we have too many omega-6s relative to the omega 3’s, these fats commandeer the shared pathway. The literature abounds with studies showing that we are uniformly deficient in omega-3s and excessive in omega-6s. The ratios are what matters.
The science supporting the overall benefits of the omega-3 fats EPA and DHA is extensive. Studies repeatedly relate these PUFAs to lower rates of cardiovascular disease (EPA), dementia and Alzheimer’s (DHA) and autoimmunity (EPA and DHA). There is so much information out there in the literature!
EPA and DHA are PUFAs. But not all PUFAs are EPA and DHA. So, if you read that PUFA’s are bad, your next question should be which PUFAs? Omega 6 fats and arachidonic acid are PUFAs that unquestionably carry greater risk than the omega 3’s.
If the answer is “the omega 3’s” your next question should be “Which omega 3’s?”. If you are taking a fish oil supplement, a careful read of the label may reveal a smaller percentage of DHA/EPA and a higher quantity of “other” omega-3 fats. All omega-3 fats can be oxidized (bad), but the “others” don’t carry the same biological benefits of DHA/EPA.
Is Estrogen Bad?
“All estrogen is bad”. This is another inaccurate dogma. The hormone is pleiotropic (look it up!). This means that the hormone exerts different effects at different concentrations at different times throughout woman’s life. For a large part of one’s life, this hormone is critical and is ideally balanced by a physiological amount of progesterone.
But if one is obese, anovulatory, has poor detoxification pathways and bowel function, and a family history of endometrial or breast cancer, there is no question that excessive estrogen increases risk.
Hormone replacement therapy is far too nuanced to cover in a post such as this. Historically, 10% of women died during childbirth, and 90% of women didn’t live past the age of 50. Vaccines, antibiotics, refrigeration, and hygiene have effectively doubled our lifespan. I believe that correctly applied HRT can benefit a select group of women under select circumstances. But it’s not “one size fits all”.
I have seen correctly how correctly applied HRT can be transformative to a woman’s health and well-being. I have seen how poorly prescribed HRT can cause irreversible harm.
As an OBGYN who studies extensively, has practiced functional medicine exclusively for 15 years, and has used only bioidentical hormones with my patients for a quarter of a century, I strive to avoid dogmatic silos. Human biology is far too complex to simplify things into a “take and/or do this” versus “don’t” choice.
I encourage everyone reading this to apply similar discretion and specificity to the understanding of the science. I was “dinged” online recently for writing objectively about the importance of omega-3 fats in our biology, and referred to the haidut.me blogs to be appropriately “schooled”. This is an anonymous “expert” on everything medical who publishes posts that are IMO “true/true and unrelated.”
But guess what? Every paper in this collection broadly referenced the PUFAs in the substack headings. On close examination, each of these papers specifically pointed out the dangers of the linoleic, Omega-6, and arachidonic acid PUFAs. They didn’t discuss the beneficial, essential ones. This was the identical point that I was making in my post!
In conclusion, I believe that dogma can be dangerous. I recommend learning from trusted sources and working with a guide who can help you to distinguish the nuances of biology, physiology, and health.
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