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Home , Docosahexaenoic acid, Eicosapentaenoic acid, Palmitoleic acid

WINTER 2010

dialogAn informative newsletter for the specialized clients of Doctor’s Data, Inc.

Scientific Support The Science behind DDI’s new Fatty Acids Analysis by Chuck Masur, MD, Scientific Support Department

atty acids (FA) are long chain fatty acids” (VLCFA; make other longer chain fatty monocarboxylic acids longer than 22 atoms). acids. Diets high in palmitic that have the general This categorization generally acid may be associated with F formula CnH2n+1COOH. holds true except in the case of increased risk of developing They may be either saturated essential fatty acids (EFA) where (this is David Quig, PhD (no carbon-to-carbon double short-chain EFAs are 18 somewhat controversial as palm Vice President bonds; e.g. palmitic and stearic long and long-chain EFAs are oil also has a number of healthy acids) or unsaturated (one or 20 or more carbons in length. attributes). (18:0) more carbon-to-carbon double FAs with more than one C=C is another common saturated bonds; e.g. eicosapentaenoic double bond are referred to as that is found in many acid and docosahexaenoic polyunsaturated fatty acids vegetable and animal and acid). FAs either are absorbed (PUFA). oils. It can be produced by during digestion or made in processing in water the body from other fats that Fatty acid nomenclature under high temperature and are absorbed. They are a major varies but most readers will be pressure (e.g. pressure cooking source of substrate for the familiar with the omega-x (ω-x) produces stearic acid by the production of energy; during system which is correctly read hydrolysis of triglycerides); prolonged exercise they are the as “omega (ω) minus x”—the and it can be produced by Chuck Masur, MD main nutrient mobilized from fat first carbon-to-carbon double the hydrogenation of some stores. Erythrocyte fatty acid bond is at the xth position, unsaturated vegetable oils. analysis is superior to plasma counting from the terminal Stearic acid can be oxidatively

fatty acid testing as erythrocyte methyl. [CH3(CH2)4 desaturated back to oleic

FA levels better reflect long-term CH=CHCH2CH=CH(CH2)7COO acid, more readily so than the fatty acid intake because of less H] for example, is an omega-6 desaturation of sensitivity to recent intake and (ω-6) FA and, using the same back to ), and a slower turnover rate (Qi Sun et convention, alpha-linolenic acid thus may be “less unhealthy”

al (2007), American Journal of [CH3CH2CH=CHCH2CH=CHC than other saturated fatty acids.

Clinical Nutrition 86(1):74-81). H2CH=CH(CH2)7COOH] is an FAs may be as short as 4 omega-3 (ω-3) FA. Unsaturated fatty acids have carbons in length (e.g. butyric at least one carbon-to-carbon Barb Berta, MS, RD acid) but most fatty acids, at Saturated fatty acids have double bonds—their carbon least those from natural sources no carbon-to-carbon double atoms are bound in either a (fats and oils), generally are at bonds. For example, palmitic — continued on next page Doctor’s Data, Inc. least 8 carbons in length (e.g. acid (16 carbons long and with 3755 Illinois Avenue octanoic, or caprylic, acid) but no carbon-to-carbon double INSIDE St. Charles, IL 60174-2420 may comprise chains of 4 to as bonds; i.e. 16:0) is one of the 800.323.2784 (US & Canada) Meet Karen Urek, many as 28 carbon atoms. FAs most common saturated fatty Vice President of Operations 3 630.377.8139 (Elsewhere) may be “short” (SCFA; less than acids found in animals and 44.(0)8712.180.052 (UK) 6 carbons), “medium” (MCFA; plants. It is the first fatty acid Comprehensive Vaginosis Profile 3 630.587.7860 (fax) 6 to 12 carbons), “long” (LCFA; produced during fatty acid [email protected] 12 to 22 carbons) or “very synthesis and can be used to Frequently Asked Questions 4 www.doctorsdata.com WINTER 2010 DOCTOR’S DATA INC.

The Science behind DDI’s new Fatty Acids Analysis — continued from page 1 cis- ( atoms are on the same side of a carbon-to-carbon SOME SAMPLE FATTY ACID RATIOS Worst ω-6 to ω-3 Ratio Poor Ratio Better Ratio Best Ratio bond) or trans- (hydrogen atoms on opposite sides of the double Sunflower – No ω-3 Cottonseed – almost no ω-3 Canola (rapeseed) oil 2:1 Flax seed oil 1:3 bond) configuration. Cis- fatty Peanut – No ω-3 Grapeseed – almost no ω-3 Olive 3:1 to 13:1 acids (i.e. those FAs with one Corn 46:1 Soybean 7:1 or more cis configurations) can be quite curved and are less flexible and are less able an ω-6 (or visa versa) is possible bodies for fuel. Ketone bodies (DHA) and, being non-animal to be closely packed (as in nor is it possible to convert can be produced in the liver by in origin, the DHA produced in membrane structures). Trans- saturated fats into ω-3 or ω-6 of FAs. this fashion is acceptable to fatty acids, on the contrary, unsaturated FAs. those on strict vegetarian diets. are relatively straight. Most EFAs are used in the Digestion and uptake of fatty In a similar vein, the oil from trans- FAs (trans- fats) are not productions of hormone-like acids is complex. SCFAs and brown alga (kelp) is high in ω-3 found in and are produced substances that regulate a wide MCFAs are absorbed directly (EPA). through human intervention by range of functions including via the intestinal capillaries The ω -6 to ω-3 ratio (see hydrogenation (processing) of blood pressure, coagulation, and travel through the portal chart above) in dietary intake will unsaturated fatty acids. Trans- levels, immune response circulation; LCFAs are too large ultimately influence the ratio of fats are found in margarines, and inflammatory responses to be absorbed directly and the ensuing such as fried foods, commercially to injury and infection. but are absorbed through the , prepared foods, baked goods Unfortunately, a typical Western lipid membranes of the cells of and . Clearly then, and partially hydrogenated diet may be high in ω-6 FAs the microvilli, reassembled into ω-3 and ω-6 fatty acids should vegetable oils. Diets high in but low in ω-3 FAs (e.g. EPA, triglycerides and then coated be consumed in the appropriate trans- fats may be associated DHA) and may be associated with cholesterol and protein— proportions. Healthy ratios of with increased rick of coronary with depression and behavioral the complexes formed are called ω-6 to ω-3 range from 1:1 to 1:4 heart disease. Examples of changes including violence. chylomicrons. Chylomicrons while the ratios in the standard/ unsaturated FAs include alpha- FAs play an important role in enter the lymphatic capillaries typical western diet (SAD) may linolenic acid (18:3 ω-3), heart health as they provide and travel via the thoracic duct range from 10:1 to 30:1 (i.e. eicosapentaenoic acid (20:5 the substrates for mechanical into the left subclavian vein and dramatically skewed toward ω-3), and electrical activity in cardiac are distributed directly from the ω-6 predominance. (22:6 ω-3 ), tissue. heart throughout the circulatory (20:4 ω-6), linoleic acid (18:2), tree without a first pass The new Fatty Acids; and (20:4 ω-6) —all Free fatty acids (FFA) are FAs through the liver. Chylomicrons, Erythrocyte panel from DDI are cis- unsaturated FAs. that are not bound, or attached eventually, are processed by provides individual assessments in some fashion, to other the liver into very low density of important saturated and Essential fatty acids (EFA) are molecules such as triglycerides lipoproteins (VLDL) and low unsaturated FAs and gives FAs that cannot be synthesized or . They are not density and lipoproteins (LDL). helpful commentary on these within an organism and must be water soluble therefore can findings. In addition, the panel obtained from dietary sources. only be transported within the The standard American diet presents important FA ratios, There are two families of EFAs: circulatory system bound to (SAD) is high in carbohydrates provides information about their omega-3 and omega-6, all of albumin in plasma. FAs can be and, as grains are high in ω-6 clinical importance and assists which are polyunsaturated FAs stored in fat cells (adipocytes) and low in ω-3 FAs, the ratio of the clinician in making evidence- (PUFA). Humans can produce and, upon being released ω-6 to ω-3 FAs usually is higher based decisions and more all but two FAs (linoleic acid from adipocyte storage, can than optimal. , fish oils, effective treatment plans for (18:2 ω-6) and alpha-linolenic become FFAs. FFAs are utilized wild game (i.e. not grain-fed), their patients.  acid (18:3 ω-3); both are widely as substrate for energy (ATP) free-range beef and their dairy found in plant oils and are the production. Heart and skeletal products as well as range-fed parent compounds of the ω-3 muscle energy production sheep and poultry all contain and ω-6 FA series. It is possible pathways prefer FFAs over more prominent levels of ω-3 to convert one ω-3 FA to another glucose for ATP production; FAs. The C cohnii ω-3 or one ω-6 to another ω-6 can’t use FFAs so it and Schizochytrium sp. are rich but no conversion from an ω-3 to depends on glucose or ketone in ω-3 Docosahexaenoic acid

2 An informative newsletter for the specialized clients of Doctor’s Data, Inc. dialog O

Behind the Scenes at DDI— Meet Karen Urek, MT (ASCP), Vice PresidentOH of Operations NH2

aren Urek joined During her 18 years at Karen comments “I have had Doctor’s Data in 1992 to DDI, Karen has been directly the opportunity to work with HO integrate her laboratory involved with the day-to-day George Hickok, the founder Kclinical background with testing and the research & of DDI and many of the initial the scientific expertise involved development of new testing. visionaries that challenged the in laboratory testing. Karen New advances in technology has direction of main stream medical received her B.S. in Medical greatly expanded and improved practices. It has been inspiring Technology from the University laboratory testing and Karen has to work in this arena where the of Illinois and is licensed by the been instrumental in promoting emphasis is on prevention and American Society of Clinical and in developing new tests. health promotion. It has been Pathologists (ASCP). She worked 15 new chemistry tests and an disturbing to see the changes 11 years as a technologist in array of stool microbiology and occurring in healthcare in this hospital environments and 12 parasitology testing have been country, especially in regard to years in management roles at a introduced during this time. laboratory testing. Cost cutbacks large Blood Bank in the Chicago She has been associated with 6 and excessive regulatory area. Karen was instrumental in publications and has given over oversight have stifled the assuring that DDI met regulatory 8 presentations on DDI testing. utilization and development of a requirements in order to be It is Karen’s goal to maintain the potential wealth of information licensed by CLIA, OSHA, New highest quality of testing and to that can be used to facilitate York, California, Florida, and maximize the influence of the lab medical decisions and provide other states throughout the US. results on the management of better patient care.”  patient’s health.

BV and vulvovaginal candidiasis What’s New at DDI— are not clear, a likely factor is by Barb Berta, MS RD and David Quig, PhD change in the normal vaginal microbiota (Lactobacilli) resulting Comprehensive Vaginosis outcome. A BV score is provided in proliferation of harmful Profile(optional at home based upon a well established bacteria or yeast. The balance specimen collection) algorithm and, susceptibility of microflora may be disrupted testing is performed on all by any combination of poor diet, Doctor’s Data now offers a cultures of yeast and pathogenic poor hygiene, and overuse of COMPREHENSIVE VAGINOSIS bacteria providing botanical antibiotics or corticosteroids, PROFILE which includes and pharmaceutical treatment abnormal menstrual flow, use of specimen collection materials options. oral contraceptives, pregnancy, that enable patients to obtain Symptoms of vaginitis may be sexual contact, douching, samples at home. Diagnosis of responsible for 10% of all visits and use of perfumed hygiene vaginal infections by symptoms by women to their healthcare products or an intrauterine alone, or self-diagnosis with use practitioners. Typical symptoms contraceptive device. Potential of over-the-counter products, are include vaginal discomfort, complications associated common practices but can result itching, burning, discolored with BV include upper genital in misdiagnosis and treatment malodorous discharge and urinary tract infections, preterm failure. The profile is utilized for sometimes pain. The major delivery, postoperative pelvic the detection and identification causes of infectious vaginitis are infections and increased of normal and pathogenic BV and vaginal yeast infections. susceptibility to sexually bacteria, yeast, Trichomonas Bacterial vaginosis is common transmitted diseases (including vaginalis (pathogenic parasite) and underestimated since Trichomoniasis). and other important cells data from the 2001-2002 and The option of at home (Gram stain, microscopic) that 2003-2004 NHANES indicate specimen collection with the DDI permit differentiation between that about 30% of women of Comprehensive Vaginosis Profile bacterial vaginosis (BV) and child bearing age were positive will facilitate accurate diagnosis vaginitis and aid in developing for BV and 50% of women of the causes of the symptoms the most efficacious treatment with BV were asymptomatic. of vaginitis and permit protocols for positive patient Although the exact causes of appropriate targeted therapy.  3 WINTER 2010 DOCTOR’S DATA INC. dialog An informative newsletter for the specialized clients of Doctor’s Data, Inc.

Frequently Asked Questions

Q&A > The Urine test is > I’m a new client and I > IMPORTANT NOTE an excellent way to assess have some general questions for Iodine sufficiency but about some of your tests, The importance of how do I make sure I collect some test protocol questions, rotating your kit stock the sample properly? and also some questions . . . JB, Irvine CA about the results of a test Beginning in May 2009, we that I ordered recently. What began placing expiration dates Barb Berta MS, RD responds: is the process and who do on each of our test kits to help There are five pointers that I speak with to get these your staff quickly identify if the are most important to insure questions addressed? kit you are providing to your proper sampling for the urine . . . ML, Edmonton, Canada patient is still valid for testing. Iodine test: It is important to check these 1. Avoidance of all Iodine Chuck Masur MD responds: dates before handing out a kit supplements 24 hours prior For your general questions you as some of the preservatives to and during the test might first refer to our web used inside the kits may no site at www.doctorsdata. longer be viable once the 2. Collecting the urine for a com. Clicking on the Tests/ date passes, particularly for full 24 hours without producing Assessments Info tab will our gastrointestinal profiles. more urine that the 3000 ml jug present you with our menu of Samples that arrive at our 3. Correctly reading the Nutritional, Gastrointestinal laboratory after the expiration 24 hour volume and Environmental analyses. date has lapsed may not be valid Clicking on a particular menus for testing and could result in the 4. Accurately recording the item will give you a detailed need for your patient to recollect full 24 hour urine volume on explanation of that test and another specimen. Please the requisition form offer you a clickable link to a pdf feel free to contact Customer 5. Mixing the container well picture of a sample report. If Service at any time if you believe before pouring the sample you need further assistance, our that your kits may soon be out of into the collection vial.  Customer Service department is date. We will be more than happy available at (800) 323-2784 from to either provide you with new 8:00AM until 6:00PM central kits, or send you replacement time Monday through Friday. materials for just those items These are the first people that approaching expiration.  you should speak with as they can provide answers to most commonly asked questions. We appreciate your continued If you would like to discuss interest and urge you to the results of a particular test contact us should you have any in detail, or have questions questions. Our Customer Service about testing protocols, Department is available between methodology or technology you 8:00 and 6:00 CST Monday can ask to be put through to the through Friday. CONTACT US Scientific Support Department. Alternatively, you can request to Phone: speak directly with David Quig, 800-323-2784 PhD (VP Scientific Support), or 630-377-8139 Chuck Masur, MD or Barb Berta, MS RD. If it would be Fax: more convenient, you can book 630-587-7860 telephone appointments with any of the Scientific Support Email: personnel for detailed and/or [email protected] lengthy consultations. 

3755 Illinois Avenue, St. Charles, IL 60174-2420 4 800.323.2784 (US & Canada) • 630.377.8139 (Elsewhere) • 44.(0)8712.180.052 (UK) 630.587.7860 (fax) • [email protected] • www.doctorsdata.com