Linoleic Acid (LA) Deficiency

What Is Linoleic Acid?

[dropcap]L[/dropcap]inoleic acid is an essential omega-6 fatty acid that comes from plant sources. Essential means the body must have it to maintain health and life sustaining functions. Omega-6 fatty acids are polyunsaturated.

Among its many vital roles in the body, linoleic acid composition of intestinal membranes is important for epithelial cell function and disturbances may contribute to the pathophysiology of celiac disease.¹

Q: What are epithelial cells?

A: Epithelial cells make up the surface mucosa of the digestive tract and also the respiratory tract, urinary tract and genital tract.

Linoleic acid is an important building material for the eicosanoids, a large group of highly bioactive hormone-like substances including prostaglandins, leukotrienes, and thromboxanes that are involved in blood clotting, inflammation, and vasoconstriction.²

What Is Linoleic Acid Deficiency in Celiac Disease?

• Linoleic acid deficiency is a symptom of celiac disease that results when the level within cells is too low to meet metabolic needs of the body for this fatty acid.
• Deficiency is characterized by impaired growth in infants and children, skin integrity, clot formation, blood vessel constriction, reproduction, and inflammatory response.
• Research shows that significant differences were observed in mucosa of patients with active celiac disease compared with controls. Linoleic acid level was decreased, whereas those of its derivatives were elevated (eg. arachidonic acid), indicating increased transformation of omega-6 fatty acid. Mead acid level was increased, with an increased ratio of mead acid to arachidonic acid levels, suggesting essential fatty acid deficiency.
• Altered fatty acid content may contribute to the pathophysiology of celiac disease because fatty acids are important for enzymes and for the transport and receptor functions of epithelial membranes which line the small intestine.³
• The fatty acid abnormality of intestinal mucosa in patients with active celiac disease was not reflected in blood values, that is blood tests  do not show deficiency at the cell level.

How Prevalent Is Linoleic Acid Deficiency in Celiac Disease?

Linoleic acid deficiency was found to be common in study subjects with untreated celiac disease.⁴

What Are The Symptoms Of Linoleic Acid Deficiency?

Linoleic acid deficiency is marked by these symptoms:

• Apathy.
• Poor inflammatory response to injury.
• Prolonged bleeding time (slow clotting).
• Low blood pressure.
• Mild skin scaling.
• Hair loss.
• Fatty liver.
• Excessive thirst.
• Infertility.
• In children, growth retardation and short stature develops.

How Does The Body Get Linoleic Acid?

• Linoleic acid is an essential fatty acid that must obtained in the diet.
• It can be used in the body as a parent to synthesize arachidonic acid, another omega-6 fatty acid, provided there is an adequate supply.⁵

What Does Linoleic Acid Do In The Body?

1. Precursor for substances needed for the inflammatory response to injury or invasion.⁶
2. Precursor in the formation of potent vasoconstrictors to control blood pressure.
3. Precursor in the formation of platelet aggregators to control bleeding in injury.
4. Opposing action to omega-3 fatty acids in acting as second messenger in chemical neurotransmitter systems, as well as, contributing to numerous other aspects of cell signaling.
5. Important for enzymes and for the transport and receptor functions of epithelial membranes of intestinal mucosa.⁷
6. Needed for skin, nail and hair health.
7. Needed for hormone balance.

How Does Linoleic Acid Deficiency Develop in Celiac Disease?

Linoleic acid deficiency in celiac disease results from these mechanism:

• Malabsorption.
• Lack of necessary vitamin and mineral co-factors, including zinc, magnesium, manganese, and vitamins B3, vitamin B6 and vitamin C.

Does Linoleic Acid Deficiency Respond To Gluten-Free Diet?

Yes. Celiac disease-related linoleic acid deficiency responds to nutritious gluten free diet containing adequate linoleic acid. However, linoleic acid supplementation is suggested.⁶

6 Steps To Correct Linoleic Acid Deficiency:

• [dropcap]1[/dropcap]Meet, or Exceed the AI (Adequate Intake) Requirement for Linoleic Acid Deficiency in Grams (g) per day:

[box type=”success” ]17 and 12 g/day for men and women aged 19–50 y, respectively: 60 calories of pure linoleic acid.⁸[/box]

• [dropcap]2[/dropcap]Diet – Include Food Sources Richest in Linoleic Acid:

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Plant Sources:

• Vegetable oils such as safflower oil, corn oil, sunflower oil, and ground nut oils.
• Nuts.
• Seeds.
• Soy products.
• Fortified orange juice.
• Broccoli.
• Bok choy.
• Green leafy vegetables such as turnip greens, beet greens, collards, kale, and dandelion.⁵[/box]

 

• [dropcap]3[/dropcap] Diet – Avoid  or Limit These Foods That Deplete or Interfere With Absorption:

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• Green tea.
• Foods containing quercetin such as parsley, red onions, sage, citrus fruits, and tomatoes.
• Foods containing tumeric.

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[dropcap]4[/dropcap]Monitor Medications That Deplete. or Interfere With Absorption:

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Here are common medications that deplete linoleic acid. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

• Aspirin.
• Ibuprofen®.[/box]

• [dropcap]5[/dropcap]Manage Nutritional Supplements to Obtain Linoleic Acid:

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• Evening primrose oil.
• Borage oil.
• Black current seed oil supplements in capsule and liquid forms.

Caution: 

Omega-6 fatty acids are contraindicated in any inflammatory disease or conditions that can be made worse, such as high blood pressure, high cholesterol, heart disease, diabetes, asthma, prostate enlargement, or cancer.[/box]

• [dropcap]6[/dropcap]Other Supplements That Deplete or Interfere With Absorption:

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• Vitamin E, fish oil,  curcumin, and tumeric supplements block the metabolism or conversion of  linoleic acid to eicosinoids.  Check with your pharmacist.

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What Do Medical Research Studies Tell About Linoleic Acid Deficiency in Celiac Disease?

RESEARCH STUDY SUMMARIES

“Abnormal fatty acid pattern in intestinal mucosa of children with celiac disease is not reflected in serum phospholipids.” This study evaluating whether the intestinal mucosal fatty acid status was reflected in serum phospholipids of patients with celiac disease, demonstrated that the fatty acid abnormality of intestinal mucosa in patients with active celiac disease was not reflected in serum values. Significant differences were observed in mucosa with active celiac disease compared with controls.

Linoleic acid (18:2n-6) level was decreased, whereas those of its derivatives were elevated, indicating increased transformation of omega-6 fatty acid. Mead acid (20:3n-9) level was increased, with an increased ratio of Mead acid to arachidonic acid (20:4n-6) levels, suggesting essential fatty acid deficiency. Altered fatty acid content may contribute to the pathophysiology of the disease because fatty acids are important for enzymes and for the transport and receptor functions of epithelial membranes.¹

Sources:

1. Steel DM, Ryd W, Ascher H, Strandvik B. Abnormal fatty acid pattern in intestinal mucosa of children with celiac disease is not reflected in serum phospholipids. J Pediatr Gastroenterol Nutr. 2006 Sep; 43(3):318-23. [↩] [↩]
2. Richardson AJ. The importance of omega-3 fatty acids for behavior, cognition, and mood. Scandinavian Journal of Nutrition. 2003; 47(2):92-8 [↩]
3. Steel DM, Ryd W, Ascher H, Strandvik B. Abnormal fatty acid pattern in intestinal mucosa of children with celiac disease is not reflected in serum phospholipids. J Pediatr Gastroenterol Nutr. 2006 Sep; 43(3):318-23. [↩]
4. Krums LM, Pafenov AI, Ekisenina NI. Disorders in lipid metabolism in patients with chronic diseases of the small intestine. Klinicheskaia Meditsina. Nov 1990;68(11):54-7. [↩]
5. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩] [↩]
6. Richardson AJ. The importance of omega-3 fatty acids for behavior, cognition, and mood. Scandinavian Journal of Nutrition. 2003;47(2):92-8 [↩] [↩]
7. Steel DM, Ryd W, Ascher H, Strandvik B. Abnormal fatty acid pattern in intestinal mucosa of children with celiac disease is not reflected in serum phospholipids. J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):318-23. [↩]
8. Institute of Medicine: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington D.C., National Academy of Sciences. [↩]