why is fish oil working?

[Guest guest]

We will be taking my son for a metabolic work-up at Stanford in the near

future. If it sheds any light on

underlying mechanism I will certain post the info. Below is a response I

received from

a pediatrician/metabolic specialist friend of a friend, who does work on

fatty acid oxidation. No answers,

just more questions. But the word on apraxia and fish oil is still not

common knowledge even

among pediatricians who focus on fatty acid metabolism. We will have to

change that. -

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Apraxia is quite a non-specific finding and see it as an occasional finding

in my metabolic patients. My sense is that it is more common in the

disorders of energy metabolism but this may just be an ascertainment bias.

My most dramatic case is a women with a respiratory chain defect in whom

this is a major problem. A high fat diet is often used in therapy for these

defects but seldom is as effective as you describe in your son.

Nevertheless, he should have a complete metabolic evaluation to look for

known disorders if this hasn't already done. The metabolic group at Stanford

is certainly qualified

to do this. While I doubt you'll find something previously described, the

results may point in useful direction. If you've had testing done, I'd be

happy to take a look at it if you provide me copies of the reports.

The clinical improvement seen in your sone with the omega fatty acid

supplement is striking. Most parents witnessing a placebo effect will report

an initial improvement that is not sustained. You, however, make a very

compelling story for the supplement overcoming a metabolic block in your

son. Such dramatic responses to supraphysiologic doses of something are most

suggestive of a transport defect (as in primary carnitine deficiency, etc)

or a cofactor deficiency (such as biopterin defects in PKU). Alternatively,

you may be overcoming some biosynthetic block through activation of a

secondary pathway. It's unlikely to be a degradative defect since one would

expect worsening with excess supplementation of the non-metabolizable

compound.

Regardless, a good starting point would be to break down the heterogenous

preparation that you are using into it's individual components and test

these for bioefficacy. This would best be done in a Clinical Research Center

setting or at least through a metabolic center that could follow metabolite

profiles carefully through the changes. One might also be able to follow

things in cultured fibroblasts but only if the process involved was

expressed in these cells. And of course, you'd loose the ability to follow

clinical response. Dr. Enns may also be able to facilitate some baseline

metabolic studies on and off therapy as a starting point.

I'm sorry I can't provide more of a specific direction, but I think it is

worth your time pursuing this. Let me know if I can help further.

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