Abstract Body (Do not enter title and authors here): Background

Peanuts, a heart-healthy staple due to their high polyphenolic antioxidant content, contain a substantial amnount of omega 6 fatty acids. An excess of the Omega-6 polyunsaturated fatty acids (PUFAs), up regulates the body’s inflammatory pathways.The n-6 PUFA-derived lipid mediators trigger inflammation, platelet aggregation, and vasoconstriction. Omega 3 fatty acids in foods such as salmon or avocado, inhibit inflammation and platelet aggregation while enhancing vasodilation. Over consumption of omega 6 fatty acids by more than the 5-10% daily recommendation can lead to inflammatory conditions like myositis, as seen in this case presentation.

Case Presentation

A 70-year-old Caucasian male presented to his primary care clinic for worsening bilateral lower extremity myalgias for the past few months. His medical history includes hypertension, non-insulin- dependent type 2 diabetes, and hyperlipidemia. He denied any trauma, strenuous exercise, myocardial infarction, or mechanical falls. His home medications were aspirin, low-dose Crestor, Pioglitazone, Janumet, and Farxiga. Radiographic imaging of the lower extremities was unremarkable. He had elevated creatinine kinase (CK) levels from 2018-2022, ranging from 300-500’s. A trial withholding the statin (Crestor), was initiated to check for improvement, but serum creatinine levels remained high. His muscle biopsy was unrevealing as well. During an office visit in 2022, the patient incidentally stated he had been eating a one-pound bag of shelled peanuts daily for the lat 4 years to improve his health. He was advised to eliminate peanuts for a month and have a follow up CK level testing.

Results:
The creatinine kinase levels between 2018-2022 revealed a baseline elevation until May 2022 when the patient returned for an office visit after abstaining from peanuts for a month. His CK levels not only normalized in May 2022, but also coincided with resolution of his myalgias. These results reveal the association between over consumption of omega 6 fatty acids as a trigger for myositis.

Conclusion:
The patient was educated on the detrimental health effects from over consumption of omega 6 fatty acids and the importance of moderation in the diet. This case illustrates the link between omega-6 fatty acid as a precursor to inflammatory disease. The patient's peanut consumption being the culprit of his myositis also highlights the importance of good history taking and exploring diet as a conduit to disease management.