Supplements

Fish Oils: EPA (eicosapentaenoic acid)

Fish oils are a rich source of two essential fatty acids -- EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Fish oil is a good source of omega-3 essential fatty acids. Cod liver oil is the most commonly used fish oil.

A twenty year Dutch study has shown that by increasing consumption of cold-water fish and fish oil, we can dramatically reduce the risk of heart disease. Another major study calculated a 50 percent reduction in fatal heart attacks for people who consume more salmon and other cold-water fish.

EPA and DHA help keep blood platelets from clumping, thereby preventing the formation of clots that could cause a heart attack. Even in high concentration there is no increase in abnormal bleeding and fish oils are considered the number one alternative therapy to warafin (Coumadin), an anti-coagulant commonly prescribed.

The elevated triglycerides, which are strongly associated with heart disease, have been lowered with daily doses of as little as 1 gram each of EPA and DHA. More than seventy studies documented that omega-3 oils can be counted on to lower triglycerides by an average of 25-35 percent.

Fish oils act as a preventative for irregular heartbeat (arrhythmia). A regular rhythm is reestablished in a majority of heart patients when taking fish oil supplements.

Large doses ­ up to 10 grams per day ­ have lowered the number of angina attacks by 41 percent. Fish oils' ability to lower blood pressure is well documented, even at a dose of 2 grams per day. Recent experiments using 4 grams of EPA and DHA daily have been quite successful.

Recent studies indicate that fish oils consistently diminish the triglyceride threat faced by most diabetics. Although some research indicates the EPA may raise blood glucose, others have found no impact at all. 500 IU of supplemental vitamin E, research demonstrates, can prevent most EPA-produced elevations of blood sugar.

Omega-3 oils have a particularly inhibitory effect on cancers of the breast and colon. Women who eat fish high in EPA, for example, have a significantly lower rate of breast cancer. Additionally, women who have been diagnosed with a tumor typically display a smaller concentration of omega-3 fats in their breast tissue than do their healthy peers.

Fish oils can cut down on the number of T suppressor cells (the cells that turn off the immune response) when 18 grams daily are given.

EPA supplements both decrease pain and increase ease of movement making them beneficial for anyone suffering from illnesses in which inflammation plays a major role. This includes treatment for arthritis, as the fish oils effectively replace nonsteroidal anti-inflammatory drugs (NSAIDs). Fish oil will not work as fast as NSAIDs. A daily dosage is necessary of 3-4 grams and improvements may take months to appear.

Rheumatoid arthritis is just one of several autoimmune disorders benefited by fish oils. Clinical studies showing the ability of EPA/DHA to produce remissions in lupus are beginning to appear.

Fish oils markedly decrease the damage of colitis and Crohn's disease. They do this by reducing the over-production of inflammatory compounds that are associated with colitis.

Atopic eczema and acne may be caused by an imbalance in the production of inflammatory hormones in the skin. All of these can be helped by fish oil supplements. EPA and DHA are especially effective in psoriasis. When omega-3s were emulsified and given by infusion in a German experiment, twenty people with acute cases of psoriasis improved dramatically in just one week. Daily dosages of 10 grams or more are required, lower amounts do not always help.

Six grams per day of EPA can improve recovery and restore renal function in recipients of a kidney transplant, as well as in people with nephritis and lupus nephritis.

Other Conditions: There is evidence to suggest that n-3 fatty acids from fish oils may also benefit patients with chronic obstructive pulmonary disease or renal disease and could be useful for conditions such as ulcerative colitis, Type II diabetes, and Crohn's disease.

Sources: Cold water fish: wild salmon (not farm raised), mackerel, sardines, herring

Precautions: Side effects observed in clinical trials using fish oil capsules include loose stools, abdominal discomfort, and unpleasant eructation. Although it does not appear to pose a clinical concern, fish oil supplements may also cause a slight prolongation of bleeding time.

Some sources say that supplements containing EPA are not recommended for infants or small children because they offset the balance between DHA and EPA during this phase of development. By inference, it would be wise to exercise caution in pregnant women as well.

Consumption of fish oils may increase antioxidant requirements in the body; some recommend that individuals taking fish oil supplements should take extra vitamin E. Caution should likely be exercised, though, when using this combination in patients with bleeding disorders as well as in patients on anticoagulant or antiplatelet medications.

Dosage Ranges and Duration of Administration:
Dietary recommendations: 2 to 3 servings of fatty fish per week, which corresponds to 1.25 g EPA plus DHA per day.

Fish oil supplements: 3 to 4 g standardized fish oils per day. This amount corresponds to 2 to 3 servings of fatty fish per week.

Some products may also contain vitamin E to prevent oxidation of the oil in the capsule to maintain freshness through the expiration date. Follow the directions on product labels for both dosage information and storage requirements. Some products may require refrigeration. Do not use products beyond their expiration date.

INTERACTIONS

Aspirin
In a double-blind, randomized, crossover study, six healthy volunteers were given aspirin (40 mg/day) combined with omega-3 fatty acids (5.3 g) (Iacoviello et al. 1992). The combination lowered the fibrinolytic response to venous occlusion and could be helpful in the treatment of some forms of coronary artery disease.

Cyclosporine
In a double-blind, randomized, placebo-controlled study, 28 cardiac transplant patients received an immunosuppressive regimen consisting of cyclosporine (6 mg/kg body weight), azathioprine (2 mg/kg/day), and prednisolone (0.2 mg/kg/day) with either omega-3 fatty acids (4 g/day: 46.5% EPA and 37.8% DHA) or placebo (Andreassen et al. 1997). Both treatment groups also received alpha-tocopherol (3.7 mg). Treatment commenced 4 days postoperatively and continued for 6 months, with blood levels of cyclosporine remaining stable for both groups. After 6 months, systolic blood pressure decreased in the omega-3 group and increased in the control group. Diastolic blood pressure increased in both groups; this increase was statistically significant in the control group. An earlier study in 20 cardiac transplant patients receiving omega-3 fatty acids (3 g/day: EPA and DHA) in conjunction with cyclosporine and antihypertensive medications for 12 weeks supports these findings (Ventura et al. 1993). The mechanism of action may be due to decreasing systemic vascular resistance. The combination of omega-3 fatty acids with cyclosporine may show promise as effective hypertension prophylaxis in cardiac transplant patients.
Another placebo-controlled, prospective, double-blind, randomized study involving 26 patients was conducted to evaluate the effects of omega-3 fatty acids on cyclosporine-induced nephrotoxicity (Badalamenti et al. 1995). Liver transplant patients were given omega-3 fatty acids (12 g/day: 18% EPA and 12% DHA) or placebo while on cyclosporine therapy. After 2 months, renal plasma flow increased by 22%, the glomerular filtration rate (GFR) increased by 33%, renal blood flow increased by 17%, and renal vascular resistance decreased by 20% for patients receiving omega-3 fatty acids. No changes were noted in the control group.

Kidney transplant recipients also benefited from supplementation with omega-3 fatty acids (6 g: 30% EPA and 20% DHA) during cyclosporine therapy in a double-blind, placebo-controlled, prospective, randomized clinical trial involving 21 subjects (Homan van der Heide et al. 1990). After 3 months, blood pressure decreased in the omega-3 group, and GFR and renal plasma flow increased by 20.3% and 16.4%, respectively. However, another double-blind, randomized, controlled study with 25 renal transplant patients did not demonstrate any clinically significant benefits derived from one year of treatment with omega-3 fatty acids (6 g: 30% EPA, 20% DHA) (Kooijmans-Coutinho et al. 1996).

Etretinate
A randomized, open study was conducted to evaluate the effects of highly purified EPA (1800 mg/day) in combination with low-dose etretinate (0.3 to 0.5 mg/kg/day) for 12 weeks in patients with chronic, stable psoriasis vulgaris (Danno and Sugie 1998). Patients continued to be treated with a topical corticosteroid that previously had been ineffective. At the end of the study, clinical improvement was noted in 100% of the patients receiving etretinate with EPA as compared to 90% in the patients receiving etretinate monotherapy. The number of patients reporting adverse reactions was similar in both groups.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Omega-3 fatty acids (5 and 10 mL/kg body weight) significantly protected the gastric mucosa against ulcers induced by NSAIDs, reserpine, and necrotizing agents in rats (Al-Harbi et al. 1995).