|
|
1-800-228-0872 |
|
|
|
|
1-800-228-0872 |
|
|
|
|
T. J. Clark & Company Video Library and |
|
T. J. Clark’s
Catalyzed
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Information
from National Library of Medicine and the National Institutes of Health (NIH)
There is evidence from multiple studies supporting intake
of recommended amounts of DHA and EPA in the form of dietary fish or fish
oil supplements lowers triglycerides, reduces the risk of death, heart
attack, dangerous abnormal heart rhythms, and strokes in people with known
cardiovascular disease, slows the buildup of atherosclerotic plaques
("hardening of the arteries"), and lowers blood pressure
slightly. However, high doses may have harmful effects, such as an
increased risk of bleeding. Although similar benefits are proposed for
alpha-linolenic acid, scientific evidence is less compelling, and
beneficial effects may be less pronounced. Some species of fish carry a higher risk of environmental
contamination, such as with methylmercury. SynonymsReturn
to top
α-linolenic acid (ALA, C18:3n-3), alpha-linolenic
acid, cod liver oil, coldwater fish, docosahexaenoic acid (DHA, C22:6n-3),
eicosapentaenoic acid (EPA, C20:5n-3), fish oil fatty acids, fish body
oil, fish extract, fish liver oil, halibut oil, long chain polyunsaturated
fatty acids, mackerel oil, marine oil, menhaden oil, n-3 fatty acids, n-3
polyunsaturated fatty acids, omega fatty acids, omega-3 oils,
polyunsaturated fatty acids (PUFA), salmon oil, shark liver oil, w-3 fatty
acids. Note: Should not be confused with omega-6 fatty acids. EvidenceReturn
to top
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
*Key to grades Uses based on tradition or theory
The below uses are based on tradition or scientific
theories. They often have not been thoroughly tested in humans, and safety
and effectiveness have not always been proven. Some of these conditions
are potentially serious, and should be evaluated by a qualified healthcare
provider. Acute
myocardial infarction (heart attack), acute respiratory distress syndrome
(ARDS), age related macular degeneration, aggressive behavior,
agoraphobia, AIDS, allergies, Alzheimer's disease, anticoagulation,
antiphospholipid syndrome, attention deficit hyperactivity disorder
(ADHD), anthracycline-induced cardiac toxicity, bacterial infections,
breast cysts, breast tenderness, chronic fatigue syndrome (postviral
fatigue syndrome), chronic obstructive pulmonary disease, cirrhosis,
common cold, congestive heart failure, critical illness, deficiency
(omega-3 fatty acid), dermatomyositis, diabetic nephropathy, diabetic
neuropathy, dyslexia, dyspraxia, endocrine disorders (glycogen storage
diseases), exercise performance enhancement, fibromyalgia, gallstones,
gingivitis, glaucoma, glomerulonephritis, gout, hay fever, headache,
hepatorenal syndrome, hypoxia, ichthyosis (skin disorder),
immunosuppression, inflammatory conditions (Behcet's syndrome), joint
problems (cartilage repair), kidney disease prevention, kidney stones,
leprosy, leukemia, malaria, male infertility, mastalgia (breast pain),
memory enhancement, menopausal symptoms, menstrual cramps, methotrexate
toxicity, multiple sclerosis, myopathy, nephritis (autoimmune),
neuropathy, night vision enhancement, obesity, osteoarthritis,
osteoporosis, otitis media (ear infection), panic disorder, peripheral
vascular disease, pregnancy nutritional supplement, premature birth
prevention, premenstrual syndrome, prostate cancer prevention, protection
from isotretinoin drug toxicity, psychological disorders (borderline
personality disorder), Raynaud's phenomenon, Refsum's syndrome, retinitis
pigmentosa, Reye's syndrome, seizure disorder, Sjogren's syndrome, suicide
prevention, systemic lupus erythematosus, tardive dyskinesia, tennis
elbow, ulcerative colitis, urolithiasis (bladder stones), vision
enhancement, weight loss. DosingReturn
to top
The
below doses are based on scientific research, publications, traditional
use, or expert opinion. Many herbs and supplements have not been
thoroughly tested, and safety and effectiveness may not be proven. Brands
may be made differently, with variable ingredients, even within the same
brand. The below doses may not apply to all products. You should read
product labels, and discuss doses with a qualified healthcare provider
before starting therapy.
Adults (18 years and older):
Average dietary intake of omega-3/omega-6 fatty acids:
Average Americans consume approximately 1.6 grams of omega-3 fatty acids
each day, of which about 1.4 grams (~90%) comes from α-linolenic
acid, and only 0.1-0.2 grams (~10%) from EPA and DHA. In Western diets,
people consume roughly 10 times more omega-6 fatty acids than omega-3
fatty acids. These large amounts of omega-6 fatty acids come from the
common use of vegetable oils containing linoleic acid (for example: corn
oil, evening primrose oil, pumpkin oil, safflower oil, sesame oil, soybean
oil, sunflower oil, walnut oil, wheatgerm oil). Because omega-6 and
omega-3 fatty acids compete with each other to be converted to active
metabolites in the body, benefits can be reached either by decreasing
intake of omega-6 fatty acids, or by increasing omega-3 fatty acids. Recommended daily intake of omega-3 fatty acids (healthy
adults): For healthy adults with no history of heart disease, the American
Heart Association recommends eating fish at least two times per week. In
particular, fatty fish are recommended, such as anchovies, bluefish, carp,
catfish, halibut, herring, lake trout, mackerel, pompano, salmon, striped
sea bass, tuna (albacore), and whitefish. It is also recommended to
consume plant-derived sources of α-linolenic acid, such as
tofu/soybeans, walnuts, flaxseed oil, and canola oil. The World Health
Organization and governmental health agencies of several countries
recommend consuming 0.3-0.5 grams of daily EPA + DHA and 0.8-1.1 grams of
daily α-linolenic acid. A doctor and pharmacist should be consulted
for dosing for other conditions. Children (younger than 18 years):
Omega-3 fatty acids are used in some infant formulas,
although effective doses are not clearly established. Ingestion of fresh
fish should be limited in young children due to the presence of
potentially harmful environmental contaminants. Fish oil capsules should
not be used in children except under the direction of a physician. SafetyReturn
to top
The
U.S. Food and Drug Administration does not strictly regulate herbs and
supplements. There is no guarantee of strength, purity or safety of
products, and effects may vary. You should always read product labels. If
you have a medical condition, or are taking other drugs, herbs, or
supplements, you should speak with a qualified healthcare provider before
starting a new therapy. Consult a healthcare provider immediately if you
experience side effects. Allergies
People with allergy or hypersensitivity to fish should
avoid fish oil or omega-3 fatty acid products derived from fish. Skin rash
has been reported rarely. People with allergy or hypersensitivity to nuts
should avoid alpha linolenic acid or omega-3 fatty acid products that are
derived from the types of nuts to which they react. Side Effects and Warnings
The U.S. Food and Drug Administration classifies low
intake of omega-3 fatty acids from fish as GRAS (Generally Regarded as
Safe). Caution may be warranted, however, in diabetic patients due to
potential (albeit unlikely) increases in blood sugar levels, patients at
risk of bleeding, or in those with high levels of low-density lipoprotein
(LDL). Fish meat may contain methylmercury and caution is warranted in
young children and pregnant/breastfeeding women. Omega-3 fatty acids may increase the risk of bleeding,
although there is little evidence of significant bleeding risk at lower
doses. Very large intakes of fish oil/omega-3 fatty acids
("Eskimo" amounts) may increase the risk of hemorrhagic
(bleeding) stroke. High doses have also been associated with nosebleed and
blood in the urine. Fish oils appear to decrease platelet aggregation and
prolong bleeding time, increase fibrinolysis (breaking down of blood
clots), and may reduce von Willebrand factor. Potentially harmful contaminants such as dioxins,
methylmercury, and polychlorinated biphenyls (PCBs) are found in some
species of fish. Methylmercury accumulates in fish meat more than in fish
oil, and fish oil supplements appear to contain almost no mercury.
Therefore, safety concerns apply to eating fish but likely not to
ingesting fish oil supplements. Heavy metals are most harmful in young
children and pregnant/nursing women. Gastrointestinal upset is common with the use of fish oil
supplements. Diarrhea may also occur, with potentially severe diarrhea at
very high doses. There are also reports of increased burping, acid
reflux/heartburn/indigestion, abdominal bloating, and abdominal pain.
Fishy aftertaste is a common effect. Gastrointestinal side effects can be
minimized if fish oils are taken with meals and if doses are started low
and gradually increased. Multiple human trials report small reductions in blood
pressure with intake of omega-3 fatty acids. Reductions of 2-5 mmHg have
been observed, and effects appear to be dose-responsive (higher doses have
greater effects). DHA may have greater effects than EPA. Caution is
warranted in patients with low blood pressure or in those taking
blood-pressure lowering medications. Although slight increases in fasting blood glucose levels
have been noted in patients with type 2 ("adult onset")
diabetes, the available scientific evidence suggests that there are no
significant long-term effects of fish oil in patients with diabetes,
including no changes in hemoglobin A1c levels. Limited reports in the
1980s of increased insulin needs in diabetic patients taking long-term
fish oils may be related to other dietary changes or weight gain. Fish oil taken for many months may cause a deficiency of
vitamin E, and therefore vitamin E is added to many commercial fish oil
products. As a result, regular use of vitamin E-enriched products may lead
to elevated levels of this fat-soluble vitamin. Fish liver oil contains
the fat-soluble vitamins A and D, and therefore fish liver oil products
(such as cod liver oil) may increase the risk of vitamin A or D toxicity. Increases (worsening) in low-density lipoprotein levels
("bad cholesterol") by 5-10% are observed with intake of omega-3
fatty acids. Effects are dose-dependent. Mild elevations in liver function tests (alanine
aminotransferase) have been reported rarely. Skin rashes have been reported rarely. There are rare reports of mania in patients with bipolar
disorder or major depression. Restlessness and formication (the sensation
of ants crawling on the skin) have also been reported. Pregnancy and Breastfeeding
Potentially harmful contaminants such as dioxins,
methylmercury, and polychlorinated biphenyls (PCBs) are found in some
species of fish, and may be harmful in pregnant/nursing women.
Methylmercury accumulates in fish meat more than in fish oil, and fish oil
supplements appear to contain almost no mercury. Therefore, these safety
concerns apply to eating fish but likely not to ingesting fish oil
supplements. However, unrefined fish oil preparations may contain
pesticides. It is not known if omega-3 fatty acid supplementation of
women during pregnancy or breastfeeding is beneficial to infants. It has
been suggested that high intake of omega-3 fatty acids during pregnancy,
particularly DHA, may increase birth weight and gestational length (254).
However, higher doses may not be advisable due to the potential risk of
bleeding. Fatty acids are added to some infant formulas. InteractionsReturn
to top
Most
herbs and supplements have not been thoroughly tested for interactions
with other herbs, supplements, drugs, or foods. The interactions listed
below are based on reports in scientific publications, laboratory
experiments, or traditional use. You should always read product labels. If
you have a medical condition, or are taking other drugs, herbs, or
supplements, you should speak with a qualified healthcare provider before
starting a new therapy.
Interactions with Drugs
In theory, omega-3 fatty acids may increase the risk of
bleeding when taken with drugs that increase the risk of bleeding. Some
examples include aspirin, anticoagulants ("blood thinners") such
as warfarin (Coumadin®) or heparin, anti-platelet drugs such as
clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as
ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®). Based on human studies, omega-3 fatty acids may lower
blood pressure and add to the effects of drugs that may also affect blood
pressure. Fish oil supplements may lower blood sugar levels a small
amount. Caution is advised when using medications that may also lower
blood sugar. Patients taking drugs for diabetes by mouth or insulin should
be monitored closely by a qualified healthcare provider. Medication
adjustments may be necessary. Omega-3 fatty acids lower triglyceride levels, but can
actually increase (worsen) low-density lipoprotein (LDL/"bad
cholesterol") levels by a small amount. Therefore, omega-3 fatty
acids may add to the triglyceride-lowering effects of agents like
niacin/nicotinic acid, fibrates such as gemfibrozil (Lopid®), or resins
such as cholestyramine (Questran®). However, omega-3 fatty acids may work
against the LDL-lowering properties of "statin" drugs like
atorvastatin (Lipitor®) and lovastatin (Mevacor®). Interactions with Herbs and Dietary Supplements
In theory, omega-3 fatty acids may increase the risk of
bleeding when taken with herbs and supplements that are believed to
increase the risk of bleeding. Multiple cases of bleeding have been
reported with the use of Ginkgo biloba , and fewer cases
with garlic and saw palmetto. Numerous other agents may theoretically
increase the risk of bleeding, although this has not been proven in most
cases. Based on human studies, omega-3 fatty acids may lower
blood pressure, and theoretically may add to the effects of agents that
may also affect blood pressure. Fish oil supplements may lower blood sugar levels a small
amount. Caution is advised when using herbs or supplements that may also
lower blood sugar. Blood glucose levels may require monitoring, and doses
may need adjustment. Omega-3 fatty acids lower triglyceride levels, but can
actually increase (worsen) low-density lipoprotein (LDL/"bad
cholesterol") levels by a small amount. Therefore, omega-3 fatty
acids may add to the triglyceride-lowering effects of agents like
niacin/nicotinic acid, but may work against the potential LDL-lowering
properties of agents like barley, garlic, guggul, psyllium, soy, or sweet
almond. Fish oil taken for many months may cause a deficiency of
vitamin E, and therefore vitamin E is added to many commercial fish oil
products. As a result, regular use of vitamin E-enriched products may lead
to elevated levels of this fat-soluble vitamin. Fish liver oil contains
the fat-soluble vitamins A and D, and therefore fish liver oil products
(such as cod liver oil) may increase the risk of vitamin A or D toxicity.
Since fat-soluble vitamins can build up in the body and cause toxicity,
patients taking multiple vitamins regularly or in high doses should
discuss this risk with their healthcare practitioners. Methodology Return
to top
This information is based on a professional level
monograph edited and peer-reviewed by contributors to the Natural Standard
Research Collaboration (www.naturalstandard.com): Serguei Axentsev, MD,
PhD, D.Sci. (Natural Standard Research Collaboration); Rawan Barakat,
PharmD (Massachusetts College of Pharmacy); Ethan Basch, MD (Memorial
Sloan-Kettering Cancer Center); Steve Bent, MD (University of California
San Francisco); Cynthia Dacey, PharmD (Natural Standard Research
Collaboration); Cathi Dennehey, PharmD (University of California San
Francisco); Paul Hammerness, MD (Harvard Medical School); Paul Knaus,
PharmD (Northeastern University); Mojisola Sekoni, PharmD (Massachusetts
College of Pharmacy); Elizabeth Sheehan, PharmD (Northeastern University);
Michael Smith, MScPharm, ND (Canadian College of Naturopathic Medicine);
Philippe Szapary, MD (University of Pennsylvania); Catherine Ulbricht,
PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural
Standard Research Collaboration). Selected references Return
to top
1.
Berbert AA, Kondo CR, Almendra CL, et al. Supplementation
of fish oil and olive oil in patients with rheumatoid arthritis. Nutrition
2005;21(2):131-136. 2.
Bittiner SB, Tucker WF, Cartwright I, et al. A
double-blind, randomised, placebo-controlled trial of fish oil in
psoriasis. Lancet 2-20-1988;1(8582):378-380. 3.
Bjorneboe A, Smith AK, Bjorneboe GE, et al. Effect of
dietary supplementation with n-3 fatty acids on clinical manifestations of
psoriasis. Br J Dermatol 1988;118(1):77-83. 4.
Brouwer IA, Zock PL, Camm AJ, et al. Effect of fish oil on
ventricular tachyarrhythmia and death in patients with implantable
cardioverter defibrillators: the Study on Omega-3 Fatty Acids and
Ventricular Arrhythmia (SOFA) randomized trial. JAMA. 2006 Jun
14;295(22):2613-9. 5.
Burns CP, Halabi S, Clamon G, et al. Phase II study of
high-dose fish oil capsules for patients with cancer-related cachexia.
Cancer 7-15-2004;101(2):370-378. 6.
Chan JK, McDonald BE, Gerrard JM, et al. Effect of dietary
alpha-linolenic acid and its ratio to linoleic acid on platelet and plasma
fatty acids and thrombogenesis. Lipids 1993;28(9):811-817. 7.
Dry J, Vincent D. Effect of a fish oil diet on asthma:
results of a 1-year double-blind study. Int Arch Allergy Appl Immunol.
1991;95(2-3):156-157. 8.
Duffy EM, Meenagh GK, McMillan SA, et al. The clinical
effect of dietary supplementation with omega-3 fish oils and/or copper in
systemic lupus erythematosus. J Rheumatol. 2004;31(8):1551-1556. 9.
Erkkila AT, Lichtenstein AH, Mozaffarian D, et al. Fish
intake is associated with a reduced progression of coronary artery
atherosclerosis in postmenopausal women with coronary artery disease. Am J
Clin Nutr. 2004;80(3):626-632. 10.
Fenton WS, Dickerson F, Boronow J, et al. A placebo-controlled
trial of omega-3 Fatty Acid (ethyl eicosapentaenoic Acid) supplementation
for residual symptoms and cognitive impairment in schizophrenia. Am J
Psychiatry 2001;158(12):2071-2074. 11.
Lim WS, Gammack JK, Van Niekerk J, et al. Omega 3 fatty acid for
the prevention of dementia. Cochrane Database Syst Rev. 2006 Jan
25;(1):CD005379. 12.
Mostad IL, Bjerve KS, Bjorgaas MR, et al. Effects of n-3 fatty
acids in subjects with type 2 diabetes: reduction of insulin sensitivity
and time-dependent alteration from carbohydrate to fat oxidation. Am J
Clin Nutr. 2006 Sep;84(3):540-50. 13.
Olsen SF, Secher NJ, Tabor A, et al. Randomised clinical trials of
fish oil supplementation in high risk pregnancies. Fish Oil Trials In
Pregnancy (FOTIP) Team. BJOG. 2000;107(3):382-395. 14.
Stoll AL, Severus WE, Freeman MP, et al. Omega 3 fatty acids in
bipolar disorder: a preliminary double-blind, placebo-controlled trial.
Arch Gen.Psychiatry 1999;56(5):407-412. 15.
Su KP, Huang SY, Chiu CC, et al. Omega-3 fatty acids in major
depressive disorder. A preliminary double-blind, placebo-controlled trial.
Eur.Neuropsychopharmacol. 2003;13(4):267-271. November
01, 2006.
|
|
|
T. J. Clark's Secure Shopping Cart Order Line 1-800-228-0872 Copyright
© 1998-2008 T. J.
Clark & Company *These statements have
not been evaluated by the Food and Drug Administration. |
