Eicosapentaenoic acid (EPA)

Overview
Eicosapentaenoic acid (EPA) is one of several omega-3 fatty acids used by the body. The typical Western diet is relatively deficient in omega-3 fatty acids compared to the diets of our ancestors. The main dietary sources of EPA in the United States are cold water fish, such as wild salmon. Fish oil supplements may also raise concentrations of EPA in the body. Increased intake of EPA has been shown to be beneficial in coronary heart disease, high blood pressure, and inflammatory disorders, such as rheumatoid arthritis.

Uses
Autoimmune Diseases
The omega-3 fatty acids, including EPA, found in fish oils have been shown to modify the immune response and may be helpful in treating inflammatory autoimmune diseases such as rheumatoid arthritis

Cardiovascular Health
Omega-3 fatty acids have also been shown to improve cardiovascular health and may prevent the accumulation of plaque (cholesterol and fat) on the walls of the arteries. Fish oil supplementation may also reduce high blood pressure in people with diabetes.

Growth and Development
The omega-3 fatty acids in proper balance are essential for normal growth and development. Nutrition experts have issued recommendations for appropriate intake of each type of omega-3 fatty acid in infant formulas and diets. According to these recommendations, intake of EPA for infants on formula diets should be less than 0.1%.

Other Conditions
Omega-3 fatty acids, including EPA, may also have positive effects on lung and kidney diseases, type 2 diabetes, obesity, ulcerative colitis, Crohn's disease, anorexia nervosa, burns, osteoarthritis, osteoporosis, attention deficit hyperactivity disorder, and early stages of colorectal cancer.

Dietary Sources
You can obtain EPA by eating cold water fish, such as wild salmon (NOT farm-raised), mackerel, sardines, and herring. Some fish may contain heavy metals, such as mercury. Make sure you buy quality fish and do not eat it more than three times a week if you are pregnant.

Available Forms
EPA is also available in fish oil supplements. Some commercial products may also contain vitamin E to maintain freshness.

How to Take It
The International Society for the Study of Fatty Acids and Lipids (ISSFAL) recommends the following intakes of EPA:

Pediatric
EPA is naturally found in breast milk. Therefore, breastfed infants should be receiving sufficient amounts of EPA.
ISSFAL recommends that formula for infants contain less than 0.1% EPA.

Adult
The adequate daily intake of EPA for adults should be at least 220 mg per day.
Therapeutic recommendations from diet: 2 - 3 servings of fatty fish per week, which corresponds to 1,250 mg EPA plus DHA per day.
Fish oil supplements: 3,000 - 4,000 mg standardized fish oils per day. This amount corresponds to 2 - 3 servings of fatty fish per week.

Some commercial products may also contain vitamin E or other antioxidant to maintain freshness. For supplements, follow the directions on product labels for both dosage information and storage requirements, as some products may require refrigeration. Do not use products beyond their expiration date.

Precautions
Supplements containing EPA may not be recommended for infants or small children because they upset the proper balance with DHA, another omega-3 fatty acid needed during early development. This suggests that pregnant women should also be cautious about taking fish oil supplements.

Make sure the fish oil supplement you use has been tested for heavy metals, such as mercury and lead. Do NOT choose a fish oil supplement that contains vitamin A. This supplemental vitamin along with a multivitamin (which also contains vitamin A) may cause overdosage. Check with your health care provider for further information.

Fish oil capsules may be associated with side effects, including loose stools, abdominal discomfort, and unpleasant belching. In addition, they may prolong bleeding time slightly. Therefore, people with bleeding disorders or those taking blood-thinning medications should discuss the use of fish oil capsules with their health care providers before taking them. Consumption of fish oil supplements may also increase antioxidant requirements in the body. Taking extra vitamin E along with these supplements may be warranted, but only if you consult your health care provider first.

Possible Interactions
In combination with aspirin, omega-3 fatty acids could help treat coronary artery disease. Consult your health care provider about whether this combination would be appropriate for you if you have coronary artery disease.

Omega-3 fatty acids may reduce some of the side effects associated with cyclosporine therapy, which is often used to lower the chances of rejection in transplant recipients. Consult your health care provider before adding any new herbs or supplements to your existing medication regimen.

In an animal study, omega-3 fatty acids protected the stomach against ulcers induced by reserpine and nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin. Consult your health care provider before using omega-3 fatty acids if you are currently taking these medications.

EPA has also been shown to boost the effects of a combination of low-dose etretinate and a topical corticosteroid medication used to treat severe, chronic psoriasis. Consult your health care provider to determine if this combination therapy may be of benefit for you if you suffer from chronic psoriasis.