Feature Summary:
Vitamin D and omega-3 fatty acids from fish oil are among the most powerful nutrients for improving overall health, and they are also among the most commonly deficient. EPA and DHA improve a number of cardiovascular risk factors including lowering of atherosclerotic burden, reducing triglyceride levels and blood pressure, and improving platelet and vascular function.1,2,3,4 Vitamin D has also been shown to modify cardiovascular risk and reduce the risk of several cancers, autoimmune disease, osteoporotic fractures, and overall mortality.5,6,7,8,9 EPA and DHA are essential to the resolution of inflammatory processes, as well as tissue repair, by providing the substrates for anti-inflammatory prostaglandins, resolvins and protectins, and vitamin D has recently been shown to have anti-inflammatory effects as well.10,11,12 Omega-3 fatty acids are incorporated into membrane phospholipids, affecting cellular membrane organization, ion permeability, intracellular signalling, gene expression and the activity of membrane-associated proteins.13 EPA and DHA combined with vitamin D are likely to have synergistic benefits for improving overall wellness, as well as for preventing and treating a wide variety of cardiovascular, inflammatory and autoimmune conditions.14
Medicinal Ingredients:
Serving Size: 1 EnteripureTM Softgel
Servings per Container: 90
Each Softgel Contains:
Fish Oil Concentrate (Molecularly Distilled, Ultra Purified)
(Anchovy, Sardine and/or Mackerel)........................................1407 mg
Omega-3 Fatty Acids...........................................................900 mg
Eicosapentaenoic Acid (EPA)............................................600 mg
Docosahexaenoic Acid (DHA)...........................................300 mg
Vitamin D3 (Cholecalciferol)...................................................25 mcg (1000 IU)
†Expressed as ethyl esters
Non-Medicinal Ingredients:
Enteripure™ softgel (gelatin, glycerin, purified water, pectin), natural vitamin E.
Allergens:
Contains no artificial colours, preservatives, or sweeteners; no dairy, sugar, wheat, gluten, yeast, soy, egg, shellfish, salt, tree nuts, or GMOs. Sealed for your protection. Do not use if seal is broken. For freshness, store in a cool, dry place.
Recommended Use:
1 softgel per day or as directed by a health care practitioner. Keep out of reach of children.
Contraindications:
Individuals with an allergy to fish or seafood should use caution, though fish oil is rarely allergenic. Both benefit and risk has been documented for those at risk of or being treated for cardiac arrhythmias, with close supervision indicated.15 Pregnant and nursing women are often advised to consume a minimum of 300 mg DHA per day, and although DHA is recognized as essential to neurological development, no dosage recommendations have been made for children or infants. Supplemental vitamin D should be used with caution in those with sarcoidosis, lymphoma, tuberculosis, hypercalcemia or renal impairment.16
Drug Interactions:
The antihypertensive effect of fish oil and/or vitamin D may potentially reduce the need or dosage for blood pressure medications, and patients should be closely monitored. Because fish oil has an antithrombotic effect, caution is advised for those on anticlotting, antiplatelet or anticoagulant medications, or those at high risk of bleeding.17 At doses greater than 3 g per day, hyperglycemia has been observed in diabetics and those with hypertriglyceridemia and close monitoring of patients on antidiabetic medication is recommended. Vitamin D may increase the risk for hypercalcemia when taken with a thiazide medication (diuretic).18 Benefit has been shown when fish oil is taken with statins, SSRIs, anticonvulsant and cytotoxic medications.19,20
References:
1. Pischon T, Hankinson SE, Hotamisligil GS, et al. Habitual dietary intake of omega-3 and omega-6 fatty acids in relation to inflammatory markers among US men and women. Circulation. 2003 Jul 15;108(2):155-60.
2. Swanson D, Block R, Mousa SA. Omega-3 fatty acids EPA and DHA: health benefits throughout life. Adv Nutr. 2012;3:1-7.
3. Wang C, Harris WS, Chung M, et al. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondaryprevention studies: a systematic review. Am J Clin Nutr. 2006 Jul;84(1):5-17.
4. Saito Y, Yokoyama M, Origasa H, et al. Effects of EPA on coronary artery disease in hypercholesterolemic patients with multiple risk factors: sub-analysis of primary prevention cases from the Japan EPA Lipid Intervention Study (JELIS). Atherosclerosis. 2008 Sep;200(1):135-40.
5. Muscogiuri G, Sorice GP, Ajjan R, Mezza T, Pilz S, Prioletta A, Scragg R, Volpe SL, Witham MD, Giaccari A. Can vitamin D deficiency cause diabetes and cardiovascular diseases? Present evidence and future perspectives. Nutr Metab Cardiovasc Dis. 2012 Feb;22(2):81-7.
6. Fletcher JM, Basdeo SA, Allen AC, Dunne PJ. Therapeutic use of vitamin D and its analogues in autoimmunity. Recent Pat Inflamm Allergy Drug Discov. 2012 Jan;6(1):22-34.
7.Baz-Hecht M, Goldfine AB. The impact of vitamin D deficiency on diabetes and cardiovascular risk. Curr Opin Endocrinol Diabetes Obes. 2010 Apr;17(2):113-9.
8. Zittermann A, Prokop S. The role of vitamin D for cardiovascular disease and overall mortality. Adv Exp Med Biol. 2014;810:106-19.
9. Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014 Apr 1;348:g1903. doi: 10.1136/bmj.g1903.
10. Yedgar S, Krimsky M, Cohen Y, et al. Treatment of inflammatory diseases by selective eicosanoid inhibition: a double-edged sword? Trends Pharmacol Sci. 2007 Sep;28(9):459-64.
11. Schmitz G, Ecker J. The opposing effects of omega-3 and omega-6 fatty acids. Prog Lipid Res.2008 Mar;47(2):147-55.
12. Zanetti M, Harris SS, Dawson-Hughes B. Ability of vitamin D to reduce inflammation in adults without acute illness. Nutr Rev. 2014 Feb;72(2):95-8. doi: 10.1111/nure.12095.
13. Jung UJ, Torrejon C, Tighe AP, et al. n-3 Fatty acids and cardiovascular disease: mechanisms underlying beneficial effects. Am J Clin Nutr. 2008 Jun;87(6):2003S-9S.
14. Manson JE, Bassuk SS, et al. The Vitamin D and OmegA-3 TriaL (VITAL): rationale and design of a large randomized controlled trial of vitamin D and marine omega-3 fatty acid supplements for the primary prevention of cancer and cardiovascular disease. Contemp Clin Trials. 2012 Jan;33(1):159-71.
15. Kromhout D, de Goede J. Update on cardiometabolic health effects of -3 fatty acids. Curr Opin Lipidol. 2014 Feb;25(1):85-90.
16. Sage RJ, Rao DS, Burke RR, Lim HW. Preventing vitamin D toxicity in patients with sarcoidosis. J Am Acad Dermatol. 2011 Apr;64(4):795-6.
17. Harris WS. Expert opinion: omega-3 fatty acids and bleeding-cause for concern? Am J Cardiol. 2007 Mar 19;99(6A):44C-46C.
18. Boulard JC, Hanslik T, Alterescu R, Baglin A. [Symptomatic hypercalcemia after vitamin D-thiazide diuretics combination. Two cases in elderly women]. Presse Med. 1994 Jan 22;23(2):96.
19. Toyama K, Nishioka T, Isshiki A, et al. Eicosapentaenoic Acid combined with optimal statin therapy improves endothelial dysfunction in patients with coronary artery disease. Cardiovasc Drugs Ther. 2014 Feb;28(1):53-9.
20. Mischoulon D, Freeman MP. Omega-3 fatty acids in psychiatry. Psychiatr Clin North Am. 2013 Mar;36(1):15-23.
