Indications

EPO SAP is effective for relief of symptoms associated with premenstrual syndrome and menopause.
EPO SAP can be used topically to treat atopic dermatitis in both children and adults as well as for breast tenderness.
EPO SAP contains gamma-linolenic acid, an essential fatty acid which can be used to treat conditions of EFA deficiency including inflammation and thrombosis.
EPO may provide a suitable alternative to fish oils in balancing prostaglandin synthesis and systemic inflammation in patients who have chosen vegetarian or vegan lifestyles.

Ingredients

Each non-GMO softgel contains:
Evening primrose oil ... 1000 mg
Containing:
Gamma-linolenic acid (GLA) (9–10%) ... 90–100 mg
Oleic acid ... 100 mg
Linoleic acid (LA) ... 680 mg
Vitamin E (d-alpha-tocopherol) ...30 IU

Contains no: Preservative, artificial flavor or color, sugar, dairy, starch, wheat, gluten, corn, soya or yeast. Solvent-free.

Description

Evening primrose oil (EPO) contains essential fatty acids that have several beneficial effects in the body. EPO is a source of gamma-linolenic acid (GLA) which, when used topically, has been demonstrated to aid in the management of atopic dermatitis. EPO also contains precursors of prostaglandin E1 which, when deficient, can contribute to many female hormone balancing concerns, including PMS symptoms such as depression, irritability, breast pain and fluid retention. Deficiency of prostaglandin E1 can also contribute to menopausal symptoms including hot flashes. EPO also inhibits leukotriene synthesis, which is an inflammatory mediator and can therefore be used to reduce systemic inflammation in the body.

PURITY, CLEANLINESS and STABILITY Third party testing on the finished product ensures EPO SAP is free of heavy metals, herbicides, pesticides and other impurities.

WHAT ARE OMEGA-6 FATTY ACIDS? Omega 6 fatty acids (n–6) are polyunsaturated fatty acids and are considered essential fatty acids (EFAs) because they cannot be synthesized by humans, thus must be obtained from the diet. The omega 6 fatty acids include arachidonic acid (AA), exclusively found in animal products; gammalinolenic acid (GLA) and linoleic acid (LA), almost exclusively from plant sources. Plant sources of n–6 EFAs include: nuts, seeds, grains, safflower, sunflower, sesame, corn and cottonseed. Due to the high content of animal products and arachidonic acid in the standard western diet, EFA imbalance is commonplace. High AA intake ultimately leads to an increased formation of the prostaglandin-2 series (PG2) and the hormone leukotrienes (LT) via the phospholipase A2 biochemical pathway. Both PG2 and LT (4-series) are pro-inflammatory, and have been linked to chronic inflammation, arthritis, cardiovascular disorders, asthma, mood disorders, obesity and cancer.

WHY IS EVENING PRIMROSE OIL A SUPERIOR n–6 SOURCE? Evening primrose oil (EPO) is a vegetable oil that is a rich source of n–6 essential fatty acids. EPO is unique as it is comprised of linoleic acid, 7–10% gamma-linolenic acid (GLA) and vitamin E. GLA is considered to be the active ingredient in EPO that is responsible for health benefits. GLA, if not acquired in the diet, is typically derived from LA via the rate-limiting enzyme delta 6 desaturase, a process which is positively modulated by zinc, magnesium, vitamin B6, vitamin B3 and vitamin E. GLA is in turn metabolized to DGLA, and ultimately anti-inflammatory metabolites, including most notably, the prostaglandin-1 series (PG1). Supplementation of EPO provides GLA directly to the biochemical pathway, overcoming the rate-limiting delta 6 desaturase enzyme. Proper n–6 EFA balance and metabolism is critical for the maintenance of cellular health and a balanced inflammatory response. By increasing EPO intake, inflammation is decreased by increasing levels of PG1.

ATOPIC DERMATITIS/ECZEMA Atopic dermatitis (AD) is a chronic, inflammatory and pruritic condition. Defective metabolism of n–6 EFAs leading to relative dominance of proinflammatory prostaglandins (PG2) has been reported as an important factor in the pathogenesis of AD(1). Studies of AD show sufficient levels of LA and deficient levels of GLA, DGLA, AA, and docosapentaenoic acid(2). This suggests a reduced conversion of linoleic acid to GLA(2) via delta-6-desaturase. Supplementation of EPO overcomes delta 6 desaturase load by supplying GLA directly, increasing PGE1 production.
• Daily supplementation of 500 mg EPO over 5 months improved symptoms (extent, intensity, itchiness and dryness) in 96% of subjects with AD (only 32% of the placebo group showed improvement)(3).
• Double-blind studies show that supplementing with 500 mg EPO showed an increase in metabolites of GLA, and significant improvement of eczema symptoms(4). PMS Premenstrual syndrome, a common disorder in women of reproductive age, is characterized by emotional and physical symptoms that occur cyclically during the luteal phase of the menstrual cycle. The disorders can manifest with a wide variety of symptoms, including depression, mood lability, abdominal pain, breast tenderness, headache, and fatigue. It is suggested that altered prostaglandin metabolism leads to pathophysiologic levels of PG2 (in brain, breast, gastrointestinal tract, kidney and reproductive tract), promoting many PMS symptoms(5). EPO helps to regulate hormones and improve nerve functions, thereby aiding in the symptom management of PMS. Neuroinflammation caused by inflammatory prostaglandin and cytokine production can lead to depression and other neuro-degenerative diseases(6). EPO has been shown to be effective as treatment for depression and irritability, breast pain and tenderness, and the fluid retention associated with the premenstrual syndrome(5, 7).
• Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat symptoms of PMS. NSAIDS produce an analgesic effect, and at high doses inhibit production of inflammatory prostaglandins. Supplementation with EPO aids in the balance of prostaglandins via an increase in the anti-inflammatory PG1 series. Studies show that 64% of women suffering from mastalgia may exhibit improvement of symptoms after three months supplementation with EPO(8).
• Symptoms of mastalgia can range from minor to debilitating, and be cyclical or persistent. Clinical studies implementing 500 mg EPO twice daily show a 97% positive response within six months, in women suffering from persistent mastalgia, and may be recommended as first line therapy(9).
• Daily doses of 1200 IU vitamin E, 3000 mg EPO, or vitamin E and EPO in combination at these same dosages taken for six months proved to be more effective at reducing the severity of cyclical mastalgia compared to placebo(10).
• Studies have compared EPO to pharmaceutical interventions (bromocriptine and danazol) for the treatment of mastalgia. Results indicated that EPO is as effective as bromocriptine in releiving pain (60% of subjects), with fewer reported adverse effects(11). MENOPAUSE Vasomotor disturbances, including flushing and sweating, are the most characteristic and noticeable symptoms experienced during the climacteric, associated with falling estrogen concentrations. Research suggests that EPO helps to decrease the occurrence of hot flashes, as its metabolites provide high concentrations of prostaglandins which decrease the affinity of ligands such as estrogens and other hormones for their receptors(12). 440 mg EPO with isoflavones and vitamin E showed a dramatic reduction of menopausal complaints within the first three months of treatment(13). THROMBOSIS AND CARDIOVASCULAR HEALTH Thrombosis is the aggregation of platelets and fibrin forming a blood clot. Studies suggest that EPO shows considerable anti-anticoagulant and antiplatelet activity in animals and has potential to reduce cardiovascular morbidity and mortality(14). Outside of direct vessel injury, those at risk to thrombosis are people who have cardiovascular disease and/or diabetics. Human studies show that 4000 mg EPO contributes to normalizing lipid metabolism and decreases chances of the occurrence of thrombosis(15).

Quantity

90 softgels per bottle

Dose

Take 1–2 capsules daily with a meal.

Potential side effects/Safety

EPO is generally well tolerated and few side-effects are reported. Minor
gastro-intestinal complaints include nausea, abdominal discomfort, increased
bowel movements, diarrhea and headaches have been sparingly reported(16).
Caution is advised in combining interventions that are antihypertensive, anticoagulant,
anti-platelet, or include NSAIDs, anticonvulsants or neuroleptics(15).
Historically, EPO was considered to be contraindicated for those experiencing
seizures or diagnosed with epilepsy, and when taking anticonvulsants such
as phenothiazine. Recent studies suggest that EPO has anticonvulsant effects
due to increasing levels of PG1(17).

References

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1. Horrobin, DF. “Essential fatty acid metabolism and its modification in atopic eczema”. Am J Clin Nut 2007;71(suppl):367S-72S.
2. Manku MS, Horrobin DF, Morse N et al. “Redused levels of prostaglandins precursors in the blood of atopic patients:
defective delta-6-deaturase function as a biochemical basis for atopy”. ProstaglandinsLeokot Med. 1982;9:615-628.
3. Swapan Senapati, Sabyasachi Banerjee, Dwijendra Nath Gangopadhyay. “Evening primrose oil is effective in atopic
dermatitis: a randomized placebo-controlled trial”. Indian J Dermatol Venereol Leprol. 2008 Sep-Oct;74(5):447-52.
4. Hederos CA, Berg A. “Epogram evening primrose oil treatment in atopic dermatitis and asthma”. Arch Dis Child. 1996.
Dec;75(6):494-7.
5. Horrobin DF. “The role of essential fatty acids and prostaglandins in the premenstrual syndrome”. J Reprod Med. 1983
Jul;28(7):465-8.
6. Laye S. “Polyunsaturated fatty acids, neuroinflammation and well being”. Prostaglandins Leukot Essent Fatty Acids.
2010 Mar 12 (Epub)
7. Dickerson LM, Mazyck PJ, Hunter MH. “Prementrual syndrome”. Am Fam Physician. 2003 Apr 15;67(8):1743-52.
8. Qureshi S, Sultan N. “Topical nonsteroidal anti-inflammatory drugs versus oil of evening primrose in the treatment of
mastalgia”. Surgeon. 2005. Feb;3(1):7-10.
9. Cheung KL. “Management of cyclical mastalgia in oriental women: pioneer experience of using gamolenic acid (Efamast)
in Asia”. Aust N Z Surg. 1999 Jul;69(7):492-4.
10. Pruthi S, Wahner-Roedler DL, Torkelson CJ, Cha SS, Thicke LS, Hazelton JH, Bauer BA. “Vitamin E and evening primrose
oil for management of cyclical mastalgia: a randomized pilot study”. Altern Med Rev. 2010 Mar;15(1):59-67.
11. Gately CA, Miers M, Mansel RE, Hughes LE. “Drugs treatments for matalgia: 17 years experience in the Cardiff
mastalgia clinic”. J R Soc Med. 1992 Jan;85(1):12-5.
12. Chenoy R, Hussain S, Tayob Y, O'Brien PM, Moss MY, Morse PF. “Effect of oral gamolenic acidfrom evening primrose
oil on menopausal flushing”. BMJ, 1994 Feb 19;308(6927):501-3.
13. Canceol Hidalgo MJ, Castelo-Branco C, Blumel JE, Lanchares Perez JL, Alvarez DeLos Heros JI, Isona Study Group. “
Effect of a compound containing isoflavones, primrose oil and vitamin E in two different doses on climeratic symptoms”.
J Obstet Gynaeol. 2006 May;26(4):344-7.
14. Riaz A, Khan RA, Ahmed SP. “Assessment of anticoagulant effect of evening primrose oil”. Pak J Pharm Sci. 2009
Oct;22(4):355-9
15. Takahashi, R, Inoue J, Ito H, Hibino H. “Evening primrose oil and fish oil in non-insulin-dependent-diabetes”.
Prostaglandins, Leukot and Essential Fatty Acids. 1993. Aug;49(2):569-71
16. Bayles B, Usatine R. “Evening primrose oil”. Am Fam Physician. 2009 Dec 15;80(12):1405-8.
17. Puri BK. “The safety of evening primrose oil in epilepsy”. Prostaglandins Leukot Essential Fatty Acids. 2007 Aug; 77(2):101-3