From the Guidelines
To modify supplements containing academic acid and EPA to optimize fatty acid profiles, I recommend using prescription-grade omega-3 fatty acids, specifically purified EPA at 4 grams per day, as it has been shown to lower very high triglyceride levels and reduce cardiovascular risk. This is based on the most recent and highest quality study, REDUCE-IT 1, which demonstrated a 25% reduction in the primary composite endpoint of cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina.
When modifying supplements, it is essential to consider the following:
- Use prescription-grade omega-3 fatty acids, as they are more effective and better regulated than nonprescription fish oil products 1
- Increase EPA dosage to 4 grams per day, as this has been shown to be effective in reducing triglyceride levels and cardiovascular risk 1
- Ensure adequate DHA, but note that purified EPA has been shown to be effective even without high doses of DHA 1
- Take supplements with a meal containing some fat for optimal absorption
- Monitor for potential adverse effects, such as atrial fibrillation, and evaluate the potential net benefit of prescription omega-3 fatty acids in patients at high risk of AF 1
The benefits of using prescription-grade omega-3 fatty acids, specifically purified EPA, include:
- Reduced triglyceride levels
- Reduced cardiovascular risk
- Improved cell membrane fluidity and signaling pathways that regulate inflammation
- Competing with omega-6 fatty acids for the same enzymatic pathways, thereby reducing production of pro-inflammatory compounds
Regular blood testing of fatty acid profiles can help monitor effectiveness and guide further adjustments to the supplementation regimen. It is crucial to consult with a healthcare professional before making any changes to supplements, especially for patients with established cardiovascular disease or those at high risk of AF.
From the Research
Modifying Supplements to Elevate Fatty Acid Profile
To modify supplements and elevate the fatty acid profile, particularly focusing on academic acid and EPA, it's essential to understand the roles and interactions of different fatty acids in the body.
- Omega-3 fatty acids, including EPA and DHA, have distinct biological effects and may have variable clinical effects 2.
- The clinical significance of understanding the complexity of omega-3 fatty acid biology is crucial for maximizing cardiovascular risk reduction 2.
- EPA and DHA have differences in their effects on lipoprotein metabolism, with EPA decreasing hepatic lipogenesis and DHA enhancing VLDL lipolysis and increasing HDL cholesterol 2.
Omega-3 Fatty Acids and Health Benefits
Omega-3 polyunsaturated fatty acids (PUFAs) include α-linolenic acid (ALA), stearidonic acid (SDA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) 3.
- Many epidemiological studies have been conducted on the health benefits of omega-3 PUFAs, including their effects on cardiovascular disease, diabetes, cancer, Alzheimer's disease, dementia, depression, visual and neurological development, and maternal and child health 3.
- Higher intakes of omega-3 PUFAs, especially EPA and DHA, are associated with a lower incidence of chronic diseases characterized by elevated inflammation, including cardiovascular diseases 4.
Mechanisms of Action of EPA and DHA
EPA and DHA reduce plasma TG levels and are approved for the treatment of patients with severe hypertriglyceridemia 5.
- The main effects of both EPA and DHA are decreased fasting and postprandial serum TG levels, through reduction of hepatic very-low-density lipoprotein (VLDL)-TG production 5.
- The exact mechanism for reduced VLDL production is not clear but does not include retention of lipids in the liver; rather, increased hepatic fatty acid oxidation is likely 5.
Nutritional Indices for Assessing Fatty Acids
Various nutritional indices can be used to assess the composition of fatty acids, including the PUFA/SFA, index of atherogenicity (IA), and the index of thrombogenicity (IT) 6.