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Omega-3 fatty acids, fish oil, alpha-linolenic acid



Interactions

Omega-3/Drug Interactions:
  • GeneralGeneral: In human research, increased levels of docosahexaenoic acid (DHA) in the blood were associated with a decreased risk of relapsing to substance abuse (21).
  • AntiandrogensAntiandrogens: Clinical evidence suggests that dietary supplementation with polyunsaturated fatty acids increases the efficacy of antiandrogen therapy in the treatment of prostate cancer (283).
  • Antiarrhythmic agentsAntiarrhythmic agents: There is conflicting clinical evidence regarding the antiarrhythmic effects of fish oil (284; 285; 286; 96). Eicosapentaenoic acid (EPA) may block fast voltage-dependent sodium channels via specific binding, which results in prolongation of the inactivated states of these channels (287; 288). Fish oil may have a protective against arrhythmias; however, the exact mechanism is not understood nor are the effects with antiarrhythmic agents.
  • AntiarthriticsAntiarthritics: According to clinical evidence of its efficacy in the treatment of arthritis (289; 290; 176; 178; 175; 174; 166; 291; 177; 292; 173; 172; 170; 169; 167; 192), fish oil may theoretically act synergistically with other antiarthritic agents.
  • AntiasthmaticsAntiasthmatics: There is conflicting evidence regarding the effect of fish oil on asthma (293; 90; 294; 295; 296; 297; 298; 194; 299; 300; 301; 302; 303), and its effects with antiasthma drugs are not well understood. In one study, a decreased use of short-term bronchodilators was reported (105). However, exacerbation of asthma has been reported (82; 118).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: There are case reports of increased bleeding and elevated international normalized ratios (INR) in patients taking warfarin with fish oil (62; 63). Diets containing salmon oil, mackerel, or cod liver oil have been reported to prolong bleeding times in healthy volunteers (235; 304; 305; 306; 307). This effect may be due to fish oil-induced suppression of thromboxane A2 synthesis. In human research, the addition of omega-3 ethyl esters to a combination of aspirin and clopidogrel increased the platelet response to clopidogrel after percutaneous coronary intervention (308). In patients who are aspirin-resistant, addition of omega-3 fatty acids to aspirin improved the response to aspirin and reduced platelet reactivity (309). Some clinical evidence suggests that fish oil does not affect coagulation, even when taken with anticoagulant or antiplatelet agents like aspirin (310; 238). Recent reviews report a lack of evidence for significant bleeding risk with fish oil consumption (239; 41; 311).
  • Antidepressant agentsAntidepressant agents: In human research, addition of omega-3 fatty acids to sertraline treatment did not increase the antidepressant effects of this agent (312).
  • Antidiabetic agentsAntidiabetic agents: 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 statistically significant long-term effects of fish oil in patients with diabetes, including no changes in hemoglobin A1c levels (64; 65). 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 (66; 67). The effects of fish oil with antidiabetic agents are not well understood. Selected abstracts from the British Dietetic Association Conference in 2008 on the impact of fish oil supplements on insulin sensitivity have been published (313). Further details are lacking.
  • AntiestrogensAntiestrogens: Laboratory evidence indicates a decreased estrogen receptor production with fish oil supplementation (79).
  • AntihypertensivesAntihypertensives: Multiple human trials report small reductions in blood pressure with intake of omega-3 fatty acids (68; 69; 70; 71; 72; 73; 74; 314; 315). Reductions of 2-5mmHg have been observed, and effects appear to be dose responsive (higher doses have greater effects) (69). DHA may have greater effects than EPA (316). Theoretically, concurrent use of fish oil with antihypertensive agents may cause additive blood pressure lowering.
  • Anti-inflammatoriesAnti-inflammatories: Reduction of inflammation has been observed in various animal models (317; 318; 319; 320; 321; 322; 323) and in humans (324). The effects of fish oil with anti-inflammatory agents are not well understood.
  • AntilipemicsAntilipemics: In animal and human models, omega-3 fatty acids lowered triglyceride levels (325; 326), but may actually increase (worsen) low-density lipoprotein (LDL; "bad cholesterol") levels by a small amount (75). In human research, addition of omega-3 fatty acids to simvastatin increased LDL cholesterol levels; however, this increase was confined predominantly to those with low LDL cholesterol levels (327). Addition of simvastatin and omega-3 fatty acids had greater beneficial effects on plasma lipids over simvastatin alone (328; 243). In atorvastatin-treated patients, reduced non-high-density lipoprotein (HDL) cholesterol levels over atorvastatin alone (329). Total cholesterol, triglyceride, and very-low-density lipoprotein cholesterol levels were reduced, and HDL cholesterol levels increased, to a significantly greater extent than placebo plus atorvastatin. In rosuvastatin-treated patients, omega-3 improved endothelial-dependent vasodilation (330). Addition of the omega-3 fatty acids also further improved the lipid profile. The addition of EPA to statins increased the prevention of primary and secondary major coronary events (331).
  • AntineoplasticsAntineoplastics: Epidemiologic evidence suggests that fish oil may reduce the risk of developing breast, colon, or prostate cancer (332; 333; 334; 335; 336; 337; 338). The effects of fish oil with antineoplastic agents are not well understood.
  • AntipsychoticsAntipsychotics: Preliminary evidence suggests that some psychiatric conditions, including depression and hyperactivity, are associated with low EPA and DHA levels (339) ((340; 341; 342; 343; 344; 345; 346), and fish oil has been demonstrated to be beneficial in reducing symptoms of bipolar disorder in humans (92). In patients taking clozapine, omaga-3 fatty acids reduced triglyceride levels; total and LDL cholesterol levels increased (75).
  • AntiretroviralsAntiretrovirals: In patients on antiretroviral therapy, omega-3 fatty acids reduced triglyceride levels (101; 347). The potential effects of different doses of omega-3 polyunsaturated fatty acids on hypertriglyceridemia, compared with fibrates, in patients with HIV on combination antiretroviral therapy has also been discussed (348). Further details are lacking at this time.
  • DexamethasoneDexamethasone: In humans treated with omega-3 fatty acids, area under the curve of plasma insulin response was reduced following induction of insulin resistance by dexamethasone (349).
  • HepatotoxinsHepatotoxins: Mild elevations in liver function tests (alanine aminotransferase) have been reported rarely (84). Theoretically, concurrent use of omega-3 fatty acids with hepatotoxic agents may increase the risk of liver damage.
  • Hormonal agentsHormonal agents: Clinical evidence suggests that dietary supplementation with polyunsaturated fatty acids increases the efficacy of antiandrogen therapy in the treatment of prostate cancer (283). There is laboratory evidence of decreased estrogen receptor production with fish oil supplementation (79).
  • ImmunosuppressantsImmunosuppressants: In renal transplant patients, fish oil did not significantly alter immunosuppressant drug toxicity (specifically calcineurin inhibitor toxicity) (350).
  • PaclitaxelPaclitaxel: The maximum tolerated dose, dose-limiting toxicity (DLT), and pharmacokinetics of weekly DHA-paclitaxel (taxane fatty acid conjugate) were determined (351). The use of DHA allowed for the slow release of paclitaxel.

Omega-3/Herb/Supplement Interactions:
  • AntiandrogensAntiandrogens: Clinical evidence suggests that dietary supplementation with polyunsaturated fatty acids increases the efficacy of antiandrogen therapy in the treatment of prostate cancer (283).
  • AntiarrhythmicsAntiarrhythmics: There is conflicting clinical evidence regarding the antiarrhythmic effects of fish oil (284; 285; 286; 96). EPA may block fast voltage-dependent sodium channels via specific binding, which results in prolongation of the inactivated states of these channels (287; 288). Fish oil may have a protective against arrhythmias; however, the exact mechanism is not understood nor are its effects with antiarrhythmic agents.
  • AntiarthriticsAntiarthritics: According to clinical evidence of its efficacy in the treatment of arthritis (289; 290; 176; 178; 175; 174; 166; 291; 177; 292; 173; 172; 170; 169; 167; 192), fish oil may theoretically act synergistically with other antiarthritic agents.
  • AntiasthmaticsAntiasthmatics: There is conflicting evidence regarding the effect of fish oil on asthma (293; 90; 294; 295; 296; 297; 298; 194; 299; 300; 301; 302; 303). However, exacerbation of asthma has been reported (82; 118).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: There are case reports of increased bleeding and elevated international normalized ratios (INR) in patients taking warfarin with fish oil (62; 63). Diets containing salmon oil, mackerel, or cod liver oil have been reported to prolong bleeding times in healthy volunteers (235; 304; 305; 306; 307). This effect may be due to fish oil-induced suppression of thromboxane A2 synthesis or higher prostacyclin I3 levels. However, there is clinical evidence that suggests fish oil does not affect coagulation, even when taken with anticoagulant or antiplatelet agents like aspirin (310; 238). Recent reviews report a lack of evidence for significant bleeding risk with fish oil consumption (239; 41; 311).
  • Antidepressant agentsAntidepressant agents: In human research, addition of omega-3 fatty acids to sertraline treatment did not increase the antidepressant effects of this agent (312).
  • AntiestrogensAntiestrogens: Laboratory evidence indicates decreased estrogen receptor production with fish oil supplementation (79).
  • Anti-inflammatoriesAnti-inflammatories: Reduction of inflammation has been observed in various animal models (317; 318; 319; 320; 321; 322; 323) and in humans (324). The effects of fish oil with anti-inflammatory agents are not well understood.
  • AntilipemicsAntilipemics: In animal and human models, omega-3 fatty acids lowered triglyceride levels (325; 326) but may actually increase (worsen) low-density lipoprotein (LDL; "bad cholesterol") levels by a small amount (75). Theoretically, concurrent use of fish oil with triglyceride-lowering agents may cause additive triglyceride lowering. Caution is warranted, however, because omega-3 fatty acids may antagonize the effects of LDL-lowering agents.
  • AntineoplasticsAntineoplastics: Epidemiologic evidence suggests that fish oil may reduce the risk of developing breast, colon, or prostate cancer (332; 333; 334; 335; 336; 337; 338). The effects of fish oil with antineoplastic agents are not well understood.
  • AntioxidantsAntioxidants: In human research, a combination of EPA, gamma-linolenic acid (GLA), and antioxidants improved respiratory symptoms and decreased mortality in septic patients (352). In fish oil-supplemented mothers, antioxidant status did not decrease (282). In humans exposed to particulate matter, supplementation with fish oil increased Cu/Zn superoxide dismutase activity and glutathione levels (8). In vitro, DHA decreased oxidative stress in human fibroblasts (353). GSH content was increased and was associated with elevated catalytic activities of gamma-glutamyl-cysteinyl ligase, glutathione reductase, and glutathione S-transferase.
  • AntipsychoticsAntipsychotics: Preliminary evidence suggests that some psychiatric conditions, including depression and hyperactivity, are associated with low EPA and DHA levels (339; 340; 341; 342; 343; 344; 345; 346), and fish oil has been demonstrated to be beneficial in reducing symptoms of bipolar disorder in humans (92). The effects of fish oil with antipsychotic agents are not well understood.
  • Conjugated linoleic acidConjugated linoleic acid: In human research, supplementation with CLA plus long-chain omega-3 fatty acids prevented increased abdominal fat mass and raised fat-free mass and adiponectin levels in younger obese individuals; insulin sensitivity was not negatively affected (354). In older obese men, the combination of omega-3 fatty acids and CLA increased fasting glucose (354). In human research, CLA had no effect on DHA status, suggesting that it did not increase synthesis of DHA from alpha-linolenic acid (355). In intestinal cells in vitro, conversion of trans-vaccenic acid to CLA was affected by EPA (356).
  • Evening primrose oilEvening primrose oil: In pregnant women, a combination of fish oil and evening primrose oil increased plasma gamma-linolenic acid (GLA), dihomo (D)-GLA, and DHA levels, without having a negative effect of arachidonic acid (357).
  • Fat-soluble vitaminsFat-soluble vitamins: Fish liver oil contains the fat-soluble vitamins A and D, and therefore, fish liver oil products (such as cod liver oil) may theoretically increase the risk of vitamin A or D toxicity. Fever was reported in a clinical trial (225). Vitamin D absorption from fish oil capsules vs. multivitamins was examined; no differences were noted (358). The effect of fish oil on vitamin D absorption has been examined (359). Further details are lacking at this time.
  • FolateFolate: A combination of methyltetrahydrofolic acid and fish oil further increased fetal omega-3 status and attenuated depletion of maternal stores over fish oil alone in pregnant women (252). In human research, a combination of fish oil and 5-methyltetrahydrofolate (5-MTHF), during the second half of pregnancy, increased the level of proliferation cell nuclear antigen (PCNA) vs. placebo (360).
  • Gamma-linolenic acidGamma-linolenic acid: In human research, a combination of EPA, GLA, and antioxidants improved respiratory symptoms and decreased mortality in septic patients (352). According to a clinical trial, in patients with acute lung injury, a diet enriched with a combination of EPA and GLA was helpful for gas exchange, respiratory dynamics, and requirements for mechanical ventilation (361).
  • GlucosamineGlucosamine: In human research, a combination of omega-3 fatty acids and glucosamine was more beneficial than glucosamine alone for symptoms of osteoarthritis (362).
  • HepatotoxinsHepatotoxins: Mild elevations in liver function tests (alanine aminotransferase) have been reported rarely (84). Theoretically, concurrent use of omega-3 fatty acids with hepatotoxic agents may increase the risk of liver damage.
  • Hormonal herbs and supplementsHormonal herbs and supplements: Clinical evidence suggests that dietary supplementation with polyunsaturated fatty acids increases the efficacy of antiandrogen therapy in the treatment of prostate cancer (283). There is laboratory evidence of decreased estrogen receptor production with fish oil supplementation (79).
  • HypoglycemicsHypoglycemics: 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 (64; 65). 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 (66; 67). The effects of fish oil with antidiabetic agents are not well understood.
  • HypotensivesHypotensives: According to human studies, omega-3 fatty acids may lower blood pressure (314; 315).
  • LycopeneLycopene: In vitro, lycopene and EPA synergistically inhibited the growth of human colon cancer HT-29 cells (363).
  • ImmunosuppressantsImmunosuppressants: In renal transplant patients, fish oil did not significantly alter immunosuppressant drug toxicity (specifically calcineurin inhibitor toxicity) (350).
  • Medium-chain triglyceridesMedium-chain triglycerides: In patients with severe hypertriglyceridemia, a formula containing omega-3 fatty acid medium-chain triglycerides resulted in a decrease in plasma triglycerides and cholesterol, and a slight reduction in glucose and uric acid (364). In men, following a bolus injection of 80% medium-chain triglycerides and 20% fish oil, omega-3 fatty acids increased in leukocytes and platelets within 60 minutes (365).
  • PhosphatidylserinePhosphatidylserine: In a group of nondemented elderly with memory complaints, a novel preparation of phosphatidylserine with DHA attached improved cognitive performance vs. placebo (366).
  • PhytosterolsPhytosterols: The combination of omega-3 fatty acids with phytosterols for decreased cardiovascular disease risk was the topic of a review (367). The authors discussed recent evidence suggesting that the combination of phytosterols and omega-3 fatty acids may reduce cardiovascular risk in a complementary and synergistic way. In human research in persons fed an olive oil-based diet, a supplement containing fish oil fatty acid esters of plant sterols reduced triglyceride levels more than sunflower oil esters of plant sterols (368).
  • PolicosanolPolicosanol: The effects of a combination treatment with policosanol and omega-3 fatty acids on platelet aggregation have been studied in a randomized, double-blind clinical study (369). Further details are lacking.
  • SeleniumSelenium: In humans, plasma selenium was positively correlated with fish consumption and omega-3 polyunsaturated fatty acids in red blood cells polyunsaturated fatty acids (PUFAs) (370).

Omega-3/Food interactions:
  • GeneralGeneral: The U.S. Food and Drug Administration (FDA) has ruled that the use of EPA and DHA, the primary omega-3 fatty acids found in fish, as dietary supplements is safe and lawful provided that daily intakes of EPA and DHA omega-3 fatty acids do not exceed 3g per person from conventional food and dietary supplement sources.
  • EggsEggs: In healthy volunteers, omega-3-enriched eggs (two eggs daily for six weeks) decreased triglyceride levels, as well as insulin and C-reactive protein (371).
  • Ketogenic dietKetogenic diet: In animal research, an unrestricted ketogenic diet enriched with omega-3 fatty acids and medium-chain triglycerides delayed tumor growth (372).
  • MilkMilk: In patients with metabolic syndrome, milk enriched with omega-3 and oleic acid fatty acids, folic acid, and vitamin E, resulted in a reduction in serum triglycerides, as well as total and LDL cholesterol (373).
  • Olive oilOlive oil: The addition of olive oil to patients supplemented with fish oil increased the beneficial effects of fish oil on rheumatoid arthritis symptoms (374).
  • ProteinProtein: In cancer patients, a protein- and energy-dense EPA-containing nutritional supplement resulted in reduced weight loss and increased remission rate when compared with patients not receiving this supplement (375).

Omega-3/Lab interactions:
  • Adrenocorticotropic hormone (ACTH)Adrenocorticotropic hormone (ACTH): In human research, fish oil blunted ACTH levels in healthy humans submitted to intravenous lipopolysaccharide (376).
  • AlbuminAlbumin: Decreased plasma albumin occurred in patients receiving omega-3 fatty acid supplementation (140).
  • Alpha tocopherolAlpha tocopherol: In human research, omega-3 fatty acids increased alpha-tocopherol levels (189).
  • Alzheimer's disease markersAlzheimer's disease markers: In patients with Alzheimer's disease, dietary omega-3 fatty acids did not influence the AD markers tau-protein, hyperphosphorylated tau-protein, and beta-amyloid (Abeta(1-42)) in cerebrospinal fluid (377).
  • Antioxidant statusAntioxidant status: In humans exposed to particulate matter, supplementation with fish oil increased Cu/Zn superoxide dismutase activity and glutathione levels (8).
  • Beta-hydroxybutyrateBeta-hydroxybutyrate: In healthy subjects, EPA decreased postprandial beta-hydroxybutyrate responses (378).
  • Blood pressureBlood pressure: According to human studies, omega-3 fatty acids may lower blood pressure (314; 315; 128).
  • C-reactive protein (CRP) levelsC-reactive protein (CRP) levels: The data on fish oils and CRP are mixed (379; 380; 381; 102; 382). While omega-3 fatty acids from both plants (ALA) and fish (EPA + DHA) have been shown to reduce CRP in some studies, others have failed to show an effect.
  • CatecholaminesCatecholamines: In human research, fish oil blunted norepinephrine levels in healthy humans submitted to intravenous lipopolysaccharide (376). In human research, omega-3 fatty acids decreased plasma norepinephrine (383).
  • Coagulation panelCoagulation panel: There are case reports of increased bleeding and elevated international normalized ratios (INR) in patients taking warfarin with fish oil (62; 63). Diets containing salmon oil, mackerel, or cod liver oil have been reported to prolong bleeding times in healthy volunteers (235; 304; 305; 306; 307). This effect may be due to fish oil-induced suppression of thromboxane A2 synthesis or higher prostacyclin I3 levels. In human research, oil from Schizochytrium spp. (high in omega-3 DHA and omega-6 DPA) increased factor VII coagulant activity (216). In human research, omega-3 consumption decreased platelet aggregation ex vivo (384).
  • CortisolCortisol: In human research, fish oil blunted plasma cortisol levels in healthy humans submitted to intravenous lipopolysaccharide (376).
  • CreatineCreatine: In human research, omega-3 fatty acids consumption resulted in reduced serum creatine levels (103).
  • CytokinesCytokines: In Alzheimer's disease patients, fish oil rich in DHA reduced interleukin (IL)-6, IL-1beta, and granulocyte colony-stimulating factor secretion after stimulation of peripheral blood mononuclear cells with lipopolysaccharide (385). Tumor necrosis factor-alpha, IL-8, IL-10, and granulocyte-macrophage colony-stimulating factor secretion were not affected. Decreased cytokines have been shown in other studies (386). However, multiple studies have found a lack of effect of omega-3 fatty acids on inflammatory cytokines has been shown in other human studies (102; 377; 387).
  • Glucose, insulin, and hemoglobin A1cGlucose, insulin, and hemoglobin A1c: 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 (HbA1c) levels (64; 65). In healthy volunteers, diets rich in alpha-linolenic acid, EPA, or DHA did not significantly affect blood concentrations of glucose, insulin, fructosamine, or HbA1c (388). 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 (66; 67).
  • Heart rateHeart rate: In human research, habitual consumption of tuna or other fish and marine omega-3 is associated with specific heart rate variability components in older adults, including indices of vagal activity, baroreceptor responses, and sinoatrial node function (389). In human research, fish oil/omega-3 fatty acids decreased heart rate (390; 391; 5).
  • Intercellular adhesion molecule-1 (ICAM-1)Intercellular adhesion molecule-1 (ICAM-1): In hemodialysis patients, omega-3 fatty acids resulted in a decrease in serum sICAM-1 (102).
  • LeukotrienesLeukotrienes: In human research, omega-3 fatty acids increased synthesis of leukotriene B5 and suppression of leukotriene B4 synthesis by ionophore-stimulated neutrophils (82; 392). In healthy subjects, DHA increased the leukotriene B5:leukotriene B4 ratio (393).
  • Lipid profileLipid profile: In animal and human models, omega-3 fatty acids lowered triglyceride levels (325; 326) but may actually increase (worsen) low-density lipoprotein (LDL; "bad cholesterol") levels by a small amount (75; 216). In human research, addition of omega-3 fatty acids to simvastatin increased LDL cholesterol levels; however, this increase was confined predominantly to those with low LDL cholesterol levels (327). In patients with metabolic syndrome, purified EPA decreased small, dense LDL cholesterol and remnant lipoprotein particles (382). In hypertriglyceridemic men, DHA decreased levels of triglyceride as well as small, dense LDL particles (138). In healthy men, fish oil in a single meal increased very-low-density lipoprotein (VLDL) concentration but reduced VLDL particle size vs. a reference meal (394). In healthy Japanese subjects with a high basal level of fish consumption, fish oil supplementation did not decrease plasma triglyceride, total cholesterol, LDL cholesterol, or whole-blood viscosity, and there were no changes in the fatty acid composition of plasma and erythrocyte phospholipids (395). In children with hyperlipidemia following a low-fat diet, DHA increased LDL subclass 1 and HDL subclass 2 (large and buoyant; less atherogenic particles) and decreased LDL subclass 3 (small and dense; more atherogenic particles) (396). In hypertriglyceridemic men, DHA decreased fasting plasma remnant-like particle-cholesterol (RLP-C) and improved the red blood cell omega-3 index, novel risk factors for cardiovascular disease (397).
  • Liver function testsLiver function tests: Mild elevations in liver function tests (alanine aminotransferase) have been reported rarely (84). A parenteral lipid emulsion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil decreased liver enzymes (aspartate aminotransferase, alanine-aminotransferase, and alpha-glutathione S-transferase) vs. the control emulsion in postoperative patients (398).
  • Red blood cell omega-3 indexRed blood cell omega-3 index: In hypertriglyceridemic men, DHA decreased fasting plasma remnant-like particle-cholesterol (RLP-C) and improved the red blood cell omega-3 index, novel risk factors for cardiovascular disease (397).
  • SeleniumSelenium: In humans, plasma selenium was positively correlated with fish consumption and omega-3 polyunsaturated fatty acids in red blood cells PUFAs (370).
  • ThrombomodulinThrombomodulin: In human research, omega-3 fatty acids decreased thrombomodulin levels (399).
  • White blood cellsWhite blood cells: In healthy subjects, postoperative patients, and HIV patients, DHA increased the leukotriene B5:leukotriene B4 ratio (393; 101; 189).

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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