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Evening primrose oil (EPO) is a dietary supplement that contains essential fatty acids such as omega-3 and omega-6 and has been investigated in-depth for its effectiveness for conditions that are associated with a deficiency in essential fatty acids. It has a good safety profile with mild side effects and rare serious adverse events. It should not be taken during pregnancy, prior to surgery, in patients at risk for seizures. There have been no reports of toxic ingestion, mortality, or teratogenicity with Evening primrose oil supplementation, and usage during lactation is presumed to be safe. The evening primrose can be found in North America east of the Rocky Mountains, and was naturalized into Europe and Asia from North America in the early 17th century. The entire plant can be eaten such as it'roots, leaves, flowers, buds, seedpods); leaves are cooked and eaten like spinach and the roots are boiled and taste sweet. Evening primrose was a staple food for many Native American tribes and a famine food for Chinese farmers. European settlers and Native Americans used the whole plant to ameliorate ailments such as bruising, stomachaches, and shortness of breath. Evening primrose oil is derived from the plant's small, dark seeds. China is now the major grower of evening primrose seed in the world, supplying an estimated 90% of the world's crop. A total of approx 400 ton of seeds are processed each year in the United States and Canada. One major supplier of this supple derives the oil from specially selected and hybridized forms of Oenothera species. Today, the oil is used medicinally to treat a myriad of conditions related to essential fatty acid (EFA) deficiencies, low dietary intake of linoleic acid, and a variety of reproductive, cardiovascular, inflammatory, and neurological disorders. It is added to foods as a source of essential fatty acids and used in topical products such as soaps and cosmetics. Clinical evidence of nutritional supplementation with it to correct dermal conditions is mixed. One theory for the mixed results is that in some persons, once sensitized, immunological factors may override what help it can offer. Very high doses of Evening primrose oil or linoleic acid, with corresponding correction of plasma EFA levels, produce some clinical improvement. Results showed that arachidonic acid were consistently and significantly lower in children who later had atopic eczema. Some studies have shown that evening primrose oil administration can improve the percentage of body surface involvement, itch, dryness, scaling, and inflammation associated with atopic eczema. A meta-analysis of nine controlled trials involving EPO in the treatment of atopic eczema showed a highly significant improvement in the symptom of itch over placebo. In 1993, Berth-Jones conducted a randomized, double-blind, parallel-group designed study to investigate whether supplementation with it alone or a combination of Evening primrose oil and fish oil helped with clinical symptoms of atopic dermatitis. A total of 133 patients (adults and children were evenly distributed) with chronic hand dermatitis enrolled and were randomized to

receive either Epogam® (per 500 mg capsule), Efamol Marine (per 430 mg capsule of Evening primrose oil/fish oil), or placebo (paraffin/ olive oil). No improvement with was found. In 1996, Whitaker et al. conducted a clinical trial to test if this supplementation affected the changes in lamellar bodies and lipid layers of the stratum corneum in patients with chronic (longer than 12 months) hand dermatitis. This parallel, double-blind, placebo-controlled trial had 39 patients with chronic hand dermatitis or eczema and 10 age- and sex-matched healthy controls for statistical comparison. Treatment lasted for 16 weeks, with the active group taking Evening primrose oil (twelve 500-mg Epogam capsules daily for a total dose of 600 mg linolenic acid) and the placebo group taking placebo (twelve 500-mg sunflower capsules daily), after which there was an 8-week washout period. Although the improved in the clinical impressions of dermatitis, there was no statistical difference between groups and no structural change in skin specimens was seen. Evening primrose oil is regulated as a dietary supplement in the United States. It is approved in Canada as an over-the-counter product for use in EFA-deficiency conditions and as a dietary supplement to increase EFA intake. In the United Kingdom, it is on the General Sales List. In Germany, it is approved for use as food and is approved there in the treatment and symptomatic relief of atopic eczema. The German Commission E has not approved the use of evening primrose oil for any condition at this time. It is possibly effective for essential fatty acid deficiency and breast pain, and for rheumatoid arthritis after 6 months of treatment. Efficacy of this supplement has not been clearly established for the following: atopic eczema, premenstrual syndrome, hot flashes, night sweats, shortening duration of labor, attention-deficit disorder, hyperactivity disorder, and chronic fatigue syndrome. In Sweden, It is classified as a natural product. It has a Class 1 Safety Rating with the American Herbal Product Association.

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