Pure NKO by Pure Prescriptions

POSSIBLY EFFECTIVE

• Dry eye. Taking oral krill oil seems to reduce dry eye symptoms. Details: Clinical research shows that taking krill oil (Nutra-Life OceanClean red krill oil) providing eicosapentaenoic acid (EPA) 945 mg and docosahexaenoic acid (DHA) 510 mg daily for 90 days improves overall symptoms of dry eye disease by 77% when compared with placebo. Taking krill oil also appears to improve tear film stability and eye redness (96114).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. Oral krill oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking capsules containing krill oil, zinc, vitamin D, sea buckthorn berry oil, cacao bean extract, hyaluronic acid, and red clover isoflavones (GliSODin Skin Nutrients Advanced Anti-Aging Formula, Isocell North America Inc.) 780 mg three times daily along with applying tazarotene cream 0.1% nightly for about 12 weeks improves fine wrinkles, overall sun damage, skin moisture, and skin elasticity when compared with tazarotene cream alone. It is not clear if these benefits are due to krill oil, other ingredients, or the combination (91778).
• Alzheimer disease. Although there has been interest in using oral krill oil for Alzheimer disease, there is insufficient reliable information about the clinical effects of krill oil for this condition.
• Cancer. Although there has been interest in using oral krill oil for cancer prevention, there is insufficient reliable information about the clinical effects of krill oil for this condition.
• Cardiovascular disease (CVD). Although there has been interest in using oral krill oil for CVD, there is insufficient reliable information about the clinical effects of krill oil for this condition.
• Cognitive function. It is unclear if oral krill oil is beneficial for improving cognitive function in children. Details: A clinical trial shows that taking krill oil 4 grams daily, providing eicosapentaenoic acid (EPA) 520 mg and docosahexaenoic acid (DHA) 280 mg, usually for 12 months does not improve measures of cognitive function compared with placebo in school children (110372,110374). Some of the children took krill oil 2 grams daily for 3 months before changing to 4 grams for the remaining 9 months. In addition, despite the relatively large number of children included in the study, conclusions are limited due to high drop-out and low adherence rates. The effect of krill oil on cognitive function in adults is not clear.
• Depression. It is unclear if oral krill oil is beneficial for depression in adolescents. Details: In adolescents with depressive feelings, preliminary clinical research shows that taking 4 capsules daily of krill oil for 3 months, and then 8 capsules daily for another 9 months, does not reduce self-reported depressive feelings or improve self-esteem when compared with placebo (104571). However, compliance was low. The krill oil product used provided eicosapentaenoic acid 65 mg and docosahexaenoic acid 35 mg per capsule. The effect of krill oil on clinical depression or in adults with depression is not clear.
• Diabetes. It is unclear if oral krill oil is beneficial for glycemic control. Details: In patients with type 2 diabetes, preliminary clinical research shows that taking two krill oil capsules daily providing omega-3 fatty acids 1000 mg for 4-21 weeks does not improve most glycemic indices when compared to olive oil. However, there was a small improvement in levels of high-density lipoprotein (HDL) cholesterol after 21 weeks (104572). Most patients in this study were also using oral hypoglycemic drugs.
• Dysmenorrhea. It is unclear if oral krill oil is beneficial for reducing pain or analgesic use. Details: Preliminary clinical research shows that taking a specific krill oil product (Neptune Krill Oil, Neptune Technologies & Bioresources, Inc.) 2 grams daily reduces the need for analgesics in females with dysmenorrhea by up to 50% from baseline (15754). The validity of this finding is limited by the lack of a control group.
• Exercise-induced muscle damage. It is unclear if oral krill oil is beneficial for reducing exercise-induced muscle damage. Details: A small clinical trial in resistance-trained males shows that taking krill oil 3 grams daily for 3 days before a bout of muscle-damaging resistance exercise modestly reduces levels of serum creatine kinase 24 and 48 hours later compared with taking placebo. There were also modest improvements in agility in the first 24 hours and muscle strength over 72 hours. The krill oil provided eicosapentaenoic acid (EPA) 360 mg and docosahexaenoic acid (DHA) 210 mg daily, as well as 2590 mcg daily astaxanthin. There were no effects of taking krill oil on levels of lactate dehydrogenase or on recovery for sprint time (110373). Preliminary clinical research in untrained males shows that taking a specific blend of krill oil and New Zealand green-lipped mussel lipid extract (ESPO-572, Pharmalink), at a dosage of 200 mg daily for 30 days, starting 26 days before a downhill run and following 72 hours post-exercise, reduces plasma creatine kinase and tumor necrosis factor-alpha levels, and improves joint range of motion, when compared with placebo. However, this combination was similarly effective to a lipid extract of New Zealand green-lipped mussel (PCSO-524; Pharmalink), suggesting that any benefits may be due to New Zealand green-lipped mussel, as opposed to krill oil (105509).
• Hyperlipidemia. Evidence for the use of oral krill oil for hyperlipidemia is conflicting. Details: A meta-analysis of clinical research shows that taking krill oil reduces levels of low-density lipoprotein (LDL) cholesterol by about 16 mg/dL in patients with hypercholesterolemia, hypertriglyceridemia, or normal lipid levels (96162). However, a sensitivity analysis reveals that this benefit is related to the inclusion of a single preliminary clinical trial. This trial shows that taking a specific krill oil product (Neptune Krill Oil, Neptune Technologies & Bioresources, Inc.) 1-3 grams daily for 12 weeks reduces LDL cholesterol, total cholesterol, and triglycerides, and increases high-density lipoprotein (HDL) cholesterol, when compared with both fish oil and placebo in patients with hyperlipidemia (15753). When this study was removed from the meta-analysis, krill oil showed no significant benefit on LDL cholesterol levels (96162). However, the available clinical research has involved a range of doses, durations, and populations (15753,19374,96162). Another meta-analysis of clinical research in healthy volunteers or people with dyslipidemia, diabetes, metabolic syndrome, or cardiovascular disease shows that krill oil and fish oil similarly lower LDL cholesterol, total cholesterol, and triglycerides, and increase HDL cholesterol (104110).
• Hypertension. Although there has been interest in using oral krill oil for hypertension, there is insufficient reliable information about the clinical effects of krill oil for this condition.
• Hypertriglyceridemia. It is unclear if oral krill oil is beneficial for hypertriglyceridemia. Details: A meta-analysis of clinical research shows that taking krill oil reduces triglyceride levels by about 14 mg/dL in patients with hypercholesterolemia, hypertriglyceridemia, or normal lipid levels (96162). Another meta-analysis of two randomized, controlled trials in patients with severe hypertriglyceridemia shows that taking krill oil 4 grams daily for 12 weeks reduces triglyceride levels by 26%, compared with a 15% reduction in the placebo group (107474). Also, a small clinical study in patients with hypertriglyceridemia shows that taking a specific krill oil product (Superba Krill Oil, Aker BioMarine ASA) 0.5-4 grams in two divided doses daily for 12 weeks lowers triglyceride levels by 10% when compared with baseline. The effect does not appear to be dose-dependent, and there is significant variability in the triglyceride level changes. Krill oil did not affect levels of total, LDL, or HDL cholesterol (91600).
• Obesity. It is unclear if oral krill oil is beneficial for weight loss. Details: A small clinical trial in females with a body mass index (BMI) over 25 kg/m2 shows that taking krill oil (Pholias, Anapolis, Goias) 1.5 grams twice daily for 8 weeks, providing eicosapentaenoic acid (EPA) 500 mg daily, does not affect anthropometric measures, including waist and abdominal circumference and BMI, compared with placebo (110371).
• Osteoarthritis. It is unclear if oral krill oil is beneficial for osteoarthritis. Details: Clinical research in patients with knee osteoarthritis shows that taking krill oil (Superba BOOST, Aker BioMarine) 4 grams daily for 6 months, providing eicosapentaenoic acid (EPA) 0.6 grams, docosahexaenoic acid (DHA) 0.28 grams, and astaxanthin 0.45 mg daily, modestly improves knee pain, stiffness, and function, compared with taking placebo. However, it is unclear if any benefits are clinically significant and there was no effect on the estimated use of NSAIDs (110370). Also, preliminary clinical research shows that among patients with cardiovascular disease and either rheumatoid arthritis or osteoarthritis, taking a specific krill oil product (Neptune Krill Oil, Neptune Technologies & Bioresources, Inc.) 300 mg daily for 30 days improves pain by 38%, stiffness by 39%, and functionality by 36% when compared with baseline. These improvements are significantly greater than those seen with placebo (15760). The effects of krill oil specifically in patients with osteoarthritis is unclear from this study.
• Parkinson disease. Although there has been interest in using oral krill oil for Parkinson disease, there is insufficient reliable information about the clinical effects of krill oil for this condition.
• Premenstrual syndrome (PMS). It is unclear if oral krill oil is beneficial for reducing symptoms of PMS. Details: Preliminary clinical research shows that taking a specific krill oil product (Neptune Krill Oil, Neptune Technologies & Bioresources, Inc.) 2 grams daily reduces self-reported symptoms of PMS (15754). However, the validity of these findings is limited by concerns with the study methodology. Other preliminary clinical research shows that taking a specific combination product containing krill oil 350 mg, thiamine 1.4 mg, riboflavin 1.6 mg, vitamin B6 2 mg, soy isoflavones 50 mg, and rosemary extract 50 mg (Cleanmarine for Women, Novabrands Ltd. Co) two capsules daily for 3 months reduces anxiety, mood swings, breast tenderness, food cravings, bloating, skin outbreaks, forgetfulness, fatigue and insomnia, and headaches when compared with baseline. However, it is unclear if these improvements are due to krill oil, other ingredients, or the combination, and the validity of these findings is limited by the lack of a comparator group (91604).
• Rheumatoid arthritis (RA). It is unclear if oral krill oil is beneficial for RA. Details: Preliminary clinical research shows that among patients with cardiovascular disease and either rheumatoid arthritis or osteoarthritis, taking a specific krill oil product (Neptune Krill Oil, Neptune Technologies & Bioresources, Inc.) 300 mg daily for 30 days improves pain by 38%, stiffness by 39%, and functionality by 36% when compared with baseline. These improvements are significantly greater than those seen with placebo (15760).
• Sarcopenia. It is unclear if oral krill oil is beneficial for improving muscle loss or strength in older adults. Details: Clinical research in inactive adults over age 65 years shows that taking krill oil (Superba BOOST, Aker BioMarine) 2 grams twice daily, providing eicosapentaenoic acid (EPA) 772 mg, docosahexaenoic acid (DHA) 384 mg, and choline 316 mg, for 6 months modestly increases knee and grip strength, and muscle thickness, compared with taking placebo. Knee and grip strength increased by 7.1% and 8.8%, respectively, over baseline. Both improvements were statistically significant compared with placebo. However, there was no effect on general physical performance (110369).
• Stroke. Although there has been interest in using oral krill oil for stroke, there is insufficient reliable information about the clinical effects of krill oil for this condition. More evidence is needed to rate krill oil for these uses.

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POSSIBLY SAFE ...when used orally and appropriately, short-term. Krill oil has been used safely at doses of up to 4 grams daily in clinical trials lasting for up to 6 months (15753,15754,15760,19374,91600,96114,96162,107474,110370).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately (110372,110374). In children 14 years of age, krill oil 4 grams daily, providing doses of eicosapentaenoic acid (EPA) 520 mg and docosahexaenoic acid (DHA) 280 mg daily, has been used with apparent safety for up to 12 months (110372,110374).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, krill oil may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.  Details Taking high doses of omega-3 fatty acids from fish oil can modestly decrease platelet aggregation (8671,8679,8696,19375). Since krill oil also contains these fatty acids, taking high doses of krill oil might also inhibit platelet aggregation. Theoretically, taking high doses of krill oil with antiplatelet or anticoagulant drugs might increase the risk of bleeding. However, the omega-3 content of krill oil is much lower than that of fish oil.

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, taking krill oil with antidiabetes drugs might increase the risk of hypoglycemia.  Details Some research in animals and humans shows that krill oil might lower blood glucose levels (15753,19376). However, a small study shows that taking krill oil does not reduce blood glucose levels in patients with type 2 diabetes, most of whom were taking antidiabetes drugs (104572).

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General ...Orally, krill oil seems to be well tolerated when used in doses up to 4 grams daily.
Most Common Adverse Effects:
Orally: Bloating, decreased appetite, diarrhea, fishy burps, flatulence, heartburn, nausea, and stomach discomfort.

Cardiovascular ...Orally, krill oil may cause hypertension, but this effect has only been observed for one patient in one clinical trial (91600).

Dermatologic ...Orally, krill oil may cause minor facial skin rash, skin oiliness, or localized pimples (15754,91599,110372,110374).

Gastrointestinal ...Orally, krill oil may cause gastrointestinal side effects including stomach discomfort or upset, decreased appetite, taste change, heartburn, fishy burps, bloating, flatulence, diarrhea, vomiting, and nausea (57836,91599,91600,110372,110374). However, these effects seem to be less severe or occur less often with krill oil compared to fish oil (15754).

Neurologic/CNS ...When taken orally, headache, tiredness, and dizziness have been reported rarely in clinical research (110372,110374).

Pulmonary/Respiratory ...When taken orally, sore throat has been reported rarely in clinical research (110372,110374).

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