How do I know that Metagenics marine oil is high quality?
Metagenics unconditionally guarantees the quality and purity of our concentrated EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) formulas made with marine oil. Each formula contains only the highest quality, purity-certified omega-3 fatty acids that meet or exceed label claim (milligram, not just area percent). These formulas are also enhanced with antioxidants to aid product stability.
The exceptional manufacturing and purification technology for our marine oils produces a product that exceeds the highest quality standards available for fish oil. It also exceeds the quality criteria for the Council for Responsible Nutrition's Omega-3 Monograph (the industry's current voluntary standard for purity). Our dedication to every detail and exhaustive testing includes:

• In-house and third-party (independent) testing of raw materials (marine oil) for heavy metals and other harmful contaminants
• In-house and third-party testing of EPA/DHA content of final product
• In-house testing for yeasts, molds, and harmful bacteria
• In-house testing for disintegration time and shelf stability

How do I order Metagenics nutritional products?
Metagenics formulas are only available through licensed healthcare practitioners. Patients may find a practitioner.

What is Estrovera?
Estrovera is a nutraceutical that contains a unique phytoestrogenic extract of a garden rhubarb species that has been recommended in Germany for menopausal complaints since 1993. This extract, referred to in research as ERr 731®, was introduced in 2009 to the United States and is available exclusively from Metagenics. Estrovera contains the first phytonutrient compound shown in well-designed clinical studies to offer effective hot flash reduction similar to conventional hormones therapies, but without the associated risks or other serious adverse events. Estrovera's main active ingredient has also demonstrated significant improvements in common menopausal complaints—such as poor mood, anxiety, and sleep quality—as well as additional measures of quality of life and general health and well-being.♦

How do I find a Metagenics practitioner near me?
Simply click here to locate a health care practitioner near you who offers Metagenics nutraceuticals and medical foods or to find a certified FirstLine Therapy practitioner who offers therapeutic lifestyle changes programs.

Will Estrovera relieve my menopausal hot flashes? And how does it compare to hormone therapies (HT)?
Estrovera offers fast and effective hot flash relief with only 1 tablet daily. Estrovera's active ingredient (ERr 731) is perhaps the only natural approach shown to provide consistent and significant symptom reduction comparable to conventional HT—without the associated risk of serious adverse effects. In a double-blind, placebo-controlled clinical study of perimenopausal women, ERr 731 was shown to relieve moderate and severe hot flashes after only 4 weeks (a study measurement point); the frequency and intensity of hot flashes were further decreased at 8 and 12 weeks. In another double-blind, placebo-controlled clinical study, the efficacy of ERr 731 was confirmed with a statistically significant, average reduction in hot flash frequency from 12 to 2 daily. A comparison of hot flash weekly weighted scores from this study suggests that the effectiveness of ERr 731 is comparable to that of an ultra low dose of HT.♦

Do you conduct third-party (independent) testing for verifying marine oil purity?
EVERY batch of our marine oil concentrates is assayed by one of the top independent testing labs in the world and currently the world market leader in testing for dioxins. Testing every batch of concentrated oil prior to bottling or encapsulation is highly unusual and Metagenics may be the only professional nutraceutical company to practice this added safety measure. Checks for numerous contaminants are conducted including:

• 220 pesticides
• 6 heavy metals
• 7 markers of PCBs
• 15 dioxins & furans
• 12 dioxin-like PCBs

What quality measures do you take for your softgels?
The gelatin used in our softgels is obtained from countries known to be free of bovine spongiform encephalopathy (BSE) and have programs in place to prevent its occurrence. And for enteric-coated formulas, we utilize enteric coating compliant with the United States Pharmacopeia (USP) to avoid premature dissolution in the stomach. According to USP guidelines, enteric coating must delay gastric disintegration by a minimum of one hour.

How does Estrovera compare to other natural approaches for menopausal hot flash relief?
Due to a lack of well-controlled studies for many natural approaches, including other phytoestrogens, it's difficult to make a comparison. ERr 731 appears to represent a more effective approach than soy, black cohosh, red clover, hops, and flax lignans (to name just a few) that are currently recommended for hot flash relief. Research to date suggests that ERr 731 may be the first phytoestrogen extract to transcend the placebo effect in clinical studies with menopausal women to offer a higher degree of effectiveness with minimal safety concerns for long-term use.♦

How do I contact Metagenics?
If you have questions about a specific Metagenics product or how to use it, please consult your health care practitioner. For other questions or comments, please Contact us Online.

Does Metagenics fish oil contain mercury or other contaminants?
We use fish oil from fresh, clean, deep-sea, wild-caught, cold-water fish with lower risk of contamination. In addition, our purity-certified fish oils undergo a proprietary refinement process to remove heavy metals and other environmental pollutants. An advanced molecular distillation process of every batch ensures the highest purity and batch consistency. And every batch is thoroughly tested for impurities at every step, from raw material to packaging. Our dedication to exhaustive third-party and in-house testing enable us to make the following guarantees:

• Mercury—less than 5 ppb (below detection limit)
• Lead—less than 20 ppb (below detection limit)
• Dioxins and Furans TEQ—less than 0.5 ppt
• PCBs TEQ—less than 1 ppt
• Also tested for yeasts, molds, and bacteria

Does Estrovera help mood or sleep quality?
Estrovera's phytoestrogenic extract has been clinically demonstrated to significantly improve measures of common menopausal symptoms: heart complaints (e.g., racing), sleep problems, poor mood, irritability, anxiety, physical/mental exhaustion, sexual problems, bladder problems,
vaginal dryness, and joint/muscle discomfort. It has also been shown to improve other measures of anxiety, menopause-specific quality of life, and general women's health and well-being.♦

What makes Metagenics different from most nutritional supplement companies?
A lot of things make us stand above other companies—a focus on patient health, quality manufacturing, ingredient testing, safety reviews, clinical testing, scientific research, unique formulas, and more. For specifics, check out the Quality Difference section.

What are the advantages of choosing EPA-DHA oil formulas from Metagenics?
Not all EPA-DHA oil formulas are the same. The advantages of our premium, purity-certified EPA-DHA oil formulas include:

• Third-party, purity-certified
• Natural lemon flavor
• Concentrated levels of specific omega-3s
• Custom made in Norway
• Low cost per concentrated dose

Is Estrovera use recommended for perimenopausal and postmenopausal women?
Yes. Unlike conventional hormone therapies, Estrovera's main ingredient has been demonstrated as a safer approach for perimenopausal women. The predicted safety profile for ERr 731 suggests safe use through postmenopause until symptoms dissipate.♦

Is the Metagenics marine oil pharmaceutical grade, ultra pure, and/or ultra refined?
There is no unified definition for these terms. To date, the only internationally recognized, minimal quality standards are based on the EU CRN monograph. "Pharmaceutical grade" is a marketing term often used to imply a higher standard of purity. While there are pharmaceutical grades established for some chemicals, there is no such grade for marine oils. However, our fish oils are produced in Norway and the manufacturing plant is licensed for pharmaceuticals by the Norwegian Medicines Agency, Norway's equivalent to the Food and Drug Administration. (There are only 3 pharmaceutical licensed omega-3 manufacturing facilities in the world.) Under the accepted market definitions, Metagenics offers "ultra pure" and "ultra refined" marine oil formulas that meet a higher standard of quality.

How do I take Estrovera?
Take 1 tablet daily with breakfast and a glass of water or as directed by your health care practitioner.

Do I need a stronger dose for more severe symptoms?
Because positive clinical outcomes have been seen at varying intensities of hot flashes at the 4 mg dose, higher doses are not recommended. In fact, women with greater symptomatology in clinical studies reported the greatest benefit, yet did not exceed the recommended dosage. Follow all health care provider recommendations for the dosage of any product, natural or otherwise.♦

Is the Metagenics fish oil collected from Norwegian fish?
The fish oil in Metagenics formulas is processed in Norway, but the fish may also come from elsewhere. Fish oil resellers may imply that their product is made exclusively from fish from Norwegian waters. In truth, the majority of wild-caught fish for supplements comes from off the coast of South America (Peru and Chile), with smaller amounts coming from Europe, Africa, and the United States. What is the key takeaway point? Don't be misled by slick marketing tactics. The finest raw material sources start with fresh, clean, deep-sea, wild-caught, cold-water fish (from Norway or elsewhere); the oils from these fish should then be further purified through advanced processes to remove any concern of harmful levels of potential contaminants.

Is Metagenics Omega-3 oil clinically tested?
Thousands of studies have been conducted on the potential health benefits of fish or essential fatty acids from fish oil (particularly EPA and DHA) in human health. As a research-based company dedicated to patient health, Metagenics focuses on maintaining a variety of purity-certified, highly concentrated formulas to best suit individual health needs. These advanced formulas have been successfully utilized in documented case studies at the FMRC[link] and are recommended by health care professionals worldwide.

How quickly will I notice improvement?
It may take up to 4 weeks for you to notice sustained improvement. Daily supplementation with Estrovera for a minimum of 3 months is suggested to ensure better outcomes, or as your practitioner recommends. You may also benefit from keeping a weekly hot flash diary to help them track Estrovera's effectiveness, as well as to identify eating and lifestyle habits that may also trigger symptoms (e.g., spicy foods, vigorous exercise, heated rooms, and stressful situations).♦

What makes Estrovera unique?
Estrovera contains a novel extract from the root of rhapontic or Siberian rhubarb (Rheum rhaponticum L.). This extract contains natural bioflavonoid compounds (primarily rhaponticin) that are similar to resveratrol and may work collectively to offer menopausal symptom relief. The effectiveness of this extract has been confirmed with well-designed, placebo-controlled clinical studies.♦

Why can't I just take flaxseed oil?
Flaxseed oil has been shown to benefit health in several areas, and is an important source of alpha-linolenic acid (ALA), another omega-3 essential fatty acid that is the "parent" for EPA and DHA. While ALA can be converted in the body to EPA and DHA, this process is relatively slow and unreliable in humans—and typically yields only minimal amounts of either EPA or DHA. To achieve similar amounts of EPA and DHA as found in supplements from marine sources (that have already converted ALA to EPA and DHA), an exponentially larger amount of plant-derived ALA would have to be consumed. ALA, EPA, and DHA have each demonstrated unique health support applications. Therefore, substituting flaxseed oil where concentrated EPA or DHA is recommended may not produce expected clinical outcomes.

How does Estrovera work?
Like many popular approaches for menopausal symptom relief, the exact mechanism of action is not yet clear. (And neither is the exact cause of hot flashes.) ERr 731 has been shown in vitro to exhibit selective estrogen receptor modulator (SERM) properties, primarily as an agonist of estrogen receptor-β, which has been suggested as a possible mechanism of action for observed menopausal symptom relief. Furthermore, the root of Rheum rhaponticum naturally contains significant amounts of the antioxidant flavonoid quercetin, which suggests that ERr 731 may also protect against oxidative stress that contributes to menopause and other age-related complaints.♦

Which is better—ethyl ester or triglyceride form?
Both forms provide excellent health support, and clinical experience has shown no difference. While dietary fats, such as those in fish, are naturally found in a triglyceride form, it's not the form our body absorbs. Triglyceride marine oil must first be digested by the body. Similarly, the molecular distillation process for manufacturing and purifying marine oils "digests" the oils and converts them into the ethyl ester form. All purified and concentrated marine oils are converted to ethyl ester forms during processing. If desired, an additional processing step can reassemble the oils back into the triglyceride form. The primary benefit of this step is for stability of the oil in lieu of a capsule, such as in liquids where the oil is more vulnerable to oxidation. This reconverted triglyceride form must still be broken down (digested) prior to absorption. Processed triglyceride form marine oil does not mean a more "natural" oil. Furthermore, unprocessed oils in triglyceride form may contain impurities that "predigested" ethyl ester forms of fish oil do not. A majority of marine oil studies have been conducted using the ethyl ester form, so this extra processing step to assure safety does not appear to detract from its health support potential.

Are Estrovera's ingredients safe?
Estrovera's novel rhubarb extract has an excellent predicted safety profile. ERr 731 has been reviewed by the FDA as a new dietary ingredient and has been dispensed in Germany since 1993 with over 60 million doses to date. ERr 731 and its individual components have been evaluated via in vitro to exhibit predictably safe activity in endometrial and bone cell lines. In vivo toxicity studies have demonstrated no significant effects in clinical observations, blood tests, microscopic findings, and other standard toxicology measures (including those of the uterus). Safety has been further demonstrated through well-designed clinical studies with over 400 patients that include 1- and 2-year evaluations for long-term efficacy. These clinical studies have shown no clinically relevant changes in endometrial biopsies, bleeding, weight, blood pressure, pulse, or other standard laboratory parameters. No serious adverse events associated with ERr 731 use have been reported to date.♦

Does Estrovera have any serious adverse events?
Estrovera's active ingredient, ERr 731, is well tolerated. There have been no serious reported adverse effects associated with ERr 731 supplementation in clinical studies (lasting up to 2 years), in vivo studies, and clinical experience with more than 60 million doses since 1993. Mild and transient symptoms suspected to be related to ERr 731 (e.g., headache) intake have been observed to dissipate after discontinuation.♦

How does a TOTOX level predict rancidity? And does Metagenics test for it?
Rancidity is immediately noticeable by smell or taste-no sophisticated test required. Nevertheless, TOTOX levels are often quoted as an indicator of marine oil freshness, which is partially true. But oxidative values are only one set of parameters in determining the quality or rancidity of marine oil. Oxidative measures include peroxide, anisidine, and/or TOTOX ("total oxidation"—a calculated expression of anisidine value + 2x peroxide value).

Marine oils with high oxidative values will likely have strong odor and poor taste, but so can marine oils with low values (due to degraded components during oil decomposition that are undetectable in oxidative tests). Metagenics marine oils are tested for peroxide and anisidine levels (which may be used to calculate TOTOX) after manufacture of the oil—prior to adding flavor and/or encapsulation—and safeguarded at every step thereafter. For added insurance, Metagenics also repeats peroxide assays after final processing (capsulation, bottling), as these tests detect the first compounds of oxidation (i.e., hydroperoxides) and validate that no oxidation occurred during final processing to degrade the purity of the oils.

Also note that natural antioxidants (e.g., mixed tocopherols, rosemary) are added to each formula to maintain stability over the product's shelf life. In addition, we provide proper storage guidelines on the product labels for all marine oil supplements to maintain product quality.

Why add lemon flavor?
Even the cleanest marine oil carries a slightly detectable "fishy" taste that might prevent product use and clinical outcomes. No flavor, however, could mask the taste or smell of rancidity.

Why is there a laxative warning on the label in California?
This label warning is required by California state law only and does not appear outside the state. Labeling requirements mandate a warning on all dietary supplements containing any amount of herbs known to have a laxative effect, including rhubarb. Although ERr 731 is established in humans to have no laxative effect (unlike some medicinal rhubarb species), there are no exceptions to the labeling requirement and any rhubarb-containing product sold in California must carry this warning.♦

Who should NOT take Estrovera?
Due to lack of safety studies, Estrovera supplementation is not recommended for use during pregnancy, if you are planning to get pregnant, or while nursing. Like other supplements containing natural selective estrogen receptor modulator (SERM) compounds (phytoestrogens), Estrovera should be avoided if you have a known or suspected estrogen-dependant cancer(s), as the effects on cell lines are not known.

Should Estrovera be combined with any other therapy to see positive results?
Because lifestyle factors (e.g., diet, exercise, stress, smoking, alcohol, caffeine, body mass index) can increase the intensity of symptoms, health authorities suggest that a healthier lifestyle greatly contributes to the success of any menopausal approach. Your doctor may recommend Estrovera as part of a comprehensive lifestyle protocol specific to menopausal women. Furthermore, in addition to mineralization support for bone protection (e.g., calcium, magnesium, and other minerals), postmenopausal women may also need nutritional support for bone remodeling, which is also influenced by estrogen decline.♦

Are there benefits to taking Estrovera long term?
Estrovera's phytoestrogenic extract has been investigated in 4 published clinical studies lasting up to 2 years that demonstrate continuing benefit with regular use. Because the extract components are rapidly metabolized within hours of intake, they do not stay in the body to offer residual benefits after intake is halted or missed. Symptoms such as hot flashes reportedly increase a few days after discontinuation, suggesting that daily intake is crucial for sustained relief.♦

Why does Estrovera need to be enteric-coated?
The bioflavonoid compounds in Estrovera break down rapidly. The enteric coating therefore prevents the tablet from premature breakdown in the stomach, ensuring that all the potentially active ingredients are delivered to the small intestine for optimal use. The inactive ingredients used in the enteric coating are approved for use in dietary supplement manufacturing and enhance the delivery of Estrovera's natural active ingredients without compromising its predicted safety profile.♦