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On physical examination he had dry, strawlike hair, very solubility dry skin with scaling and flaking of his hands, a midsystolic cardiac click with a late systolic murmur, and numerous white spots on his fingernails. Laboratory studies showed low red blood cell solubility magnesium. EFA levels in serum showed an unusual pattern with very marked elevation of AA and solubility slight depression of DGLA. All the n3 EFAs were markedly depressed. Therapy was initiated with magnesium and EPO, 3 gm daily. He was also placed on a low-fat diet. Within 2 weeks he experienced complete cessation of chest pain. When the results of the fatty acid profile were returned, he was started on Max-EPA, 3 gm daily. After 3 months of being pain-free. he developed a return of chest pain despite adherence to his diet and the nutritional supplements. Questioning revealed that 2 weeks earlier he had begun using a cheaper brand of EPO purchased from a mail order house. Subsequent analysis of that alleged EPO showed a negligible GLA content.
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