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    Risks associated with omega-3 supplementation

     

    Omega-3 fatty acid benefits

    As you probably know, omega-3 fatty acids are found in the form of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-lipoic acid (ALA). Depending on how much Lifetime television you watch, you will be familiar with these acronyms.

    EPA and DHA are the most beneficial, and they are available from marine animal sources. ALA is converted to EPA and DHA, and is found in plant-based sources such as flax seeds, walnuts, chia, and hemp. (I am not sure about you but I am not a fan of eating chia or hemp.)

    Advantages to supplementation as reported by the national Center for Complementary and Integrative Health include benefits to infant brain development, ocular inflammation, and rheumatoid arthritis.

    Improved cardiac health appears to be less supported by literature reports. Recent reports of the benefits for cognitive impairment,1 concussion, and traumatic brain injury2 are intriguing to those with a family history of dementia—and parents of football players.

    The U.S. Food and Drug Administration (FDA) suggests taking dietary supplements containing omega-3 fatty acids provided they do not consume more than 3 grams per day.3

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    Side effects of omega-3 fatty acids

    I looked into the side effects. The FDA has listed increased bleeding time and increases in the frequency of atrial fibrillation or flutter in the first few months of taking Lovanza (omega-3-acid ethyl esters, GlaxoSmithKline), a 4-gm dose prescription fish oil preparation. Increased bleeding time can be a concern even in healthy patients not taking blood thinners prior to surgery or invasive procedures.4

    I had a discussion about this with my own primary care physician (PCP), who voiced concern over taking baby aspirin relative to blood thinning. She said increased bleeding can be a problem in healthy adults who suffer from trauma in accidents and require emergency surgery. If baby aspirin usage is unreported to their medical provider, there may be complications.

    Literature reports regarding complications related to intake of omega-3 supplements are few. One report describing a subdural hematoma after a fall in an elderly woman taking warfarin and omega-3s5 substantiates my PCP’s concern with accidents and blood-thinners.

    One case describes a sudden spike in international normalized ratio (INR, also called standardized prothrombin time) in a patient taking warfarin (Coumadin, Bristol-Myers Squibb), omega-3s, and trazadone (Oleptro, Labopharm).6 Another reports an increase in INR in a patient taking 1.5 mg daily of warfarin after doubling her fish oil dose from 1000 to 2000 mg daily.

    Tracy Schroeder Swartz, OD, MS, FAAO
    Tracy Schroeder Swartz currently practices at Madison Eye Care Center in Madison, Alabama. She serves as Education Chair for the ...

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