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    Risks associated with omega-3 supplementation


    A study describes development of a duodenal ulcer in a 60-year-old athlete who consumed 20 g of omega-3s daily for a year to increase athletic performance.7 The diagnosis occurred after he took cortisone and antibiotics, although he had no previous history of gastrointestinal problems.

    The study authors suspected the bleeding ulcer resulted from the high dose of omega-3 fatty acids and its effect on bleeding—compounded by the fact that cortisone increases the fatty acids oxidation and may render it pro-inflammatory. Other antithrombotic microconstituents included in the supplements and diet may also have been related.

    Another study compared bleeding risk in patients taking aspirin and clopidogrel (Plavix, Bristol-Myers Squibb) when fish oil was added. This retrospective review compared 182 medical records of primarily coronary artery disease patients being treated with high-dose fish oil (mean dose 3 +/- 1.25 g), aspirin (mean dose 161 +/- 115 mg), and clopidogrel (mean dose 75 mg), to 182 controls treated with aspirin and clopidogrel alone.

    During a mean follow-up period of 33 months, one major bleeding episode occurred in the group taking fish oil and another medication, while no major bleeding episodes occurred in the non-fish oil group (P =1.0). During follow-up, four minor bleeding episodes (2.2 percent) occurred in the fish oil group, and seven (3.9 percent) in the non-fish oil group. Authors concluded the high-dose fish oil was safe in combination with aspirin and clopidogrel and does not increase the risk of bleeding compared with that seen with aspirin and clopidogrel alone.8

    Related: Understanding and defining MGD

    My research confirms

    Based on my research, my opinion is that you could run into problems with omega-3 supplements, but you may be safe at my preferred therapeutic dosage. I continue to recommend 2000mg of fish oil, or two capsules of krill oil, for dry eye. I also continue to suggest it to those with autoimmune conditions, arthritis, and ocular inflammation.

    Though I continue to recommend omega-3s, I have added a disclaimer, “These supplements are powerful, and I need you to inform your doctors that you are taking them. If you have surgery, taking these may affect your surgical outcome.”

    For my patients who are currently under the care of a cardiologist or with a bleeding disorder, I discuss taking these supplements with their doctors prior to making the recommendation.


    1. Cederholm T. Fish consumption and omega-3 fatty acid supplementation for prevention or treatment of cognitive decline, dementia or Alzheimer's disease in older adults—any news? Curr Opin Clin Nutr Metab Care. 2017 Mar;20(2):104-109.

    2. Lewis MD. Concussions, Traumatic Brain Injury, and the Innovative Use of Omega-3s. J Am Coll Nutr. 2016 Jul;35(5):469-75.

    3. U.S. Food & Drug Administration (FDA). Guidance for Industry: A Food Labeling Guide (12. Appendix D: Qualified Health Claims). http://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/labelingnutrition/ucm064923.htm. Accessed February 10, 2017.

    4. Y. L. Chee,  J. C. Crawford,  H. G. Watson and M. Greaves.   Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures.  British Committee for Standards in Haematology, British Journal of Haematology, 2008, 140, 496–504)

    5. McClaskey EM, Michalets EL. Subdural hematoma after a fall in an elderly patient taking high-dose omega-3 fatty acids with warfarin and aspirin: case report and review of the literature. Pharmacotherapy. 2007 Jan;27(1):152-60.

    6. Jalili M, Dehpour AR. Extremely prolonged INR associated with warfarin in combination with both trazodone and omega-3 fatty acids.  Arch Med Res. 2007 Nov;38(8):901-4.

    7. Detopoulou P, Papamikos V. Gastrointestinal bleeding after high intake of omega-3 fatty acids, cortisone and antibiotic therapy: a case study. Int J Sport Nutr Exerc Metab. 2014 Jun;24(3):253-7.

    8. Watson PD1, Joy PS, Nkonde C, Hessen SE, Karalis DG.  Comparison of bleeding complications with omega-3 fatty acids + aspirin + clopidogrel--versus--aspirin + clopidogrel in patients with cardiovascular disease.  Am J Cardiol. 2009 Oct 15;104(8):1052-4. 

    Read more from Dr. Schroeder-Swartz here

    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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