bleeding problem

[Guest guest]

Hi All,

I added Ultimate Omega to their mix of omega supplements (they were taking

3-6-9) and I had a bleeding problem - did I screw up, is this one that I

shouldn't use (too concentrate perhaps?) any advice welcome!

[Guest guest]

Hi !

For bleeding questions you can have your child's ped order a CBC to

check platelet function and have a further work-up by a hematologist.

Is the Omega 359 (which is the ProEFA) helping at all? How many

ProEFA are you giving your child now? The Ultimate Omega isn't the

formula most of us add to the mix for the best results- it's slightly

higher in the DHA and slightly lower in the EPA. When raising the

Omega 3 over the Omega 6 you want to raise mainly the EPA. And you

can't lose that tiny ratio of GLA or it doesn't work either. Once

you hit 2 ProEFA you probably will find better results by adding one

ProEPA. In the past I never really shared this so out in the

open as I didn't want everyone to start all the oils at once and this

new sharing may be raising new issues. In the past many of us

increased gradually and learned to add things over months.

There are a few archives on bruising but you are the first to report

bleeding even though it has come up in regards to should you pull a

child off the oils prior to surgery. Are you giving your child any

vitamin E outside what is in the fish oils? If so how much of that?

Re: EFA Oils, Surgery and Bleeding Issues

Here is a response from developmental pediatrician Dr. Marilyn Agin,

M.D. regarding discontinuing fish oils prior to surgery.

" There is no need to discontinue EFAs weeks before surgery. The oils

have a slight anticoagulation effect but there have been no reports

about clotting problems. To be cautious, we had recommended stopping

the EFAs a few days before surgery, but that may not even be

necessary, especially for ear tubes or strabismus (eye) surgery where

there is virtually no blood loss. If there is a child though, that

has a preexisting hematologic (blood-related) problem, the parents

should first speak to their hematologist or pediatrician before

starting EFAs. Just remember taking EFAs is akin to eating a fatty

fish meal (e.g., salmon, sardines) so it is generally perfectly safe

to use them, unless your child is allergic to fish! "

Marilyn Agin, MD

~~~~~~~~~~~~~~and since not anything on bleeding for fish oils

Re: fish oil and bruising

Hey Dawn!

Below are some archives from this group on bruising and EFAs. I

know you are seeing some amazing surges from the recent increase

(and heard from Kathy too) but it was a large increase all at once

and you are now up to 9 capsules a day. Perhaps after speaking with

your child's doc just go back to where you were -the 6? And increase

one capsule at a time instead (ProEFAs first then the ProEPA)

Anyway -so far nobody found out any direct links on this even when

tested as you'll read in the archives below. Can tell you that I

used to bruise lots as a child too and was not on fish oil. I seem

to have outgrown it because I don't bruise as easily now as I did

then. But yes in my case I was borderline anemic as a child -but

don't think you just develop that all of a sudden -but don't know.

(come to think of it I stopped bruising since being on the fish oils!)

From: " Marilyn Agin M.D. "

Date: Thu Apr 25, 2002 9:06 am

Subject: EFAs/ side effects

Hi Everyone,

These issues about the potential side effects of the EFAs do

frequently come up. I typically mention the anticoagulation effect to

parents b/c everyone always asks about side effects. The only way we

are going to know for sure is to do a bleeding time on a group of

kids on EFAs. It is a blood test to check how fast your blood clots.

There was one case that came up maybe 6 mos ago about a mom who

discovered increased bruising in her child. I suggested she take him

off the EFAs and get a CBC to check his platelets. The blood test was

fine and she resumed the supplement at a lower dose.

Re: seizures, I think there is probably a very small risk and a lot

to gain in a seizure prone child. I think if we suggest starting

with a low dose and building up slowing there shouldn't be a

problem. There is always the possibility of drug interactions with

the EFAs but that would be more so in the adult population. We always

need to say check w/ your doctor, even though we may know more than

the practitioner!

I summary, we should say the EFAs appear to be safe and are unlikely

to cause bleeding or seizures in seizure prone children, but we

typically advise parents to check with their pediatricians in these

situations.

Marilyn Agin MD

Re: fish oil and surgery

Hi ,

I've never heard about time 'after' surgery to be off the fish oils -

but check with your child's surgeon.

And before surgery -to be or not to be on the oils,

that's still the question.

There's actually an unofficial look into surgery and mega high

dosages of fish oils. The largest group of people prescribed to be

on high dosages of fish oils daily by their MDs are those with heart

disease. Those with diagnosed heart disease also happen to be the

group who may have no chance to stop the fish oils prior to surgery

due to say emergency open heart surgery...and yet there are no cases

of hemorrhaging for those taking the high dosages of fish oils as

per Dr. Stoll (read Dr. Stoll's quote below) and Dr.

(quote below as well) In addition as you will read

below in one of the archives my own Mom went in for open heart

surgery and her heart surgeon told her she did not have to stop

taking her fish oils prior -and my Mom (reported by those in the

operating room) had very little bleeding during surgery, and for

sure she healed much faster than the norm. This is probably because

fish oil is not like man made blood thinners -it works with the body

as needed.

Here's a small quote from a much larger article from the Saturday

Evening Post. An interview with Dr. Stoll:

" Post: Is there a downside to supplementing with omega-3?

Dr. Stoll: There isn't. Some people may experience GI distress if

they take a large amount of a low-quality supplement. But the

highest good-quality fish oil is not rancid and has little or no

taste and has no side effects. Another issue that people worry about

is bleeding, because EPA inhibits platelet aggregation. But we

scoured the scientific literature, and there has never been a

documented case of bleeding due to omega-3 fatty acids.

We recently reviewed about 18,000 people who participated in

clinical trials with omega-3s, largely in cardiology studies, and we

couldn't find one instance of bleeding in any of the trials. There

was no bleeding, even if used in IVs prescribed before and during

cardiac surgery. I think this perception is a myth because omega-3s

don't inhibit the platelets as strongly as aspirin–perhaps 60 to 70

percent as much as aspirin–and unlike aspirin, the effect is

reversible.

Post: When a patient is on blood thinners, such as coumadin, should

they exercise caution when supplementing with omega-3?

Dr. Stoll: In that situation, I usually recommend a lower dose, not

exceeding one or two grams of EPA per day. At this dosage, there

should be no effect on the action of coumadin. The unanswered

question is, together are they providing too much anticoagulation?

Nonetheless, there may be some minute risk of a negative interaction

with anticoagulants, such as warfarin (coumadin), high-dose aspirin,

or ibuprofen-like medications, based on animal data and anecdotal

reports in humans.

However, large-scale controlled clinical trials with patients

receiving omega-3 fatty acid supplements with either aspirin or

warfarin observed no cases of bleeding even after one year of the

combined treatments. It would be a shame if cardiac patients or

their physicians avoided the use of omega-3 supplements out of fear.

I am thoroughly convinced that the dramatic and lifesaving cardiac

actions of omega-3s far outweigh the very small or nonexistent risk

of bleeding. "

SOURCE: Saturday Evening Post, May/June 2005, by .

http://www.satevepost.org/issues/2005/0506/7370750.shtml

Small quote from Dr. -more below in archives:

" There is a

long-standing myth that omega-3s cause bleeding. We have used data

from 18,000 or 20,000 patients who were in clinical trials over the

years-mostly in heart disease, and there is not one case of bleeding

from omega-3s "

http://www.equazen.com/newsfile_newsletter4_contents.htm

I had my tonsils taken out in kindergarten and had to be rushed to

emergancy because I started to hemorrhage. Even though I was only

five years old I will never forget those horrible moments in my life

having a tube forced down my throat while being down, that's how I

remember it. Thing is -I was not on fish oil then. Sure there are

horror stories about surgeries - but those stories like mine are the

exception -not the rule with or without fish oil in the picture.

So far in this group this topic has come up a number of times and no

problems with bleeding reported by those that stopped or didn't stop

the oils prior to surgery. (most do stop a week before as a just in

case) Below are some archives on this, best to you and your child

during this time, and speedy recovery to her!

Here's some archives on this topic:

From: " kiddietalk " <kiddietalk@...>

Date: Mon Apr 29, 2002 11:20 pm

Subject: Re: QUESTION

Hi ,

Tanner never had surgery since on the EFAs in the past three years,

but about a year ago my mom was diagnosed with heart problems and

needed surgery so of course I had her go on high dosages of EFAs. My

mom informed her heart surgeon she was on the Omega 3's and he OK's

it. When she went through surgery they reported little blood loss

and that it went great (I take their word for it -wasn't there) Her

healing time was amazing and quick and she's back to teaching ball

room dance again (she's 72 -and Liz from Georgia knows -kind

of a stand up she's so funny) And yes she's still on the Omega 3/6

formula -but I'm not sure if she needs the 6 too like our kids do -or

just the 3?

Anyway -you may want to read up online about the differences between

a natural blood thinner like fish oil and a man made blood thinner

like aspirin in books like Dr. Stoll's book The Omega 3 Connection,

or read about natural blood thinners at sites like

http://www.cdc-cdh.edu/hospital/cardio/art7.html .

What I hear, just like Dr. Agin states below, is stopping the EFAs a

week before the surgery -and then continuing after. Of course there

is also the other side of the coin with surgery and fish oil-there

was an article published in the Sept. 1, 2001 issue of The Lancet

stating that a supplement combination of L-arginine, omega-3 fatty

acids, and brewer's yeast helped improve post-operative recovery from

heart surgery. The patients given the supplement combination had

stronger immune response and experienced fewer post-operative

infections than patients receiving placebo.

http://news.bbc.co.uk/hi/english/health/newsid_1517000/1517318.stm

If you really don't want to stop the EFAs for a week -you can try

increasing the amount of fish sticks your child eats that week. And

if your child really misses the fishy taste of the fish oil you can

buy some Harry Potter Bertie Botts Every Flavor Beans at Toys R Us

and hope you get a sack with lots of sardine flavored beans in it.

(yuck I thought it was coconut!!...well they are both the white

ones!!)

And speaking of Toys R Us and the recent posts about reading

programs -I know there are fabulous educational sites and programs

out there for learning to read and write, etc. Don't underestimate

the power of a good toy inventor (OK -so I used to do that) or

creator ( that too) to market something that is good for your child

in a way that is fun. I really respect Henson -we miss you Jim, PBS,

Nick, and Noggin for doing a great job of that -and Disney too of

course. So while you are checking out stuff online at educational

sites -like CHERAB advisor Dr. a Tallal's Fast For Word program

at http://www.scientificlearning.com which is highly recommended from

what I hear and read -have fun and browse the toy stores like Zany

Brainy, FAO Schwarz, Learning Express, and Toys R Us, etc. for

educational books, games -including electronic games like LeapFrog

http://www.leapfrog.com (never ending learning -can't beat that) -

and software. Also find a great kids library section in your own

town -or another town over and take your child to the read alongs,

etc. they schedule. Some PlayStation and Nintendo games are

educational believe it or not. They have Sesame Street, Dragon

Tales, Disney, etc.

Even videos can teach. My kids love this cheap little home video

called Operation Dalmatian Fun With Letters with the Z Meany Evil

Wizard who teases Zim Zim and his dog Zoo when they are singing the

alphabet song by mock singing " A, B, C, D, wah -wah -wah " and he

does an awful thing (don't want to give the ending away... OK just a

bit -he blows a gust of wind and sends Zim Zim's dog Zoo to A land,

and Zoo has to go through the whole alphabet to get back to Zim Zim)

You know maybe when I'm done with this nonprofit stuff I'll go back

to animation -sometimes I miss it (can you tell?)

~~~~~~~~~~end of archive

=====

[Guest guest]

Can we please talk about other things too? Thank you.

[Guest guest]

Hi,

just responding to the comment " can we talk about something else " --

i may have missed something, but was there prior conversation on

bleeding problems? should i not have raised it? just wondering... --

we had a really scary moment with it, so i thought it would be helpful

to get thoughts on why (again for background, we had just added one

ultimate omega, thinking it was teh same as EPA maybe its not?)

[Guest guest]

Hi !

Of course we need to talk about this! Did you read my answer to you?

What do you mean by " bleeding " ? Nose bleeds? What kind of episode?

I can't find one message in the archives about fish oils and

bleeding. The fish oils are natural and work with the body as I just

posted in the last message to you. And while I didn't just " scour "

the literature I did google it and didn't find anything to disagree

with Dr. Stoll's quote

" But we scoured the scientific literature, and there has never been a

documented case of bleeding due to omega-3 fatty acids "

Here's a small clip from a much larger article from the Saturday

Evening Post. An interview with Dr. Stoll:

" Post: Is there a downside to supplementing with omega-3?

Dr. Stoll: There isn't. Some people may experience GI distress if

they take a large amount of a low-quality supplement. But the

highest good-quality fish oil is not rancid and has little or no

taste and has no side effects. Another issue that people worry about

is bleeding, because EPA inhibits platelet aggregation. But we

scoured the scientific literature, and there has never been a

documented case of bleeding due to omega-3 fatty acids.

We recently reviewed about 18,000 people who participated in

clinical trials with omega-3s, largely in cardiology studies, and we

couldn't find one instance of bleeding in any of the trials. There

was no bleeding, even if used in IVs prescribed before and during

cardiac surgery. I think this perception is a myth because omega-3s

don't inhibit the platelets as strongly as aspirin–perhaps 60 to 70

percent as much as aspirin–and unlike aspirin, the effect is

reversible.

Post: When a patient is on blood thinners, such as coumadin, should

they exercise caution when supplementing with omega-3?

Dr. Stoll: In that situation, I usually recommend a lower dose, not

exceeding one or two grams of EPA per day. At this dosage, there

should be no effect on the action of coumadin. The unanswered

question is, together are they providing too much anticoagulation?

Nonetheless, there may be some minute risk of a negative interaction

with anticoagulants, such as warfarin (coumadin), high-dose aspirin,

or ibuprofen-like medications, based on animal data and anecdotal

reports in humans.

However, large-scale controlled clinical trials with patients

receiving omega-3 fatty acid supplements with either aspirin or

warfarin observed no cases of bleeding even after one year of the

combined treatments. It would be a shame if cardiac patients or

their physicians avoided the use of omega-3 supplements out of fear.

I am thoroughly convinced that the dramatic and lifesaving cardiac

actions of omega-3s far outweigh the very small or nonexistent risk

of bleeding. "

SOURCE: Saturday Evening Post, May/June 2005, by .

http://www.satevepost.org/issues/2005/0506/7370750.shtml

" Some studies with omega-3-acids demonstrated prolongation of

bleeding time. The

prolongation of bleeding time reported in these studies has not

exceeded normal limits

and did not produce clinically significant bleeding episodes. "

http://www.fda.gov/cder/foi/label/2004/21654lbl.pdf

And not that this has anything to do with your question but

found this funny that in that same pdf I found this quote

" CLINICAL PHARMACOLOGY

Mechanism of Action

The mechanism of action of Omacor® is not completely understood.

Potential

mechanisms of action include inhibition of acyl CoA:1,2-

diacylglycerol acyltransferase

and increased peroxisomal â-oxidation in the liver. Omacor® may

reduce the synthesis

of triglycerides (TGs) in the liver because EPA and DHA are poor

substrates for the

enzymes responsible for TG synthesis, and EPA and DHA inhibit

esterification of other

fatty acids. "

http://www.fda.gov/cder/foi/label/2004/21654lbl.pdf

And if the FDA doesn't understand it completely either -none of us

can feel so bad!

I checked the archives and in June you asked

" Hi All, Does anyone know whether vitamin E has any impact on

hyptonia?? thanks "

Did you start your child on vitamin E? While fish oils are not

linked to bleeding vitamin e is.

=====

[Guest guest]

Hi ,

I saw that post, too, and was confused as to why it was posted. It's

not like anyone was posting anything political or anything off topic,

so I couldn't figure out why anyone was unhappy.

Oh, well!

in OH

>

> Hi,

> just responding to the comment " can we talk about something else " --

> i may have missed something, but was there prior conversation on

> bleeding problems? should i not have raised it? just wondering... --

> we had a really scary moment with it, so i thought it would be helpful

> to get thoughts on why (again for background, we had just added one

> ultimate omega, thinking it was teh same as EPA maybe its not?)

>

[Guest guest]

I have read that fish oil can thin the blood and in rare instances cause

bleeding.

-- [ ] Re: bleeding problem

Hi !

Of course we need to talk about this! Did you read my answer to you?

What do you mean by " bleeding " ? Nose bleeds? What kind of episode?

I can't find one message in the archives about fish oils and

bleeding. The fish oils are natural and work with the body as I just

posted in the last message to you. And while I didn't just " scour "

the literature I did google it and didn't find anything to disagree

with Dr. Stoll's quote

" But we scoured the scientific literature, and there has never been a

documented case of bleeding due to omega-3 fatty acids "

Here's a small clip from a much larger article from the Saturday

Evening Post. An interview with Dr. Stoll:

" Post: Is there a downside to supplementing with omega-3?

Dr. Stoll: There isn't. Some people may experience GI distress if

they take a large amount of a low-quality supplement. But the

highest good-quality fish oil is not rancid and has little or no

taste and has no side effects. Another issue that people worry about

is bleeding, because EPA inhibits platelet aggregation. But we

scoured the scientific literature, and there has never been a

documented case of bleeding due to omega-3 fatty acids.

We recently reviewed about 18,000 people who participated in

clinical trials with omega-3s, largely in cardiology studies, and we

couldn't find one instance of bleeding in any of the trials. There

was no bleeding, even if used in IVs prescribed before and during

cardiac surgery. I think this perception is a myth because omega-3s

don't inhibit the platelets as strongly as aspirin–perhaps 60 to 70

percent as much as aspirin–and unlike aspirin, the effect is

reversible.

Post: When a patient is on blood thinners, such as coumadin, should

they exercise caution when supplementing with omega-3?

Dr. Stoll: In that situation, I usually recommend a lower dose, not

exceeding one or two grams of EPA per day. At this dosage, there

should be no effect on the action of coumadin. The unanswered

question is, together are they providing too much anticoagulation?

Nonetheless, there may be some minute risk of a negative interaction

with anticoagulants, such as warfarin (coumadin), high-dose aspirin,

or ibuprofen-like medications, based on animal data and anecdotal

reports in humans.

However, large-scale controlled clinical trials with patients

receiving omega-3 fatty acid supplements with either aspirin or

warfarin observed no cases of bleeding even after one year of the

combined treatments. It would be a shame if cardiac patients or

their physicians avoided the use of omega-3 supplements out of fear.

I am thoroughly convinced that the dramatic and lifesaving cardiac

actions of omega-3s far outweigh the very small or nonexistent risk

of bleeding. "

SOURCE: Saturday Evening Post, May/June 2005, by .

http://www.satevepost.org/issues/2005/0506/7370750.shtml

" Some studies with omega-3-acids demonstrated prolongation of

bleeding time. The

prolongation of bleeding time reported in these studies has not

exceeded normal limits

and did not produce clinically significant bleeding episodes. "

http://www.fda.gov/cder/foi/label/2004/21654lbl.pdf

And not that this has anything to do with your question but

found this funny that in that same pdf I found this quote

" CLINICAL PHARMACOLOGY

Mechanism of Action

The mechanism of action of Omacor® is not completely understood.

Potential

mechanisms of action include inhibition of acyl CoA:1,2-

diacylglycerol acyltransferase

and increased peroxisomal â-oxidation in the liver. Omacor® may

reduce the synthesis

of triglycerides (TGs) in the liver because EPA and DHA are poor

substrates for the

enzymes responsible for TG synthesis, and EPA and DHA inhibit

esterification of other

fatty acids. "

http://www.fda.gov/cder/foi/label/2004/21654lbl.pdf

And if the FDA doesn't understand it completely either -none of us

can feel so bad!

I checked the archives and in June you asked

" Hi All, Does anyone know whether vitamin E has any impact on

hyptonia?? thanks "

Did you start your child on vitamin E? While fish oils are not

linked to bleeding vitamin e is.

=====

[Guest guest]

Hi thanks --

no somehow missed the first answer! sorry about that

it was a hamster bite, a small one, but blood was everywhere and we

had a very hard time stopping it

they are on vitamin e, but they were on 3-6-9 and vit e before and

have even had hamster bites in exactly the same spot (ornery hamster i

know) and never this reaction -- which is why i worried it was tied to

the ultimate omega addition to their mix.

thanks so much for the reply --

--

[Guest guest]

Hi Dina!

Do you have the reference to your statement?

Think we all have heard it and it's come up here for years but there

is so much that disproves it and I can't find a credible reference

that supports it. Vitamin e on the other hand is linked to bleeding

and we have since learned that 's child was on vitamin e which

may or may not be why the hamster bite caused excessive bleeding.

Again this topic didn't come up before however if you check the

archives.

In June of 2005 when Nordic raised the dosage of vitamin e from 8 IUs

of vitamin e to 15IU I posted the following here (this was prior to

adding more vitamin e talk here which posted May 2006)

So again -with one capsule of " normal " fish oil a day like ProEFA -

most of us would consume 15 IUs of Vitamin E (2 = 30 IU) (just to

remind from above:

" The Tolerable Upper Intake Limit (UL) for alpha-tocopherol is set

at 1000 mg (1500 IU) "

1000 - 30 = (probably room for Poly-Vi-Sol)

And another thing to keep in mind...if a child is on fish oil...then

he or she will need extra Vitamin E because....

" There is some concern that a diet rich in fish oil taken for many

months may induce a deficiency of vitamin E. People who eat a diet

high in fish or who take fish oil supplements may want to consider

taking vitamin E supplements. "

http://www.usadrug.com/IMCAccess/ConsSupplements/VitaminEcs.shtml

And...this is why Nordic Naturals 'raised' the vitamin E in the

ProEFA up from 8 IUs to 15 IUs per capsule.

But unlike fish oil here is the risk of vitamin e from that same

message

" Even though this study provides

evidence that taking a vitamin E supplement containing 530 mg or 800

IU for four months is safe, the long term safety of vitamin E

supplementation has not been tested. The Institute of Medicine has

set an upper tolerable intake level for vitamin E at 1,000 mg (1,500

IU) for any form of supplementary alpha-tocopherol per day because

the nutrient can act as an anticoagulant and increase the risk of

bleeding problems. "

http://www.cc.nih.gov/ccc/supplements/vite.html#risk

" Toxicity

No known toxicity to vitamin E has been observed. High intakes of

vitamin E (100 times the recommended level) may decrease availability

or interfere with utilization of other fat-soluble vitamins (vitamin

A, D and K). In experimentally-induced vitamin E toxicity, impaired

bone mineralization, decreased storage of vitamin A in the liver, and

prolonged clotting times have been observed.

The upper safety limit for vitamin E intake established by the Food

and Nutrition Board of the Institute of Medicine is 1,000 mg daily

(as a-tocopherol in food or supplemental form) for adults.

Vitamin E Tolerable Upper Intake Levels

Life Stage Vitamin E(mg)

Infants

0-6 mo N/A

7-12 mo N/A

Children

1-3 years 200

4-8 years 300

Males, Females

9-13 years 600

14-18 years 800

19-70 years 1000

70 years 1000

http://www.feinberg.northwestern.edu/nutrition/factsheets/vitamin-e.html

But back to fish oils

I remember when Dr. Agin and I with a bunch of our families including

Jeanne Buesser's were interviewed for a PBS documentary on Omega 3s

they were searching desperately for something –anything negative

about them as they wanted to show pros and cons of course. They told

me " we can't find any. Do you know of any " Of course I shared about

the temporary loose stools and the temporary change in behavior

shared here through the years prior to the surge –but think they were

searching for something most would consider a " side effect "

To me the Physicians' Health Study that followed 14,916 patients with

coronary heart disease on 8 grams of fish oils and aspirin a day

showed even for those that needed emergency open heart surgery no

increase in bleeding. And most of our children are not on daily

aspirin! Unlike fish oil that is a natural blood thinner -aspirin is

synthetic so they have different properties.

Actually if you look into it -you'll find the opposite! A few years

ago when this came up I had found this study

" Increasing the amount of fish in the diet may help reduce menstrual

disorders. In one study of Danish women, menstrual pain was greater

in women with lower levels of omega 3 fatty acids, which is found in

fish oil. In another study, supplements of fish oil appeared to

reduce heavy bleeding in adolescent girls. "

http://www.medceu.com/index/index.php?page=get_course & courseID=2016 & nocheck

Fish oil does not seem to cause bleeding problems when it is taken by

itself 142 or with aspirin. 143 Nonetheless, people who are at risk

of bleeding complications for any reason should probably consult a

physician before taking fish oil.

http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthga\

te=%2221684.html%22

From this study WS. Dietary fish oil and blood lipids. Curr

Opin Lipidol. 1996;7:3-7.

(parts I pulled out)

Effect of Omega-3 Fatty Acids on Coagulation Profiles

A concise review of studies on the prevention of thrombosis in

laboratory animals and in humans emphasized the important role of n-3

PUFA, which affects cellular responses in platelets, monocytes, and

endothelial cells.16 The reduced platelet aggregation and prolonged

bleeding times of the Greenland Eskimos suggested an important

mechanism by which n-3 PUFAs could affect CHD.17 When bleeding times

are measured, the effects of fish oil are additive to those of

aspirin.18 Studies in swine fed high cholesterol diets with and

without cod liver oil showed that there was less coronary

atherosclerosis in the cod liver oil group but that there was no

relationship to lipid changes. The pigs fed cod liver oil had

significant decreases in serum thromboxane B2 levels and increases in

platelet fatty acid deposition of EPA.19 Fish oil supplements

increased levels of tissue plasminogen activator (TPA) and decreased

concentrations of plasminogen activator inhibitor, both enhancers of

fibrinolysis.20 One study comparing fish oil with rapeseed oil noted

that fish oil decreased lipoprotein(a) by 14%.21 This effect was not

seen in all male subjects who were hospitalized with CHD but did

correlate with a large reduction in TPA. The Atherosclerosis Risk in

Communities study compiled data from four US communities (15 000

participants, both black and white) on six hemostatic factors:

fibrinogen, factor VII, factor VIII, von Willebrand factor, protein

C, and antithrombin III.22 These were communities not known for their

high intake of fish. Dietary intake of n-3 PUFA showed negative

associations with levels of fibrinogen, factor VIII, and von

Willebrand factor and a positive association with protein C (whites

only). These findings may help explain, in part, the reduced

incidence of vein graft occlusion seen in patients after coronary

artery bypass grafting who receive n-3 PUFA.23 In a randomized

controlled trial of dietary supplementation with n-3 fatty acids in

bypass patients who received usual anticoagulation with aspirin or

warfarin, an inverse relation between relative change in serum

phospholipid n-3 fatty acids and vein graft occlusions was observed.

Thus, the prevention of thrombosis remains a promising area for n-3

PUFA research.

A nested case-control study was conducted among the 14 916

participants in the Physicians' Health Study.33 Each participant with

MI was matched by smoking status and age with a randomly chosen

control participant who had not developed CHD. Fish oil intake was

estimated by measuring plasma levels in cholesterol esters and

phospholipids. No association was found between fish oil levels and

the incidence of MI even when results were adjusted for major

cardiovascular risk factors. Although early trials suggested that

fish oil held some promise if ingested early before angioplasty, a

clinical trial large enough to find a significant effect did not,

despite a dose of 8 g/d of n-3 PUFA.34 This trial did document the

safety of fish oil supplementation without any evidence of excess

bleeding in the patients who all took aspirin. Moreover, a clinical

trial with angiographic end points showed that among

normocholesterolemic men with CHD, fish oil treatment (6 g n-3 PUFA

for 2 years) did not produce significant changes in the diameter of

the coronary arteries.35

And because I can't recall if I included this archive with my last

answer to

Res-Q 1250 and Blood Coagulation

Fish oil supplementation does not increase bleeding tendency

OSLO, NORWAY. A group of Norwegian medical researchers reports that

fish oil supplementation does not increase the bleeding tendency in

heart disease patients receiving aspirin or warfarin. The study

involved 511 patients who had undergone coronary artery bypass

surgery. On the second day after the operation half the patients

were assigned in a random fashion to receive 4 grams of fish oil per

day (providing 2 g/day of eicosapentaenoic acid, 1.3 g/day of

docosahexaenoic acid, and 14.8 mg/day of vitamin E). At the same

time the patients were also randomized to receive either 300 mg of

aspirin per day or warfarin aimed at achieving an INR of 2.5-4.2.

The patients were evaluated every 3 months and questioned about

bleeding episodes for the duration of the 9-month study.

The researchers concluded that fish oil supplementation did not

result in a statistically significant increase in bleeding episodes

in either the aspirin group or in the warfarin group. They also

found no significant long-term effects of fish oil on common

parameters of coagulation and fibrinolysis. They noted that the

blood levels (serum phospholipid levels) of eicosapentaenoic acid

and docosahexaenoic acid increased by 140% and 14% respectively in

the patients taking fish oil. The serum triglyceride levels

decreased by 19.1% in the fish oil group while no significant change

was observed in the remainder of the patients. NOTE: This study was

partially funded by Pronova Biocare AS (a fish oil manufacturer) and

Nycomed Pharma AS. Eritsland, J., et al. Long-term effects of n-3

polyunsaturated fatty acids on haemostatic variables and bleeding

episodes in patients with coronary artery disease. Blood Coagulation

and Fibrinolysis, Vol. 6, 1995, pp. 17-22 "

http://www.n3inc.com/bloodcoagulation.html

Unlike aspirin however -fish oils works with the body -so it thins

the blood if needed. It's not a medication however that thins the

blood, so there are not the same issues as taking a blood thinner.

As you read in the study above or will see in the archives below for

example -even heart patients on high dosages of fish oils who have

emergency open heart surgery have no excessive bleeding. It seems

like fish oil comes with a host of urban legends for some reason.

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