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(Motrin, Advil) or naproxen (Naprosyn, Aleve), all of which could exacerbate bleeding. In
addition, omega-3 essential fatty acids may increase the risk of bleeding when taken
with herbs and supplements that are believed to increase the risk of bleeding such as
ginkgo, garlic and salt palmetto. Writing in Brown et al. II, Mischoulon and Freeman
counsel that special care should be taken by people taking medications that affect
platelet function. However, Fugh-Berman and Gerbarg state categorically that fish and
fish oil do not increase bleeding risk.
Berkeley Wellness minimizes concerns about bleeding: "Contrary to previous thinking,
fish oil does not cause excessive bleeding, even when combined with blood-thinning
drugs. An interaction with anti-clotting medication (such as warfarin) is theoretically
possible, but recent research has found no evidence of significant risk, even at high
doses.... Similarly, [one] need not worry about interactions with aspirin, which also has
an anti-clotting effect. Indeed the American Heart Association advises low-dose aspirin
and omega-3s for people with heart disease.” Low-dose aspirin used for the prevention
of myocardial infarction appears safe in combination with omega-3s.
Stoll comments that “only rare and sporadic cases of abnormal bleeding have been
reported” in the use of omega-3s. Specifically, he states that: “No cases of bleeding have
been reported in the greater than 17,000 subjects that have participated in omega- 3
clinical trials."^51
The Natural Standard cautions that omega-3's may lower blood pressure and add to the
effect of blood pressure medications, commenting that multiple clinical trials have
reported “small” reductions in blood pressure (two to five mm. of mercury), with the
effect proportional to the dosage. Thus, caution is warranted if the consumer has low
blood pressure or is taking blood-pressure-lowering medications. The Natural Standard
concludes that the risk of blood pressure changes at lower dosages is low. Still, people
contemplating surgery or dental procedures should discuss significant omega- 3
supplementation with their surgeon or dentist and consider tapering off for the
procedure.