Anticoagulant therapy

Good day Mr. Jelínek,

I would like to ask - I have a client who is taking Brilique (for blood thinning) and Godasal (against blood clots) after a heart attack, and was advised by his doctor to stop supplementing Omega 3. As you previously mentioned in the advisory section on Omega 3 fatty acids - I understand that Omega 3 supplementation enhances the effect of anticoagulant treatment, which can be potentially dangerous due to increased bleeding risk. However, I wish to inquire if recommending dietary adjustments for the client to balance the omega 6/omega 3 ratios - that is, increasing the intake of foods/sources rich in omega 3 such as flaxseeds, hemp seeds, chia seeds and/or their oils, fatty fish like salmon, tuna, mackerel - could also significantly enhance the effect of anticoagulant therapy. Furthermore, how should these ratios be determined during such treatment? Would it make sense not to adjust the diet at all since he has been on these medications for almost a year?

Thank you for your response and have a nice day.

Adjusting one's diet makes sense, but it must be done cautiously. If the goal is to adjust the O3:O6 ratio, focus first on the achievable limitation of O6. When increasing O3, supplementation is not necessarily required; start by incorporating sources of ALA, from which the body will produce the minimum necessary doses of DHA and EPA, which seems to be a safe approach. If you include fish, the intake of O3 is somewhat debatable, because the amount varies significantly among the same species of fish depending on the conditions in which they lived. The differences can be multiple, making it difficult to adjust the diet according to the doctors’ requirements. For controlled management of coagulation factors, it is safer if the intake of anticoagulants remains long-term stable (= without significant fluctuations), allowing doctors to better adjust medication dosages.

Hello, you mention that coenzyme Q10 may reduce the effect of Warfarin - a blood-thinning medication. How is it with Omega-3 fatty acids, which can also be used to improve blood viscosity? Will it work? Or will Q10 also inhibit this process?
Can this be addressed in this manner? I assume the client should consult a doctor about this...
Thank you.

In general, a person suffering from any health problem for which they take medication should consult their physician about the appropriateness or inappropriateness of dietary supplements. The effects of supplements are continually improving due to ongoing developments, but despite efforts by legislative restrictions aimed at reducing their impact on metabolism, there is a risk of adverse reactions. In anticoagulant therapy, this is true for the use of vitamin K, and Coenzyme Q10 has similar effects. Conversely, omega-3 fats have an anticoagulant effect and may enhance the effects of these medications.

Hello, Mr. Jelínek,

I would like to ask if the exact mechanism of action of omega 3 on anticoagulants is known. I understand it in the case of vitamin K because Warfarin is actually an anti-vitamin K, but I haven't read about the omega 3 mechanism anywhere.

Thank you.

P.S. I highly commend the quality of your course.

Thank you for the compliment; I am glad that you are enjoying the course. You are presenting me with a teaching challenge in the form of the necessity to cater information not only to the general public, who are interested in delving into the secrets of proper nutrition, but also to you - the experts - whose know-how far exceeds the expert framework of this course. This drives me to avoid disappointment and further propels me forward...:-)

Anticoagulants such as Warfarin or Heparin only prevent the formation of blood clots (meaning they do not affect existing clots) by competing with vitamin K, which the body needs for the synthesis of coagulation factors. The mechanism of omega-3's influence on platelet aggregation is different: Omega-3 fatty acids compete with omega-6 (primarily arachidonic acid) for incorporation into the platelet membranes (this is one reason why it is recommended to ensure an omega-3 to omega-6 ratio of 1:1-5). If the primary components of the omega-3 intake spectrum are EPA and DHA, there is an increase in the production of prostaglandin I2 (prostacyclin - PGI2), which directly inhibits platelet aggregation and has local vasodilatory effects. Concurrently, there is a decrease in the production of thromboxane A2, a derivative of arachidonic acid produced by platelets, which enhances vasoconstriction and supports the activation of new platelets.

These effects result in prolonged bleeding time and reduced platelet aggregation, with the extent depending not only on the omega-3 to omega-6 ratio but also on the medications used (medications containing acetylsalicylates also play a role). Achieving this state through dietary adjustments is very challenging, and such situations are primarily associated with the use of higher doses of omega-3 from supplements.