Cod Liver Oil Warning

[Art O Ceitinn]

My INR rose from 3.2 to 7.9 after taking cod liver oil capsules for a few days.

 

[Chuck C]

Interesting. I take 6,000mg of fist oil per day and have never had an issue. Mine is made from anchovy, sardine and mackeral. I've also taken pills made from salmon in the past. I've not taken cod liver oil and don't plan to. I wonder if there is an interfering enzyme, in that it is taken from the cod's liver?

 

[tom in MO]

My cardio had me on fish oil but told me to stop after my AVR. Said there was no need for it. Post-surgery the heart rehab classes identified fish oil as a supplement that you should tell your cardio about if you start taking it.

 

[Brinntache]

Fish oil interaction with warfarin - PubMed
Seems like it can be a thing for some people. Now be aware that this study covers exactly 1 patient, so keep it in context.

 

[pellicle]

Seems like it can be a thing for some people. Now be aware that this study covers exactly 1 patient, so keep it in context.

seems consistent with most medical (n=1) studies published ... actually it fits the original declaration of the OP ... but it will be interesting to see how many follow.
Hey @Timmay , have you been taking Fish Oil?

PS: reading the summary:

...patient has her INR checked in the anticoagulation clinic and is followed monthly by the clinical pharmacist. Prior to the interaction, her INR was therapeutic for 5 months while she was taking warfarin 1.5 mg/d. The patient admitted to doubling her fish oil dose from 1000 to 2000 mg/d.

two things stood out:

1. super low dose to maintain therapeutic window, this would suggest that they are a very slow metaboliser of warfarin, thus any interactions will be magnified
2. monitored monthly ... say no more

The Usual Suspects

 

[pellicle]

Mine is made from anchovy, sardine and mackeral

my god man ... you know what the bible says about mixing things (Leviticus, Deuteronomy et al, C2000BC)!!

{I admit this isn't the most recent study, but it is still commonly cited in "the literature" ;-) }

 

[Chuck C]

my god man ... you know what the bible says about mixing things !! Leviticus ...

That was old testament legalism man! Jesus made things right and said the law is dead and we can eat all foods

Mark 7:19​

"..because it does not enter his heart but his stomach, and is eliminated, thus purifying all foods?”

 

[pellicle]

Mark 7:19​

"..because it does not enter his heart but his stomach, and is eliminated, thus purifying all foods?”

well sure, but what about the Jews? They don't believe that rubbish... A Jew may need to go on Warfarin and then be conflicted by the writings of authority ... I believe also the Islamic have some respect for the Torah too. Actually ... I think Christians have admonished me in the past citing the Old Testament (aka the Torah), so there seems to be division in the literature.

Actual scientific research may be needed ...

 

[pellicle]

not enter his heart but his stomach, and is eliminated

I wonder how that goes for nematodes ....

 

[pellicle]

My INR rose from 3.2 to 7.9 after taking cod liver oil capsules for a few days.

in light of the study cited by @Brinntache may I ask your daily dose?

 

[Art O Ceitinn]

in light of the study cited by @Brinntache may I ask your daily dose?

This details are on the jar (1000mg cod liver oil with omega-3 and vitamins A and D 240mg Active Omega-3) I took one per day for about a week. Because of my Celtic background I have Haemochromatosis which has f******up my joints and the 3 Witches of Eastwick that is my nickname for my wife and her 2 sisters came to the conclusion that COD LIVER OIL is great for my joints. Maybe they are after my money to expand their COVEN.

 

[Chuck C]

This may be of some interest, with respect to the concerns of fish oil and warfarin. However, the study involved other fish oils, not cod liver oil. Art's n=1 study may be the only one there is for cod liver oil.

"Fish and krill oil supplementation had no significant influence on both warfarin TTR control, bleeding incidence, or thromboembolic events in AF and DVT patients "

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037562/

 

[Brinntache]

Because of my Celtic background I have Haemochromatosis which has f******up my joints.

For joints I am a big fan of Glucosamine. Maybe get the Tumeric compound version, since I'm guessing you don't get a lot of spice in your fine Irish cuisine. (blood sausage anyone?...)

 

[pellicle]

This details are on the jar (1000mg cod liver oil with omega-3 and vitamins A and D 240mg Active Omega-3) I took one per day for about a week.

I was meaning your daily dose of warfarin...

 

[Art O Ceitinn]

I was meaning your daily dose of warfarin...

Oops ! I take previscan not warfarin. My dose 125 gram per week and my INR was 3.2 last week. I am happy with it being 2.5 to 3.5 but aim for around 3. I have a St Jude 27mm.

 

[Protimenow]

For joints I am a big fan of Glucosamine. Maybe get the Tumeric compound version, since I'm guessing you don't get a lot of spice in your fine Irish cuisine. (blood sausage anyone?...)

If you're taking warfarin, avoid Turmeric. It messes with INR.

Collagen is good for joints - and doesn't mess with INR.

As far as purifying foods (you can eat anything you want), I don't eat pork. Enoxaparin (Lovenox) has pork components. I asked my rabbi if I can use it, because it's made from pork, and was told that the restriction was about EATING it - not about injecting something that contains it. This, of course, would make porcine valves okay, too.

 

[Timmay]

I'll definitely be coming back to this and running an experiment with Cod Liver Oil and how it affects my INR. There's no hard evidence that it affects my INR - but it's possible given a high spike that was seen after taking a tablespoon of Carlson Cod Liver Oil (Lemon Flavored).

1 Tablespoon contains ...

3300mg of Omega-3's
1200 IU of Vit D
20mg Vit E
760 mcgRAE of vit A.

Why do I have Cod Liver Oil? I'm a huge fan of Omega-3's. I usually get them through my sardines (one small can on a sammich has 1,700mg of Omega-3's!) But when I think about my week and calculate that I didn't get enough of them, I have used Cod Liver Oil to supplement. I've only taken it once since my surgery and being on Warfarin. I didn't even think twice about it. But later realized that maybe it was the cause of my highest INR spike to date (a 4.0).

Again - no hard proof from me on this. But I hope to do some testing with it in about a month or so. I'll report back to this thread.

 

[pellicle]

If you're taking warfarin, avoid Turmeric. It messes with INR.

@Brinntache
My advice would instead be "if you take turmeric then make sure you are consistent with both it and warfarin and determine your warfarin dose by measuring INR to see if it needs adjustment."

 

[pellicle]

high spike that was seen after taking a tablespoon of Carlson Cod Liver Oil (Lemon Flavored)

So it was directly before that?

 

[Chuck C]

Why do I have Cod Liver Oil? I'm a huge fan of Omega-3's. I usually get them through my sardines (one small can on a sammich has 1,700mg of Omega-3's!)

I try to get a good amount of Omega-3s in my diet as well. I like to get it from wild caught fish near the bottom of the food chain, to minimize risk of mercury. Like you, I eat sardines, wild caught. I also eat a good amount of wild caught Sockeye salmon. Both very high in Omega-3s.

I hope to do some testing with it in about a month or so. I'll report back to this thread.

That would be great. Curious to see your results.