What not to take with fish oil?

The three questions a pharmacist asks, because they cover everything not to take with fish oil

What not to take with fish oil is a question a pharmacist answers with three questions of their own, and the three cover everything, the rest of the shelf and the cupboard being fine. Question one, are you on a blood thinner or antiplatelet: warfarin, a direct oral anticoagulant, aspirin or clopidogrel, since EPA and DHA modestly reduce platelet stickiness, an effect that is small at supplement doses, that the regulator's five-gram safe level accounted for and that the trials up to that dose did not find clinically important bleeding from in healthy adults, but that the pharmaceutical omega-3 preparations carry a note about and that a prescriber wants to know of, especially at the gram-and-above doses of the research rungs, so the answer to question one is not to stop the fish oil but to mention it. Question two, are you having an operation: the surgical team is told of every supplement, fish oil included, and high doses are paused on their advice in the run-up, the same conversation the ginkgo and turmeric pairings prompt, since a modest antiplatelet effect matters more on an operating table than at a dinner table, and a standard 250mg softgel is usually of no concern while a four-gram habit is worth stopping a week or two before. Question three, is it a liver oil beside a multivitamin or a vitamin A supplement: a body-oil fish oil carries no vitamin A and raises no question, but a cod liver oil carries hundreds of micrograms of preformed vitamin A a capsule, and stacked with a multivitamin's vitamin A or a separate vitamin A supplement it can approach the adult upper level of 3000 micrograms a day, with pregnancy advice being to avoid liver oils altogether, so the answer is to add the vitamin A across the two labels or to choose a body oil, the fish oil and vitamins page's one real caution.

Everything else, which is fine, the storage enemies, and the three questions filed

Everything else is fine, and the list is worth stating because the folklore is long. Vitamins: no vitamin conflicts with a fish oil, the water-soluble ones absorbing on their own routes, the fat-soluble ones absorbing better beside it, and vitamin E being in the softgel already as its antioxidant, so vitamin D, vitamin C, the B vitamins and a multivitamin's contents, question three aside, all go with it. Minerals: magnesium, zinc, iron and calcium do nothing to a fat, calcium at gram-scale forming soaps with a little of a meal's fat in a way that is measurable in a laboratory and negligible at a lifter's doses, so a mineral tub sits beside a softgel without conflict. Protein, creatine and the shelf: whey, casein, creatine, a pre-workout's caffeine, beta-alanine and the rest bind nothing and are bound by nothing, the stacking pages' standing finding. Food and drink: a meal helps, an ethyl ester oil absorbing several-fold better with fat, and coffee, tea and moderate alcohol affect nothing. Medicines beyond the three questions: statins, blood pressure tablets, antibiotics, antidepressants and the common prescriptions share no pathway with a fat, a pharmacist confirming the cupboard in one conversation. The things to keep a fish oil from are not in the cupboard but around the tub: heat, light and air oxidise EPA and DHA, so the tub lives in a cool dark cupboard or the fridge with its lid closed and is finished within a couple of months of opening, the freshness read that matters more than any stacking question. The three questions filed: a blood thinner, an operation, a liver oil beside a vitamin A source, with everything else fine and the tub kept from heat, light and air, and the worked example being a body oil with no vitamin A that answers question three by itself, one softgel with food at 17p, £14.99 for 90.

The verdict, three questions, a long list of things that are fine, and a tub to keep cool

What not to take with fish oil: nothing, once three questions are answered, whether you are on a blood thinner or antiplatelet, in which case the fish oil's modest antiplatelet effect is mentioned to the prescriber rather than stopped, whether you are having an operation, in which case the surgical team is told and high doses paused on their advice, and whether the fish oil is a liver oil beside a multivitamin or a vitamin A supplement, in which case the vitamin A is added across labels against the 3000 microgram limit or a body oil is chosen, with every vitamin, mineral, protein, creatine, coffee and common medicine fine beside a fat and the tub kept from heat, light and air. A body oil with no vitamin A: Futuro Labs Omega 3 Fish Oil, one softgel with food, 180mg EPA and 120mg DHA, 90 for £14.99 at 17p a day.

What to check on the label

Questions people also ask

What should not be taken with fish oil?

Nothing needs avoiding once three questions are answered: a reader on a blood thinner or antiplatelet mentions the fish oil to the prescriber, a reader facing an operation tells the surgical team, and a reader on a cod liver oil beside a multivitamin adds the vitamin A across labels; every vitamin, mineral, protein, creatine and common medicine is fine beside a fat.

Can I take fish oil with blood thinners?

Usually, with the prescriber's knowledge: EPA and DHA modestly reduce platelet stickiness, an effect small at supplement doses and not associated with clinically important bleeding in trials up to five grams in healthy adults, but one the pharmaceutical preparations carry a note about and that matters more at gram-and-above doses.

Should I stop fish oil before surgery?

Tell the surgical team and follow their advice: a standard 250mg softgel is usually of no concern, while a high-dose habit of several grams a day is worth pausing a week or two before, the modest antiplatelet effect mattering more on an operating table.

Can I take cod liver oil with a multivitamin?

With the vitamin A added across both labels: a cod liver oil carries hundreds of micrograms of preformed vitamin A a capsule and a multivitamin carries its own, the adult upper level being 3000 micrograms a day and pregnancy advice being to avoid liver oils, so a body-oil fish oil beside a multivitamin avoids the sum.

What ruins fish oil?

Heat, light and air, which oxidise EPA and DHA in the tub rather than anything taken beside it, so the tub lives in a cool dark cupboard or the fridge with its lid closed and is finished within a couple of months of opening.

Sources

1. EFSA Panel on Dietetic Products. Scientific opinion on the tolerable upper intake level of EPA, DHA and DPA: supplemental intakes of EPA and DHA combined up to about 5g/day do not raise safety concerns for adults. EFSA Journal 2012;10(7):2815. https://www.efsa.europa.eu/en/efsajournal/pub/2815
2. Electronic medicines compendium (emc): Summaries of Product Characteristics for omega-3-acid ethyl esters 1000mg capsules (Omacor and generics) and icosapent ethyl (Vazkepa). https://www.medicines.org.uk/emc/search?q=omega-3-acid+ethyl+esters
3. The cod liver oil and vitamin A literature: cod liver oil carries preformed vitamin A at hundreds of micrograms per teaspoon or capsule, the adult upper level for preformed vitamin A being 3000 micrograms a day and pregnancy advice being to avoid liver oils, so a cod liver oil stacked with a multivitamin or a vitamin A supplement is the one combination in which a fish oil can push a vitamin over its limit. https://www.gov.uk/government/publications/sacn-vitamin-a-and-health
4. The calcium and fat absorption literature: calcium supplements form insoluble soaps with fatty acids in the gut, modestly increasing faecal fat excretion, an effect measurable at gram-scale calcium and negligible at the modest doses a lifter takes. PubMed record

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