Who should not take EPA DHA?

The first verb, should not, three readers only, and the second verb, should ask first, five situations

Who should not take EPA and DHA is a question the shelf answers with a long list and the honest page answers with three verbs, because most of the shelf's list is not should not but should ask, and the difference matters to a reader deciding whether a softgel is off the table or simply a question for someone. The first verb, should not, has three readers. A reader whose clinician has said stop: a cardiologist, a surgeon, a haematologist or a GP who has said stop fish oil has a reason the site cannot see, and the instruction stands until the clinician changes it, the stopping page's note that there is nothing to withdraw from. A reader allergic to the product's own ingredients: fish allergy is to fish proteins, and a refined fish oil contains little or no protein, so most fish-allergic people tolerate fish oil supplements with their allergist's guidance rather than being excluded by the allergy, the fish allergy and fish oil literature's finding, but a reader allergic to gelatin, to a carrier oil or to any other listed ingredient should not take that product, and a reader whose fish allergy is severe asks the allergist before any fish-derived oil and has algal EPA and DHA as the alternative. Anyone under eighteen: this site gives no supplement guidance for under-eighteens, whose omega-3 comes from the plate and from a parent's conversation with a GP or a dietitian, so the third should not is the site's rather than the register's. The second verb, should ask first, has five situations, none of which is an exclusion and all of which are a conversation. On an anticoagulant, warfarin or a newer agent, or dual antiplatelet therapy: EPA and DHA lengthen bleeding time slightly at gram doses, minor in the trials and never an organ bleed, so the clinician is told and decides, a standard softgel usually being fine and a gram or more being the question. An atrial fibrillation history, or a large endurance training history in middle age: the dose-related rhythm signal makes the higher rungs a question for the cardiologist, with a standard softgel below the signal's range. Surgery ahead: the trials that continued fish oil to the day of surgery found no extra bleeding, so the older advice to stop a fortnight before has weak evidence, and the practical rule is to declare it on the pre-operative form and do what the surgical team says. Kidney or liver disease: the high doses are the question, a standard softgel being fine in most and the nephrologist or hepatologist deciding above it. Pregnant and considering cod liver oil: the DHA claim for the foetal brain at 200mg more a day is a reason to take a body fish oil, and cod liver oil is the one to ask about, since its vitamin A is the pregnancy concern and a body oil carries none.

The third verb, should not at this dose, the everyone-left instruction, the two lists people expect and do not find, and the verbs filed

The third verb, should not at this dose, applies to everyone and answers most of the fear on the page: above a gram a day without a reason, since the outcome trials found nothing at a gram for prevention and the index over a season is the only reason to be there; four grams without a prescriber, since that is the rung where the rhythm signal is most evident and the leaflet's bleeding and LDL notes apply, a prescription dose assembled from a shelf being the site's standing warning; and above the five-gram safe level at all, sixteen standard softgels, the only hard ceiling. The everyone-left instruction is the oily-fish audit, which is where a reader who is not in the three verbs lands: one standard softgel for a low-fish plate, none for oily fish twice a week, with food, without a prevention belief and without a high dose. The two lists people expect and do not find are worth naming. There is no list of conditions that exclude a standard softgel, since diabetes, high blood pressure, a statin, thyroid disease, asthma and the rest neither interact with 300mg of EPA and DHA nor appear on any leaflet as a contraindication for it, the medications page's finding that the interactions live at gram doses with anticoagulants and almost nowhere else. And there is no list of people for whom fish oil is dangerous at a standard dose, the outcome trials having given a gram a day to tens of thousands of people of every kind for years and recorded minor gut complaints and minor bleeding as the harms, so the who-should-not question, honestly answered, is short in its first verb, conversational in its second, and mostly about the dose in its third. The verbs filed: should not, for a clinician's stop, an allergy to the product's ingredients and anyone under eighteen; should ask first, for anticoagulants, a rhythm history, surgery, kidney or liver disease and pregnancy with cod liver oil; should not at this dose, above a gram without a reason, four grams without a prescriber and five grams at all; and the audit for everyone left, with the worked example being the audit's softgel, a body oil with no vitamin A, £14.99 for 90 at 17p.

The verdict, a short first list, a conversational second, and a third that is about the dose

Who should not take EPA and DHA: by three verbs, should not for a reader whose clinician has said stop, a reader allergic to the product's own ingredients rather than to fish protein, which a refined oil barely contains, and anyone under eighteen, for whom this site gives no supplement guidance, should ask first for a reader on an anticoagulant, with an atrial fibrillation history, facing surgery, with kidney or liver disease, or pregnant and considering cod liver oil rather than a body oil, each a conversation rather than an exclusion, and should not at this dose for anyone above a gram a day without a reason, at four grams without a prescriber or above the five-gram safe level at all, with everyone the three verbs leave deciding by the oily-fish audit. The audit's softgel, a body oil with no vitamin A: Futuro Labs Omega 3 Fish Oil, one with food, 180mg EPA and 120mg DHA, gelatin shell, lab-tested purity, 90 for £14.99 at 17p a day.

What to check on the label

Questions people also ask

Can I take fish oil if I am allergic to fish?

Usually, with an allergist's guidance: fish allergy is to fish proteins and a refined fish oil contains little or none, so most fish-allergic people tolerate it, while a severe fish allergy asks the allergist before any fish-derived oil and has algal EPA and DHA as the alternative, and an allergy to gelatin or a carrier oil rules out that product.

Should I stop fish oil before surgery?

Declare it and do what the surgical team says: the trials that continued fish oil to the day of cardiac and other surgery found no increase in bleeding or transfusion, so the older advice to stop a fortnight before has weak evidence, and the team's instruction, either way, is the one to follow.

Can I take EPA and DHA with blood thinners?

Ask first: EPA and DHA lengthen bleeding time slightly at gram doses, minor in the trials and never an organ bleed, so a reader on warfarin, a newer anticoagulant or dual antiplatelet therapy tells the clinician, a standard softgel usually being fine and a gram or more being the question the clinician answers.

Who should avoid high doses of omega-3?

Anyone without a reason: above a gram a day the outcome trials found nothing for prevention and the index over a season is the only reason to be there, four grams is a prescriber's rung where the rhythm signal is most evident, and five grams is the safe level, with a rhythm history, an anticoagulant and kidney or liver disease making the higher rungs a clinician's question.

Is there any health condition that means I cannot take a normal dose of fish oil?

Almost none: diabetes, high blood pressure, a statin, thyroid disease and asthma neither interact with 300mg of EPA and DHA nor appear on any leaflet as a contraindication, the outcome trials having given a gram a day to tens of thousands of people of every kind for years with only minor gut and bleeding effects, so the exclusions are a clinician's stop, an ingredient allergy and being under eighteen.

Sources

1. The fish allergy and fish oil literature: fish allergy is to fish proteins, and refined fish oil contains little or no protein, so most fish-allergic people tolerate fish oil supplements, but the allergy guidance is to discuss it with an allergist and to prefer an algal oil where doubt exists. PubMed record
2. The omega-3 and surgical bleeding literature: trials that continued fish oil up to the day of cardiac and other surgery found no increase in bleeding or transfusion, so the older advice to stop a week or two before an operation has weak evidence behind it, and the practical rule is to declare the supplement and follow the surgical team's instruction either way. PubMed record
3. Meta-analyses of cardiovascular outcome trials of marine omega-3: a dose-related increase in the risk of atrial fibrillation, most evident at doses of four grams a day and small or absent below one gram, a finding that sets the honest ceiling of high-dose omega-3 for a healthy adult. PubMed record
4. 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

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