Q&A: fish oil’s association with stroke and atrial fib; anti-reflux meds; metformin for COVID & Ashwaganda for sleep
Keep your questions coming!
ICYMI 👉
In this week’s reader-submitted Q&A, we’re tackling these questions:
Does fish oil increase the risk for a-fib and stroke?
Should I be worried about taking an anti-reflux medicine long-term?
Do you recommend Metformin for COVID?
Does ashwagandha impact sleep and brain health?
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: FISH OIL’S ASSOCIATION WITH AFIB AND STROKE
My cardiologist recommended fish oil for my heart - I have atrial fib and high cholesterol. But my sister’s cardiologist (my sister also has atrial fib) said that fish oil doesn’t do anything good - and it may even make atrial fib WORSE and increase the risk of a stroke. Do you have any advice on this?
- Paula
Dear Paula,
Great question. Fish oil is one of the most widely used supplements in the U.S., despite the absence of good evidence as to whether it offers any benefit to cardiovascular health.
Recent research has suggested some potential risks associated with their use, particularly concerning atrial fibrillation (AF) and stroke. As you know, atrial fibrillation is a type of irregular heart rhythm that can lead to serious complications, including stroke. Some large clinical trials and meta-analyses have found that high doses of omega-3 supplements may be associated with an increased risk of developing atrial fibrillation. A study published in BMJ Medicine this year found that people without cardiovascular disease who regularly take fish oil supplements have a 13% higher risk of developing atrial fibrillation.
However, the relationship between fish oil supplements and stroke is more complex. Note that there are two types of strokes: ischemic (caused by blood clots) and hemorrhagic (caused by bleeding). Fish oil is thought to have protective effects against ischemic stroke due to its anti-inflammatory and anti-clotting properties. However, some concerns have been raised about the potential for fish oil to increase the risk of hemorrhagic stroke because of its blood-thinning effects. Which is probably why the evidence on fish oil and stroke risk is mixed. Some studies suggest a potential increase in the risk of hemorrhagic stroke (like the BMJ Medicine study above), while others (like this study published in JAMA) do not show a significant increase.
Given these mixed findings, I suggest two things: 1) moderation and 2) medical advice. It is generally better to get omega-3s through food (think: fatty fish such as salmon, mackerel, and sardines; flaxseeds; chia seeds; walnuts; and certain oils like flaxseed oil and canola oil). The American Heart Association (AHA) and other medical organizations don't strongly recommend fish oil supplements for preventing cardiovascular disease either.
But if you want to take fish oil, keep the dose moderate and check with your doctor, always!
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QUESTION #2: ANTI-REFLUX MEDICATION
I have reflux and take non prescription Prilosec (omeprazole) daily. It works great. I do not have symptoms when I take it. If I stop, I get reflux again. I worry about taking it every day because of long term risk of the medication but my doctor says to continue it. Is that ok?
- RK
Hi RK,
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