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Flaxseed and flaxseed oil (Linum usitatissimum)



Interactions

Flaxseed/Drug Interactions:
  • GeneralGeneral: Consumption of flaxseed (not flaxseed oil) may decrease the absorption of co-administered oral medications/vitamins/minerals. Oral drugs should be taken an hour before or two hours after flaxseed to prevent decreased absorption.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets (flaxseed and flaxseed oil): There is a lack of available literature reporting a flaxseed-warfarin interaction or flaxseed-related bleeding. However, considering the suspected ability of omega-3 fatty acids to inhibit platelet aggregation, there is at least a theoretical potential for flaxseed (and other sources of omega-3 fatty acids) to affect bleeding. Some studies have reported decreased platelet aggregation (2; 4) and increased bleeding time (3), but this is in contrast with a study in healthy men noting a lack of effect on coagulation status using dietary alpha-linolenic acid (ALA) (34).
  • Antidiabetic agentsAntidiabetic agents: Based on case series, the intake of omega-3 fatty acids (which are present in flaxseed) may cause hyperglycemia (29), however results are conflicting (32).
  • AntihypertensivesAntihypertensives: Preliminary human evidence suggests that higher levels of linolenic acid in human adipose tissue may correlate with lower blood pressure (27), and that two weeks of flaxseed supplementation lowers blood pressure (28). Flaxseed supplemented diets have had mixed effects on blood pressure in rats (54; 55).
  • Anti-inflammatory agentsAnti-inflammatory agents: Based on laboratory study, flaxseed decreases the permeability of ketoprofen (79).
  • Antilipemic agentsAntilipemic agents: Flaxseed and flaxseed oil have been demonstrated to possess lipid-lowering properties in vitro and in animals (80; 5; 6). Multiple poor-quality human studies have administered flaxseed products and measured effects on lipids, with mixed results (81; 82; 28; 8; 83; 56; 34; 45; 84; 85; 86; 4; 32; 87; 22; 40). It has been reported that defatted flaxseed (equivalent to the fiber component of flaxseed) can significantly reduce levels of total cholesterol and low-density lipoproteins (LDL) (8).
  • Antineoplastic agentsAntineoplastic agents: Numerous epidemiologic, animal, in vitro, and in vivo studies support the hypothesis that mammalian lignans have cancer protective effects (88; 89; 90; 91; 92; 93; 94; 95; 96; 97; 98; 11; 99; 100; 101; 102; 103; 104; 105). Dietary flaxseed may increase the effects of tamoxifen, a medication used to treat cancer.
  • Antiobesity agentsAntiobesity agents: There is limited research on the effects of flaxseed flour and ALA (derived from flax) in obese patients. Flax supplementation may cause weight gain or weight loss in different patient populations (44; 106).
  • Cardiovascular agentsCardiovascular agents: It has been proposed that flaxseed, and its lignan complex, may exert a beneficial effect on atherosclerotic plaque formation or cardiovascular outcomes, based on purported antioxidant and lipid-lowering properties (80; 18). Limited human study and scientific reviews suggest a possible antiarrhythmic effect of ALA and omega-3 fatty acids (107; 108; 109).
  • Cognitive agentsCognitive agents: Preliminary evidence supports the idea that deficiencies or imbalances in certain highly unsaturated fatty acids may contribute to attention deficit hyperactivity disorder (ADHD). Supplementation with flax in these populations resulted in an increase in alpha-LNA and a slight decrease in the ratio of arachidonic acid to eicosapentaenoic acid (110).
  • Diuretics, loopDiuretics, loop: Based on laboratory study, flaxseed decreases the permeability of furosemide (79).
  • Gastrointestinal agents, miscellaneousGastrointestinal agents, miscellaneous: Based on clinical study and case reports, ingestion of flaxseed products may cause nausea, vomiting, and abdominal pain (9; 52; 53), and may have laxative effects resulting in prolonged diarrhea, increased number of bowel movements, and gastrointestinal distress (30; 46; 9).
  • Hormonal agentsHormonal agents: Flaxseed (not flaxseed oil) contains lignans, which may possess estrogen receptor agonist or antagonist properties (64), with unclear interactions with hormonal agents.
  • Laxatives Laxatives (flaxseed, not flaxseed oil): Laxatives and stool softeners may increase or enhance the laxative effects of flaxseed (30).
  • Mood stabilizers Mood stabilizers (flaxseed and flaxseed oil): In theory, consumption of flaxseed may increase episodes of mania and hypomania in bipolar patients (9).
  • Prostaglandins (Iloprost, treprostinil)Prostaglandins (Iloprost, treprostinil): There is a theoretical risk of bleeding from platelet aggregation inhibition with flax (2; 4; 3). Combination of flaxseed with inhaled iloprost or treprostinil may increase the risk of bleeding.
  • Proton pump inhibitors (PPIs)Proton pump inhibitors (PPIs): In theory, the combination of proton pump inhibitors with flaxseed oil high in omega-3 fatty acids may have additive anti-ulcer effects.
  • Skeletal muscle relaxants (metaxalone)Skeletal muscle relaxants (metaxalone): There is a theoretical risk of bleeding from platelet aggregation inhibition with flax (2; 4; 3). Combination of muscle relaxants and aspirin with flaxseed may increase the risk of bleeding.

Flaxseed/Herb/Supplement Interactions:
  • GeneralGeneral: Consumption of flaxseed (not flaxseed oil) may decrease the absorption of co-administered oral medications/vitamins/minerals. Oral agents should be taken an hour before or two hours after flaxseed to prevent decreased absorption.
  • AntacidsAntacids: Combination of proton pump inhibitors with flaxseed oil high in omega-3 fatty acids may have additive anti-ulcer effects.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets (flaxseed and flaxseed oil): There is a lack of available literature reporting a flaxseed-warfarin interaction or flaxseed-related bleeding. However, considering the suspected ability of omega-3 fatty acids to inhibit platelet aggregation, there is at least a theoretical potential for flaxseed (and other sources of omega-3 fatty acids) to affect bleeding. Some studies have reported decreased platelet aggregation (2; 4) and increased bleeding time (3), but this is in contrast with a study in healthy men noting a lack of effect on coagulation status using dietary alpha-linolenic acid (ALA) (34).
  • Anti-inflammatory herbs and supplementsAnti-inflammatory herbs and supplements: Based on laboratory study, flaxseed decreases the permeability of ketoprofen (79).
  • AntilipemicsAntilipemics: Flaxseed and flaxseed oil have been demonstrated to possess lipid-lowering properties in vitro and in animals (80; 5; 6). Multiple poor-quality human studies have administered flaxseed products and measured effects on lipids, with mixed results (81; 82; 28; 8; 83; 56; 34; 45; 84; 85; 86; 4; 32; 87; 22; 40). It has been reported that defatted flaxseed (equivalent to the fiber component of flaxseed) can significantly reduce levels of total cholesterol and low-density lipoproteins (LDL) (8).
  • AntineoplasticsAntineoplastics: Numerous epidemiologic, animal, in vitro, and in vivo studies support the hypothesis that mammalian lignans have cancer protective effects (88; 89; 90; 91; 92; 93; 94; 95; 96; 97; 98; 11; 99; 100; 101; 102; 103; 104; 105).
  • Antiobesity herbs and supplementsAntiobesity herbs and supplements: There is limited research on the effects of flaxseed flour and alpha-linolenic acid (derived from flax) in obese patients. Flax supplementation may cause weight gain or weight loss in different patient populations (44; 106).
  • Cardiovascular herbs and supplementsCardiovascular herbs and supplements: It has been proposed that flaxseed, and its lignan complex, may exert a beneficial effect on atherosclerotic plaque formation or cardiovascular outcomes, based on purported antioxidant and lipid-lowering properties (80; 18). Limited human study and scientific reviews suggest a possible antiarrhythmic effect of ALA and omega-3 fatty acids (107; 108; 109).
  • Cognitive agentsCognitive agents: Preliminary evidence supports the idea that deficiencies or imbalances in certain highly unsaturated fatty acids may contribute to attention deficit hyperactivity disorder (ADHD). Supplementation with flax in these populations resulted in an increase in alpha-LNA and a slight decrease in the ratio of arachidonic acid to eicosapentaenoic acid (EPA) (110).
  • DiureticsDiuretics: Based on laboratory study, flaxseed may alter the effects of some types of diuretic herbs and supplements (79).
  • Gastrointestinal herbs and supplementsGastrointestinal herbs and supplements: Based on clinical study and case reports, ingestion of flaxseed products may cause nausea, vomiting, and abdominal pain (9; 52; 53), and may have laxative effects resulting in prolonged diarrhea, increased number of bowel movements, and gastrointestinal distress (30; 46; 9).
  • HypoglycemicsHypoglycemics: Based on case series, the intake of omega-3 fatty acids (which are present in flaxseed) may cause hyperglycemia (29), however, results are conflicting (32).
  • HypotensivesHypotensives: Preliminary human evidence suggests that higher levels of linolenic acid in human adipose tissue may correlate with lower blood pressure (27), and that two weeks of flaxseed supplementation lowers blood pressure (28). Flaxseed supplemented diets have had mixed effects on blood pressure in rats (54; 55).
  • LaxativesLaxatives (flaxseed, not flaxseed oil): Flaxseed may possess laxative properties which may act additively with other laxative agents (30).
  • Mood stabilizers Mood stabilizers (flaxseed and flaxseed oil): In theory, consumption of flaxseed may potentially increase episodes of mania and hypomania in bipolar patients (9).
  • Muscle relaxantsMuscle relaxants: There is a theoretical risk of bleeding from platelet aggregation inhibition with flax (2; 4; 3). Combination of muscle relaxants and aspirin with flaxseed may increase the risk of bleeding.
  • PhytoestrogensPhytoestrogens: Flaxseed (not flaxseed oil) contains lignans, which may possess estrogen receptor agonist or antagonist properties (64), with unclear interactions with herbs and supplements purported to possess estrogenic properties.
  • PsylliumPsyllium (flaxseed, not flaxseed oil): In theory, concomitant use of flaxseed and psyllium may reduce the absorption of oral medications.
  • Vitamin EVitamin E (flaxseed, not flaxseed oil): Consumption of flaxseed may result in increased liver vitamin E levels, as indicated in animal study (61).

Flaxseed/Food Interactions:
  • Processing/cookingProcessing/cooking: Processing and cooking may alter the lipid content and stability of alpha-linolenic acid (ALA) in spaghetti containing ground flaxseed (111).

Flaxseed/Lab Interactions:
  • Alkaline phosphataseAlkaline phosphatase: The use of flaxseed (not flaxseed oil) may decrease alkaline phosphatase levels (61).
  • Blood testsBlood tests: Based on animal data, flaxseed (not flaxseed oil) may increase total red blood cell counts (61).
  • Blood pressureBlood pressure: Four weeks use of flaxseed does not appear to lower blood pressure (112).
  • Coagulation panelCoagulation panel: Flaxseed or flaxseed oil may increase bleeding time (3).
  • Plasma EPA levelsPlasma EPA levels: Following administration of 3g ALA from flaxseed oil capsules for 12 weeks, plasma eicosapentaenoic acid (EPA) levels significantly increased compared to placebo (p=0.004).
  • Serum glucoseSerum glucose: Based on case series, the intake of omega-3 fatty acids (which are present in flaxseed) may cause hyperglycemia (29), however results are conflicting (32).
  • Serum lipidsSerum lipids: Consumption of flaxseed or flaxseed oil may decrease total cholesterol levels (81; 4; 32; 87; 22; 40; 28; 8), lower low-density lipoprotein (LDL) levels (81; 4; 32; 87; 28; 8) and triglycerides (4; 28; 5), although conflicting data exists (61; 112; 113; 112).
  • Serum testosterone, luteinizing hormone (LH)Serum testosterone, luteinizing hormone (LH): In theory, the use of flaxseed (not flaxseed oil) may increase serum levels of LH or testosterone (70).

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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