Should My Son Continue Taking Fish Oil for Ankylosing Spondylitis?

Can I continue taking fish oil?

Hello Dr.
Tseng, my son is 21 years old and has been diagnosed with ankylosing spondylitis for nearly four years.
Initially, he was only taking Celebrex (he tried Voltaren but it was ineffective).
Over the past year, he has added two capsules of Salazopyrin, and although his pain is well-controlled and his CRP levels have improved (from around 1.6 to about 0.6), he has been unable to manage his ESR effectively (which often remains around 50, not occasionally, but frequently).
Recently, during the summer break, in addition to Salazopyrin and Celebrex, he started taking fish oil (three capsules daily, with a total of 1200 mg of Omega-3) and probiotics.
After one month, his hsCRP surprisingly dropped to 0.38, and his ESR decreased to 13, while his platelet count (PLT) was 225 (I mention PLT because it is related to the main concern).
I believe this is a very good result, possibly coincidental, but it is great news for us.
Therefore, I plan to have my son continue taking Salazopyrin (I will stop Celebrex since he is no longer in pain) along with fish oil and probiotics for observation.
However, nothing is perfect; I read online that fish oil may have the potential to inhibit coagulation and lead to internal bleeding.
Since starting Salazopyrin, my son's PLT has decreased from the previous range of 250-290 to 210-250 (it seems that Salazopyrin has affected his platelet count, but it is not a continuous decline, rather it fluctuates between 210 and 250).
I would like to ask Dr.
Tseng: 1) After taking fish oil for one month, with a PLT of 225 (previously fluctuating between 210-250 without fish oil), should I be concerned that continuing fish oil might lead to internal bleeding for my son? 2) Would you recommend that my son continue taking fish oil for further observation? Thank you, doctor.

Hao, 50~59 year old female. Ask Date: 2023/09/12

Dr. Zeng Guosen reply Internal Medicine

The normal range for platelet count is approximately 150,000 to 400,000.
Your son's platelet count of 210,000 to 290,000 is actually within the normal range, so there is no need to worry.
1) In healthy individuals who are not taking antiplatelet or anticoagulant medications, such platelet levels should not lead to bleeding.
2) There is no strong evidence or guidelines supporting the use of Omega-3 for ankylosing spondylitis.
However, if your ESR/CRP levels have normalized as you described, it is advisable to consider using it, while monitoring and regularly tracking the data.
Thank you for your question.

Reply Date: 2023/09/12

More Info

When considering whether your son should continue taking fish oil for his ankylosing spondylitis (AS), it's essential to weigh the benefits against any potential risks. Based on the information you've provided, it appears that your son has experienced a significant improvement in his inflammatory markers, particularly hsCRP and ESR, after incorporating fish oil into his regimen. This is encouraging, as omega-3 fatty acids, which are abundant in fish oil, are known for their anti-inflammatory properties.

1) Regarding your concern about platelet count (PLT) and the risk of bleeding: A platelet count of 225, especially when it falls within the normal range (typically 150-450 x 10^9/L), is not alarming. The slight fluctuations you mentioned, from 210 to 250, are not uncommon and can occur due to various factors, including hydration status, physical activity, and even dietary changes. While fish oil does have anticoagulant properties, the risk of significant bleeding is generally low, especially if your son is not on other anticoagulant medications. The benefits of fish oil in reducing inflammation may outweigh the potential risks, particularly since his inflammatory markers have improved. However, it is always prudent to monitor his platelet levels and consult with a healthcare provider if there are any significant changes or concerns.

2) As for whether to continue fish oil, the evidence suggests that omega-3 fatty acids can be beneficial for individuals with inflammatory conditions like ankylosing spondylitis. Given the positive response you've observed in hsCRP and ESR, it would be reasonable to continue the fish oil supplementation while keeping an eye on his overall health and any potential side effects. It is also advisable to maintain regular follow-ups with his healthcare provider to monitor his condition and adjust his treatment plan as necessary.

In addition to fish oil, it's important to consider a holistic approach to managing ankylosing spondylitis. This includes maintaining a balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and lean proteins. Regular physical activity is also crucial, as it helps maintain flexibility and reduce stiffness associated with AS. Engaging in low-impact exercises, such as swimming or cycling, can be particularly beneficial.

Furthermore, probiotics, which your son is also taking, may contribute positively to gut health and inflammation management. The gut microbiome plays a significant role in immune function and inflammation, and maintaining a healthy balance of gut bacteria can be advantageous for individuals with autoimmune conditions.

In summary, based on the current evidence and your son's positive response to fish oil, it seems reasonable to continue its use while monitoring his platelet levels and overall health. Always consult with a healthcare professional for personalized advice and to ensure that any supplementation is appropriate for his specific health needs.

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