Supplements can seem like a harmless addition to your wellness routine. The reality is, unlike prescription medications, the U.S. Food and Drug Administration does not have the authority to approve dietary supplements for safety and efficacy before they hit store shelves. When it comes to bleeding disorders, some supplements may even prove harmful.
“We don’t always know the mechanism of harm for these supplements. And it’s not just patients with bleeding disorders, but all individuals,” says Rajiv Pruthi, MBBS, a hematologist at the Mayo Clinic in Rochester, Minnesota. As director of the Mayo Clinic’s hemophilia treatment center and co-director of the Special Coagulation Laboratory, Pruthi conducts both patient-centered clinical research and laboratory research.
However, most research on supplements and bleeding focuses on people without bleeding disorders. Pruthi says that while there isn’t much clinical evidence on how specific supplements affect people with bleeding disorders and which they should avoid, research does find that certain supplements may cause harm in two different ways:
Supplements May Increase Surgical Bleeding
According to a 2021 report in Mayo Clinic Proceedings on the preoperative management of surgical patients using dietary supplements, these include:
- Garlic extract
- Ginkgo biloba
- Glucosamine/chondroitin
Even people without bleeding disorders should avoid these supplements, especially before they’re scheduled to have surgery, Pruthi says.
Supplements Can Affect Platelet Function
These include:
- Flaxseed
- Grapeseed
- Melatonin
Both platelets and clotting factors make up your blood’s coagulation system — the process that stops bleeding when a blood vessel gets injured. “If you already have a compromised coagulation system, and then you’re just adding another variable that impacts your coagulation system, it has the significant potential to cause harm,” Pruthi explains.
How to Take Supplements Safely
Before you take any supplement, always talk to your primary care doctor and consult the hematologist at your hemophilia treatment center. “My general advice is not to take supplements, especially if there is no clear benefit and also because of the unknowns,” Pruthi says.
A daily multivitamin is one exception. “Most multivitamins are pretty straightforward and have micronutrients that are very important for bodily functions,” Pruthi says. “But usually you should get everything you need in a well-balanced diet.” To be on the safe side, read the label to make sure none of the ingredients that can affect bleeding are in your multivitamin.
Your primary care provider can also make sure that what you want to take is safe for you and your medical history. Through blood tests, they can also check for common vitamin deficiencies and recommend vitamin supplements that make sense for you to take. When in doubt, always ask.
NBDF’s Steps for Living website has more information about dietary supplements and bleeding disorders.