DEAR DR. BLONZ: Is there an issue with taking a fish oil supplement while on Coumadin? I require that medication to adjust the way my blood clots, and have been on it for many years. Will fish oil interfere with my regular blood monitoring tests? My doctor explained that I should continue to eat my typical diet, and then after the blood test, my dose would be adjusted as necessary. -- R.R.

DEAR R.R.: The key is to make consistent decisions when it comes to dietary components that can affect how your blood clots; that includes supplements and other medications you might be taking. Once your dose of Coumadin, often referred to as a “blood thinner,” is set, you need to maintain the habits that you had at the establishment of that dose. If a new prescription medication is being considered for any reason, your physician should be aware that you are on a medication involved with blood clotting.

As regards dietary supplements, including fish oil, touch base with your physician or the clinic professionals involved with the setting/adjusting of your dose before starting anything new. You are in a situation where a specific blood-clotting ability is the goal, and various foods, medications and supplements can have opposing effects on the clotting process.

You specifically asked about fish oil supplements, also referred to as omega-3 fatty acids, EPA and/or DHA. Studies looking at their effects on blood clotting have reported differing results, depending on the dose and the patient’s particular situation. This is why it’s important to work with the physician involved with your Coumadin therapy to determine whether this supplement is right for you, and if so, at what dosage. The periodic monitoring of how your blood is clotting is designed to detect when there is a need for adjustment in your Coumadin. If an adjustment is made in your dose, follow their advice as to whether the new dietary/supplement habits you had begun should now be considered your new norm. Read more on this at tinyurl.com/yad65rms.

DEAR DR. BLONZ: I had a reaction of muscle pain when I started taking Crestor last spring. I had to stop taking it. Now I learn that Lipitor has similar side effects, including liver issues. My question: Is there a homeopathic way to lower one’s cholesterol? -- J.M.

DEAR J.M.: Crestor (rosuvastatin) is one of a number of statin medications that can be taken to treat high blood cholesterol. Most of these medications will list muscle pain as a possible side effect, but this does not mean that experiencing this with one type of statin means that you will have a similar reaction to any statin. Check with your physician to see what alternatives might be appropriate. As for homeopathy, I am unaware of any evidence for effective treatments in this area.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: Are some calcium supplements better than others? I had been using oyster shell calcium, but read there are risks of a contaminant. Is this form safe? -- B.B., Milwaukee, Wisconsin

DEAR B.B.: Calcium supplements from natural sources are the ones at higher risk for lead contamination, mainly because they tend to form in areas where lead is also hanging around. These sources include oyster shell, dolomite and bone meal.

Oyster shell calcium can become a problem when the oysters developed in lead-contaminated waters. Dolomite, also called dolomitic limestone, is a mined mineral that’s composed primarily of calcium carbonate and magnesium carbonate, plus some other elements. If the mineral happens to be in areas that contain elevated amounts of lead, this natural source would also have its share of this unwanted mineral.

Bone meal makes sense as a calcium supplement because, in addition to the calcium, it contains the other trace elements used to make bones. The problem is that an animal’s bones often serve as storage tissue for heavy metal contaminants in the diet. Animals allowed to graze near sources of industrial pollution can become sources of higher-than-normal levels of these contaminants in their bones and other tissues.

This doesn’t mean that all natural sources are contaminated; it is just to let you know that when you choose a calcium supplement made from any of these compounds, you need to check the source. That means verifying that the company providing the supplement has tested their product and can provide assurances of its purity. Opt only for those brands that state their product is low-lead or lead-free. In general, only purchase supplements that provide you with the quality assurances that you, as a customer, need in order to be comfortable.

DEAR DR. BLONZ: I appreciate your science-based, respectfully written column, and never miss it. But I have a small correction to a recent answer about chelation therapy. You stated that the EDTA in lavender blood-collection tubes prevents blood from clotting by chelating the iron. Actually, it chelates the calcium in the plasma; the iron in cells is not accessible to the EDTA because the cells remain intact. -- E.B., retired clinical lab scientist, via email

DEAR E.B.: Thanks much for this correction.

DEAR DR. BLONZ: I was surprised when I read that the pH of lemon juice was actually lower than that of vinegar, making it more acidic. I can drink lemon juice straight, but vinegar takes my breath away. I have always been under the impression that if I substituted lemon juice for vinegar in a dressing or recipe, I should use slightly more lemon juice, which now seems unnecessary. -- B.G., San Diego, California

DEAR B.G.: pH is a measure of acidity, and it does not necessarily equate with taste. The vinegar used in foods comes from acetic acid, a substance that is produced during spoilage. It is pure acetic acid, so your taste buds get a real shot of that one component. In lemon juice, we have citric acid with a few other organic acids, but there are other flavor qualities to balance out the sensation. Vinegar acidities can vary, but most are about 5 percent. Lemon juice is in the same range. Your reactions make more sense when you consider the larger flavor context.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: Does the fact that muscle weighs more than fat explain the annoying fact that I tend to gain weight when I exercise? -- S.M., Hayward, California

DEAR S.M.: Let’s first acknowledge the obvious: that a pound of muscle weighs the same as a pound of fat. There are differences in caloric density, which is the number of calories (energy) per unit weight. A gram of fat contains nine calories, over twice the four calories in a gram of protein or a gram of carbohydrate. (A gram of alcohol, for what it’s worth, contains seven calories.) Using a monetary analogy, a $10 bill weighs the same as a $5 bill, but the 10 has twice the “spending energy” as the five.

The answer to your question lies with the fact that we are water-based organisms. Fat is the most concentrated form of energy in the human body, and adipose tissue, which is where fat is stored, contains very little water. By contrast, the protein that makes up our metabolically active muscles and organs is mostly water. The body prefers not to waste energy, so it will only have around the amount of muscle needed to maintain the status quo.

Whenever our routines become less active, the body will slowly reduce its muscular mass down to the basic level needed to keep the show going. When our routines or exercise habits involve an increased muscular demand, the body will respond by increasing its muscle mass. Other adaptations to regular increased muscular demand include an increased vasculature (blood vessels) and blood volume to carry the nutrients and waste products, and increased ventilatory capacity to deliver oxygen and remove carbon dioxide as needed.

Let’s assume you are eating a fixed number of calories when you begin an exercise program. As your body experiences the stress of exercise, it responds by making new muscles to handle the load. It also makes all the other supporting tissues and fluids -- all of which are primarily water. This means that the numbers on the scale can go up slightly, but realize that it is mostly water weight you are gaining. You are not getting fatter, but home scales do not provide that breakdown. (For this, you need to do a body composition test.)

If you were to stop exercising, you might lose weight. But again, it is water you are losing, and you might be getting fatter (increased percent body fat) at the same time.

Focusing solely on the scale can be discouraging and misleading, because it does not give you the complete picture, even when good things are going on inside. And never forget that additional muscle mass means that more energy is being burned, even while you are at rest. Think about an 8-cylinder engine versus a 4-cylinder engine, with the larger engine burning more gas even while idling.

Becoming fit is the way to go. It improves your general health and enhances your body’s ability to handle many types of stress.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.