DEAR DR. BLONZ: You often mention the benefits of eating fish like salmon or sardines, which are high in omega-3 fats. But does this recommendation hold if you are on anticoagulants? I have deep vein thrombosis, and have been taking Coumadin. As part of my treatment, I go in regularly to measure my “bleeding time.”

I cook and eat fish periodically, and have taken a fish oil supplement for many years. But during a recent call with friends, they warned me that it could be dangerous, and that I should avoid all omega-3 fats from fish or supplements. Since I know these are essential nutrients, what do you advise? -- S.P., Chicago, Illinois

DEAR S.P.: Bottom line up top: If you are taking an anticoagulant such as Coumadin, you need to take care when making changes to your habitual intake of omega-3 fats. That does not mean you should stop or avoid them; the key is to be careful when making changes to your routine intake -- whether increasing or decreasing. Let me explain.

The omega-3 fats at issue include EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid, respectively), which are found in fish and other seafood. These have a shorter cousin, ALA (alpha-linolenic acid), which is found in plants. The body has metabolic pathways that turn ALA into EPA and DHA, but it’s not an efficient process. Most omega-3s of plant origin get used or stored for energy, with only a small fraction being converted into EPA or DHA.

The significance here is that bleeding time -- the tendency and time for one’s blood to clot -- can be affected by significant changes in the level of omega-3s in the body. This includes making additions or reductions in the levels consumed regularly. While these omega-3 fats are essential nutrients for all of us, there is a need to be aware of potential interactions with medicines affected by blood’s tendency to clot.

One such concern is the condition you mention, deep vein thrombosis, in which blood flow is restricted in a vein because a clot has formed. (Read more about DVT at b.link/dvt2020.) One therapy for DVT involves anticoagulants, also referred to as blood thinners -- including the one you take, Coumadin (brand name for warfarin). Such therapies are utilized to fine-tune coagulation to prevent unwanted blood clots, while maintaining the ability to form clots where needed.

When using anticoagulant medications, it is essential to test -- both initially and periodically -- to establish and adjust the dose needed. Once the dose is determined, you don’t want to make changes by adding or stopping elements that can ruin the recipe.

You mentioned that you cook; consider taking a look at a cookbook that focuses on this issue. I am familiar with two such books, both written by physicians: “The Coumadin Cookbook” by Rene Desmarais and “The Dr. Gourmet Diet for Coumadin Users” by Timothy Harlan.

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: What is known about the Ganoderma mushroom that gets roasted and used as a coffee substitute? I am having trouble finding out information from sources that do not benefit from its sale. I had a sample and enjoyed the flavor, and I have read about health benefits, but I want to know more about what I would be ingesting before I buy. Thank you for your help. -- G.G., Hayward, California

Dear G.G.: Definitely best to check things out in advance. A mushroom is a fungus and not considered a plant. It gets the nutrients it needs from organic matter; in essence, mushrooms live off dead plants. A number are treasured for culinary uses, while some are feared for their deadly toxins, and others are known for their psychoactive effects. Some mushrooms are studied for their medicinal properties. For example, a number of mushroom compounds are being investigated for effects on cancer when taken alone or used in conjunction with more conventional therapies. As is often the case with natural-occurring compounds, there can be variations from harvest to harvest. All this translates to plenty of unknowns about the precise identification and level of active ingredients and what they will do in the human body.

The beverage you mention is made from roasted Ganoderma, its full name being Ganoderma lucidum, more commonly known as the reishi mushroom. Reishi mushrooms have a long history in traditional Eastern medicine and herbology. An active area of study with reishi relates to their bioactive compounds and potential benefits to the immune system.

As exciting as this all is, it is essential to not get ahead of the science. I mention this because the compounds in mushrooms evolved to protect the mushroom’s ability to grow and propagate. They are in the mushroom to help the mushroom, not us, so they can be present in tiny amounts (although with some toxins, this is enough!). Does this all change if we “extract” a specific component from a mushroom’s symphony of self-made compounds and then give it to a human at higher levels? It can be an undertaking with some risks, so caution is advised. We should understand what’s going on as best we can to avoid inadvertently ingesting something that can cause harm. (See b.link/vpxxw for a general take on mushrooms.)

I am familiar with reishi being taken as a tea or added to a coffee product; it can also be dried and used as a dietary supplement. I am not very familiar with the roasting of reishi for use as a coffee substitute. It is unclear whether and how a roasting process might affect reishi’s bioactive compounds. Could there be potential interactions with health conditions, medications or other dietary supplements? If it will be used as a routine beverage, will there be an effect from chronic usage?

My concerns might seem a bit excessive, but it is important to think and act prudently when tossing unknowns into our mix, particularly if we have ongoing health conditions and are using medications. (Ironically, it is often when something is wrong and we are disappointed with existing treatments that we turn to such alternatives.) We go through this whenever we add something new, but we have a long history of use as a guide with foods and culinary mushrooms.

I realize that I am leaving you with more questions than answers, but I want you to be aware of the issues. Exercise caution. If you have ongoing health conditions and are taking meds, please run this by your health practitioner and your pharmacist and track what happens.

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: In a recent column, you gave some information on roasted nuts. I have read the book “Diet and Salad” by Norman Walker, D.Sc., in which he wrote: “Nuts which have been cooked, roasted or otherwise subjected to excessive heat are harmful on account of the change which takes place in the fat under these conditions. The reaction on (sic) the liver and gall bladder is then detrimental and may sooner or later interfere with the complete and proper function of these organs.”

Given this, you might want to rethink your answer or at least do a bit more research. -- V.R., via email

DEAR V.R.: Thanks for your note, but I have no confidence in the scientific statements and related opinions of Norman W. Walker. The records I consulted indicate that he was a businessman, not a scientist. The book you cite indicates Walker had a D.Sc. (doctor of science), and on others of his books, his name is followed by “Ph.D.” However, I could find no indication of any earned graduate degree in nutrition or any field related to food science or health.

I will certainly acknowledge that peanuts are not “officially” nuts; they are in the legume family, which has been mentioned before in this column and in my books. Even so, the nutrient composition of peanuts makes it reasonable to include them in discussions about nuts and seeds. Those who have adverse reactions to peanuts, including allergies, must certainly stay away from them. But aside from those medical constraints, peanuts -- when properly grown, harvested and roasted -- are not toxic, nor are roasted nuts in general.

Walker was an advocate of raw foods and juicing, so much of his writing reflects a bias against any form of cooking. His paragraph on peanuts uses the term “excessive heat.” Of course, if you burn nuts (or peanuts), they will be damaged and can form harmful substances -- but this can be said for most foods. It does not apply if nuts are correctly roasted. Consider, also, that burned nuts (and peanuts) will have a nasty smell and will no longer be palatable.

Peanuts, and nuts in general, tend to be healthful additions to the diet. Walker’s writings imply that any roasted nuts are dangerous, and I’m afraid that’s not right. We are all entitled to our opinions, but the statements in that paragraph are nutty, to say the least.

DEAR DR. BLONZ: In a cooking show I saw, the chef said that when we eat meat, as with a steak, we are eating cow muscle. I brought the subject up during a conversation recently, and was immediately disagreed with. This person said that we are eating the “fleshy part,” whatever that is. Please elaborate a little so that I may forward it to that individual. -- R.S., Broken Arrow, Oklahoma

DEAR R.S.: Steak and other “muscle meats” do come from an animal’s muscle tissue. “Flesh” can refer to meat, soft tissue (including muscle and fat) or organs such as the liver or kidney. As a generic term, it can refer to animal tissue in general.

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.