Flax Seeds: Benefits, Dosage, Contraindications

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Flax is a plant native to Europe, Asia, and the Mediterranean, cultivated for over 5,000 years for its nutritional and medicinal value. The oil was a traditional food of the Egyptians from the time of the pharaohs to the present day. It is also part of the Chinese pharmacopoeia. It is an annual herbaceous plant that can reach up to 1 meter in height. The blue flowers bloom for one morning before losing their petals during the day. The flax seeds mature 30 days later. The parts used in therapeutic applications are the seed and the seed oil. These seeds contain phytoestrogens, 3-9% mucilaginous polysaccharides, and soluble oils. The fiber is found in the seed coat gum. The phytoestrogens present in flax seeds include secoisolariciresinol and matairesinol lignans. Flax oil contains about 55% alpha-linolenic acid ALA (an omega-3 essential fatty acid), making it one of the richest dietary sources of ALA. It also contains other unsaturated fatty acids, such as linoleic acid and oleic acid. Linoleic acid (omega-6) and oleic acid (omega-9) each contribute 15% to the total fatty acid content of the oil. Flax seeds are consumed to relieve constipation, regulate intestinal flora, fight cholesterol and hypertension, and more broadly prevent cardiovascular diseases. They can also relieve menopause symptoms and mastalgia (breast pain). They are also consumed as an emollient preparation for the short-term symptomatic treatment of gastritis and enteritis and for the symptomatic relief of irritable bowel syndrome. Also as supportive therapy for symptoms of diverticulosis. In these three indications, the efficacy is based on human experience and long-standing traditional use. Note: Although flaxseed and psyllium have the same effects on constipation symptoms, weight, glycemic, and lipid levels, treatment with flaxseed appears to be superior to psyllium.

Other name(s) 

Cultivated Flax

Scientific name(s)

Linum usitatissimum

Family or group: 

Fatty Acids, Super Food, Plants

Active ingredients:

Alpha-Linolenic Acid

Linoleic Acid

Oleic Acid

Secoisolariciresinol Diglucoside (SDG)


Indications

Rating methodology

EFSA approval.

Several clinical trials (> 2) randomized controlled with double blind, including a significant number of patients (>100) with consistently positive outcomes for the indication.
Several clinical trials (> 2) randomized controlled with double blind, and including a significant number of patients (>100) with positive outcomes for the indication.
One or more randomized studies or multiple cohorts or epidemiological studies with positive outcomes for the indication.
Clinical studies exist but are uncontrolled, with conclusions that may be positive or contradictory.
Lack of clinical studies to date that can demonstrate the indication.


Constipation
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Flaxseed is an important source of dietary fiber and has a laxative effect. In a clinical trial on healthy young adults, flaxseed-based muffins containing 25 g of ground flaxseed twice daily for 4 weeks increased weekly bowel movements by 30% compared to a control group. Other clinical research in diabetic patients with constipation shows that taking 10 g of flaxseed twice daily for 12 weeks improves stool form and moderately reduces constipation compared to a placebo.

Posologie

posologieOral: seed

posologie15 - 50 g

formulationpowder, seeds


Hypercholesterolemia
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Most research shows that daily intake of 20 to 50 g of flaxseed reduces total cholesterol by 5 to 15% and LDL cholesterol by 8 to 18% in various populations, including those with normal cholesterol levels, patients with hypercholesterolemia, postmenopausal women, and patients with cardiovascular diseases or at risk. Although some studies have shown that flaxseed preparations do not affect triglyceride levels, a large meta-analysis shows - when analyzing subgroups - that flaxseed consumption does indeed reduce triglyceride levels in overweight or obese patients, or those with high baseline triglyceride levels.

Posologie

posologieOral: seed

posologie20 - 50 g

formulationpowder, seeds


Hypertension
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Meta-analyses of clinical research show that flaxseed is effective in reducing blood pressure; however, the most effective magnitude, dose, and form remain to be determined. According to a subgroup analysis, consumption of flaxseed powder was effective in reducing both diastolic and systolic blood pressure, flaxseed oil was effective in reducing only diastolic blood pressure, while flaxseed lignan extract showed no effect on hypertension.

Posologie

posologieOral route: seed

posologie30 - 60 g

formulationpowder, seeds


Type 2 Diabetes
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Flaxseed may improve glycemic control in patients with type 2 diabetes. The effects seem to be greater with the consumption of whole flaxseeds, in those with higher baseline blood glucose and insulin levels, and when used for at least 12 weeks. Patients receiving flaxseed oil also demonstrated improvements in insulin metabolism markers and inflammation. A meta-analysis of 25 clinical studies involving 1,879 patients shows that whole flaxseed may reduce blood glucose compared to control treatments such as wheat germ or uncooked rice. Another recent meta-analysis of 7 clinical trials shows that intake of flaxseeds, generally ground, at a rate of 13 to 40 g per day for 8 to 12 weeks, has a slight beneficial effect on fasting blood glucose, insulin, insulin resistance, and glycated hemoglobin (HbA1c), compared to no intervention or the use of another fiber source. Other studies have shown that using a standardized flax lignan extract at 600 mg three times a day, providing 360 mg of secoisolariciresinol diglucoside (SDG), reduces HbA1c in patients with type 2 diabetes, but does not seem to improve fasting blood glucose, insulin levels, or insulin resistance in patients with type 2 diabetes. Furthermore, there is a beneficial effect of flax seeds in preventing diabetes complications. High dietary consumption of ALA has been associated with a lower risk of peripheral neuropathy.

Posologie

posologieOral route: seed

posologie10 - 60 g

formulationpowder, standardized SDG extract, oil, seeds


Mastalgia
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Clinical research shows that taking 25 g of flaxseed powder daily for 2 months reduces the intensity of breast pain by about 72% and the duration of the pain by 60% from baseline in healthy women suffering from cyclic mastalgia; compared to placebo.

Posologie

posologieOral route: seed

posologie25 g

formulationpowder


Obesity
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Supplementation with flaxseeds, but not with lignan extract or flaxseed oil, appears to be modestly beneficial for obese or overweight patients. Individual clinical research and a meta-analysis of 45 studies involving 2,561 patients show that consuming flaxseeds reduces body weight, body mass index (BMI), and waist circumference. According to a meta-analysis, body weight is reduced by an average of 1.75 kg, BMI by an average of 0.63 kg/m2, and waist circumference by an average of 1.21 cm compared to control in adults, most of whom were overweight or obese at baseline. The greatest benefit is observed in adults with a baseline BMI greater than or equal to 27. Consuming flaxseeds of at least 30 g per day for at least 12 weeks demonstrated the greatest efficacy. Flaxseed lignan extract and flaxseed oil do not appear to be effective in reducing weight, BMI, or waist circumference.

Posologie

posologieOral route: seed

posologie30 g

duration12 - weeks

formulationseeds


Cardiovascular Diseases
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Epidemiological evidence for the prevention of secondary coronary events due to ALA, in the context of a modified Mediterranean diet, supports the hypothesis of prevention or treatment of cardiovascular diseases. In secondary prevention trials, such as the Lyon Diet Heart Study (1999), reporting the effects of the Mediterranean diet, it has been shown that ALA has a significant cardioprotective effect, with a decrease in the risk of recurrent, fatal, and non-fatal myocardial infarction, and a significant reduction in the risk (73%) of major cardiac mortality and morbidity parameters. Researchers suggest that the omega-3 ALA component in the oil contributes to the antiatherogenic effect via anti-inflammatory and antiproliferative mechanisms. They suggest that dietary flaxseed may also protect against ischemic heart disease by improving vascular relaxation responses and inhibiting the incidence of ventricular fibrillation.

Posologie

posologieOral route: seed

posologie2 - 5 g

formulationoil


Prostate Cancer
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Preliminary clinical research shows that flaxseed may affect the prostate and prostate cancer markers. Adding ground flaxseeds at 30 g per day, combined with a low-fat diet, can reduce prostate-specific antigen (PSA) levels in men with prostatic intraepithelial neoplasia (PIN), a precancerous proliferation of prostatic epithelial cells. It also appears to slow the proliferation of prostatic epithelium. Population research also suggests that the consumption of dietary lignans is associated with a decreased risk of developing prostate cancer. Flaxseeds being one of the most important sources of lignans. However, no research has specifically evaluated the effect of flaxseed consumption on prostate cancer risk.

Posologie

posologieOral route: seed

posologie30 g

formulationpowder


Breast Cancer
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Large-scale population studies suggest that a high intake of dietary lignans is associated with a significant reduction in the risk of developing breast cancer. A population study suggests that the consumption of lignans is associated with a reduced risk of breast cancer in premenopausal women, but not in postmenopausal women. The consumption of 25 g of ground flaxseeds per day for about 40 days significantly reduces tumor cell proliferation markers in women recently diagnosed with breast cancer. However, the effect of flaxseed consumption on breast cancer outcomes is not known.

Posologie

posologieOral route: seed

posologie25 g

duration40 - days

formulationpowder


Chronic Inflammatory Bowel Diseases
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Preliminary clinical research conducted on patients with ulcerative colitis shows that taking 30 g of ground flaxseed per day for 12 weeks improves disease severity and quality of life compared to a control. Preliminary clinical research conducted on patients with ulcerative colitis shows that taking 10 g of flaxseed oil per day for 12 weeks improves disease symptoms and quality of life compared to a control.

Posologie

posologieOral: seed

posologie30 g

duration12 - weeks

formulationpowder, oil


Menopause
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The evidence regarding the effect of flaxseed on menopause symptoms has been contradictory. Some randomized clinical research has observed significant reductions in hot flashes after 12 weeks of treatment. Other research concludes that flaxseed was not found effective in reducing the severity or frequency of hot flashes. Biomarkers of estrogenic effects (endometrial or vaginal epithelium thickness) did not change during these trials.

Posologie

posologieOral: seed

posologie25 g

formulationpowder


Benign Prostatic Hyperplasia
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Preliminary clinical research shows that taking a flax lignan extract, at a dose of 300 mg or 600 mg per day for 4 months, significantly reduces lower urinary tract symptoms and quality of life scores compared to placebo, in men suffering from benign prostatic hyperplasia. These results remain to be confirmed.

Posologie

posologieOral: seed

posologie1 - 2 g

formulationstandardized extract in SDG


Digestive Disorders
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Mucilage is considered to have a palliative effect in patients suffering from pain associated with gastrointestinal problems. In an open pilot study, 70 patients suffering from various functional upper abdominal disorders, such as feelings of pressure and satiety, loss of appetite, nausea, vomiting, and heart disorders, were treated with an aqueous preparation of flaxseed mucilage (1:10) at a dose of 8 x 25 g per day. All patients except three experienced improvements. After three days, the total symptom score had significantly decreased. The score for each individual symptom decreased on average, with the greatest reductions observed for the feeling of pressure (41.5%) and fullness (36.8%). In global assessments, both by patients and physicians, efficacy was rated as good or very good in most cases.

Posologie

posologieOral: seed

posologie5 - 10 g

formulationseeds


Irritable Bowel Syndrome
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Flaxseeds are more frequently used for irritable bowel syndrome but also inflammation of the intestine caused by excess laxatives. Currently, there is no scientific evidence to support these traditional uses.

Posologie

posologieOral: seed

posologie24 g

formulationpowder


Dermatoses
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Supportive treatment for symptoms of painful skin inflammations. The effectiveness is plausible based on human experience and long-standing use.

Posologie

posologieOral: seed

posologie30 - 50 g

formulationpoultice


Properties


Cardiovascular

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Flax seeds are used for atherosclerosis because they can reduce platelet aggregation and serum cholesterol and thus might reduce atherogenic risks. Flax seeds also contain alpha-linolenic acid (ALA), which may help reduce serum cholesterol. As ALA can be converted into long-chain polyunsaturated fatty acids (omega-3) in humans, it can potentially replicate the beneficial effects of fish oils. ALA has been demonstrated to have a significant cardioprotective effect, with a decrease in recurrent myocardial infarction, both fatal and non-fatal, and a significant reduction in the risk of major parameters of cardiac mortality and morbidity. It has been suggested that alpha-linolenic acid (ALA) in flax oil contributes to the antiatherogenic effect through anti-inflammatory and antiproliferative mechanisms.

Usages associés

Cardiovascular Diseases

Digestive Effect

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Mucilage would have a palliative effect in patients suffering from pain associated with gastrointestinal issues. In an open pilot study, 70 patients suffering from various functional upper abdominal conditions, such as feelings of pressure and satiety, loss of appetite, nausea, vomiting, and heartburn, were treated with an aqueous preparation of flaxseed mucilage (1:10) at a dose of 8 x 25 g per day. All patients except three experienced improvements. After three days, the total symptom score had significantly decreased. The score of each individual symptom decreased on average, the most significant reductions being observed for the feeling of pressure (41.5%) and the feeling of fullness (36.8%). In overall assessments, both by patients and physicians, the efficacy was judged to be good or very good in most cases.

Usages associés

Irritable Bowel Syndrome, Digestive Disorders

Anticancer

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Secoisolariciresinol and matairesinol are metabolized by mammalian intestinal flora bacteria into enterolignans, namely enterodiol and enterolactone. Due to their structure similar to estradiol, enterolignans act as selective estrogen receptor modulators. They are referred to as SERM (specific estrogen receptor modulators). Depending on the nature of phytoestrogens (PE) and the ratio of PE/estrogen concentrations, enterolignans can act: - as agonists, by simulating estrogen binding, but with different effects depending on the subsequent interaction with transcription activators or inhibitors of certain genes. - as antagonists, by preventing the binding of estrogen and thus inhibiting its action mediated by receptor binding. They can therefore inhibit the proliferative effect of estrogen-dependent breast cancer cells by reducing the competition of endogenous estrogen binding to estrogen receptors, which would result in an anti-estrogen effect. In a systematic review [Flower 2014] including 2 randomized controlled trials, 2 uncontrolled trials, a biomarker study, and 5 observational studies, flaxseed (25 g/day) increased the apoptotic index of the tumor and decreased HER2 expression and cell proliferation in recently diagnosed breast cancer patients compared to placebo. Uncontrolled studies and biomarker studies suggested beneficial effects on cell proliferation, atypical cytomorphology, and mammographic density, as well as potential antiangiogenic activity at doses of 25 g of ground flaxseed or 50 mg of secoisolariciresinol diglucoside (SDG) per day. Following breast cancer, research into prostate cancer shows that flaxseed (30g/day) can affect the prostate by reducing prostate cancer markers, such as prostate-specific antigen (PSA) levels, and slowing epithelial proliferation of the prostate. Although the mechanism of action is unclear, in humans, urinary enterolignan levels are correlated with a reduction in the proliferation of prostate cancer cells, suggesting a potential role for enterolignans derived from flax lignans.

Usages associés

Prostate Cancer, Breast Cancer, Benign Prostatic Hyperplasia

Laxative

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Dietary fibers such as flax seeds bind to water and swell to form a demulsifying gel in the intestine. Since the water bound to these fibers cannot be absorbed in the colon, the feces are softened, and the volume of intestinal content increases. A decrease in transit time and an increase in stool weight by physical stimulation of intestinal peristalsis with flax seeds have been demonstrated in two multicentric studies (n=108 and n=114) in patients with constipation.

Usages associés

Constipation

Estrogenic Action

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Lignans are phytoestrogens with mild estrogenic effects and potentially anti-estrogenic effects. Serum concentrations and urinary excretion of lignans can variably increase when people consume large quantities of flaxseeds and other lignan-rich foods. Lignans share some structural similarities with endogenous estrogens; each has a diphenolic cyclic structure. Flaxseed lignans alter estrogen metabolism to produce less active estrogen metabolites. In an open, randomized, crossover study involving 18 women with normal cycles, the effects of consuming flaxseed powder on menstrual cycle were studied. Each subject consumed their usual omnivorous, low-fiber diet (control) for 3 cycles and their usual diet supplemented with flaxseeds (10 g/day) for another 3 cycles. During the 36 control cycles, 3 anovulatory cycles occurred, whereas none occurred during the 36 flaxseed cycles. Compared to control ovulatory cycles, flaxseed ovulatory cycles were consistently associated with longer luteal phase lengths (mean 12.6 versus 11.4 days). There were no significant differences between flaxseed and control cycles regarding estradiol or estrone concentrations during the early follicular, mid-follicular, or luteal phases. Although flaxseed ingestion did not significantly impact luteal phase progesterone concentrations, luteal phase progesterone/estradiol ratios were significantly higher during flaxseed cycles. Mid-follicular phase testosterone concentrations were slightly higher during flaxseed cycles. Flaxseed ingestion had no effect on DHEA-S, PRL, or SHBG concentrations at the beginning of the follicular phase.

Usages associés

Menopause, Mastalgia

Lipid-lowering

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Flaxseed, at a daily dosage of 20 to 50 g, can significantly reduce total cholesterol (TC) and LDL-C. The cholesterol-lowering effects were more pronounced in women (particularly postmenopausal women) and those with initially high cholesterol levels. No significant change was observed in HDL-C and triglycerides concentrations. Whole flaxseed is the most commonly studied form in lipid-lowering studies because its high fiber content and ALA are assumed to act synergistically, which explains why there are relatively few studies using oil alone. Studies conducted with the oil have shown mixed results. At worst, the oil caused an increase in fasting triacylglycerol concentrations and a decrease in HDL cholesterol. At best, it has been described in previous studies as having effects comparable to bio-equivalent doses of fish oils.

Usages associés

Hypercholesterolemia

Anti-inflammatory

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ALA (in flaxseed oil) suppresses AA production by interfering with the conversion of LA to AA (arachidonic acid), and reduces the biosynthesis of inflammatory eicosanoids, but not to the same extent as EPA and DHA. Cytokines, another important group of inflammatory mediators, are generated in response to these eicosanoids and are influenced by changes in omega-3/omega-6 ratios in cell membranes. In one study, consumption of flaxseed oil (equivalent to 13.7 g/day of ALA) for 4 weeks by healthy male subjects resulted in a 30% reduction in TNF-alpha, a 31% reduction in IL-1-beta, a 29% reduction in thromboxane B(2), and a 30% reduction in PGE2. Also, several studies have confirmed that high-dose flaxseed oil consumption reduces endothelial inflammation. Flaxseed has been shown to improve inflammatory markers, including C-reactive protein and interleukin (IL)-6, as well as some adhesion markers. The anti-inflammatory effects of flaxseed might help to protect against cardiovascular diseases and other metabolic diseases.

Usages associés

Vascular disorders, Irritable bowel syndrome

Hypotensive

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A meta-analysis of 15 trials with 1302 participants supplemented with various flaxseed products showed significant reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The reduction in SBP was significant with flaxseed powder but not with oil or lignan extract. However, DBP was significantly reduced with both powder and oil preparations but not with lignan extract.

Usages associés

Hypertension

Vascular effect

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In a 12-week study conducted on healthy subjects aged 55 to 75 years, low levels of ALA (equivalent to about 5 ml/day of flaxseed oil) have shown to decrease certain markers of endothelial activation. More specifically, ALA reduced soluble plasma VCAM-1 concentrations by 16% and soluble E-selectin by 23%.

Usages associés

Cardiovascular diseases, Vascular disorders

Hypoglycemic

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Viscous dietary fibers can delay gastric emptying, as shown in several studies on non-insulin-dependent diabetic volunteers. Adding certain types of dietary fibers to the diet significantly decreased postprandial hyperglycemia. The postprandial glycemic response to a 50 g carbohydrate load given as flax bread is 27% lower than that of regular white bread. Flaxseed also appears to lower insulin levels in postmenopausal women and lower insulin and glucose levels in adults.

Usages associés

Type 2 diabetes


Safety dosage

Adult from 12 years: 5 g - 60 g (powder)

- As a laxative: 5 g of whole seeds, finely cracked or freshly crushed, soaked in water and taken with a glass of liquid three times a day. The effect starts 18 to 24 hours later. - Support treatment for dyslipidemia and hypertension: 20 to 50 g per day. - As an emollient for gastritis and/or enteritis: for a mucilaginous preparation, soak 5-10 g of whole flaxseeds in 150 ml of water and filter after 20-30 minutes. - Topical use: 30-50 g of ground or powdered seeds (can be defatted) as a poultice or warm compress. Due to the gradual mode of action of laxatives, treatment should be continued for at least 2 to 3 days to ensure optimal benefit. Flaxseeds (whole, finely cracked, or freshly ground) should be soaked and taken with extra liquid to prevent compaction and intestinal obstruction. For example: 15 g of crushed or ground flaxseeds to be taken in several doses. The last dose should be taken around 4 pm. Pre-soak the seeds in a large volume of water (150 ml) for about twenty minutes, consume the mixture, and drink one or two more glasses of water.

Adult from 12 years: 2 g - 5 g (oil)

- Anticoagulation: 5.9 g/day of ALA. - Improvement of endothelial function: 2 g/day of ALA. - Lipid balance: 60 ml/day of flaxseed oil. - Prevention of coronary diseases: 1-3 g/day ALA. Product quality is a key aspect of flaxseed oil supplementation. Due to the high oxidation potential of the oil, it is recommended to use only refrigerated oils, packaged in opaque containers. Once opened, the product should be consumed within a few weeks and stored in the refrigerator.

Child from 6 to 12 years:

Half of the adult dose.


Interactions

Médicaments

Platelet Aggregation Inhibitors/Anticoagulant: weak interaction

Flaxseed oil can decrease platelet aggregation. Beware of simultaneous use with aspirin, clopidogrel, dalteparin, enoxaparin, heparin, ticlopidine, warfarin...

Antidiabetic: weak interaction

It is important to closely monitor blood glucose levels when taking antidiabetic medications simultaneously with flaxseeds.


Precautions

Child up to 6 years: use with caution

Use under medical supervision

Pregnant woman: avoid

There is a lack of sufficient data. According to general medical practice, the product should not be used during pregnancy without medical advice.

Breastfeeding woman: avoid

There is not enough data.

Hemorrhagic disease: avoid

There is evidence that the oil contained in flaxseed may decrease platelet aggregation. In theory, flaxseed could increase the risk of bleeding in patients with bleeding disorders; use with caution.


Contraindications

Intestinal blockage: prohibited

People with an intestinal blockage, esophageal narrowing, and acute intestinal inflammation should avoid consuming large amounts of flaxseed. The risk is reduced if flaxseeds are consumed with a sufficient amount of liquid.