Living with a Mechanical Heart Valve: Click.Tick.Thump. Love It!

Support Group for Mechanical & Artificial Heart Valve Surgery & Using Warfarin

Other than the Vitamin K vs. Coumadin/Warfarin balancing act most of us are dealing with, any comments on your current diet? 

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Hi Racer.

My diet is pretty much the same as any normal person that watches their weight and and food nutrition levels. I do however make it a point to have at least one leafy green vegetable high in vitamin K a day - ie advocado, spinach, lettuce etc and also have a small glass of wine a day and in the summer a beer as well. I have at least 2 pieces of fresh fruit a day as well. I do not have any diet restrictions but - like everything else with diet and nutrition - I try to eat healthily and do not let warfarin restrictions on diet overule healthy eating. Because I incorporate Vitamin K into my diet daily and also alcohol (in moderate quantity)I have established a fairly stable INR level - based on HAVING these in my daily diet. I also try to walk at least 2 miles a day and swim in summmer and generally take stairs - if possible - although in small quantities(!) - and generally keep active physically. I am a firm believer in exercise complimenting a balanced diet!

Like anything - common sense rules. If you have a much bigger than usual Vitamin K food intake or drink a bottle of red wine you are going to have a serious fluctuation in your INR level the next day. However, apart from one or 2 hiccups with taking antibiotics (which are devasting to my INR levels!) I am very happy with my nutrition and choice of food, and my weight has stayed pretty much the same (11.8-11-10) over the last 7 years since my AD operation and my new valve.

As I said - common sense rules.

cheers

Graeme
Dear Graeme,
The balance you have worked out with your diet seems like it works well for you. I am more uneven in my alcohol intake. Some weeks I have nothing, then maybe one drink, then another week maybe three or four. I am surprised you are able to have Spinach. My list from the Cardiologist(which originated from Dr.Gourmet.com) indicates: Spinach raw 144.9 micrograms Vitamin K in 1 cup, also, Spinach cooked 888.5 micrograms per 1 cup, Spinach frozen 1189.5 per 10 oz.
I am only allowed 100 micrograms of Vitamin K every other day. You can imagine spinach is basically not on the menu for me.

I have gotten my exercise level back in a more normal, active level. I do stairmaster at a level 6 for 30 minutes and then a full circuit of weight machines. I do this about three times a week. Occasionally I walk outside and leisurely swim. I do all with caution and listening to my body. I agree with your philosophy of balance in nutrition and exercise. I have a bit of work to do to get my diet back into something more balanced and healthy. I have let stress and convenience rule a bit. Even though I know how to eat healthy, low fat I have let it slide a bit. My weight is steady at 127 pounds. I think sometimes we can easily be in denial of the actual health level of our diet. I will take your example as an encouragement and motivator to me to turn my diet around to one of more vegies/fruit and lower fat. By the way how many micrograms of Vitamin K are you allowed? Thanks for your response.
Racer

I'm a bit of a loner with my thoughts and actions for Warfarin management and diet as opposed to what my specialists say - but as my GP says - 'if it works for me - do it!' I refer in particular to vitamin K - ie spinach is a good example. I dont weigh my daily intake of vitamin K - say today - uncooked spinach in a salad as it's summer..I simply have what I term a small-medium helping and leave it at that.

What my logic is - as i said in my previous post was/is to incorporate a certain amount of vitamin k (not a lot I might add!) vegetables into my diet from the outset of receiving my valve and new warfarin regime so that my warfarin intake from the start - was measured on an INR that incorprated a small amount of vitamin K and alcohol DAILY into my diet.

If you stop/start the intake of either into your diet you run the very real risk of LARGE fluctuations in your INR as it will react to a stop/start intake. Daily REGULAR intake allows you to set your INR accordingly based on having these in your DAILY diet.

Hope this helps!

Cheers

Graeme
I guess there isn't much change in my diet either way sine before the surgery I was already on a low-sodium diet (2,000 mg a day allowance but sometimes I didn't come close and once a week I would have a "splurge meal" but try not to completely over do the allowance.

i was basically eating the same things in the hospital but also got told no caffeine (coffee, tea, regular sodas, Chocolate) which I knew for the chest wounds and healing, bu something about having to cut it out completely seems fishy to me

Does anyone know why Cranberry Juice and Sauce are Not to be had? is that part of the Coumadin/Warfarin thing High in vitamin K?
Hey Jonathon..

Glad things r going along well..at the risk of being a 'know it all' i am going to stick my oar in here..as to cutting out completely - like forever..(!!) caffeine (coffee, tea, regular sodas, Chocolate..wtf? My docs have never said that..again - and i'm banging on here.. moderation and common sense prevails.. i have about 2 cups of tea day and 1 cup of coffee..with unprocessed sugar (1 teaspoon) a day - and a small piece of chocolate every night- which the latest medical advice now says is good for you..??/ salt..in moderation.. i don't use it in cooking... soda pop (lemonade over here) i rarely drink if at all only in the summer..moderation.. common sense...again! Whilst you are healing - yes.. i can see that..but never again??? The only thing i can say to that advice is that everyone is different and if there is an underlying issue such as high cholesterol count that could be the reason why they have issued this advice.. but as im always in the acceptable range for this and weight and bp are also fine so that might be why i have not had that advice.. if in doubt ask for another professional opinion..

As to cranberry juice and any cranberry sauce or drink...NO!!!! it incredibly high in vitamin K and is a no-no as it will wreck your INR - not to take!

hope all else well...

cheers

Graeme

Yesss!! dvide..yieght, bp my nchlo

Jonathan F Bushey said:
I guess there isn't much change in my diet either way sine before the surgery I was already on a low-sodium diet (2,000 mg a day allowance but sometimes I didn't come close and once a week I would have a "splurge meal" but try not to completely over do the allowance.

i was basically eating the same things in the hospital but also got told no caffeine (coffee, tea, regular sodas, Chocolate) which I knew for the chest wounds and healing, bu something about having to cut it out completely seems fishy to me

Does anyone know why Cranberry Juice and Sauce are Not to be had? is that part of the Coumadin/Warfarin thing High in vitamin K?
Jonathan, I also have not been told to avoid these things. Of course you must follow the advice that is specific to you. However, I am a firm believer in being very communicative with your health providers. Ask your questions, no question is wrong, this is your life. I was given an amount of Vitamin K that I should have every other day, 100 micrograms (mcg) and on the other days none. For example 1/2 cup broccoli is approximately 100 mcg. If they haven't given you an amount like this, see if they will. I can't imagine trying to manage my diet blindly without truly knowing how much or little of something was safe for me to consume. Also, I highly recommend writing a list of your questions down, having it near the phone so you can field questions on the fly if you should be speaking with your physician or physician assistant. Also, always take a list with you to your appointments, it will take stress off of you to remember as well as make efficient use of the appointment time. My Doc is very used to my little lists now :) Again wishing you peace and strength.

Graeme said:
Hey Jonathon..

Glad things r going along well..at the risk of being a 'know it all' i am going to stick my oar in here..as to cutting out completely - like forever..(!!) caffeine (coffee, tea, regular sodas, Chocolate..wtf? My docs have never said that..again - and i'm banging on here.. moderation and common sense prevails.. i have about 2 cups of tea day and 1 cup of coffee..with unprocessed sugar (1 teaspoon) a day - and a small piece of chocolate every night- which the latest medical advice now says is good for you..??/ salt..in moderation.. i don't use it in cooking... soda pop (lemonade over here) i rarely drink if at all only in the summer..moderation.. common sense...again! Whilst you are healing - yes.. i can see that..but never again??? The only thing i can say to that advice is that everyone is different and if there is an underlying issue such as high cholesterol count that could be the reason why they have issued this advice.. but as im always in the acceptable range for this and weight and bp are also fine so that might be why i have not had that advice.. if in doubt ask for another professional opinion..

As to cranberry juice and any cranberry sauce or drink...NO!!!! it incredibly high in vitamin K and is a no-no as it will wreck your INR - not to take!

hope all else well...

cheers

Graeme

Yesss!! dvide..yieght, bp my nchlo

Jonathan F Bushey said:
I guess there isn't much change in my diet either way sine before the surgery I was already on a low-sodium diet (2,000 mg a day allowance but sometimes I didn't come close and once a week I would have a "splurge meal" but try not to completely over do the allowance.

i was basically eating the same things in the hospital but also got told no caffeine (coffee, tea, regular sodas, Chocolate) which I knew for the chest wounds and healing, bu something about having to cut it out completely seems fishy to me

Does anyone know why Cranberry Juice and Sauce are Not to be had? is that part of the Coumadin/Warfarin thing High in vitamin K?
Asked the Cardiologist today if he knew why cranberries and cranberry Juice and sauce are bad... His answer is that the metabolism created by the cranberries effects the coumadin's time and effectiveness.

~ Jonathan
as i understand it cranberries only have an effect with warfarin. i have always thought that coumadin was the trade name for phenprocoumon, but it transpires after a quick check coumadin is just another name for warfarin - i was put on marcumar (phenprocoumon - from Roche) and heparin in hospital, and just assumed coumadi - marcumar were the same thing. i have no issues as far as i can tell with cranberry juice on phenprocoumon, and it forms a regular part of my diet because of my kidney paranoia!
EDIT: i did a little digging around and found this which may be of interest for you (specifically page 3, 4 & 5): http://www.unifra.br/pos/aafarm/downloads/_herb%20drug%20interactio...
maybe you should ask about phenprocoumon, if cranberries are a necessary evil...
r
Hi guys
I was also told that Cranberries affected the metabolism of warfarin so avoid them, I also avoid grapefruit & grapefruit juice because I'm on statins (apparently it affects the liver and interferes with the way the statins work). The dietary advice I've been given has been a bit unsatisfactory - eat what you consider to be a normal healthy diet and we'll adjust the warfarin to maintain the target INR. I've never been given any info regarding Vit K levels and have had conflicting advice about alcohol (told it increased INR in hospital and have since been told by practice nurses it decreases INR - my personal experience is that even in moderation it increases INR but only by a small amount so I seem to be able to drink spasmodically and stay in range). Like most of you I've obtained info about which foods contained Vit K and I try to eat consistently.

I'm now self monitoring! Bought Coagucheck and am delighted to find out that my PCT are allowing my GP to prescribe lancets and testing strips. How interesting so many people are feeling the cold, I've had the same experience, invested in a single electric blanket to put on my side of the bed to save my poor hubby suffering under the weight of ever increasing TOG ratings!

Johnathan - I was advised to wrap my arms around myself and hold firmly (imagine giving yourself a hug) if I was coughing or especially sneezing, its very explosive. Glad you're doing okay - get yourself wrapped up and have a walk outside it'll do you the world of good to be in the fresh air.


Richard Deal said:
as i understand it cranberries only have an effect with warfarin. i have always thought that coumadin was the trade name for phenprocoumon, but it transpires after a quick check coumadin is just another name for warfarin - i was put on marcumar (phenprocoumon - from Roche) and heparin in hospital, and just assumed coumadi - marcumar were the same thing. i have no issues as far as i can tell with cranberry juice on phenprocoumon, and it forms a regular part of my diet because of my kidney paranoia!
EDIT: i did a little digging around and found this which may be of interest for you (specifically page 3, 4 & 5): http://www.unifra.br/pos/aafarm/downloads/_herb%20drug%20interactio...
maybe you should ask about phenprocoumon, if cranberries are a necessary evil...
r
Thanks Laura.

I have not changed my diet/eating habits at all from before surgery as I was already on a 2,000mg of sodium a day diet and trying to watch my sugar and carb's intake as well. The doctor said I could have some caffeine in "moderation" or small amounts if I need it to stay awake. As for alcohol I am staying clear of it for now until I can find out more from the doctor after this first 2 months of healing is done. After that I may just decide to be straight edge (no drugs, no alcohol) for the most part, as I know I have to take my prescriptions daily to be safe and sound. I can deal with not having the cranberries but will miss them a little. There are other fruits I can use to replace them in my trail mixes and certain deserts and so on.

As for the being cold or feeling cold I am trying to find my longer sleeve t-shirts... that aren't signed by the Gin Blossoms or any rave DJ's that I have had the privilege to hang out with over the years. I am also looking into wearing sleeves or fingerless gloves while at home to keep my hands and fore arms warmer. I am not big on heat blankets but might get one for this winter if other alternative methods don't work for me. Being single kinda sucks when you get cold at night lol.

On a side note my home visitation Nurse/aid has talked to me several times about another patient she is dealing with, a teenage kid. He is flipping out over having to be on the same diet I am and has had the same surgery or similar from my understanding. I will pass this site on to her so she can give it to him as well as any other patients she thinks needs a social site to learn more and ask questions of others. I already make links from here to my facebook when i ost the blogs and several friends have come to read them and look around the site. I hope they pass it on to their friends and loved ones as well as I know there are more people in the area and in the group I participate in that are in the same boat as the rest of us but afraid to speak up.

~ Jonathan

Geez I don't know how to describe it two weeks ago I was in the hospital  on a drip because my blood got to thick. My liver had decided to re-adjust on it's own. I cannot eat anything dark green whatsoever. I eat Dr. Gourmet alot and use this website for Vitamin K content.

http://www.elook.org/nutrition/vegetables/2113-2.html

I have the "cards" against me as I have a wheat allergy.

When I started taking Warfarin last September I studied the vitamin K food lists in the booklets I was given, found them inconsistent (what about egg yolk and liver?), browsed the net and asked the hospital pharmacist for an authoritative list but didn't get one.  Then I decided to relax about it and not eat any of the regularly listed vitamin K foods in large amounts but otherwise to eat what I fancy.  I don't take care to balance my daily intake of vitamin K foods as I found this too much of a hassle but I'm careful to eat them in moderation. This may seem careless by the standards of some advice but my INR has been very steady.  It dipped a bit when I came off the Amiodarone but I'm currently on 4mg x 5 days and 3mg x 2 days. I have checked my approach with the pharmacist at the anticoagulant clinic and he thinks it's totally realistic.  I've stopped drinking any alcohol as it knocks me out, not because of Warfarin problems. I recognise that I am lucky in having had a steady INR from the start but I hope that my experience will be encouraging to others. For me life after a new valve is gradually getting back to normal.  I'm now off to the Gym for a work out -  free to the over 65s in this 'socialist' corner of London!!

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