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Diet/Nutrition

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

Tags: coumadin, diet, k, nutrition, vitamin, warfarin

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Permalink Reply by Richard Deal on January 21, 2011 at 10:38

i just re-read this and thought i would add what my doctors have told me about alcohol and what, from experience, i have found out.

alcohol is a mild anti-coagulant. if you consume large quantities of alcohol once in a blue moon (normally binge drinking)then it will increase your inr. if you consume large quantities of alcohol daily it will lower it. this has something to do with your liver being "shocked" in the once in a blue moon scenario and completely "forgetting" to metabolise warfarin, and in the daily scenario your liver starts to over compensate warfarin metabolism to stay on "top of things".

i have no idea how much you drink when you do drink alcohol, but i always end up drinking a week's worth of alcohol in a night if i go out - i am a classic binge drinker. as i am on phenprocoumon i will generally not take my pill on a night when i go out, but resume a normal dose the next day so as i don't really see much in the way of a change in inr. if i take my pill on the night then the next day my inr has gone up by about 1 and takes about a week to tail off back to normal range. i don't drink alcohol daily so cannot comment on inr decreasing.

i guess if you knew you were going to go out and were going to drink as if it were 1999, you could only eat spinach and broccoli to counteract any effect! i couldn't tell you how much spinach a beer is worth though ;)

take care,

r

Laura Chapman said:

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

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Permalink Reply by Racer on January 21, 2011 at 15:24

Richard, thanks for adding your info. clarifying affects of alcohol on inr. I had read that it could both increase or decrease inr,but, until now hadn't been able to ascertain what caused high or low inr. This was very helpful.

Richard Deal said:

i just re-read this and thought i would add what my doctors have told me about alcohol and what, from experience, i have found out.

alcohol is a mild anti-coagulant. if you consume large quantities of alcohol once in a blue moon (normally binge drinking)then it will increase your inr. if you consume large quantities of alcohol daily it will lower it. this has something to do with your liver being "shocked" in the once in a blue moon scenario and completely "forgetting" to metabolise warfarin, and in the daily scenario your liver starts to over compensate warfarin metabolism to stay on "top of things".

i have no idea how much you drink when you do drink alcohol, but i always end up drinking a week's worth of alcohol in a night if i go out - i am a classic binge drinker. as i am on phenprocoumon i will generally not take my pill on a night when i go out, but resume a normal dose the next day so as i don't really see much in the way of a change in inr. if i take my pill on the night then the next day my inr has gone up by about 1 and takes about a week to tail off back to normal range. i don't drink alcohol daily so cannot comment on inr decreasing.

i guess if you knew you were going to go out and were going to drink as if it were 1999, you could only eat spinach and broccoli to counteract any effect! i couldn't tell you how much spinach a beer is worth though ;)

take care,

r

Laura Chapman said:

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

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Permalink Reply by Holly Allen on February 21, 2011 at 17:55

I am still trying to figure what sets off my INR. I am often called after I get bloodwork done to double up because my INR is too low..1.2 when I should be at 2.7. Signs I have noticed when my blood is thick is I get a bad throbbing headache,and my blood vessels in my eyes will burst. I also get a strong,thick pulse in my Right ear. I am playing around to see what makes it so thick. I am sure the red wine and greens are the culprit. I am on 6mg coumadin/daily in 3mg tablets, If I feel these symptoms I have been adding a 3mg tab at night (I take my coumadin in the morning).

I want to try figure out how the INR acts with beer as I enjoy beers especially in the summer..I did have a 6 pk of rickards white,and the next day felt probably the best since my surgery. I am wondering if it was because my INR was low,and the alcohol raised it.. I find red wine does cause my INR to drop and this is when i have to increase my coumadin

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Permalink Reply by Sandra Emilianowicz on February 21, 2011 at 22:51

I was told by my Dr. not to change my diet, they would change the coumadin/warfarin around my diet.

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Permalink Reply by Graeme on February 22, 2011 at 10:51

Hey Holly

I think I have covered this a few times in other posts but here's my take on alcohol and diet on warfarin again ... My 8 year anniversary for my AD and subsequent MHV implant comes up in April. My INR is rock solid apart from a couple of bouts with antibiotics when it went ballistic (from 3.2 to over 8 - yes 8!) A BIT SCARY..!! But I know now to watch it like a hawk with antibis.. apart from that i sit between 2.8/9 - 3.1/2 and i dont worry about trying to keep it on an exact INR - just in that range.

I take 7 - 7.5 mg warfarin in rotation each nite. In regards to diet - frankly i pretty much eat what i feel like and drink - to moderation what i want. My theory is that if you introduce moderate alchohol into your diet and your warfarin is set based on that your INR remais fairly stable - i think i have proven that is correct after 8 years or so...! However - moderation is the key.. I love a glass of white or red wine with dinner and have such pretty much every night so my warfrain intake takes that into account.. as for a beer - i like a beer in the summer and generally swap a glass of wine for a beer of a night. again - moderation. Too much wine/beer and i get a really bad headache and a ringing in my ears.. (it's my bodys way of saying im a mini lush i 'spose.. :-)!) seriously - sporadic binge drinking is NOT a good idea with warfarin as it will really mess with you... have a smallish amount of alcohol every day and your INR should be fine...

As to food... some obvious things here as well... as like alchohol - NO binging... but have a small amount of greens every day - ie a huge plate of asparagus/advocado or spinach on a whim is NOT a good idea ..but if you have a little every day of greens high in vit k your warfarin intake should be set to allow for it... It all seems to work for me and my docs are v happy with the theory and as i said my solid INR seems to prove it.. so far!

Anyway - thats my 2 bobs worth on the subject!

cheers

Graeme

Holly Allen said:

I am still trying to figure what sets off my INR. I am often called after I get bloodwork done to double up because my INR is too low..1.2 when I should be at 2.7. Signs I have noticed when my blood is thick is I get a bad throbbing headache,and my blood vessels in my eyes will burst. I also get a strong,thick pulse in my Right ear. I am playing around to see what makes it so thick. I am sure the red wine and greens are the culprit. I am on 6mg coumadin/daily in 3mg tablets, If I feel these symptoms I have been adding a 3mg tab at night (I take my coumadin in the morning).

I want to try figure out how the INR acts with beer as I enjoy beers especially in the summer..I did have a 6 pk of rickards white,and the next day felt probably the best since my surgery. I am wondering if it was because my INR was low,and the alcohol raised it.. I find red wine does cause my INR to drop and this is when i have to increase my coumadin

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Permalink Reply by Holly Allen on February 22, 2011 at 15:47

So i guess drinking a 6 pk of beer and a big plate of spinach salad won't work!!?? Kidding!!:)

I may just start buying the .5 beer as I love the taste in the summer. Yes I was warned by my md about alcohol and even coffee,but nothing was really explained to me. I still do not have a cardiologist to boot!!! It is a question I will ask

If a need a good slap on the hands ,I need to hear the repercussions of my bad behavior if I over do it one hot summer night!! Thanks for the input Graeme!! Your advice is awesome and it is nice that someone cares out there~~ Cheers!! Holly..When I see/get a cardiologist, I will let you know what he/she told me!!:)

Graeme said:

Hey Holly

I think I have covered this a few times in other posts but here's my take on alcohol and diet on warfarin again ... My 8 year anniversary for my AD and subsequent MHV implant comes up in April. My INR is rock solid apart from a couple of bouts with antibiotics when it went ballistic (from 3.2 to over 8 - yes 8!) A BIT SCARY..!! But I know now to watch it like a hawk with antibis.. apart from that i sit between 2.8/9 - 3.1/2 and i dont worry about trying to keep it on an exact INR - just in that range.

I take 7 - 7.5 mg warfarin in rotation each nite. In regards to diet - frankly i pretty much eat what i feel like and drink - to moderation what i want. My theory is that if you introduce moderate alchohol into your diet and your warfarin is set based on that your INR remais fairly stable - i think i have proven that is correct after 8 years or so...! However - moderation is the key.. I love a glass of white or red wine with dinner and have such pretty much every night so my warfrain intake takes that into account.. as for a beer - i like a beer in the summer and generally swap a glass of wine for a beer of a night. again - moderation. Too much wine/beer and i get a really bad headache and a ringing in my ears.. (it's my bodys way of saying im a mini lush i 'spose.. :-)!) seriously - sporadic binge drinking is NOT a good idea with warfarin as it will really mess with you... have a smallish amount of alcohol every day and your INR should be fine...

As to food... some obvious things here as well... as like alchohol - NO binging... but have a small amount of greens every day - ie a huge plate of asparagus/advocado or spinach on a whim is NOT a good idea ..but if you have a little every day of greens high in vit k your warfarin intake should be set to allow for it... It all seems to work for me and my docs are v happy with the theory and as i said my solid INR seems to prove it.. so far!

Anyway - thats my 2 bobs worth on the subject!

cheers

Graeme

Holly Allen said:

I am still trying to figure what sets off my INR. I am often called after I get bloodwork done to double up because my INR is too low..1.2 when I should be at 2.7. Signs I have noticed when my blood is thick is I get a bad throbbing headache,and my blood vessels in my eyes will burst. I also get a strong,thick pulse in my Right ear. I am playing around to see what makes it so thick. I am sure the red wine and greens are the culprit. I am on 6mg coumadin/daily in 3mg tablets, If I feel these symptoms I have been adding a 3mg tab at night (I take my coumadin in the morning).

I want to try figure out how the INR acts with beer as I enjoy beers especially in the summer..I did have a 6 pk of rickards white,and the next day felt probably the best since my surgery. I am wondering if it was because my INR was low,and the alcohol raised it.. I find red wine does cause my INR to drop and this is when i have to increase my coumadin

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