Coumadin and Fruit

[Evgenii]

hi, is there any information about mango not from articles on the internet? has any of the participants eaten mango while taking warfarin? does it really increase and by how much?
sweetie (Oroblanco) (Pomelit) as dangerous as grapefruit?

 

[pellicle]

hi, is there any information about mango not from articles on the internet?

firstly let me say that while "information" exists on the internet the quality (rigor and accuracy) of that is diminishing at a rate the likes of which I've never witnessed (and I've been on the net nearly daily since about 1993). The levels of "robot copy paste" content stealing without context is massive and I believe that AI aggregation is lulling many into false senses of security (confidence).

I'm going to say: read this first:
https://cjeastwd.blogspot.com/2021/07/done-my-research.html

next we'll face the reality of "dead internet" ... but this only re-enforces my above message about critical thinking. This was well framed in the series about Chernobyl

So the ultimate filter needs to be you.

has any of the participants eaten mango while taking warfarin?

me at least, and not that I recall ever noticing (and I test weekly). However I don't sit down to a gorging feast of kilograms of Mango ... I buy one or two now and then in season ... to me the biggest issue is the rest of the impact that has on health because of the sugar.

does it really increase and by how much?

my mantra is always "test an knowthyself"

Thus I strongly advocate for self testing ...

sweetie (Oroblanco) (Pomelit) as dangerous as grapefruit?

look it up ... here's a good set of primers on what you're looking for (hint, component chemicals)

https://cjeastwd.blogspot.com/2021/05/grapefruit-and-warfarin.html

the key word in that is furanocoumarins , and its not just warfarin, its everything which is processed by the metabolism mechanism Cytochrome P450.

Everyone wants to be an instant expert ... the truth is that wisdom relies on a good knowledge base and having experience with the data. My own INR journey has been 13 years and built on solid foundations; but I do not call myself an expert, just well informed.

Best Wishes

 

[dick0236]

hi, is there any information about mango not from articles on the internet? has any of the participants eaten mango while taking warfarin? does it really increase and by how much?
sweetie (Oroblanco) (Pomelit) as dangerous as grapefruit?

Warfarin was first introduced in 1954. I started taking it in 1967.....and for 15-20 years after surgery there was little said about food consumption, except to not eat "greens". Nowadays, it is OK to have "greens" in moderate amounts. Experience has taught me that many things can affect my INR if consumed in LARGER quantities over a short period. My latest "caution" food is clementines (small citrus bites) if I consume a quart+ over a few days......I found my INR went up by .2 or .3. Now I have a few handfuls/wk with no effect on INR.

Grapefruit is dangerous?? FWIW, I have enjoyed "half of a grapefruit" or a juice glass of grapefruit juice infrequently since my surgery with no known effect on INR. I have been told that drinking a quart of grapefruit juice "at a sitting" is a NO-NO and can cause INR problems.

The withholding of many foods, on the "do-not-eat while on warfarin
list" probably does more dietary harm than moderate consumption of those foods.

 

[Evgenii]

Everyone wants to be an instant expert ... the truth is that wisdom relies on a good knowledge base and having experience with the data. My own INR journey has been 13 years and built on solid foundations; but I do not call myself an expert, just well informed.

in my country the recommendations for patients look something like this, and this list already makes me feel uneasy




I am sending you a memo on the interaction of warfarin with medications and food products:
It is not recommended to start or stop taking other medications or change the doses of medications taken without consulting your doctor.
When co-administered, the effects of discontinuing induction and/or inhibition of warfarin action by other drugs must also be taken into account.
The risk of developing severe bleeding increases with the simultaneous use of warfarin with drugs that affect platelet levels and primary hemostasis: acetylsalicylic acid, clopidogrel, ticlopidine, dipyridamole, most NSAIDs (except COX-2 inhibitors), penicillin antibiotics in high doses.
Also, the combined use of warfarin with drugs that have a pronounced inhibitory effect on cytochrome P450 isoenzymes (including cimetidine, chloramphenicol) should be avoided, since the risk of bleeding increases when taken for several days. In such cases, cimetidine can be replaced, for example, with ranitidine or famotidine.
The effect of warfarin may be enhanced by concomitant use with the following drugs: acetylsalicylic acid, allopurinol, amiodarone, azapropazone, azithromycin, alpha and beta interferon, amitriptyline, bezafibrate, vitamin A, vitamin E, glibenclamide, glucagon, gemfibrozil, heparin, grepafloxacin, danazol, dextropropoxyphene, diazoxide, digoxin, disopyramide, disulfiram, zafirlukast, indomethacin, ifosfamide, itraconazole, ketoconazole, clarithromycin, clofibrate, codeine, levamisole, lovastatin, metolazone, methotrexate, metronidazole, miconazole (including in the form of an oral gel), nalidixic acid, norfloxacin, ofloxacin, omeprazole, oxyphenbutazone, paracetamol (especially after 1-2 weeks of continuous use), paroxetine, piroxicam, proguanil, propafenone, propranolol, influenza vaccine, roxithromycin, sertraline, simvastatin, sulfafurazole, sulfamethizole, sulfamethoxazole/trimethoprim, sulfaphenazole, sulfinpyrazone, sulindac, steroid hormones (anabolic and/or androgenic), tamoxifen, tegafur, testosterone, tetracyclines, thienyl acid, tolmetin, trastuzumab, troglitazone, phenytoin, phenylbutazone, fenofibrate, feprazone, fluconazole, fluoxetine, fluorouracil, fluvastatin, fluvoxamine, flutamide, quinine, quinidine, chloral hydrate, chloramphenicol, celecoxib, cefamandole, cephalexin, cefmenoxime, cefmetazole, cefoperazone, cefuroxime, cimetidine, ciprofloxacin, cyclophosphamide, erythromycin, etoposide, ethanol.
Preparations of some medicinal plants (official or unofficial) can also either enhance the effect of warfarin: for example, ginkgo (Ginkgo biloba), garlic (Allium sativum), angelica (Angelica sinensis), papaya (Carica papaya), sage (Salvia miltiorrhiza); or reduce it: for example, ginseng (Panax ginseng), St. John's wort (Hypericum perforatum).
Warfarin and any St. John's wort preparations should not be taken simultaneously, and it should be taken into account that the induction effect of warfarin action may persist for another 2 weeks after stopping St. John's wort preparations. If the patient is taking St. John's wort preparations, the INR should be measured and the preparation should be stopped. Monitoring of the INR should be careful, as its level may increase when St. John's wort is discontinued. Warfarin can then be prescribed.
Quinine, which is found in tonic drinks, can also enhance the effects of warfarin.
Warfarin may enhance the effects of oral sulfonylurea hypoglycemic agents.
The effect of warfarin may be weakened when used concomitantly with azathioprine, aminoglutethimide, barbiturates, valproic acid, vitamin C, vitamin K, glutethimide, griseofulvin, dicloxacillin, disopyramide, carbamazepine, cholestyramine, coenzyme Q10, mercaptopurine, mesalazine, mianserin, mitotane, nafcillin, primidone, retinoids, ritonavir, rifampicin, rofecoxib, spironolactone, sucralfate, trazodone, phenazone, chlordiazepoxide, chlorthalidone, cyclosporine.
The use of diuretics in cases of pronounced hypovolemic action can lead to an increase in the concentration of coagulation factors, which reduces the effect of anticoagulants.
In case of combined use of warfarin with other drugs listed below, it is necessary to monitor INR at the beginning and end of treatment, and, if possible, 2-3 weeks after the start of therapy.
Foods rich in vitamin K reduce the effect of warfarin; decreased absorption of vitamin K due to diarrhea or laxatives potentiates the effect of warfarin. Green vegetables contain the highest levels of vitamin K, so when taking warfarin, the following foods should be consumed with caution: amaranth greens, avocados, broccoli, Brussels sprouts, cabbage, canola oil, chayotes, onions, coriander, cucumber peel, chicory, kiwi fruit, lettuce, mint, mustard greens, olive oil, parsley, peas, pistachios, red seaweed, spinach greens, spring onions, soybeans, tea leaves (but not tea-based drinks), turnip greens, and watercress.

 

[3mm]

the recommendations for patients look something like this, and this list already makes me feel uneasy

I am sending you a memo on the interaction of warfarin with medications and food products:

That is a long, complicated, scary memo! Please don't let it upset you, however.

I think the memo exaggerates the issues. Note: I am NOT A DOCTOR, and I am just giving my opinions.
For example, the memo you quote says

The risk of developing severe bleeding increases with the simultaneous use of warfarin with ... penicillin antibiotics in high doses.

1 year ago, I had to take antibiotics for several weeks because I had pneumonia. My INR went from around 2.5 up to 3.9. Then my INR came back down after I finished the antibiotics and overcame the pneumonia. There was an increased risk of bleeding, but I did not need to change any of my activities, and I had no problems.


I suggest the following. First, check your medications with your trusted sources of medical information regarding drug interactions, side effects, etc. My various doctors tell me that "drugs.com" is a reputable source of information, so I've used it regarding my own medications.

Second, give your current medication list to all of your doctors to ensure they consider what you are taking when giving new prescriptions.

Third, I strongly support self testing weekly. Eat what you want, but keep your diet reasonable consistent, learn about your own body, and adjust your warfarin dose to match your needs. Talk with pellicle on this forum; I use a version of his spreadsheet to track my warfarin and INR.

when taking warfarin, the following foods should be consumed with caution: ... broccoli, ... canola oil, ... onions, ... kiwi fruit, ... peas ...

I've not had any problems with these foods, which I consume in moderation. If someone invited me to dinner and they served a spinach salad, I would eat it happily, and then I'd note that in my INR spreadsheet to help me better learn about my body.

Using warfarin isn't hard if you: self test, take your warfarin correctly, and are reasonable careful about what you eat.

 

[pellicle]

may be

so, it also "may not be" ... thus I say "test and know thyself"

its pretty f&cking simple really ... they say these thing because

• people are without a clue
• people don't think
• people assume they can binge on anything and there is no consequences

Frank and Connie

and Dick hits the nail on the head with these key words

, I have enjoyed "half of a grapefruit" or a juice glass of grapefruit juice infrequently since my surgery with no known effect on INR.

• moderation
• occasional
• and testing his INR to know

do you drive the car blindfolded (sure seems like much of the traffic around me does)? If you don't then just like driving a car "pay attention to the readings from your instruments" ... unlike the car you only have to check one thing and check that once a week.

Just like the car if you're going too fast, ease up on the pedal, and if you're not going fast enough push it down a bit.

the details can be learned just like driving a car ...

How hard can it be?

 

[pellicle]

@Evgenii

this is my 2024 data (from my spread sheet) weekly readings (hopefully you know how to read a graph, its a lost art outside of science and engineering (despite learning it first at primary school) I have discovered.

you can see my INR has varied between 2.0 and 3.0 the vast majority of time and you can see when I've made dose corrections (on one occasion it was as much as a whole milligram per day difference but that was shown to be too much.

IF you go down this path there are people here (me at least) who can teach you how to manage.

I've been greater than 95% in range year on year for the last 12 years, which beats the 67% that clinics give you (which by the way is sufficient, if not convenient).

This whole sub-forum exists for this exact purpose
https://www.valvereplacement.org/forums/home-anticoagulation-monitoring.25/

here's an old thread I started

https://www.valvereplacement.org/threads/freedom-to-roam-or-unusual-inr-testing-locations.877523/