Cranberry Juice and Coumadin

[Herb M]

Has anyone had experience drinking cranberry Juice while on Coumadin?

I read a report that indicated the Cranbverry Juice could have a significnt impact on your INR. One man who drank it every day had his INR shoot to 50 and he died of internal bleeding. Is it really possible for an INR to be high as 50?; maybe a decimal was omitted. Other people had changes less dramatic, some increases and some decreases and some with an unstable INR. This report was based only on a handful of individuals .

 

[Ross]

It appears to be true! I don't recall reading anything about it, but Blanche has sent me some articles supporting what your asking.

Once again, I'm wrong.
(Are any of you keeping track of all the times I've been wrong lately?)

 

[JimChicago]

Here's an article about one incident concerning cranberry -

From:
http://www.ukmicentral.nhs.uk/headline/database/story.asp?NewsID=2866
>>>>
19 December 2003 Printer friendly version

Possible warfarin - cranberry-juice interaction

A case report in the BMJ describes a possible interaction between warfarin and cranberry juice, with fatal outcome. The patient was previously stable, but stopped eating due to a chest infection; for two weeks he consumed only cranberry juice. He was subsequently admitted with an INR of 50, and had a fatal internal haemorrhage. The authors note that this potential interaction has previously been reported to the CSM, and that cranberry juice contains flavonoids that could interfere with the cytochrome P450 enzyme system. They suggest that until the mechanism of the potential interaction has been clarified, patients on warfarin should limit their consumption of cranberry juice. [Editor's note: from the description, the patient clearly consumed appreciable quantities of the juice. It seems unlikely that patients need to be warned against the use of cranberry jelly with their Christmas turkey, unless they are in the habit of consuming whole jars at once.]

BMJ 2003; 327: 1454
>>>>

If the man was unable to eat his normal diet his daily vitamin K intake may have gone to almost zero plus if he was taking antibiotics wouldn't that have interfered with his digestive flora's ability to produce vitamin k? In the hospital I was given a little cranberry juice with meals (4 oz).

 

[Herb M]

Most hospitals and doctors know very little about interactions of medicines and the interaction of medicines with certain foods, supplements and vitamins. You really have to do your own investigation of these interactions.

 

[Ross]

Well it's a wake up call to me. I normally don't drink any juice, but I do like cranberry. It's one of the select few I do like to indulge in once in a while. Now that I've been shown something new, I'm going to continue to drink it, but I'm also going to watch a little closer for changes in INR too. I really don't think it has a lot to do with it, but these articles seem to suggest otherwise.

Most hospitals and doctors know very little about interactions of medicines and the interaction of medicines with certain foods, supplements and vitamins. You really have to do your own investigation of these interactions.

Exactly! The very same people who give us Boost and Ensure while in the hospital and keep us longer for unstable or low INR's. They don't know the Vit K content that's in those products.

 

[LUVMyBirman]

Hi all,

I believe the moral to the story is the gentleman
stopped eating. That alone would make your INR soar!

50, not so sure that is factual. I was a ripe 14 and a sitting miracle I was told. Sitting and or lying down and not breathing very well. Cranberry juice in moderation has not harmed me in the least.

 

[catwoman]

Gina:

You hit the nail on the head -- no intake of vitamin K and only drinking juice, of course your INR would soar if you're on warfarin.
Wonder what it would do if you weren't on warfarin??? Now that's food for thought -- or perhaps non-food for thought.

 

[Guest]

The INR is open ended. It was probably 50, since that was reported in an online version before this publication came out - they would have had time to correct it. It would be most unusual to have a fatal hemorrhage at an INR of 5.0.

Like so many of these reports there are confounding factors. Lack of eating an antibiotics have already been pointed out.

As Ross said, it is something to look out for but I don't think there is any major worry without some other acute condition.

There was a report of bleeding once i a man who was eating several pounds of carrots daily and then stopped. Carrots are not high in vitamin K, but if you get crazy things can go wrong.

 

[Harpoon]

From what I've found so far in my newest "research project" on coumadin and food interactions how much at a time and how often (or not) seems to be the key.

If you're diet has always included things like spinach on an almost daily basis then chances are your dosage accounts for the extra vitamin K present.

If you change your diet (like getting sick nad not being able to keep foods down) then obviously those levels might change. The same would be true I guess if you suddenly stopped the medication, or overdosed.

The more I look into it the more it looks like maintaining your choices in diet is what's important. If you eat something that contains a lot of vitamin K for one meal it may not do much, but if you changed to eating those foods fairly consistently then your INR might be affected.


But I'm still new to this so don't listen to me! =Þ

 

[Ross]

Harpoon that's pretty much the deal in a nutshell. With frequent INR testing, it's all managable though, so people shouldn't get the idea that they must be very strict in their diets. There are exclusions to this of course, but for the majority, this is the deal.

 

[Guest]

I wish that everyone would grasp the diet issue so easily.

 

[Harpoon]

Whoohoo!

You mean I actually got something right???


Now if only I could figure out how to keep myself from drinking so much.....


It makes sense though. Your body can only handle/tolerate so much of a given nutrient, the rest is discarded as waste. That's what can happen with people taking multivitamins. If you're already eating a well balanced diet, the multivitamin is a little irrelevant and most of it just ends up getting expelled.


Moderation. Watch what you're eating and how your body responds to it, that's all. If there's a change that isn't healthy, modify your eating habits accordingly, but don't make drastic changes because that can be harmful as well. A delicate balance.

 

[Gemma]

Does anyone happen to know if it's just cranberry juice that causes this interaction or anything containing cranberries? My boyfriend Jim didn't have cranberry jelly with his turkey on Christmas day because of the warnings at the anti-coagulation clinic but these were only in fact about juice. Also there's a really nice cheese over here that he loves - wensleydale with cranberry!! Typical, couldn't like something simple could he!!!

 

[Ross]

Cranberries are part of well, cranberries, so it should have the same meaning I guess. I think it's all hocus pokus though.

While the article makes a suggestion, there is no proof that it does much of anything. I'll let you know after Wednesday this week. I'm a guzzling Cranberry juice as I type and I'm due for the old finger stick on New Years Eve.

 

[Herb M]

I can't imagine that a cranberry flavored cheese or muffin would cause a problem. I also do not think that a little cranberry sauce with turkey is a problem. I doubt that a now and then cranberry juice will be a problem. To be cautuious it is not a good idea to to drink large quantities every day.

 

[Ross]

I'm just saying that if you eat properly and drink say oh maybe 4 or 6 ozs a day of cranberry juice, I really don't think it's going to make a difference. I'm setting out to prove that Wednesday.

 

[Harpoon]

Like anything else, it's a moderation thing. If ALL you eat or drink is cranberry based foods like cranberrys, juice, muffins, sauce, etc. then yeah, it might have some effect on your levels.


Again, there's cyanide in apple seeds, but do you know how many apples you'd have to eat (whole) in order to be killed by the cyanide???

Chances are eating such a large quanitity of apples would kill you first before the cyanide did!


**admiring Mr. Ross for his unselfish quest for scientific knowledge, inspite of the great potential risks inherent in his experiment**