describe your intake of greens and how important you think it is

[Enudely]

Hi everyone
We've been trying to get my INR stabilized for 2.5 months and it's still not stable. I was trying to pay attention to my intake of leafy greens, but then one week I ate a lot less than I normally would and my INR dropped TEN points!! So now I'm sort of not really paying much attention to my intake of Vit K foods because it seems my body doesn't react how we would expect it to. Should I try to really stabilize how many greens I'm eating? I'm not a very routine oriented person, generally, and I have two young kids so it's sometimes hard to keep track and continue eating the exact same amount of greens.
I have been consistently lower than my target range (2.5-3.5) My last test was 2.3

 

[ALCapshaw2]

Please explain how your INR could drop "TEN" points when the recommended range is 2.0 to 3.0 for Aortic Valve Replacements with no complications and 2.5 to 3.5 for Mitral Valve Replacements with no complications.

MY solution to the "be consistent in your intake of Vitamin K" is to eat a couple of different 'Green Things' per day. NO Measuring. NO Problem. (for me).

'AL Capshaw'

 

[dfelder]

"Greens" are not the only thing that affects your INR. Google the USDA Vitamin K fact sheet.

 

[dick0236]

....it's sometimes hard to keep track and continue eating the exact same amount of greens.
I have been consistently lower than my target range (2.5-3.5) My last test was 2.3

I have never attempted to be "exact" in the amount of greens I eat. I try to include a few salads, broccoli, cabbage, etc in my weekly diet. Personaly, if I was "consistently lower than my target range", I would work with my ACT manager to "nudge" my INR up closer to the mid-range by increasing my warfarin a little.

 

[KristyW]

Enudely,

I'm assuming by 10 points you mean 10-10ths or one point. As for the greens I try to eat the same amount of greens per week. I look at my warfarin dose as a weekly dose split into 7 days, so my greens intake is a weekly one too.

One of the best things that stabilized my INR was to take a multivitamin with Vitamin K in it. That way I'm consistently getting a baseline dose. That means you have to pay attention EVERY time you buy vitamins, because they change the formulation on a regular basis. The past time I bought vitamins, the same brand, the same style (centrum women's) the vitamin K had been doubled (37% to 73% RDA). I took note of it and had my INR tested within a week and got a very small increase in my warfarin dose per week (from 42.5mg/week to 45mg/week). I have never had what I eat make that much of a difference. I find that activity level and medications affect my INR much more that what I eat.

 

[Protimenow]

Although past 'knowledge' suggested that we should avoid Vitamin K if we're on coumadin, more recent studies show many benefits (besides effect on INR) are achieved from Vitamin K intake. As Al Capshaw noted in other threads, having Vitamin K in the system makes it easier to maintain a steady INR.

Yes, it's good to be fairly consistent in your intake of foods containing Vitamin K - but I wouldn't bother with bringing out a scale and weighing the greens each time I eat them, or paying a great deal of attention to how much I have on a daily basis. You shouldn't have to concentrate on eating EXACTLY the same amount of greens every day.

As Kristy suggested, a multivatimin that provides Vitamin K (as a baseline) is probably a good idea - and watching the formulation is also important. And as Dick noted, it's probably a good idea to consider slightly increasing your warfarin dosage if the greens (and Vitamin K you're taking) consistently bring your INR a bit below range.

If you had your own meter and did self-testing (which may be easier for you to do than to have to drag two kids with you to the lab or anticoagulation clinic), you may be able to keep a better handle on your INR - at least till your INR is fairly consistent.

 

[ALCapshaw2]

Another factor to consider when you are experiencing unstable INR is how your INR and Coumadin Dosing is being managed.

How Often were you being tested? Coumadin takes 4 days to become fully metabolized.
Testing more often than once a week can lead to the dreaded "Roller Coaster Effect" if your dose is changed more often than once a week.

Does your manager ever recommend Holding Doses (especially for an INR under 5.0)?
Holding a dose is known to cause INR to 'drop like a rock'.
For a Very High INR, taking 1/2 dose for ONE day will move you in the right direction without dropping like a rock.

For an INR above your target range but below 5.0, a small change in weekly dose usually corrects the problem without causing the 'roller coaster' effect.

For a Low INR, "Loading Doses" are no longer recommended because they too can lead to the 'roller coaster' effect. IF your INR is below 2.0, it may be wise to have Lovenox Injections to protect you as your INR comes back up (using your 'normal' dosing schedule or maybe a small increase to avoid 'overshooting' your target range.

It would be helpful to keep a chart showing your Daily Dose, INR Test Results, and Dose Changes.
Dosing Guidelines are available on-line from the American Association of Family Practicioneers (AAFP)
and the American College of Chest Physicians (Google 'Chest Guidelines'). These are the guidelines used by many Physicians and Coumadin Clinics. There are also several on-line Coumadin Dosing Calculators.

'AL Capshaw'

 

[MarkU]

I've never tried to manage my intake of greens (unless I want to use it as an excuse to not eat some dish that I don't care for).

I've never seen any correlation between my INR level and either my diet or activity level (even when I'm working out a lot in the middle of triathlon season). It just pretty much stays in range all the time with my normal 5.0 mg /day.

Feel pretty lucky about that when I hear about people chasing their INR all the time.

Mark



Mark

 

[hook]

Enudely,
I have never had what I eat make that much of a difference. I find that activity level and medications affect my INR much more that what I eat.

I agree 100%.:thumbup: My coumadin needs have gone from 25mg per week to 35mg per week as I started working out more and more. This is all before my K2 experiment, so that does not affect anything.

 

[skrob49]

Sometimes INR is done by venous and sometimes by finger prick. I have noted INR tests up to 0.5 higher for finger prick tests within a week of a venous test even though diet pretty much the same. To avoid too frequent puncturing of the veins, my wife goes for finger pricks in between venous but which result shall we use for INR monitoring ?? Hope the experienced here can offer some insights??

 

[catwoman]

Sometimes INR is done by venous and sometimes by finger prick. I have noted INR tests up to 0.5 higher for finger prick tests within a week of a venous test even though diet pretty much the same. To avoid too frequent puncturing of the veins, my wife goes for finger pricks in between venous but which result shall we use for INR monitoring ?? Hope the experienced here can offer some insights??

Over the nearly 8 years since my MVR, I've only had maybe 2 venipunctures post-op -- both done right before a TEE.
My PCP's office uses CoaguCheks. I went there for INRs until I got my first monitor in November 2003. Took mine to their office in early December 2003 to do a test and we compared the ProTime 3 against the CoaguChek. There was a little variation; I was told to go with the ProTime 3, not to worry about the difference.
When I got my INRatio in April 2008, I took it to the PCP's office and we ran a comparison test. There was only a 0.1 difference.
I have not taken my unit in since then.
I tested this morning and I was at 3.2. I was 3.0 on Feb. 19 and 2.4 on Feb. 5. The 2.4 was lower than I like, but I didn't change my dosage and my INR was back on track Feb. 19.
My only Rx is warfarin; I also take 2 400mg caps of niacin daily + 2 calcium/vitamin D tabs.

I do NOT track the vitamin K I eat. I eat some nearly every day, but that's always been my eating habit. I like all veggies.

 

[dick0236]

To avoid too frequent puncturing of the veins, my wife goes for finger pricks in between venous but which result shall we use for INR monitoring ?? Hope the experienced here can offer some insights??

It would not surprise me to get different results from "venus draw" vs "finger stick", especially if the tests were days, or a week, apart. The testing protocals, reagents, etc. are different between the testing methods ....and personal activities, diet, etc will differ over any period of time between tests. I also question the accuracy of EITHER testing method or the need to maintain an exact INR number. Almost all INR ranges are very broad...2.0-3.0 or 2.5-3.5 or 3.0-4.0. This would seem to indicate a wide tolerance for testing results are considered OK. I try to stay anywhere within my range and use the specific numbers only to indicate a trend. I use only one testing method (finger stick) for consistency. If I were to get a unusual INR number, my ACT manager would order a "venus draw" for confirmation. The last time that happened was over five years ago when both methods showed an INR a little above 5. Never could figure out why it happened. I held one dose, went back to my normal dose and retested (one week later) within my range of 2.5-3.5.

 

[Protimenow]

Venous and capillary (fingerprick) INRs don't always match -- but come fairly close, if the blood is taken for both within minutes of each other. I agree with Dick that the results from a SINGLE method should be used to indicate trends, rather than necessarily exact values. You'll kind of understand your normal range, and accommodate (and possibly confirm) for out of range results.

For me, diet, exercise, and sometimes even climate (HOT summer days and not enough hydration) all seem to have some effect on INR. Without getting obsessive about it, I've been able to stay within range MOST of the time ever since getting my first meter. (Last week was a bit out of range - 1.8 -- a small dosage increase brought me back. I'll know in an hour or so, after I retest, to see if I've slipped back down or if my slight decrease in activity has brought me back within range).

But, again, if you have a meter, stick with the meter. Meter and lab don't always match -- and probably won't match if you're using blood samples taken at two different times.

 

[Cris N]

My body is fairly sensitive to dietary Vit K. I take a multivitamin with 25 mcg Vit K AND a supplement of 100 mcg Vitamin K. I take them every day, without fail. This has helped me maintain a steady amount of Vit K and my warfarin dosage is adjusted to take this into account. The recommended minimum daily amount of Vit K is 80-90 mcg. My INR is much more stable doing this. I don't consume a consistent amount of Vit K through food so this helps me level off. When I do take in a 'more than normal' amount of dietary Vit K the shock to my system is much less. The light bulb analogy helps to explain it. If you're in a room with a 75 watt bulb and then increase it to 100 watts, you've only made a 33% increase. If you're in a room with a 50 watt bulb and then increase it to 100 - you now have a 100% increase. AND if you're in a room with a 25 watt bulb and then increase it to 100 it it a whopping 400% increase. Works pretty much the same with Vit K - so don't limit your veggies...or supplements - give your body the benefits of Vit K as well. Just maintain some sort of consistency.

 

[Protimenow]

Actually, Cris - going to 100 watts from 25 is a 300% increase.

But your point is well made.

 

[Enudely]

my target range is 2.5-3.5 for some reason, and yes, it had dropped to 1.5, which I guess is actually only one point. The multi vitamin I'm taking does not have Vit K. Maybe I should look into switching....

 

[Duff Man]

I try to eat some kind of veggie every day just because I think vegetables are really important for one's health. I'll randomly eat enormous amounts of vegetables. That being said, I am new to coumadin with only about 6 months under my belt and my INR hasn't been as stable as I'd like. My testing interval right now is at 1 month per the PCP's office, which I think is kind of indicative of a stabilizing INR. My testing intervals before were like 1-2 weeks.

 

[Elcarim]

Two things - the only two things - I have found that make any profound change to my INR are the way I make up my dose (as in, half a 5mg plus a 1mg, Vs one and a half 2mg tabs alternated with two 2mg tabs), and extreme changes in my activity levels.

For three years I worked a job where the pre-Christmas period was very hectic and I would lose up to 10kg in that time. My INR was affected to the point that I had to change my dose. Then post-Christmas I had to change it back. This Christmas just gone, with having a different job, this did not happen. However, I did lose 5kg gradually and it made no difference to my INR.

I am on quite a low dose and I have been stable for ages. I eat without considering how it will affect my INR, but I do try to eat well and exercise regularly.

 

[lance]

I agree 100% with MarkU. Myself, I hardly ever think about intake of "green" beyond eating something every day I know contains high amounts of V K.

I'd look to exercise and weight loss/gain before "greens".
Cheers

 

[Herb M]

If there are greens around, I eat them. I do not eat the same amount every day or every week. I check my INR every 4 to 6 weeks, so any variation in eating more or less greens is not detected. I don't worry about it.