Effects Of Indian Spices on INR

[ccrawford]

We've been experimenting with some Indian recipies and have eaten them two or three times last week. I tested today and found an INR of 5.1 I did a little research and found that ginger may have additive anti coag and anti platelet effects, and found that Turmeric (containing curcumin) may potentiate anti platelet activity. What I didn't find was some indication of how much spice it might take to cause a serious interaction with Warfarin. Anyone have any experience with INR problems and Indian food? I'd sure hate to give up such interesting and tasty recipies, but it may be another case of if it tastes good, it must be bad.

 

[jeffp]

Have a nice leafy salad with your indian food and you should balance out! (I love indian food - haven't had any in quite a while - may just go out and find some now.)

 

[Blanche]

You have asked a question that has been in the back of my mind for some time now. I hope someone has the answer. We like Mediterranean and Indian foods but have them infrequently. Many recipes include garlic, which is also a concern for anticoagulation and antiplatelet action.

I don't really worry about anticoagulation (INR) as much as I worry about platelet aggregation. As Jeff said, salads and other foods that are high in Vitamin K can be enjoyed along with modifications of the Coumadin dose to bring the INR back into range. But what of the platelets? Albert had two bleeds, one small one in his hand and a very large one in his pelvis recently. His doctor was concerned with platelets and took him off of his regular aspirin. I would think that someone who is taking Plavix, aspirin, or other medications that deal with platelets might be might be advised to use caution whe dealing with highly spiced foods.

I have a list from Sloan-Kettering that I have used quite a bit when dealing with herbs and spices. Although it does not answer your question, I have found it helpful and hope you will too.

http://www.mskcc.org/mskcc/html/11571.cfm?herbsaccept=yes

Thanks for getting the ball rolling on this one.

Regards,
Blanche

 

[ccrawford]

Blanche- Thanks for the web site. I've been using one from the Univ of Mich but the Sloan Kettering site is more comprehensive and I've bookmarked it. The suggestion about the spinach salad makes sense, but I'd still like to hear from others who may have had similar experiences in order to get some sense as to how powerful these spices might be. Anyone who has prepared Indian recipies knows that some of them contain substantial amounts of spices - much more than we typical Americans tend to use in our food preparation. That, of course, is what makes Indian food such an experience. Thanks, Chris

 

[Guest]

The test that is run to determine the INR uses thromboplastin. This involves only the part of the clotting mechanism involving warfarin. Any effect on platelets will not be reflected in any INR test.

The blood may be less likely to clot if you affect both the thrombin and the platelets but the reagents used in INR testing cannot be affected by platelets.

If you said that you had bruising after eating foods with these spices, you could maybe attribute it to the combination. But, you cannot attribute a high INR to platelet inhibition.

 

[Blanche]

Al:
Thank you for the clarification. I recall that you explained this before and mentioned that it is difficult to test platelets. I was not attributing Al's bleeds to foods. Since his INR was steady, the doctor thought platelet inhibition might...and I underscore "might" be the cause. We will never really know. All we know is that he got two very large and very black "bruises" within a week.

Some of the spices in Middle Eastern foods affect both INR and platelets. It would be helpful to know which ones and how much. I was hoping someone might have some insight here. Perhaps I'm just waiting for Godeau.

Regards,
Blanche

 

[Guest]

Clotting time is different from prothrombin time. The reason that some people get big bruises with a normal INR is due to this difference.

An example is someone with von Willebrand's disease. They have very poor platelet activity but would have a normal prothrombin time if they did not take warfarin.

I don't think that there are very many, if any, foods or spices that will affect the INR to any significant degree if they are only eaten in normal quantities. I saw a woman who ate a whole bag of cole slaw mix in two days by herself and the INR only went down about 0.4 points. The next week it was back to the usual range with no dosage adjustment.

 

[ccrawford]

Al - I agree with you with one exception. What may be a normal amount of spice to you and me may not be normal for an Indian diet. I've got recipies that would result, for example, in the ingestion of a tenth of a cup of ginger per person. That is a lot of ginger. What the effect might be of this is unknown to me. Chris