Herbal teas and fluctuating INR

[lance]

Whereas I don't believe diet affects warfarin; lately while drinking herbal teas, maybe 9 cups a week, my INR, although always in range, is fluctuating up and down. So I wonder if the teas are the cause. Any ideas?

 

[Superman]

How is it, "you don't believe diet affects warfarin"? It's not as dramatic or dicey as some portray, but it is something to be cognizant of. Through regular testing, adjusting the dose as appropriate, and a certain level of consistency in diet - it's a very manageable thing - but there is definitely an impact.

Things I notice quite clearly for me have included:
- Cranberry Juice (higher INR)
- Spinach and Brussell Sprouts (lower INR)

Just to name a couple first hand experiences. Any issues have been due a lack of consistency. Introducing said items into my diet having not had them at all prior.

Herbal tea could have an impact going from none to 9 cups weekly. Hard to say. Not sure about up and down. Depends if it's causing you to alter your dose too much kicking off what I refer to as the "yo-yo effect".

 

[lance]

It is rare for my weekly INR readings to fluctuate this much. Two weeks ago 2.7; last week 3.1; this a.m. 2.6. Same warfarin dose.
Nine cups a week is just over one a day. Anything's possible though.
Out of interest though, what quantity of juice and veggies are you referring to? Are they consumed every day?

 

[Superman]

It is rare for my weekly INR readings to fluctuate this much. Two weeks ago 2.7; last week 3.1; this a.m. 2.6. Same warfarin dose.
Nine cups a week is just over one a day. Anything's possible though.
Out of interest though, what quantity of juice and veggies are you referring to? Are they consumed every day?

Not daily. It's the irregularity that throws it off. I used to get on cranberry kicks where I'd have way too much. Or if I buy a bag of brussell sprouts, I'm the only one at home who eats them - so I'll have them with meals until they're gone, then stop. M

Are you on an irregular dose? For example - I take 6 mg some mornings and 7.5 others. If I do this in a way that my high dose changes days, it can create fake volatility. For example:

High dose Sunday - test Tuesday
High dose Saturday - test Tuesday
High dose Monday - test Tuesday

Maybe the same weekly dose, but the timing of my high and low dose can mess things up. Depends on when I metabolize that higher dose.

 

[dick0236]

It is rare for my weekly INR readings to fluctuate this much. Two weeks ago 2.7; last week 3.1; this a.m. 2.6. Same warfarin dose.

I would consider an INR of 2.7, 3.1 and 2.6 to be very well managed. I also agree with Superman that certain foods do affect my INR....altho not to any great extent unless I pig out on them over a short period of time.......or if I remove them entirely from my normal diet. My last three weekly INRs have been 2.8, 2.9 and 2.4 and I consider these acceptable (range 2.5-3.5). This is the holiday season and I expect some variations in my INR.

 

[pellicle]

I agree with Dick, and so does my cardiologist and surgeon.

Look at the variance in my INR below

[IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/4.bp.blogspot.com\/-osRGNukjU_Y\/WIDSHTp_TOI\/AAAAAAAAGok\/QgWFM67xHuAsXfjXahOFxLedi--FPC2kACLcB\/s1600\/2016-justINR.jpg"}[/IMG2]

​​​​wheb I showed this (and other data from other years) they are both of the view that my INR is quite stable.

I also second the comments bu superman.

I'd add one more juice to avoid in large and frequent amounts: grapefruit juice.

It really doesn't matter if your INR goes up and down a little. You are a natural system not a block of steel. Its when it goes out of therapeutic range that you need to take actions.

Also the variances you mention are not what is called a clinically significant change, so don't sweat it

 

[lance]

Thanks to all of you, there's very good advice posted above. It's not often my levels cause concern, I just wondered about the herbal teas because I normally don't drink them. Coffee becomes monotonous after awhile and this dull, gloomy weather we're experiencing hasn't helped either psychologically wise.

 

[RobThatsMe]

Vit K in certain Teas is high,

You should check your Vit K chart, and the ingredients in your herbal teas.
It will definitely effect your INR, especially "Green" or Black Teas.

 

[pellicle]

Hi Rob

Vit K in certain Teas is high,

it is?

http://www.ptinr.com/en/home/warfari...-warfarin.html

We assume that because green tea leaves are a high source of vitamin K that it will interfere with warfarin blood levels. But, brewed green tea contains low amounts of vitamin K, approximately 0.03 micrograms (ug) of vitamin K per 100 gm of brewed tea.[SUP]2[/SUP] The actual concentration of vitamin K in brewed tea will depend on the amount of leaves brewed and the dilution of the tea leaves.[SUP]3[/SUP]

You should check your Vit K chart, and the ingredients in your herbal teas.
.

agreed this seems to show zero:

https://ndb.nal.usda.gov/ndb/foods/s...62&measureby=m

however its worth pointing out that Vitamin K is not the only reason foods can interfere with INR ... anything that effects the P450 pathway in the liver will do the job.

http://www.ptinr.com/en/home/warfari...-warfarin.html

http://www.valvereplacement.org/foru...-python-moment

but:
https://www.ncbi.nlm.nih.gov/pubmed/9706183

further, this link (from Stanford) is actually both confusing and contradictory:
http://sim.stanford.edu/resources/smg_patient_info/Warfarin Instruction Sheet 06-10.pdf

Alcohol intake can either increase or reduce the effect of warfarin (Coumadin®) and therefore put you at risk of bleeding or clotting. While it is best if alcoholic beverages are limited or avoided while taking this medication, it is important to maintain consistency in alcohol consumption.

so, a buck "either way"


so as always test (and see how it is for you)

 

[Superman]

Starting with today's test, my last few weeks:

3.2
2.8
2.1 - Spinach and Mushroom alfredo sauce
3.0
3.3
1.9 - Brussell Sprouts
2.5
4.0 - Probably an over correction from a prior test.

I'm out of range (2.5 - 3.5) three out of eight times. I take 6 mg four or five days and 7.5 two or three days depending on the prior test. I do have Christmas dinner and one of my children has a birthday between now and my next test. Diet could be interesting.

 

[pellicle]

Starting with today's test, my last few weeks:

3.2
2.8
2.1 - Spinach and Mushroom alfredo sauce
3.0
3.3
1.9 - Brussell Sprouts
2.5
4.0 - Probably an over correction from a prior test.

Any dose changes?

 

[Superman]

Any dose changes?

Typically if I'm low I'll do three days at 7.5 mg, if I'm high or trending up fast, I'll cut back to two days at 7.5 mg.

All other days I'm at 6 mg.

 

[pellicle]

Typically if I'm low I'll do three days at 7.5 mg, if I'm high or trending up fast, I'll cut back to two days at 7.5 mg.

All other days I'm at 6 mg.

Ok ... I was curious to see if you'd been doing anything with dose changes that may correlate with that (either causal or used to fix the swings). When you wrote "" an over correction from a previous tests" I assumed that meant you had altered dose.

For myself I plot weekly (on a graph, coloured pencil on graph paper also works for those who abhor spread sheets) and if something looks to be going out of range (2.2 ~ 3 in my case) I will attempt to gently steer it back OR if I see its part of a cyclic thing (meaning a high or low trend which self corrects) then I may leave it alone and simply start an "ad hoc watch" where I check INR again on Wed (with Sat being my usual day).

Best Wishes

 

[user 16827]

I drink way too much coffee so last year i started to drink herbal tea

Green tea , cinnamon tea and chamomile, up to 5 cups a day

i noticed a drop in my INR, i avg around 2.2 - 2.8 ( 14mg daily )

while drinking the tea and taking the same dose i went down around 1.8 so i stopped the tea

 

[RobThatsMe]

content of foods in the U.S. Food and Drug Administration’s Total Diet Study

Tea from tea bag Vit K per 3.5 fl oz.

Black, brewed 0.08
Black, leaves [dry] 262
Decaffeinated, brewed 0.03
Green, leaves [dry] 1,428.
Green, leaves, brewed 0.03

 

[RobThatsMe]

Simple solution to the OP is to stop drinking your herbal teas for a while, and see where your INR level stabilizes.

 

[Superman]

Ok ... I was curious to see if you'd been doing anything with dose changes that may correlate with that (either causal or used to fix the swings). When you wrote "" an over correction from a previous tests" I assumed that meant you had altered dose.

Over correction driven by changing my dose due to a low result, and not eating what I ate the prior week that led to the low result in the first place.

I was 2.2 the week before the 4.0 and 3.5 the week before that. I was still in rapid weight loss mode so trying the figure things out.

 

[pellicle]

Over correction driven by changing my dose due to a low result

Thats sort of what i was expecing.

and not eating what I ate the prior week that led to the low result in the first place.

Do you find that foods make so much difference for yourself?

I was 2.2 the week before the 4.0 and 3.5 the week before that. I was still in rapid weight loss mode so trying the figure things out.

Actually I suspect the rapid weight loss is probably the casual factor. It may have been influencing your metabolism levels (a significant factor in dose) and perhaps a bit of blood serum albumin level (also significant due to binding reactions with warfarin)

 

[pellicle]

Hi

content of foods in the U.S. Food and Drug Administration’s Total Diet Study

Tea from tea bag Vit K per 3.5 fl oz.

Black, brewed 0.08
Black, leaves [dry] 262

I see that it drops from totally insignificant in what you would drink to high if you swallow 3.5oz of tea leaves. Which supports my views that if tea is influencing his INR then the cause isn't vitamin K

Simple solution to the OP is to stop drinking your herbal teas for a while, and see where your INR level stabilizes.

Agreed, document it and document it long term, ongoing documentation will help you sort out if any instance is actually caused by what you think it is. or was just coincidence

 

[pellicle]

In case what I am saying was lost: the observed variance in INR with herbal tea may be caused by something in the tea which effects the disposal of warfarin (the p450 pathway) and not just vitamin K

If there is an actual repeatable effect that the herbal tea always causes this effect over multiple tests.

Of course not drinking them makes for an easy solution, but if you do enjoy it, perhaps persist in seeing if it is the culprit.

I don't know if you were making the tea by hand from tea leaves, tea bags or pre made in a bottle. If the latter then preservatives may be a factor.