How sensitive is INR to diet?

[TomS]

I have been on Coumadin for two months now, with checks every two weeks, and have not seen any significant variation in readings. I've skipped meals on some days, had a couple of glasses of wine others, ate salads with dinner, then stopped eating anything green for a couple of days, etc. and have not seen reading move very much. Is it pretty much normal that INR levels don't fluctuate all that much?

 

[Ross]

Overall, diet plays a very small role in your INR. Now if you were to go on a "Nothing but greens" diet suddenly, then your going to see something, but for the most part, it's not much of an issue.

 

[Nancy]

Joe has been on Coumadin for 28 years. His most serious fluctuations are from medication adjustments, up or down and newly added or deleted meds, and his overall medical condition which also fluctuates. Activity levels play some role, and at the end of the list would be dietary sensitivity.

 

[geebee]

I agree with Nancy. The biggest changes I have seen was when I was on antibiotics and when my digoxin was discontinued.

My diet is fairly consistent in that I eat similar amounts of greens each week, drink alcohol a few times a month, etc. but I really don't think about what I am eating unless answering a thread like this one.

 

[William]

Mine go up and down ALL the time. I have found no way to keep it stable (diet, activity has all been looked at), so it's a constant change in dosage very two weeks. Sometimes I can go a three weeks without a check. Will

 

[CCRN]

Yum

Yum

I was very steady. Ate whatever I wanted but ran into a problem when I pigged out on two new recipies. One was for mango/cabbage cole slaw and the other was coucous spinach salad. Gave me a deep 0.5 point drop in my INR and I did have one episode of that weird double/kalidoscope vision. (Down to 1.8 from 2.3) They increased my weekly dose by 2.5 mg after I told them I intended to maintain eating those things because I love them and what's the point of going through all that surgical mess if you can't enjoy your greens? I DID lay off the high vit K stuff for a few days. Puts me up to 50 mg per week. I test again in a couple of weeks and expect to be fine since I'm over the vegetable binge.

 

[Guest]

William,
If your INR is still going up and down all the time, you probably have someone managing your warfarin who is not very skilled at it. There is practically no reason that you should be still getting tested every two weeks after 10 months.

 

[catwoman]

CCRN:

I noticed a drop in my INR when I had boiled cabbage for lunch (veggie plate from downtown Fort Worth cafe) and then had a nice-sized green salad at dinner. Had the cabbage @ lunch 3, 4 days running and for 2 straight weeks.

My INR went from 3.5 to 2.9. It had been 3.5-4.2 for a long time. So, I tweaked my dosage and decided I would either have cabbage at lunch or salad at dinner, but not both in the same day, at least not for several days in a row and a couple of weeks in a row.

 

[Guest]

One rather oddball thing about this is that starting Meals-On-Wheels causes a drop in the INR. Who would think that a nice program like providing food for the disabled would be dangerous, but it is. I think the reason is that, by definition, people who go on the program are unable to fix good meals. In the US, if someone is unable to fix a meal, the first things to go are usually vegetables. Then Meals-On-Wheels comes in and provides two vegetables every day. Down goes the INR.

Don't get me wrong, I'm not anti Meals-On-Wheels, I have called in referrals for my patients. It just shows how nothing is all good or all bad.

 

[FauxClaud]

Hmmm.. I havemn't been on in a bit since things have been rather smooth...but Garin's last two weekly sticks have been low..he had a 1.7 and then a 2.1 after being steady for over a month. The routine that kept him staedy was 4, 4, 4, 5 mgs pattern.
Now I was thinkning that since diet has been steady, that it could be an activity thing. He went back to skateboarding and gym class...gym with the cardiologists approval, the skateboarding without, but I hate his Cardio..and that's another story!
So I am checking up here to see if my hunch is right..BUT this:
"one episode of that weird double/kalidoscope vision" caught my eye!! As the poor boy called me from school on Monday with a double vision thing....can this be described to me a bit more? Is it a coumidin thing? He said he was in class and he felt his one eye go up and the other go sdown and he saw double..it stopped after a bit, but he had a bit of a headache and I took him home to sleep the rest of the headache off. He does get migraines..so I thought that they vision thing was maybe a visual from the migraine.
ANyway, I am going to go back to reading more now..if anyone has any clues, I would appreciate it!
Thanks

 

[Cris N]

There's been a fair amount of discussion recently on this board about 'ocular migraines' - might look into it in addition to talking to his doc.

 

[ALCapshaw2]

Do a SEARCH for "visual effects", "optical migraines" (sp?), "double vision", "kaleidoscope" or "kaleidoscopic" and you should find LOTS of posts covering this topic.

'AL Capshaw'

 

[catwoman]

Not meaning to hijack this thread, but I did a web search for ophthalmic migraines and found a site that said they can be caused by a "vasospasm," a temporary spasm in the blood vessels behind the eye. A friend who is a retired professor of optometry has told me the same.
I never had any episodes until I was perhaps 3 days post-op, still in the hospital. I continue to have them, perhaps once or twice a week. No headache, just colorful Art Deco lights for about 30 minutes.

 

[William]

Hi Al, The last fluctuation happened when I came back from Europe. It was at 5.2, they had me stop for a few days and start back at a lower dose. Next time it was at 1.7, so my dose got jacked up a bit. I'll be back next week for another check. I get it done at my Cardio Doc's office with a prick test. Separate question here, do you have some patients that complain of headaches and visual disturbances from being of Coumadin? Will

 

[catwoman]

Hi Al, The last fluctuation happened when I came back from Europe. It was at 5.2, they had me stop for a few days and start back at a lower dose. Next time it was at 1.7, so my dose got jacked up a bit. I'll be back next week for another check.

Will:
I've had a couple of times when my INR was 5.2-5.4. I home-test and so I can adjust my own dosage as needed. Formerly, I would hold a dose, but now I halve my dose for one day, then go back to normal & retest in about 5-6 days. With a mitral valve, I'd rather it be 5.2 than 1.7.

 

[Granbonny]

When I was spending time in the hospital with Daddy, I ate lunch and dinner everyday in Hospital lunchroom. Pigged out on their food. YES, it was good..Homecooked Southern food. Turnip greens and cornbread..Yummy. Hubby came down and brought my Protime..I was at 1.8.. From my normal reading of 3.0 and above a little. PLUS..taking my coumadin around 7 P.M. (time I went home to call family)Normally, I take it at 5 P.M.........First night..added a tad (less than a half) the next night same... Tested the 3rd day..2.7.. so, I'm home now and just took normal 5 mg......Thank goodness for Protime..and no more hospital food.. .......Bonnie

 

[mknuppel]

I have experienced the same thing - after surgery. I now get the episodes a couple of times a month. No headache and I could set a clock for 30 min exactly.

 

[Lynlw]

I have experienced the same thing - after surgery. I now get the episodes a couple of times a month. No headache and I could set a clock for 30 min exactly.

I just wanted to let you know this is from 2005, many of the members no longer post here

 

[Protimenow]

Yes, it's a VERY OLD thread. However, the subject may still be of interest to many of the more recent visitors here.

Thinking - particularly about Vitamin K (regular use versus complete avoidance) has changed some over the years, so it's probably not a bad idea to revisit the subject. (Also, many of the greens with high amounts of Vitamin K can change an INR pretty quickly - certainly much more quickly than the effects of warfarin. )