Lowering Warfarin dosage through diet/supplements?

[T in YVR]

Hey all,

I currently take 8.75 mg of Warfarin daily to maintain an INR range of 2-3. A few months back I started taking my Omega 3's again (had not taken them since surgery). I take 1 tab 2x daily - 1,414mg each - so about 2,800mg daily of fish oils. I have always taken these pre surgery, so my reason for taking them again was to simply reintroduce them as a daily part of my health/diet. I thought it might also raise my INR, as I heard this can happen. So, I figured I would watch it, and then lower my warfarin dosage if required. However it did nothing.

I used to take 7.5 mg, then it went up to 8.0, 8.25, then 8.50 and now 8.75, as I come into a steady INR range post surgery. I have been at 8.75 for about 2 months. So, I guess this is what my body wants and needs in order to stay between 2-3 (my INR is actually on the lower end at 2.3).

I know you should "dose the diet", which is what I do. However, I had a question - has anyone taken any supplements or made dietary changes that are permanent and regular in nature in order raise their INR naturally, and lower their daily warfarin dosage and amount of warfarin you need to consume in order to maintain a steady INR but with less warfarin?

I'm not saying I am going to do this at this stage. And I would never take anything unless it provided some health benefits. But if I ever found myself consuming a hell of alot of warfarin I suppose I would consider it, as long as it also benefited my overall health. I'm not sure if there is a point where the amount of warfarin you consume daily is considered high and can cause any side effects.

Thanks,
Tony

 

[dick0236]

I don't think 8.75 mg warfarin would be considered a high dose. When I was in my 40's and very active I took 10mg for a number of years. I remember taking fish oil 12-15 years ago with no effect on INR. I think I stopped taking the fish oil when I started taking statins for cholesterol......the statins played havoc with my INR. The only side effect I have found with warfarin is you keep your hair and you don't show your age...LOL,LOL,LOL

 

[T in YVR]

Thanks Dick - I'm pretty active as well so maybe that contributes to the dosage level? I have found that the more active I am, the more warfarin I seem to have to take. Nothing scientific on that - just noticed a trend in how much I am exercising, etc and my dosage level going up slightly. I am not bothered with the 8.75 mg yet, but just saw it creeping steadily up and started thinking about it (maybe too much!).

I had no hair before surgery and still have none afterwards, so its not helping me grow hair, that's for certain

 

[pellicle]

Hi

I currently take 8.75 mg of Warfarin daily ...
...I used to take 7.5 mg, then it went up to 8.0, 8.25, then 8.50 and now 8.75, as I come into a steady INR range post surgery. I have been at 8.75 for about 2 months.

yep, that's what happened with me too. Every month or so the amount of warfarin needed to keep my INR within range crept up. I was at that stage totally newbie and was despondent about it.

Now I understand that what was actually happening was my metabolism was returning to normal and also my fitness levels were going up (also effecting my metabolism).

I notice when I'm sick I need less daily mg and when I'm stonking out on the snow every day I need more.

that's why I happen to also like self testing and graphing my results. The trends tell me what to do.

A few months back I started taking my Omega 3's again ...
...However it did nothing.

a common finding ... as well as the common finding that "it makes no difference (really) what I eat"

So, I guess this is what my body wants and needs in order to stay between 2-3 (my INR is actually on the lower end at 2.3).

yep

However, I had a question - has anyone taken any supplements or made dietary changes that are permanent and regular in nature in order raise their INR naturally, and lower their daily warfarin dosage and amount of warfarin you need to consume in order to maintain a steady INR but with less warfarin?

I think you'll find its the opposite. Fellas like GymGuy actually take in vitamin K suppliments which means they take more warfarin but he feels that he gets a more stable INR as a result of that.

There seems to be some unsupported meme that having less warfarin is somehow better than having more.

Seems strange to me, as one who is used to thinking in terms of "orders of magnitude" in terms of the effects of a drug (one order of magnitude is times 10) . Of course such a study is impossible because unlike other durgs / foods such changes in exposure would be poisonous.

Essentially what I'm saying is that if you take 5, 8 or 12mg daily to keep in range I don't think there will be any identifiable difference

But if I ever found myself consuming a hell of alot of warfarin I suppose I would consider it

define a "heckload of warfarin".

a thread well worth reading:

http://www.valvereplacement.org/forums/showthread.php?25929-The-Largest-Daily-Dose-of-Warfarin

 

[dick0236]

Pellicle, thanks for posting that old thread. I remember that Coumadin(warfarin) was a non-issue back in the 1960s. I never knew that I would be on it for life and it was just another Rx that was on the list of meds I took home from the hospital post-op....and I did not know it was derived from rat poison until several years ago when I saw a TV documentary. My instructions where to have a blood draw every month, or so, and stop taking Coumadin if my urine turned red....and I don't remember how we where supposed to know if our INR was too low....maybe a stroke?? I still think that modern docs are much more concerned about bleeding(hi INR) over stroke(lo INR). I subscribe to the post I once saw on this forum......"blood cells are easier to replace than brain cells". The casual way that warfarin was handled back then probably had something to do with the CVA I had seven years post-op. I was really surprised, when I joined this forum, about the really bad and misleading info that was "floating around" and how helpful this Forum was in answering questions, such as the one posed in this thread. I guess, like I've seen posted, "it takes what it takes" and the only important thing is "take it as prescribed and test routinely"....that's worked for me for the past 40 years.

Didn't intend to hijack this thread....but it is important to put warfarin in it's proper persective....and it is good to know that the dosage doesn't really matter......660mg WOW!!! If that happened back when DuPont had the patent it would have cost $198/day w/10mg pills as the Dupont Coumadin was $3/pill....and that was in the 1970s, when $3/pill was "big money". Thank god for generics.....$.13/pill.

 

[T in YVR]

Thanks -appreciate the input.

Yeah, 660 mg would certainly qualify as a big dose! That's so many pills you'd have to save room after dinner for warfarin dessert....crazy.

 

[bocco]

Try starting a new supplement about a week before your scheduled blood draw. That should give you an idea if your level is changing before it gets to far.

 

[pellicle]

I dug through that thread I posted earlier and found this quote by Al Lodwick

I have never heard anything about dose correlating with life expectancy.

One thing that is going to argue against the newer drugs is that we have almost 60 years of experience with warfarin and know that, aside from bleeding, it is fairly non-toxic.

 

[Jamey T]

I have also noticed that the more active I am, the more warfarin I need. I don't have a problem with the varying dosage, because taking too little can end my way of life. I am not ready to stop being active, so I take what is needed by my body.

 

[Protimenow]

The 'Rat Poison' thing is a worthless argument. Warfarin is used to kill rats by giving them large doses mixed in with grains and cause them to bleed internally. (FWIW - I've read about warfarin-resistant rats). As an anticoagulant, it does what we need it to do, at the doses we take it for. As an anticoagulant rat (or other animal) killer, it also does what it does when doses are very high. A big candy bar for a very sensitive diabetic could be poison -- but do you see people saying not to eat chocolate?

As far as Vitamin K is concerned -- the body DOES derive benefits from Vitamin K, and modern thinking no longer says to avoid it completely. I take a low dose with a pack of vitamin supplements, and made a slight adjustment to my warfarin dose. If I miss the supplement for a few days, my INR climbs slightly. So -- it's probably not bad (perhaps even helpful) if you take low doses of Vitamin K as long as you adjust your warfarin dose to compensate. (This is where self-testing is especially valuable -- you can detect changes and make minor adjustments, if necessary).

I've been self-testing for five years and appreciate the control (and knowledge about my own INR) that it gives me. If you're considering making changes (like adding vitamin K, or changing your dose of warfarin), having a meter and self-testing are well worth considering.

 

[pellicle]

Hi

The 'Rat Poison' thing is a worthless argument.

I know, but it used to endlessly entertain my lovely wife who used to enjoy calling it that to others (and watch the "horror" on their faces). I used to get a laugh about it too. Quite a many Finns like to rub snow in your face (and she was a good shot with a snowball).

 

[pellicle]

Hi

this is among the best ways of phrasing it I've yet seen...

I don't have a problem with the varying dosage, because taking too little can end my way of life. I am not ready to stop being active, so I take what is needed by my body.

thank you.

 

[charlieecho]

I take 16mg a day. My cardiologist says I'm one of the highest out of all his patients but the correlation between dosage and health is irrelevant. For some people it just simply takes more. I do hope there is another anti-coagulant in our near future. The calcification risk from warfarin wanting to starve our body from Vitamin-K, more importantly Vitamin-K2, can be a bit concerning. This is an old article but a good read showing that K-2 can actually reverse the effects of warfarin.

http://m.lef.org/magazine/mag2009/j...l-Calcification-Bone-Loss-Cancer-Aging_01.htm

 

[Protimenow]

We don't have to starve our bodies of Vitamin K, or of K2. I take it in a supplement (80 mcg) every day. Vitamin K provides definite health benefits that we who take Warfarin DON'T HAVE TO DO WITHOUT. What's important is that you adjust your warfarin dose to accommodate for the effects of the Vitamin K dose. That's all. If I miss my daily vitamin pack (with the K), I notice that my INR will go up a bit -- but I try to be regular with my Vitamin K and my warfarin dosing. Similarly, if I take a supplement, or a run of antibiotics for some strange infection, my INR will shift -- but careful management (without causing any major changes in INR) will adjust for these other factors and STILL keep my INR in range.

So -- if you are planning on trying new supplements, just test and adjust for any effects that they may have on your INR. If you have your own meter, you're ahead of the game. (One thing -- in the past, I took quercetin and it is POSSIBLE that the results on an InRatio meter were not accurate, but I haven't used that meter or quercetin, so I can't confirm that ANY OTC supplement can fool the meters. A blood draw, if you're concerned with possible confounding effects, is never a bad idea -- unless you're overdoing the venous testing).