my self management results for 2020

[tom in MO]

then you should reach out and I'll do what I can to help
PS be wary of generics, they sometimes cause variances (complex) but if you can stick with a brand like Coumadin or Marevan

Generic drugs have to prove bioequivalence before being able to be sold in the United States. In addition, with the global pharmaceutical industry, the drug you buy under a label and the drug you buy as a generic could have come from the same factory.

 

[pellicle]

Generic drugs have to prove bioequivalence before being able to be sold in the United States. ...

I'm only going by the empirical evidence presented by others here ... myself I have no direct experience as you seem to.

 

[tom in MO]

A bioequivalence study is empirical evidence vetted by the drug company and the FDA. In addition, every year a company has to report to the FDA adverse events related to a marketed drug so the empirical evidence is added to over time. My direct experience is being on warfarin and taking whatever the pharmacy gives me.

 

[pellicle]

A bioequivalence study is empirical evidence vetted by the drug company and the FDA. In addition, every year a company has to report to the FDA adverse events related to a marketed drug so the empirical evidence is added to over time.

according to wikipedia: Bioequivalence - Wikipedia

The United States Food and Drug Administration (FDA) has defined bioequivalence as, "the absence of a significant difference in the rate and extent to which the active ingredient or active moiety in pharmaceutical equivalents or pharmaceutical alternatives becomes available at the site of drug action when administered at the same molar dose under similar conditions in an appropriately designed study."​

which would not take into account variances of half life of S and R enantiomers which is actually key to the INR ...

Warfarin Warfarin - Wikipedia

Warfarin consists of a racemic mixture of two active enantiomers—R- and S- forms—each of which is cleared by different pathways. S-warfarin is 2–5 times more potent than the R-isomer in producing an anticoagulant response​

so if brand A had a different mix of R and S then different INR's would result. I believe this is the basis for why we are often advised to not just change brand without thinking about it and doing testing and why you'll find posts here where people have had problems with generics.

My direct experience is being on warfarin and taking whatever the pharmacy gives me.

so you're saying you have no direct experience in this either

 

[Sheenas7]

not really ... although I mainly drink the same things ... red wine or beer

no wait, I've been on Gin and Tonics since Christmas

Food can be anything, I'm not into salad but I love Lamb Saag (which is lots of spinach) and I eat sausages (australian style is closer to south african), veges, rice.

Its a real mixup driven by

• whatever is on special at the supermarket
• mood
• opportunity

I love salad Pellicle. I also try to look up foods for vitamin k content but often I find contradictions. I thought lentils were high and i avoided them but I found a cite that said they were not. Do you have a favorite cite? I By the way I had the first dose of Corona vaccine from Pifzer and I tested before and a week after. Before was 2. 5 and a week later was 2.9. Not much different. Good news.

 

[tom in MO]

I love salad Pellicle. I also try to look up foods for vitamin k content but often I find contradictions. I thought lentils were high and i avoided them but I found a cite that said they were not. Do you have a favorite cite? I By the way I had the first dose of Corona vaccine from Pifzer and I tested before and a week after. Before was 2. 5 and a week later was 2.9. Not much different. Good news.

Not sure how much science is behind the published vitamin, mineral, etc. content of food. Some of those values can vary by species, soil type, fertilizer and growing conditions. My cardiac rehab nurses said to eat a variety of food with a variety of colors. That's what I try to do. The only time I think "how much vitamin k" is if my INR is off, but then "I dose the diet and do not diet the dose"

 

[pellicle]

I love salad Pellicle.

Me too

I eat it as I wish. I love spinach too, often have that in a sandwich with children and mayo, or in ramen with pork dumplings.

Same or similar results. Once I worked out how little vitamin I was in this stuff I just ignore that issue and eat what I like.

 

[pellicle]

Sheena, I forgot to address this point

I thought lentils were high and i avoided them but I found a cite that said they were not. Do you have a favorite cite

well its interesting, I did but as I haven't used it for like 6 years when I went to it (its a US Government site) its changed, tons of data isn't there and (worse) its now "powered by Bing" ... what an utter failure of a web search engine that is.

The bottom line is that I long ago (after careful analysis in conjunction with taking my INR every 3 days) I found no observable changes which could consistently be related to food.

Further this is logical when you consider the reversal guidelines talk in milligrams (mg) of vitamin K to effect a significant reversal of INR and that the amount of vitamin K in foods is measured in units one thousand times smaller (micro grams µg or more commonly pens are easier to use than computers mcg) you need to eat disproportionate amounts of the food.

Google is playing some stupid game with me right now so I can't search for the thread I posted about this but from this site:

https://www.mja.com.au/journal/2004...elines-behalf-australasian-society-thrombosis
we find the following guidance (bold mine for emphasis):

The amount of vitamin K in the diet partly determines the sensitivity to warfarin. This is important to consider in situations when diet changes, such as during illness, travel, fad diets, hospitalisation and postoperatively. Dark green vegetables such as spinach and broccoli are typically high in vitamin K. However, it takes a very large daily intake of “greens” to influence the INR. Rather than restricting vegetable intake, it is better to recommend a balanced and consistent diet​

​

The optimal IV dose of vitamin K1 for partial reversal of over-anticoagulation with warfarin is 0.5–1.0 mg. If correction of the INR (rather than just return to the usual therapeutic range) is desired, larger doses of vitamin K1 are needed (see Box 3). The INR can usually be normalised within 24 hours with an IV dose of 5–10 mg of vitamin K1. ​

The point about dark green is significant and can be found by searching foods and making the observation yourself.

Lentils are seeds and by nature have almost no vitamin K because 1) plants synthesise it and 2) seeds contain mostly energy for the tiny "germ" to "germinate" and use that storage as energy (a battery, not unlike the yolk of an egg) while it gets going and establishes itself.

so basically just eat food and enjoy it.

 

[Sheenas7]

Sheena, I forgot to address this point


well its interesting, I did but as I haven't used it for like 6 years when I went to it (its a US Government site) its changed, tons of data isn't there and (worse) its now "powered by Bing" ... what an utter failure of a web search engine that is.

The bottom line is that I long ago (after careful analysis in conjunction with taking my INR every 3 days) I found no observable changes which could consistently be related to food.

Further this is logical when you consider the reversal guidelines talk in milligrams (mg) of vitamin K to effect a significant reversal of INR and that the amount of vitamin K in foods is measured in units one thousand times smaller (micro grams µg or more commonly pens are easier to use than computers mcg) you need to eat disproportionate amounts of the food.

Google is playing some stupid game with me right now so I can't search for the thread I posted about this but from this site:

https://www.mja.com.au/journal/2004...elines-behalf-australasian-society-thrombosis
we find the following guidance (bold mine for emphasis):

The amount of vitamin K in the diet partly determines the sensitivity to warfarin. This is important to consider in situations when diet changes, such as during illness, travel, fad diets, hospitalisation and postoperatively. Dark green vegetables such as spinach and broccoli are typically high in vitamin K. However, it takes a very large daily intake of “greens” to influence the INR. Rather than restricting vegetable intake, it is better to recommend a balanced and consistent diet​

​

The optimal IV dose of vitamin K1 for partial reversal of over-anticoagulation with warfarin is 0.5–1.0 mg. If correction of the INR (rather than just return to the usual therapeutic range) is desired, larger doses of vitamin K1 are needed (see Box 3). The INR can usually be normalised within 24 hours with an IV dose of 5–10 mg of vitamin K1. ​

The point about dark green is significant and can be found by searching foods and making the observation yourself.

Lentils are seeds and by nature have almost no vitamin K because 1) plants synthesise it and 2) seeds contain mostly energy for the tiny "germ" to "germinate" and use that storage as energy (a battery, not unlike the yolk of an egg) while it gets going and establishes itself.

so basically just eat food and enjoy it.

Thank you!

 

[ATHENS1964]

My current salad (zucchini - carrots - potatoes - oregano and olive oil), every day I will try to upload a photo with the salad or legumes I eat. I want to show my friends who are interested in warfarin that they can have everything in their meal.

 

[newarrior]

My current salad (zucchini - carrots - potatoes - oregano and olive oil), every day I will try to upload a photo with the salad or legumes I eat. I want to show my friends who are interested in warfarin that they can have everything in their meal.

Oil is a killer for the heart but otherwise you're kicking it man. What's Your Greens intake like these days? is it difficult to titrate that with the drugs? How bad is the ticking of the valve?

 

[ATHENS1964]

Oil is a killer for the heart but otherwise you're kicking it man. What's Your Greens intake like these days? is it difficult to titrate that with the drugs? How bad is the ticking of the valve?

https://www.heart.org/en/news/2020/03/05/olive-oil-may-lower-heart-disease-risk

 

[pellicle]

answering for myself

What's Your Greens intake like these days? is it difficult to titrate that with the drugs? How bad is the ticking of the valve?

in order:

1. same as it ever was
2. nope, I just eat what I want (as I've pointed out dozens of times it takes eating over 1kg of the highest VitK1 vegetable to make a dent in your INR ... if you do that daily then just adjust your INR
3. its audible mostly to me, but (unless your "special meaning in life" is to find something to perpetually irritate yourself with to madness and do that), you soon find that you go whole days without noticing it till you go to bed.

some animals need a collar to stop them harming themselves after surgery

this is because they don't know to not do it (and we can't communicate that) ... harder to do with humans on internal issues. But I believe that humans can effectively do this using their mind if they wish to.

but they have to wish to

 

[Superman]

I’m on a see food diet.
I see food, I eat it.

We have a really good recipe for a spinach and mushroom Alfredo sauce that I happily enjoy without a thought. I had a salad for lunch today. My favorite beer of late has been New Belgium Trippell (8.5% abv).

INR tested at 3.0 today.

The only food I avoid is cranberry juice because I can’t stop at one glass and it sends my INR way up.

As far as the valve, it ticks. I worry when I can’t hear it.

 

[Freebird]

https://www.heart.org/en/news/2020/03/05/olive-oil-may-lower-heart-disease-risk

Agreed. BAD oil is a killer for the heart. Oils like canola, etc. are bad for you. Olive oil, coconut oil, etc. are fine. Also sugar is horrible for the heart a well. The updated saying is, don't blame the butter for what the bread did!

 

[ATHENS1964]

My lunch salad tomatoes , olive , onion ,lettuce ,cucumber , oregano, feta cheese .

 

[pellicle]

My lunch salad tomatoes , olive , onion ,lettuce ,cucumber , oregano, feta cheese .

Delicious

 

[Sheenas7]

https://www.heart.org/en/news/2020/03/05/olive-oil-may-lower-heart-disease-risk

I use olive oil everyday and believe it’s healthy for heart.

 

[Sheenas7]

Delicious

What kind of lettuce Pellicle? I use iceberg (low vitamin k) with heart of romaine.
I would love to indulge in mixed greens and butter lettuce. Both high vitamin k.
Also I love avocado but I avoid because of vitamin K. I bought a book called “the Coumadin cookbook” . Written for warfarin patients last edition 2005. It says BEWARE OF AVOCADO. It says vitamin k content in it can vary as much as 40 times! And that small amounts can alter INR.

 

[tom in MO]

What kind of lettuce Pellicle? I use iceberg (low vitamin k) with heart of romaine.
I would love to indulge in mixed greens and butter lettuce. Both high vitamin k.
Also I love avocado but I avoid because of vitamin K. I bought a book called “the Coumadin cookbook” . Written for warfarin patients last edition 2005. It says BEWARE OF AVOCADO. It says vitamin k content in it can vary as much as 40 times! And that small amounts can alter INR.

In cardiac rehab about 8 years ago I was told that book is out of date. We were told the modern philosophy is to dose the diet these days and no longer diet the dose. I was told that the "special coumadin diet" is an older philosophy found to be incorrect.

I eat avocados w/o any problems with my INR. Per HealthLink British Columbia, an avocado has 40 ug of Vit K, a cup of lettuce has 60 ug with a 1/2 a cup of mustard greens at 438ug. I eat all three without problem. One would think the mustard greens should send me over the edge. Maybe that's because although greens has 10x as much Vit K, it's harder to digest. I don't know.

One thing I am sure of, if you see published values for Vit. K w/o a reference to a reliable source...don't believe it. If it has a reliable reference, check the reference to see how the values were obtained. Testing food for vitamins has a variety of variables from the soil conditions, plant species, local environmental conditions, harvest method, post harvest handling, sampling and sample processing before it even gets to an instrument for analysis. Plus, a serving may have Vit K, but that doesn't mean your digestive system will deliver it all to your cardiovascular system.