Perplexed on what to eat

[Jayhawk]

I know we need to be consistent with eating leafy green veggies. I am the type of person that likes to eat a salad occasionally but not every day. So do I give it up all together or go ahead and eat it occasionally and not worry too much about it? With trying to eat low sodium and just getting my diet under control in general I am feeling a bit overwhelmed. I am also a type II diabetic so that enters into the equation also. Maybe a diet of cardboard boxes? Yum!!

 

[dick0236]

I've never worried a lot about diet. I try to eat a balanced diet which includes vit K vegs because I like them and I seldom concern myself about how much vit K is in any specific food. Seldom has my diet had a lot of effect on INR.

 

[angietdrake]

Our experience with Cardiologist's that are MD's has been that they want to chase INR levels by constantly adjusting the dose of whatever blood thinner the patient is on. While that approach might work for some patients whose metabolism is easy to stabilize, that approach definitely does NOT work for ALL patients! By collecting and graphing the data from a Food Log that tabulates the vitamin K content of what I eat, it is very evident that my metabolism reacts MUCH faster to changes in my daily consumption of vitamin K than it does to changes in blood thinner dosing. My recommendation is to find a Cardiologist that is also a Board Certified Internal Medicine doctor as well. They should be able to help you get a handle on the factors in your diet that might make it harder to get your INR levels stabilized into your doctor recommended therapeutic range.

 

[Freddie]

I use to fret on what to eat and how much, now I don't care. I have salads maybe 3 x a week, I'll eat ice cream scoop green veggies when ever....I don't over indulged on greens but I still eat them
Enjoy your food and love life as it should - don't let something called INR control your enjoyment of food.....

I 2nd what Dick said.

 

[pellicle]

Firstly I backup everything said above.

Secondly the INR should be thought of as "more like a guideline really" [J.Depp, "Pirates of Caribbean]. It is not a precise number nor are the limits a precision indicator. Just like your mood, or your blood pressure or your "general feeling of wellbeing" there will be cycles. Cycles are normal and cycles don't cause a problem. Problems come from the sustained state of elevated or lowered INR. I recommend you read this post for an alternative view on how to manage INR.

Rather than thinking "I've got a range which is safe" and if I fall out of range its dangerous, consider instead a target INR which is a median between the range values. Then try to keep your trend around that. It does not need to be tight, so if your "median" target was 2.5 (and you already know that your range is for instance 2~3) then if you were 2 then the decision is "do nothing and wait for a trend to emerge" rather than "do nothing because I'm range"

Don't fret, eat drink and be merry. Test weekly and don't fret with a single high or low reading. Meaning don't change dose until you see a trend emerge. Then whatever action you consider taking, make it subtle *(unless your INR something unsubtle like 8, where my advice would be as don't alter dose too much and take some vitamin K as suggested in that post)

 

[pellicle]

oh, one more point: if you're testing weekly rather than monthly then if there is a trend up you will know about it earlier. Don't panic and over correct just watch it (perhaps test again mid week if you're worried / curious as it only costs $5) it might just trend back down of its own accord.

For instance, this is a subset of my measurements from 2013

Over this period (and probably still) I'm dealing with an infection and I am on antibiotics.

Firstly there is a trend line in that graph, it shows the 2 week average of my INR (measured weekly). Its clear that not only has my INR been within range (my surgeon gave me a range of 2.2 ~ 3) but my TREND is much more clearly in range.

Now as to why to not over steer things: you can see at week 22 my INR had grown up from 2.2 to 2.5 then to 2.7 ... I decided to make an alteration in dose from 7.5mg down only a small amount to 7.3 and it dropped so I raised my dose the next week up to 7.5 again and it spiked over 3. I then over reacted and dropped my dose to 6.9mg and it plummeted the next week to 1.9 ... I went back to 7.3 and just waited. I then decided to take a more 'trend line approach' and you can see that while variant my INR trended nicely over the next 10 weeks (with a stable dose of 7.3).

Then at week 30 I measured 2.2 and observed a trend down. I decided to hold steady my dose and measure again mid week (I call this an ad-hoc measurement in my excel workbook) and found that on Wednesday (my usual testing day is Sat) it was trending back up by itself. So I did nothing to adjust my dose.

This is what I believe is classic 'see-saw' effect and comes from inappropriate changes in dose combined with what cycles are happening within your body. Sometimes they cancel out, other times they accentuate each other. Imagine if I'd been at a clinic who had suggested a greater variation of dose?

{Actually I don't have to imagine I went through that in 2012}

So my points are these:
- don't try to over steer your INR or you'll make the whole thing worse
- there are natural variants, accept them and look for longer trends not absolute values

Problems emerging from INR being high or low are typically related to very high swings or lengthy times a long way from your target INR.

So eat as you desire and don't fret if your INR is "away from school" for a few days.

 

[Protimenow]

Personally, my main concern is that my INR may drop below 2.0. Walking around with a 1.7 or 1.8 (and some meters may have enough error that a 2.0 ACTUALLY means that your INR is 1.7 or 1.8) for longer than a few days would worry me. An INR at the high end of the range doesn't bother me much. If my INR WAS low, I may make a one time adjustment and retest in a couple days. As others say on this forum, the INR often self-corrects without much intervention.

I don't worry much about leafy green intake - I don't eat much of that, anyway. IF my INR should suddenly spike to 4 or higher, I would probably add a salad for a day or two, then retest, but wouldn't go nuts with much in the way of dosage adjustment.

 

[lance]

Try and remember to dose your diet not diet the dose. I currently take 100 mcgs. of Vit.K daily and don't concern myself with what I do and do not eat when referring to INR.
I think glucose management is more challenging at least it is for me.