Question for Al - Ensure and Coumadin

[Martin_W_Riley]

Al;

I was just warned by others not to take Ensure because it has loads of vitamin k.

So panicked, I just talked to the pharmacist at the hospital and went over the label for the Canadian version of Ensure Plus from Ross (Abbott Labs Ltd) and he claimed that it did not contain any Vitamin K or phytonadione.

I was taking Ensure on top of three hardy meals to try and gain some weight (I lost weight due to a bad flu). Any advice?

In any case I will stop taking them until I get my INR tomorrow

Cheers

Martin

 

[Nancy]

Martin-

Here's a link for the nutritional value of the basic Ensure product. Each can (8 fl. oz.) contains 25% of the normal dietary value per day. Here in the States, you just have to look at the label on the can and it will tell you everything.

http://rpdcon40.ross.com/mn/Ross+MN...614A0822AE03D7F98525649E004D4F68?OpenDocument

 

[Ross]

http://www.warfarinfo.com/foods.htm

Another source of vitamin K which is frequently overlooked are the supplements such as Carnation Instant Breakfast, Ensure and Boost. These contain significant amounts of vitamin K. The TV advertising does not adequately warn the consumer of this. Physicians often overlook this also. When I see a thin, elderly lady whose INR is suddenly low, the reason she often gives is that her doctor told her to start taking one of these supplements. It is usually necessary to increase the warfarin dose after these products are started.

 

[Nancy]

Be careful of the so-called power or nutritional bars also. Some of them have 100 percent of the daily value PER BAR.

 

[Martin_W_Riley]

More Thanks - still need Al's feedback

More Thanks - still need Al's feedback

I just called Ross in Canada about their Ensure Plus product and they promissed someone would get back to me today on the matter.

In Canada the label clearly states all the ingredients and their nutritional information with recommended daily doses. There is NO MENTION of Vitamin K unlike the label in the US (for the Ensure product - I didn't see Ensure Plus in the link you gave me).

I would be surprised however if the content of the cans are different in both countries so I'm still worried having taken 2 cans per day for the last 2 days.

Thank you as well for the warning about energy bars... I use many of those bars during races and I'm not sure I would have thought to check the labels before consuming them.

This is very frustrating!!!!

I'll let you know what I hear back from Abbott (Ross).

Al any thoughts?

Cheers

Martin

 

[Martin_W_Riley]

in the mean time

in the mean time

http://www.abbott.ca/eng/images/health/content/inter.pdf

above is a link to a document off the Canadian abbott.ca site with nutritional breakdowns of their products.

Looks like the canadian chocolate ensure plus does not contain vitamin K...

I'll keep my fingers crossed

Martin

 

[Ross]

I would highly doubt that there is any difference in the K content between U.S. and Canadian products. It's nothing to get all alarmed about, but do be aware that your INR will most likely be lower and require an adjustment in dosing. Whatever you do, continue to be consistent or you'll start chasing your INR around and never get it right.

Please don't interpret our warnings as negativity. We have Doctors giving us this stuff in the ICU not knowing about the K content, then they can't figure out why our INR's are low and they keep us longer because of it. We have learned this valuable lesson and were just passing it on to save you many headaches.

 

[Mary]

I learned something big today

I learned something big today

Dear All,
I'm continually amazed at what I learn from this forum. My mom has been on coumadin for 12 years due to throwing small blood clots. She had a reoccurence of her nonHodgkin's lymphoma this past summer, and in addition, she ended up with a low grade stomach cancer.
Just like Ross said in his post, the doctors had her trying the Carnation Instant Breakfasts because she had lost so much weight. I kid you not, she barely ate anything from Thanksgiving until mid-January. In the meantime, her protime just went haywire.
I know she has never been told to watch for Vitamin K additivies. I'll call tonight to tell her what I've learned.
Thanks so much,
\Mary

 

[Martin_W_Riley]

Word back from Abbott

Word back from Abbott

Just got a call from abbott and the Canadian Ensure Plus IS DIFFERENT that the US version.

There is no added vitamin K in the Canadian formula but even though the label says there is NO vitamin K at all, Abbott explained that there may be trace amounts due to the oils they use. They said it was the equivalent of taking a glass of milk.

Interesting - I would have thought the US and Canadian products would be the same...

Cheers

Martin

I guess my INR tomorrow will be the true test!

 

[Nancy]

When Joe needed some nutritional type supplements, I gave him Ovaltine and Nestle's Quik. Ovaltine has some vitamins, but not Vit. K. Nestle's is a little more on the junk food side, but did provide some much needed calories.

If you have to watch sodium, look for that as well with all this stuff.

An 8 ounce glass of milk has 5-6 percent of the daily allotment of sodium for a normal person.

 

[McCln]

Martin

Martin

Guess what? You do not need to drink any of the ensure products anyway if you are eating regular healthy meals. Ensure is just a suppliment for those who can't eat regular meals. Please don't use this also as a meal replacement. You get all the nutrients and vitamins from balanced meals. I have tried the carnation canned, which also has vitamin K. Better to do with natural foods. Good luck and keep eating well. And welcom to the board. I try to come when I am not too tired from working on a computer all day.

Caroline
09-13-01
Aortic valve replacement
St. Jude's valve

 

[Martin_W_Riley]

Trying to gain weight

Trying to gain weight

The whole reason I started taking Ensure Plus was to gain weight!!!

I do eat 3 healthy meals a day, the two Ensure cans were added to my diet to help me get me back up to my set weight. (I had a bad flu and lost 8lbs + lost a whole bunch of weight with the OHS + I had lost weight for the marathon... In total, I'm 20-25 lbs too light and it SHOWS!!!)

Thanks everyone for your feedback.

Ovaltine... I used to take ovaltine as a kid, looks like I may go back to it soon

Martin

 

[Ross]

Let me know if you get the secret decoder ring from ovaltine. I got Jipped when I was smaller.

 

[Guest]

Looks like this was solved before I even had a chance to get on-line.

I have to say that I think that the Canadian formulation makes more sense.

We gets the people all stabilized on warfarin in the hospital with Ensure. Then they go home and don't drink it. Next thing you know everything is out of line again.

 

[Ross]

I really started to worry about you Al. Didn't see you on at all yesterday. Everything alright or are you just extremely busy?

 

[Guest]

I've been really busy. I've sold 15 books in the past week and have a "handshake agreement" on doing a 4 day consulting assignment for an out-of-town hospital.

I'm just about fully recovered from the surgery. Saw my PCP this morning and he agrees.

 

[Ross]

Thanks. I'd much rather hear that your very busy then the other way.

 

[Martin_W_Riley]

And the verdict is...

And the verdict is...

Got my INR today and it was quite high.

I've been sitting at 2.4 for the last three weeks and this week it was 3.8.

I proves that the Canadian Ensure Plus is indeed without vitamin K!

My guess is my INR is high because of the stomach flu which gave me the runs for 4 days and prevented me from eating properly.

I hope next week it will be back to normal.

Strangely, my Doctor didn't change my dose, she wants to wait for the results of next week's test before deciding what to do. She didn't seem worried either... I am!

Can't wait to get my CoaguChek S from Roche! It will be nice to have a confirmation test that I can control.

Cheers

Martin

 

[Ross]

Relax Martin, I wouldn't touch it and I really don't think Al would either. I think they are doing exactly as they should. (For once anyway)

They give us a range (either 2.0 to 3.0 or 2.5 to 3.5) and the way I see it is between 2 and 4, then if I'm outside that window, adjustment is made. Besides with an increase in activity and eating properly again, it should settle right back in the slot.

 

[catwoman]

Martin:

From what I've read, about half of your vitamin K is produced by bacteria normally present in the intestinal tract. W/ diarrhea, you're going to be deficient on vitamin K and therefore your INR will probably be higher than normal. My information also says that elevated temperature can also increase the INR.
I have 2 containers of non-fat yogurt a day to help keep those nice bacteria producing vitamin K.

And, I agree with Ross: don't sweat an upswing in INR like what you experienced. I went up to 4.2 not long ago and I assured my PCP's office it wasn't anything to worry about -- I attributed it to having 4 oz. of wine AND a martini the Saturday before I tested on Wednesday a.m. All other factors were constant. It went down to 3.9 and has been at 3.4 and 3.5 every week the last month. My goal is 3.0-3.5.