Supplements, Diet and Warfarin

[BionicBuddy]

I perused this forum and only found smatterings of info, like CBD oil, fish oil, Vitamin D, and tumeric with regards to changes in INR.

What about the following supplements: Vitamin C, Magnesium, CoEnzyme Q10, Plant sterols, Pomegranate, Tocopherols, Quercetin, Zinc, Iodine (kelp drops), probiotics, B-complex vitamins? How do they affect the INR?

I looked at Pellicle's blog but there was no search button to check for diet and supplements. Will you have a chapter in your book about diet and supps?

I saw someone on this forum who was taking only 3 mg of Warfarin! Wow. How does one get to that low dose and maintain an INR within a specific range?

I see that some of you say that you basically eat what you want. I think my husband will need to radically change his diet if he decided on the mechanical valve - like doing a 180 radical dietary shift, because he eats a high plant-based diet with tons of kale, Swiss chard, etc., etc. He's done this for decades, and that's why his cholesterol is low and on no meds, his blood pressure is low normal and on no meds, and his HbA1C is also low and he is almost 65 years of age. Do any of you self-managing INR experts here follow any strict low Vitamin K1 diets? that would also include eating lots of plants (i.e. vegetables and fruits)? He does eat lots of fish and some beef and chicken, so there's that at least. He drinks no alcohol and does no Cannabis.

This might be a silly question, but do any of you keep emergency injectable Vitamin K1 on hand in case of sudden bleeding/hemorrhaging? Or oral Vitamin K1? Or do you just use high Vitamin K1 foods as the antagonist?

Thanks in advance for your responses. I'm learning lots on this forum.

 

[dick0236]

"Dose the diet......do not diet the dose" is the motto of most veterans of long-time warfarin use. He might, or might not, have to take a stronger dose of warfarin if he eats a "ton" of high vit K foods......or he might not.

I've been on warfariin 56 years and I have never felt a need to keep drugs on hand to counteract the warfarin in my system.

He always has the option of going "tissue valve" and taking the chance of another surgery in his late 70s or early 80s. I am now 87 and I certainly would not want to go thru another surgery in my 80s.........and at his age he might be put on warfarin for reasons other than a valve.

 

[Chuck C]

Do any of you self-managing INR experts here follow any strict low Vitamin K1 diets?

I eat a diet rich in vitamin k foods. I would call it mediterranean, pescatarian. Every day, the center of my diet is a huge salad, with spinach, broccoli and assorted fruits and vegetables. In addition, I grow my own broccoli sprouts and consume about 100g per day. That is a lot of vitamin K. As Dick says, you dose the diet, you don't diet the dose.

20+ years ago it was believed that people on warfarin had to minimize their vitamin k intake. Several studies have proven this to be untrue. Having significant vitamin k in one's diet actually helps to stabilize INR.

So, almost every day I have that big salad and also a broccoli sprout protein smoothie (not as bad as it sounds- not bad at all). Some days, I might end up eating two large salads- my INR does not seem to shift at all with this increase in greens. If it is moving, it might be like an insignificant 0.1.

Greens and other foods rich in vitamin k are essential for heart health. No need to stop eating the greens. The way to go is to self test as it helps you know yourself. Eat a big salad- check INR the next day. Most here on warfarin eat what they want and just take the appropriate warfarin dosage to stay in proper range. Self testing weekly helps one get the proper dosage and stay in range a high % of the time.

You may find this study interesting:

"Vitamin K supplementation resulted in a significantly greater decrease in standard deviation of international normalized ratio (INR) compared with placebo (−0.24 ± 0.14 vs −0.11 ± 0.18; P < .001) and a significantly greater increase in percentage time within target INR range "

https://www.sciencedirect.com/scien...upplementation resulted in,0.11 ± 0.18; P < .

 

[LondonAndy]

I am firmly in the "dose the diet" camp, and give no thought to what I eat and its effect on my INR (other than knowing to generally avoid cranberry juice and grapefruit, and the limitations on certain anti-inflamatory pain meds). My diet has very limited consistency. I also take a number of supplements, such as Co-Q10, Cod liver oil as I don't like fish, and glucosamine sulphate. I drink alcohol, at random times and in moderation.

As it happens, my INR is pretty stable, but this is one of the primary reasons for self-testing. Because I test weekly, I know my INR and can adjust the dose if I need to. Not everyone feels able to do the dose adjustment themselves, especially at first, and may therefore rely on an anticoagulation clinic to tell them what dose to take if there is a change. But with experience and some cautious and small dose changing comes the confidence to self-manage. I made the odd mistake as I learnt, and my INR went a bit high as a result. But (a) I learnt from that, and (b) going high briefly is not a biggie. I still have the support of my anticoagulation clinic available if I need it, and see them twice a year to check the meter is still good.

I went for a mechanical valve because I didn't fancy open heart surgery every few years to replace a tissue valve. It's a big trauma to the body, that gets more difficult for the surgeons each time due to internal scar tissue etc, and of course we are weaker as we get older. If there was a history of arthritis in my family then I might well have reconsidered, owing to the medication restrictions of Warfarin, but thankfully there is no such history. Taking 2 or 3 minutes to prick a finger once a week at home is the price I am very willing to pay for that. There are other arguments for and against, but they are thoroughly discussed elsewhere on this forum and i just wanted to set out my personal thinking.

 

[Nick Drew]

I hade a mechanical valve fitted June last year and eat really what i want -lots of veg and fruit and fish but no meat-i drink alcohol in moderation and usually only at weekends. I have a steady INR of around 2.5 and take 4mg of warfarin. I use a coaguchek machine and sort of wonder what all the fuss is about!
However i have learnt so much from this forum and i have realised one thing-everyone is different in their needs and requirements.
I take VIT C each day and a cod liver oil tablet but i have always taken them so long may it continue.

 

[pellicle]

I use a coaguchek machine and sort of wonder what all the fuss is about!

 

[BionicBuddy]

https://www.sciencedirect.com/scien...upplementation resulted in,0.11 ± 0.18; P < .

Fascinating study. Thanks for sharing.

Chuck, you are a man after my own heart: broccoli sprouts, mediterranean and pescatarian! That was encouraging to read.

Just curious. How much Warfarin do you take?

 

[BionicBuddy]

I've been on warfariin 56 years and I have never felt a need to keep drugs on hand to counteract the warfarin in my system.

Wow. This is very hopeful.

I am now 87 and I certainly would not want to go thru another surgery in my 80s.........and at his age he might be put on warfarin for reasons other than a valve.

Holy moly Dick. You are a testament to modern medical miracles and still ticking at 87! Have you only had 1 mechanical AVR, or did you have more surgeries in those 56 years? What kind of brand/type of mechanical valve do you have? If you've had more surgeries, how long has the present one lasted?

What level of activity are you able to do? Are you able to do the same level of activity as your non-AVR friends of the same age?

There was a young 39 year old man that was about to go for surgery and asked those on the forum last year, 14 questions regarding their mechanical valve. I would have loved to have seen your responses.

 

[BionicBuddy]

I also take a number of supplements, such as Co-Q10, Cod liver oil as I don't like fish . . .

Thanks Andy. Your entire post was filled with valuable info. I'm so thrilled about the CoQ10 and fish oil!!!

If hubby ends up going for the mechanical valve, we too will become experts on INR self-management just like the rest of you on this forum.

How much Warfarin do you take, and is your dose pretty consistent, or do you change your dose frequently to obtain your target INR? Does stress (emotional/mental/physical) impact the INR at all?

 

[BionicBuddy]

I have a steady INR of around 2.5 and take 4mg of warfarin. I use a coaguchek machine and sort of wonder what all the fuss is about!

Again, very hopeful. Thanks!

However i have learnt so much from this forum and i have realised one thing-everyone is different in their needs and requirements.

Very, very true. If hubby goes for mechanical, I hope he tolerates the Warfarin like most of you folks on this forum.

Phew!! Good to hear about the Vitamin C.

 

[LondonAndy]

Thanks Andy. Your entire post was filled with valuable info. I'm so thrilled about the CoQ10 and fish oil!!!

If hubby ends up going for the mechanical valve, we too will become experts on INR self-management just like the rest of you on this forum.

How much Warfarin do you take, and is your dose pretty consistent, or do you change your dose frequently to obtain your target INR? Does stress (emotional/mental/physical) impact the INR at all?

Glad it was useful!

My dose is pretty steady at 6mg per day, but the amount does not matter - it is staying in range that does. So there is no significance if someone is taking 12mg per day and someone else 4mg.

My typical dose change will be +/- 1mg if my test shows I am approaching one end of my therapeutic range or another - ie I am trying to take preventative action. The change will normally be for one day only, occasionally two days. (Small changes are better, to avoid a risk of yo-yoing, and finding it difficult to re-establish a consistent INR level). I only need to do these changes occasionally, eg once a month or less, unless I am on holiday and the change of diet and increase in alcohol consumption (!) means a longer period of deviation from the norm is needed. (I will then also test more frequently, eg every 3 or 4 days, to check my "course corrections" are sufficient.

I am not conscious of stress having an impact on INR, though it's possible. Perhaps others can comment on that?

And just to add to my previous post, if hubby chooses a tissue valve that will also extend his life and be a good decision. We each have to weigh up what is important to us in our circumstances. With a mechanical valve, taking warfarin consistently, not missing doses, is vital, and other conditions like arthritis should be taken into account.

 

[tom in MO]

When it comes to supplements and warfarin, my cardio said to call his nurse if I start taking any. I was on fish oil and vitamins pre-operation for a BAV. This was prescribed by my cardio. Afterwards, I was told they were no longer needed. I was specifically told that fish oil can effect one's INR. I also dose the diet, eat what I want which is frequent vegetables including salad.

 

[BionicBuddy]

So there is no significance if someone is taking 12mg per day and someone else 4mg.

So I guess you're saying that dosage doesn't matter (but 12 mg would seem a bit scary to me), but it's the INR that matters to keep it within the target range.

Again, thanks for the very useful info on INR management.

I am not conscious of stress having an impact on INR, though it's possible. Perhaps others can comment on that?

Yes, I would love to hear about this.

And just to add to my previous post, if hubby chooses a tissue valve that will also extend his life and be a good decision. We each have to weigh up what is important to us in our circumstances. With a mechanical valve, taking warfarin consistently, not missing doses, is vital, and other conditions like arthritis should be taken into account.

Well, given we have been in the waiting room for 22 years, and he had been saying for all those years that he will "never have OHS", and now slowly warming up to the idea of OHS (hard to warm up when your cardiovascular system is feeling damn good), and now he says "only once and never again". So even though we like the idea of tissue, we aspire to Dick's longevity at 87 and still ticking, with a hopefully one and done approach.

We're pretty anal about testing/monitoring/etc. with other stuff, and very compliant, so that won't be an issue. He takes no meds, not even OTC NSAIDs. But now that you mention joint issues, I do have more questions. I'll start another thread on that topic.

Thanks!

 

[BionicBuddy]

When it comes to supplements and warfarin, my cardio said to call his nurse if I start taking any. I was on fish oil and vitamins pre-operation for a BAV. This was prescribed by my cardio. Afterwards, I was told they were no longer needed. I was specifically told that fish oil can effect one's INR. I also dose the diet, eat what I want which is frequent vegetables including salad.

Another thumbs up for vegetables and salad. Great! I'm breathing a sigh of relief.

 

[Timmay]

I self-manage like others here using my eBay CoaguChek meters (yes, plural, because I like to validate from time to time).

On-X mechanical valve installed about a year ago.

I’m taking about 13mg of Warfarin a day now.

I eat a huge salad for dinner about 3 times a week. Other dinners always involve veggies - broccoli or green beans or mixed veggies or a small salad.

I eat plenty of fish. My lunch is usually a sardine sandwich (unsalted and packed in water only) [FWIW, That’s almost 2 grams of Omega 3’s! No need to take fish oil]

I take a multivitamin (which has some K1 in it) as well as 180mcg of K2 (MK-7) a day. I also take chelated Magnesium and Vitamin D.

So far so good. This board and the people here have been invaluable and a true blessing for me.

 

[Chuck C]

Just curious. How much Warfarin do you take?

Currently I take 6.5mg/day. I test weekly and sometimes I'll adjust to 6.75mg/day. It seems to toggle back and forth every few months, from needing 6.5mg to 6.75 mg.

But, the amount of dose really varies a lot from person to person. Some only need 2mg to stay in range, and some need 12mg. There are even some cases where people need a lot more than that. The thing to focus on is not the dosage but the INR. We need how much warfarin we need to stay in our range. Whether a person needs 2mg or 20mg, it is nothing to worry about. It is not as though the person on 20mg has worse side effects, that is not how it works. Making sure that the INR stays within the range set up by your cardiologist is really all that matters and with self testing, you easily figure that out and then make little tweaks to the dosage whenever needed.

For example, my range from my cardiologist is 2.0 to 3.0. Although, because I do Jiu jitsu daily, I prefer to keep it at 2.0 to 2.5. Let's say I'm at 6.75mg per day, which I achieve by taking 6.5mg one day and 7mg the next day. Let's say that my INR comes back at 2.9, near the high end of my range. In that case, I would just tweak my dose down to 6.5mg for the week and see where I am at when I re-test. If the next reading has me at 2.2 to 2.6, I'll just keep it there at 6.5mg.

I'll also add that I drink moderately. I take CoQ10, fish oil and vitamin C.

 

[dick0236]

Wow. This is very hopeful.

Holy moly Dick. You are a testament to modern medical miracles and still ticking at 87! Have you only had 1 mechanical AVR, or did you have more surgeries in those 56 years? What kind of brand/type of mechanical valve do you have? If you've had more surgeries, how long has the present one lasted?

What level of activity are you able to do? Are you able to do the same level of activity as your non-AVR friends of the same age?

There was a young 39 year old man that was about to go for surgery and asked those on the forum last year, 14 questions regarding their mechanical valve. I would have loved to have seen your responses.

I have had only one valve. It is a "ball-in-cage" design and was produced by Edwards Lifesciences Co. It was the first commercially available valve in 1960........I got mine in 1967. It is my first and only artificial valve. Edwards produced my valve until 2007......when they entered the more profitable "tissue" valve market.

I have always been able to do what my friends did. Unfortunately, most, if not all my "buddies" are now dead. Time and age are now wearing on me and I can't run with the big dogs anymore.......but it has been a good run.

There are many threads on this forum that show the durability of mechanical valves.

 

[Chuck C]

I got mine in 1967. It is my first and only artificial valve. Edwards produced my valve until 2007......when they entered the more profitable "tissue" valve market.

Having repeat customers is a much better business model. You were arguably the worse customer that they ever had, never even returning once for business in 55 years

 

[BionicBuddy]

I’m taking about 13mg of Warfarin a day now.

Why do you think you are taking a relatively higher dose of Warfarin than say the folks taking 4 or 6 mg? You're taking oral Vitamin K1, but the study Chuck posted said that oral Vitamin K1 stablizes INR.

This board and the people here have been invaluable and a true blessing for me.

Blessing indeed, and hubby and I are only on the start of this journey . . . .

 

[BionicBuddy]

Whether a person needs 2mg or 20mg, it is nothing to worry about. It is not as though the person on 20mg has worse side effects, that is not how it works.

Thanks. Your entire post was informative again.

I was an ICU/ER/CCU nurse in my former life 4 decades ago, and it's hard for me to wrap my brain around 20 mg for a maintenance dose being okay and nothing to worry about, even though I understand that the INR is the key.