Supplements, Diet and Warfarin

[BionicBuddy]

... and if so, whether you actually like it ....

Too funny. I knew I was setting myself up for that one, but it was worth asking just to see your brilliant green emoji.

Actually it's mint flavoured and tastes pretty good.

 

[ATHENS1964]

https://www.news-medical.net/news/2..._campaign=cardiology_newsletter_25_april_2023

 

[Protimenow]

This reads like it was subsidized by a Sardine Marketing Council.

FWIW - I always liked sardines but haven't had them for maybe 50 years. If I recall correctly, I liked the lightly smoked sardines - and I just bought a tin. Most of the tins I've seen weren't smoked and were in Olive Oil or Water. I don't know what's best.

I'll probably give them a try soon - but I may wind up sleeping by myself tonight.

 

[Chuck C]

https://www.news-medical.net/news/2..._campaign=cardiology_newsletter_25_april_2023

Thanks for the link. Fish high in omega 3s, such as sardines herring, mackerel and salmon are an excellent source of protein. Omega 3s have anti-inflammatory properties and tend to be very heart healthy. Personally, I always buy wild caught.

https://health.clevelandclinic.org/3-fish-you-should-love-and-3-fish-you-should-snub/

 

[Chuck C]

I do understand. You dose the diet, not the other way around. And I understand that there are those eating kale, spinach, etc., now and then, and are doing just fine stabilizing their INR. And I understand that everyone's response to foods is individual. I've also read a few of the Vitamin K and anticoagulant studies on this forum that were helpful.

Given the above, I would still like to know if there is anyone on the forum taking Warfarin, who drinks powdered green drinks every day? You know, the kind with barley grass, broccoli, cauliflower, kale, spinach, collards, berries, etc. etc. etc. If so, how is it working out for you with your INR management?

Thanks in advance.

I don't drink powdered green drinks, but I have a green smoothie daily, with about 100g of broccoli sprouts, spinach and berries. I'd be willing to bet that my smoothie as as much, if not more, vitamin k than the green mix. You can look at it as taking a vitamin k vitamin daily. One of the studies previously linked showed that daily vitamin k supplementation led to more stable INR. You can look at the shake mix or smoothing as a vitamin k supplement, while getting many other beneficial things in there as well.

I have not experienced wild swings in my INR, and in fact it is very stable. This is to be expected, and is consistent from the findings of those studies which have shown that consuming higher levels of vitamin k helps with INR stability.

The principle remains the same, whether we are talking about green powdered shakes or a big salad; dose the diet, don't diet the dose.

 

[BionicBuddy]

I don't drink powdered green drinks, but I have a green smoothie daily, with about 100g of broccoli sprouts, spinach and berries. I'd be willing to bet that my smoothie as as much, if not more, vitamin k than the green mix.

 

[Megs]

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.

Hi there. I have been managing my Inr for 10 years… you can eat as you please- even with lots of Fresno/ high vir k foods- you will just need to take more warfarin. When I ate 100% of Rec daily allowance for vir k I was taking 10 mg a day. I have never had emergency vir k bc dr says it’s easier to manage with increasing your vit k via food! I do keep lovenox to bridge when Inr gets too low. Good luck!!

 

[Protimenow]

I'm not sure how much off target this post is (although it's about supplements), but I just started taking a supplement called NMN. It's supposed to provide many benefits - including helping to clear veins and help reverse aging.

After a week or so, I started to see results - my skin is much softer and smoother, some of what looked like varicose veins are not as prominent, the veins in my arms and hands are more prominent (which I think is probably a good thing), and there may be other effects. It's unclear whether the FDA will ban its sale in the U.S. because it's now an investigational substance, and the FDA usually takes investigational substances off the market. NMM is a precursor to NAD+, which is still available.

I'm monitoring my cardiac symptoms. I'm not sure if I'm now taking too much Verapamil - I'm checking with my doctor.

This has not had any impact on my INR.

It seems to be an effective, worthwhile supplement, but I have to regularly assess how I feel, and how much exertion I can handle.

 

[pekster11]

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.

My weekly dosage is usually 12.5mg
I take 2mg on Monday, Tuesday, Wednesday, Friday and Saturday..1.5mg on Sunday and 1mg on Thursday

 

[carolinemc]

I'm not sure how much off target this post is (although it's about supplements), but I just started taking a supplement called NMN. It's supposed to provide many benefits - including helping to clear veins and help reverse aging.

After a week or so, I started to see results - my skin is much softer and smoother, some of what looked like varicose veins are not as prominent, the veins in my arms and hands are more prominent (which I think is probably a good thing), and there may be other effects. It's unclear whether the FDA will ban its sale in the U.S. because it's now an investigational substance, and the FDA usually takes investigational substances off the market. NMM is a precursor to NAD+, which is still available.

I'm monitoring my cardiac symptoms. I'm not sure if I'm now taking too much Verapamil - I'm checking with my doctor.

This has not had any impact on my INR.

It seems to be an effective, worthwhile supplement, but I have to regularly assess how I feel, and how much exertion I can handle.

Always good to check with doctor before you take any supplements, for some can raise the INR, and some can cause issues and counteract whatever meds you are also on for other health issues.

 

[Protimenow]

I understand the concerns.

I checked my INR a few days after starting the supplement. I check weekly. There has been zero change to my INR. This isn't an NSAID, so I'm not too concerned about clotting (my clotting after incising my finger for the INR testing took no longer than usual).

I'm watching my blood pressure. My arrhythmias don't seem to have changed, nor has the frequency of these changed. The supplement is supposed to help with vascular flow - it would be good if I feel that my medications may be more than my body needs as a result, but so far I haven't seen any changes. My ejection fraction, tested nearly two weeks ago hasn't changed from what it was 6 or 8 months ago.

If I have issues, I'll be sure to call the doctor.

I doubt that he's heard of NMN, so he probably won't have any opinion, probably other than 'I don't know about it so don't take it.'

I'm watching for any adverse effects.

 

[LondonAndy]

I'm not sure how much off target this post is (although it's about supplements), but I just started taking a supplement called NMN. It's supposed to provide many benefits - including helping to clear veins and help reverse aging.

After a week or so, I started to see results - my skin is much softer and smoother, some of what looked like varicose veins are not as prominent, the veins in my arms and hands are more prominent (which I think is probably a good thing), and there may be other effects. It's unclear whether the FDA will ban its sale in the U.S. because it's now an investigational substance, and the FDA usually takes investigational substances off the market. NMM is a precursor to NAD+, which is still available.

I'm monitoring my cardiac symptoms. I'm not sure if I'm now taking too much Verapamil - I'm checking with my doctor.

This has not had any impact on my INR.

It seems to be an effective, worthwhile supplement, but I have to regularly assess how I feel, and how much exertion I can handle.

I was interested in NMN, as the benefits sound promising. So I started looking into it, but haven't found what looks like a reputable review site, only the reviews on seller sites. Those on Amazon appear to be mostly made by people who have only reviewed one product, ie the NMN one, which makes me suspicious.

 

[Protimenow]

I was interested in NMN, as the benefits sound promising. So I started looking into it, but haven't found what looks like a reputable review site, only the reviews on seller sites. Those on Amazon appear to be mostly made by people who have only reviewed one product, ie the NMN one, which makes me suspicious.

Amazon no longer sells NMN.
Some of the sites that sell NMN have links to what appear to be legitimate research (Renue by Science and DoNotAge have some links).
The FDA may block U.S. companies from selling NMN soon, because there's some research on it as an investigational drug, and FDA rules require that investigational drugs aren't sold over the counter.

Right now, 4/30/23, it's still available in the U.S. There are other vendors in other countries that will continue to sell it.

I'm actually seeing some benefits from it. I don't think it's just placebo effect. And, as I've said earlier, I keep a close eye on my INR and other physical signs.

 

[ATHENS1964]

https://www.news-medical.net/news/2...m_campaign=cardiology_newsletter_27_june_2023

 

[MdaPA]

And here is a study that says ...."‘Our study suggests that fish oil supplements are associated with a significantly greater risk of atrial fibrillation in patients at elevated cardiovascular risk."

Omega-3 supplementation linked with atrial fibrillation risk: a meta-analysis

 

[LondonAndy]

I have long concluded that life is bad for us ....

 

[ATHENS1964]

I did the standard inr test that I do every Saturday morning, the INR was at 3.0, while the previous week it was 2.6. I kept the usual portion for me but ate a big spinach salad with a little meat.
About 3 years ago, when I was getting ready for surgery, I was very worried about the INR, it was actually very easy.
I also occasionally do judo training, at the age of 60 I am in better physical condition than my old fellow athletes. I certainly don't do all the techniques and my teammates avoid choking me, they stop just before I stop breathing.

 

[newarrior]

Thanks for the link. Fish high in omega 3s, such as sardines herring, mackerel and salmon are an excellent source of protein. Omega 3s have anti-inflammatory properties and tend to be very heart healthy. Personally, I always buy wild caught.

https://health.clevelandclinic.org/3-fish-you-should-love-and-3-fish-you-should-snub/

Can get Omega 3 from plants without the bad fats from fish--shoot for flax and chias

 

[David Robbins]

I had a St Jude mechanical in March 2008 and a redo in July 2008, where a hole in my heart was mended, as well. I’ve been on 7.5-10mg Warfarin daily since then to maintain 2.5-3.5 INR. I eat whatever I choose, even cranberry juice for prostate health. I supplement with BCAA, EAA, multiple vitamin, DHEA and take Synthroid and Lamotrigine for thyroid and seizure control. I test every 2 weeks with the at home Coagchek system. I do intense physical activity, including rigorous running, hiking and heavy weight lifting.
Never had a bleeding problem and cardiologist opted against adding aspirin to my daily intake because of the fact I had surgery for a brain aneurysm and have a clip on an artery in my brain.
I have permanent Afib, but never tachycardia. I have an EF of 65 and a resting pulse averaging 44bpm, as I have been a serious athlete since 15 yoa.
This forum has been informative and encouraging to know many people face the same challenges as me before, during and after heart valve replacement. It does escape me why people choose tissue valves with surgeries before 55-60 yoa. The idea of a repeat operation 10-15 years later which is traumatic to your body negates that choice in my mind. Warfarin management is simple, especially if you self test.
I will ask my cardiologist about Warfsrins association with arthritis as I have mild arthritis in my hips. 50 years of weightlifting and intense athletic activity may have contributed to joint wear and tear.
I would advise everyone to avoid obsessing with research on longevity statistics as they can be concerning and unnecessarily stressful, particularly when you have a family who depend on you.
After 4 months in the hospital in 2008 and research, I know more about the heart then I ever cared to know in the past. I have 4 nurses and a Director of Cardiology in my extended family, so besides this forum I have loved ones for guidance.
So, everyone, live your life like you choose, just be vigilant and aware of your heart health.
David

 

[Chuck C]

Can get Omega 3 from plants without the bad fats from fish--shoot for flax and chias

From an INR management standpoint, there is no reason to avoid fish. Also, as long as one limits the amount of fish species that is higher in mercury, there is no reason to avoid fish. I eat fish often and prefer to stick with wild caught fish which is high in Omega 3 fats, such as Sockeye Salmon and sardines. These wild caught species are also very low in mercury, as they are low on the food chain and do not consume other fish species, but primarily live on zooplankton, amphipods (small, shrimp-like crustaceans), and insects. See links below. Your suggestion that the fat in fish is bad is not accurate, and no evidence supports this. In fact, fish consumption is correlated with better heart health, as well as lower rates of mortality and longer average lifespans.

The omega 3s found in some plants, such as chia seeds and flax seeds, is also correlated with good health outcomes. But, these sources contain ALA Omega 3s, and do not contain the vital EPA and DHA types of omega 3. The body converts a small amount of of ALA to EPA and DHA, but for most people this conversion rate is very low. Better to get your EPA and DHA from fatty fish. It should be noted that many vegan guidelines now recommend that vegans take Omega 3 suppliments, to insure that they get proper EPA and DHA.

I know that you are a patient of vegan guru Dr. Esselstyn and that he promotes avoiding all animal products, including fish. As a side note, he also makes the unsubstantiated claim that olive oil and avocado oil are unhealthy and should be avoided. I've read 2 of Dr. Esselstyn's books and watched at least 7 of his presentations. His promotion of low fat veganism extends well beyond what is in the scientific literature and into the realm of religion.

Fish consumption and lower all cause mortality and CVD

"In the present study of 431,062 participants without cancer or CVD at baseline, we observed that the intake of 1 serving/week of oily fish was associated with 7% and 15% lower risks of all-cause mortality and CVD mortality, respectively."

https://translational-medicine.biom...of,mortality and CVD mortality, respectively.
Wild caught Sockeye Salmon:

"Next, the Sockeye Salmon, because of the fact that its main diet consists of red algae and plankton, is considered the “vegetarian” of the salmon species. It does not feed on other larger fish, so it doesn’t ingest the toxins from those fish. Sockeye is considered one of the safest species to eat due to the very low level of toxicity, including mercury."

https://blog.moinkbox.com/mercury-f...eye is considered one of,are eating 6 to 8oz.
Wild caught sardines:

"In summary, sardines are a very good way to get protein as well as large amounts omega-3 fatty acids while avoiding the high levels of mercury in some other fish, like albacore tuna."

https://www.consumerlab.com/answers...sardines were also very,once or twice a week.
Some people might have other reasons, including taste, as to why they avoid fish. But, the claim that the fat is fish is unhealthy runs contrary to the evidence.