vegetarian on coumadin

[angelina]

hello! I just happened upon this forum and would have been very happy to have know of it several months ago. I'm 8 months out from a tripple (yes tripple) valve replacement. Due to two mechanical valves, I am not a coumadin lifer. I'm also mostly a vegetarian, and despite a fairly consistent diet, it's been a struggle balancing my INR over the last few months. Any other vegetarians or vegans out there on coumadin? Because I once lived on spinach and all things extra green, I'm still re-learning how to cook the healthiest possible, and working to a balance where I can reintroduce a very consistant amount of the greener stuff. Does anyone know of any resources for a vegetarian on coumadin? I've learned a ton over the last 8 months, but am always looking for more good info, the healthier the better.

I bought the Coumadin Cookbook a few months ago and was very disappointed with the recipes as well as some of the information in the book. As a result I decided to start a collection of my own recipes, with the help of a nutritionist as well as many other resources, but the little I can find out there on the veggie/coumadin diet is just that: very brief.

Thanks for your help!

 

[Luana]

I'll leave it to the experts here to address you in more detail, but the rule of thumb is: dose to the diet, not diet to the dose. You should enjoy whatever vegetables you like. I like all veggies and freely eat them and salads, and <tapping forehead with knuckles> knock on wood, have been doing fine with warfarin. I think Ross has said the Coumadin Cookbook is worthless.

Oh, it would be very good for you to list what meds you're taking.

 

[skeptic49]

Welcome to VR.org Angelina! You bring up a very good point. I'm mostly vegatarian also therefore I'll be interested in responses to your question. Please also share some of your recipes!

Best wishes,

Jim

 

[AgilityDog]

I think you mean you are NOW a coumadin lifer.

Three valves, huh? That's a pretty full valve job, alright. I'm fixing to get #2 and maybe a ring on #3. Can we be done with the plumbing work after that? please?

Yup, dose the diet. Don't diet the dose.
You are on the right track trying to be consistent. I try, but I'm not consistent. That doesn't mean you have to eat the same thing every day. But if you are used to eating a bunch of Kale each week, get your INR adjusted to that, then only eat iceberg lettuce for 2 weeks, your INR may be way high.

Because I am watching my weight and my sodium, I don't eat preprepared foods. I tend to cook up a bunch of lunches on the weekend: Soup with lots of veggies, which makes about 15 servings; whole wheat couscous with sauted cabbage, onions, celery and ground turkey (about 8 servings), stuff like that, then put them in single serving tupperware, in the freezer, and take those to work with me. Hubby makes dinner 'cause he works from home, and he goes through his 5 dish repetoire each week, with salad or sometimes brussels sprouts for me.
Ditto I make big batches of home made chili, spaghetti sauce, etc.

Burn that Coumadin Cookbook. Don't even donate to anyone. It's hazardous to their health. The author is trying to make you eat only 80 mg per day. That's impossible, even for someone on weight watchers, where we are encouraged to eat 3-5 servings of veggies per day. It's certainly impossible for a vegetarian.

You don't need a coumadin diet. Go back to eating the way you want to, and get your dosage adjusted for the diet. We'll help.

 

[Gnusgal]

I also bought the coumadin cookbook long, long ago. I have never, not once, made any of the recipes. About the only thing I "used" it for was to see what foods are higher in vit. K so I could have them in my head for those days when I needed a little vit. K boost (because INR was a tad high). Even then, it was really only a glance and I could have found the same information elsewhere. It really was a waste of money, unfortunately.

Who do you have managing your coumadin? Are they making adjustments every time you're slightly out of range (or just on the high end of your range)? Or have you stayed on a consistent dose, but your INR has bounced around anyway? Can you give us an example of your last month of dosage and INR readings? How about a typical week's menu? I'm sure all of that info could help one of our resident "experts" give you more assistance.

Oh, and WELCOME to VR!!!

 

[Philip B]

How can you have two mechanical valves and not be a coumadin lifer?

If the Coumadin Cookbook has good recipes, it might be worth keeping. We're fond of telling people to dose your diet here rather than trying to use diet to influence your dose.

I've never been much of a veggie guy, but I've been really working at increasing my intake of green stuff for the last four weeks. Basically, I eat what I want and adjust my coumadin dosage to keep my INR where it belongs. Lately, I've been consuming a lot of spinach salad with a liberal sprinkling of cranberries. I also regularly drink a soy-based diet drink.

I would think it would be easier for a vegetarian to manage INR because of the consistent intake of green stuff.

-Philip

 

[Ross]

Hello Angelina and welcome to the insane asylum.

With Coumadin, eat exactly as you always have and let the dose be adjusted to the diet you eat. EAT THOSE GREENS!!! Your body needs them. All things can be adjusted for, so if someone is telling you to stay away from high content vit k food items, you might want to stay away from those people.

Do we have other vegetarians? You betcha. Halleyg is and I'm sure she'll weigh in soon on the topic.

Can you tell us your total weekly current dose, how often they're testing you and how often they're changing your dose? We find that roughly 85% of Coumadin managers are doing it improperly. Take the Coumadin cookbook for the recipes, but discard all of the silly advice it gives you. I have a copy too that I bought when I first started Coumadin. I've since learned that the whole diet thing is a bunch of rubbish. So long as your semi consistent in your eating habits, you should be fine, though you may have to stick around us to get it right.

 

[Maryka]

Hi! I am a vegetarian and life-coumadin user. Unlike the advice of Ross and others on this list, I find I must avoid the major green leafies because otherwise my PT readings were hugely irregular. I guess if you become a self-tester you can avoid the very expensive (and frequent) co-pays to have your PT-INR tested at the doctor's office or lab. I may someday become a self-tester but, until then, I downloaded some neutral lists off the Internet of vitamin K levels of most foods. Now I have memorized most of the biggest danger foods (for me) and by avoiding them I take a fairly low and consistant dose of coumadin. The veggies I now prefer are skinned cucumbers, tomatoes, carrots, culiflower, and, of course, potatoes. I eat a LOT of beans and consequently my iron levels stay nicely high despite no meat. I eat a LOT of soy products, and find, despite mixed ratings of soy on vitamin K lists, soy does not seem to disrupt my PT-INR readings. As I noted earlier, my goal is to have consistantly good PT-INR readings that will not kill me with frequent repeats and lots of expensive co-pays.

 

[angelina]

Thanks for all your advice! Yeah, I meant to say I am NOW a coumadin lifer, not that i am not one.

It's encouraging to hear that I don't need to worry about (and count) so much of the vitamin K content I'm eating. For awhile, I was staying away from dark leafy greens but not paying much attention to the other stuff I was eating, and my INR was all over the place. Now that I'm much more consistent, I've been more stable. I take 10 mg three times a week and 15 four times a week. I've been stable for a month and a half and I'm being tested every three weeks. My cardiac RN is monotoring my dose right now.

For a given week, I eat a romaine salad almost every day, and lots of other veggies. I have tofu or soy milk about every other day. But I still stay away from the darker stuff, as advised by my nutritionist and every one of my doctors. I stay away from cranberries and cranberry juice, grapefruit and grapefruit juice, even though I have no idea what kind of impact they might have on my INR. I do drink a glass of wine every night as well. I also take several supplements on daily basis, ones which may or may not be affecting my dosage, and so I just take them consistently.

I'm glad to hear others found the Coumadin Cookbook just as worthless as I did. I do believe it's destined for the trash...

 

[Ross]

But I still stay away from the darker stuff, as advised by my nutritionist and every one of my doctors. I stay away from cranberries and cranberry juice, grapefruit and grapefruit juice, even though I have no idea what kind of impact they might have on my INR. I do drink a glass of wine every night as well. I also take several supplements on daily basis, ones which may or may not be affecting my dosage, and so I just take them consistently.

They are dead wrong about dark leafy greens. Of course, if you start them now, plan on your dose having to be increased a tiny bit. They are dead wrong about cranberry juice and cranberries. That was cleared along time ago and had no basis at all for being included in the no no list. Grapefruit jiuce I drink about 3 to 4 hours after taking my meds. Not a problem with warfarin, but it can be with other drugs, in which I now take some that won't allow me to drink it.

As you can see, doctors and coumadin managers ARE NOT staying current and most don't know what they are doing. I hope they do get on the same page someday, but I'm afraid it's not going to happen in my lifetime.

Cranberry & warfarin O.K. together
Thursday, June 1, 2006

Confusion and controversy has been put to rest regarding cranberry and warfarin use together.




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Concerns about a dangerous interaction between cranberry and warfarin have been put to rest with an article published by David Greenblatt, MD in the Anticoagulation Forum Spring 2006 newsletter.

Experts from the Tufts University School of Medicine reviewed the 12 cranberry and warfarin interaction cases submitted. There had been concerns that cranberry increases the effects of warfarin resulting in increased INR test results and possible bleeding risks. Upon a thorough investigation here is the summary of the review of the cases on file:

Based on our review, not a single one of these cases plausibly demonstrated that loss of anticoagulant control was caused by cranberry juice. Some patients had other obvious reasons for loss of control, such as dietary changes, serious illness, or use of other medications. One case even purported to show a lowering effect on the INR by cranberry juice. In a number of cases, insufficient information was available to come to a reasonable judgment of what was happening. None of the cases was properly put in the context of the real changes of warfarin anticoagulation. Anticoagulation Forum, Spring 2006

There is no evidence of loss of anticoagulation control when warfarin patients consumed cranberry juice. Patients experiencing a change in INR test results while consuming cranberry should look for other medication use, diet or illness before pointing the finger at cranberry products.



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Copyright � 2006. All rights reserved. The information contained in this page is for informational and educational use only, and should in no way be used to adjust your current medication or deviate from your physician�s current medical protocol for your condition. PTINR.com and its staff are not medical professionals and do not offer or recommend medical advice to patients or professionals visiting this site.

View this article on the web at:
http://www.ptinr.com/data/templates/article.aspx?articleid=462&zoneid=1

 

[Ross]

GRAPEFRUIT JUICE AND DRUG INTERACTIONS

Huyen-Vi Khong, Pharm. D. Candidate

This is a research paper written while on a clinical rotation in an anticoagulation clinic as student at the University of Colorado School of Pharmacy.
Please note that most of these interactions do not involve warfarin. However, this paper was well researched and many of the readers of warfarinfo.com also take these other medications, so I thought it was important enough to include it on this website.

Grapefruit juice has been found to interact with many different
medicines that are often used by senior patients. Grapefruit juice contains
a substance (not well determined) that seems to be responsible for the drug
interactions. Orange juice, on the other hand, shows no such drug
interactions when it is taken with medicines. Therefore, orange juice is highly
recommended for the same basic nutrients. Approximately 1 glass of grapefruit
juice 3 times daily for 2-3 days is enough to produce significant drug toxicity. However, eating one grapefruit daily probably does not furnish enough of the interacting ingredient to cause a major problem. Grapefruit juice and its drug interactions can cause serious potential health problems with these medications:

Calcium Channel Blockers (CCB) for high blood pressure and heart rhythm:
• Felodipine (Plendil)
• Nifedipine (Adalat, Procardia)
• Nimodipine (Nimotop)
• Nisoldipine (Sular)
• Nitrendipine (Baypress)
• Verapamil (Calan)
Grapefruit juice with these can cause dangerously low blood pressure, very slow heart rate, irregular heart rate, fluid retention, chest pain (unstable angina), heart attack, or death.
Lipid -Lowering agents for high cholesterol:
• Astorvastatin (Lipitor)
• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Simvastatin (Zocor)
Grapefruit juice with these can cause a severe muscle breakdown called rhabdomyolysis. This can be a fatal condition.
Benzodiazepines for sleep or anxiety:
• Diazepam (Valium)
• Triazolam (Halcion)
• Midazolam (Versed)
Grapefruit juice with these can cause confusion, shortness of breath, slurred speech, poor coordination, or coma.
Immunosuppresant agents for organ transplants:
• Cyclosporin (Neoral)
• Sirolimus (Rapamune)
• Tacrolimus (Prograf)
Grapefruit juice with these can cause organ rejection, kidney problems, liver problems and loss of sensation (usually in fingers or toes).
Antipsychotic agent:
• Pimozide (Orap)
Grapefruit juice with this can cause dizziness, sedation, irregular heart beat and sudden death.
Antianxiety agent:
• Buspirone (Buspar)
Grapefruit juice with this can cause dizziness, sedation, irregular heart beat and sudden death.
Anticonvulsant agent:
• Carbamazepine (Tegretol)
Grapefruit juice with this can cause dizziness, drowsiness, nausea, vomiting, tremor, agitation, seizures and coma.
Antifungal agent:
• Itraconazole (Sporanox)
Grapefruit juice with this can cause a treatment failure which could lead to death if an internal fungal infection is the problem being treated.
Anticoagulant agent:
• Warfarin (Coumadin)
There have been conflicting reports about the effect of grapefruit juice on warfarin.
Mr. Lodwick did see the following patient. A middle-aged man with liver disease was taking warfarin and atorvastatin (Lipitor). He consumed approximately two gallons of pink grapefruit juice over three days. He developed severe muscle pain and cramps to the point that he was unable to eat. His INR increased into the 6 to 7 range and he developed bloody diarrhea. About three days after he finished the grapefruit juice, he was given a dose of vitamin K by mouth. The next day the bloody diarrhea stopped and he began to return to normal.
References: Lodwick, A. Warfarin Interactions: The Consequences of Upsetting the Balance Between Warfarin and Vitamin K. Colorado Society of Health-System Pharmacists. Poster Presentation. Aurora CO October 1999.
Maudlin, R. Grapefruit Juice - Physiological Effect; Drug Interactions. Modern Medicine 1999;67:59
Micromedex Database.
© 2000 Huyen-Vi Khong

 

[dick0236]

I have never paid a lot of attention to "dont eat vit K" lists. Nor do I pay a lot of attention to the grapefruit or cranberry cautions. If you don't like vegs, don't eat 'em. If you do, and I do, eat 'em....just don't turn into a rabbit. If you like juices like grapefruit and cranberry, and I do, eat or drink them......just don't drink the whole quart of juice or eat a half dozen grapefruit. I think there may be some cautions about eating "soy products", but since I don't like 'em, I don't eat 'em anyway. Like my signature says, I have NO dietary restrictions. I didn't even know that a "don't eat vit K" list existed until 20years after surgery. I stumbled on one in a new INR clinic and thought....damn, I shouldn't have eaten all those things for all those years. Why am I not dead?". A philosophy of eat what I like, but in moderation, will continue to be my guide.....although I doubt I will be on coumadin/warfaring for another 43 years.

 

[Ross]

although I doubt I will be on coumadin/warfaring for another 43 years.

Oh I'm not so sure about that. I think your going to live a whole lot longer yet.

 

[Ross]

It's encouraging to hear that I don't need to worry about (and count) so much of the vitamin K content I'm eating.

Hon all your going to do by trying to control and count Vit K intake is drive yourself insane. Your INR will go all over the place. I know, I've been there and so has most everyone else. I think we all did the thing of, I must listen to my doctor and must adhere to the no no list, when we first started. After a while, you end up eating like you always have anyhow and then find out that sure, your dose had to be increased a little bit, but your now eating everything they told you not to.

 

[Gnusgal]

Hmm... None of my meds (other than coumadin) are on that grapefruit list. But I've always been advised to stay away. Something about it messing with the absorption of some meds if you take them in close proximity to one another. May have to rethink that one...

 

[Ross]

Hmm... None of my meds (other than coumadin) are on that grapefruit list. But I've always been advised to stay away. Something about it messing with the absorption of some meds if you take them in close proximity to one another. May have to rethink that one...

No, that's true, even for coumadin, which is why I wait 3 to 4 hours after taking it to have my beloved grapefruit juice. I cannot do that with my current medication line up. I have about 3 on that list that prohibit it.