Vitamin K saturation

[mitchner9g]

Hi all - i'm facing another valve replacement soon for my aortic autgraft (former ross patient). There has been some discussion of installing a mechanical valve in me, which of course means a coumadin regimen.

I realize that one can still enjoy vitamin K enriched food as long as you injest roughly the same amount of K every day.

But what I'm wondering is if there's been a study done to see if there exists a maximum amount of K that a body can absorb, after which it gets excreted as waste? If so, maybe one just supplement with a dosage of K that takes you up to that ceiling and then adjust Warfarin dosage accordingly?

I'm just curious because i really really really love cruciferous vegetables and spinach

 

[geebee]

Welcome.
With coumadin you do not have to eat the same things every day. Just be fairly consistent over about a weekly basis. That does not mean you have to analyze every little thing you eat but just eat a balanced diet. I rarely think of what I eat other than to know when I have a balanced diet. I love green vegies and salads. I eat vegies almost every day and salads 2 or 3 times a week.
I do not know if there is a saturation point but I would doubt it.
Best of luck to you.

 

[catwoman]

I'm sure that Al Lodwick will come in here and answer your question. He's a pharmacist and a certified anti-coagulation care provider who runs a Coumadin clinic at a hospital in Pueblo, Colorado.
I'm not sure if I've seen stats on what the RDA is for vitamin K or what happens if you get too much (other than for warfarin patients). However, I have seen serious reactions to overconsumption of other vitamins or minerals.

Your body ordinarily produces about half the vitamin K your body needs. You take in the other half. If you have a gastro-intestinal upset and are on warfarin, your INR will go up as a result. (That's when you can enjoy more green stuff.)

Right after my MVR and going on Coumadin, I was anally retentive about how much vitamin K that I was eating each day. Man, I'd peel green apples rather than eat the peel (which does have a little vitamin K). I'd pass up pickles. I'd peel cucumbers. I wouldn't eat broccoli the same day I had a salad.

No more!!

I love green stuff and eat basically what I want. I have a home test machine and can stay on top of my INR changes more readily than folks who visit their PCP or a clinic every so often.

 

[mitchner9g]

oh, and about GI upset...

oh, and about GI upset...

Thanks friends - I'll bring these ideas to my surgeon.

catwoman reminded me about another thing that i worry might interact with coumadin, and that is ulcerative colitis, which i have.

anyone out there got colitis as well? i'm able to manage it pretty well with meds, but worry about bleeding due to flairups. my proctologist says as long as the colitis meds work, it should be okay.

but with this disease, bad flairups can happen. so bleeding seems like at least a potential issue, and so i'm curious if anyone has a response to that.

again, many thanks, this forum is pretty darned cool.

 

[Ross]

With a disease like that, I'd be apprehensive at the very least to put you on Coumadin. Of course, I have a lung disease that on occasion, my lungs hemorrhage, so I'm not an ideal candidate either, but I'm on it. I guess we take our chances and hope and pray it was the right thing to do.

As for the K thing, discussing it with your surgeon is likely to leave you questioning things. Fact of the matter is, very few Doctors understand Coumadin or how it works. They are still preaching from philosophy 25 years ago or more and have no clue about now. Don't change anything you eat. Eat what you want and as much as you want. Dose that diet, you do not diet the dose given to you. This too, is contrary to what many Doctors will say, but it's the honest to Gods truth!

We get people in here trying to use Vit K content charts and figure their intake that way. You can always tell when someone is listening to an experienced Coumadin user and one who is listening to a Doctor that doesn't know any better. They sit an pick at that chart and still can't figure out why their INR yo yo's.
Use those only for guidelines, preferably don't use them at all. Trying to manage off one of those is impossible.

 

[Georgia]

The ulcerative colitis would be one of the few things that'd make me really reconsider getting a mechanical valve. I don't have experience with it vis a vis coumadin; and can't remember a lot of discussion here about this. But it's a real red flag, I think. This is definitely something you'd want to discuss with your surgeon - in depth. And perhaps consult your gastroenterologist.

 

[Guest]

Water soluble vitamins can reach a saturation point and be expelled from the body in the urine.

Vitamin K is a fat soluble vitamin and it gets stored in the fatty tissues, if not indefinitely, at least almost without limit.

That is why someone who is given a massive dose of vitamin K like 10 mg IV every 12 to 24 hours for 4 or 5 doses will not have their warfarin re-regulated for a month or more. The vitamin K will leach out slowly.

For those of you who are proud of your low body fat content, consider that the brain is largely fat...

 

[mitchner9g]

...and colitis?

...and colitis?

Ah, so maybe it would be something to do if I were to, say, travel abroad for a six week trip. But it doesn't sound like they'd want to do this sort of thing long term. Well, I'll keep thinking about it...thank you for the response!

Anyway, perhaps you have experience with warfarin administration in patients with colitis? I haven't found much "out there" though my proctologist did not seem to think it was a huge deal with me. Just want another data point.

 

[DrAllan]

You ask an interesting question that I have not found a good answer to. Vitamin K is water soluble and easily excreted. The closest I have come to anything that approaches your question is a patent application about mixing high dose vitamin K with warfarin. The premise is that the dietary fluctuations are a small percentage of the total oral intake under these circumstances and there is less fluctution in the INR. Althought the patent alludes to this, there are no studies in themedical literature to support it. Attached is the abstract of the patent. If you wish to read the entire patent, then go to the patent office website at www. Uspto.gov and do a search on the patent number in the published application section.

Best to you

Allan

United States Patent Application 20050215625
Kind Code A9
Nesselroad, James M. III September 29, 2005

Combination therapy for anticoagulation

Abstract
A combination anticoagulation medicament including vitamin K with warfarin in an oral form is described. Between 50 and 5000 micrograms of vitamin K are combined in a single oral medication with 0.5 to 15 milligrams of warfarin for administration. The combination of vitamin K with warfarin in a single orally dosed form is a novel approach to improving the effectiveness of anticoagulation. The combination allows for broader application of warfarin in medical anticoagulation and reduces the variability of anticoagulation due to the influences of diet, additional medications, nutritional status, changes in physical condition, and potentially other factors. Use of the combination therapy improves the safety of warfarin as an appropriate anticoagulant for many medical conditions.

 

[mitchner9g]

.

.

Wow, that patent listing is exactly what i was asking about.

Well, I guess I'll watch the progress on this closely then. I wonder which pharma this nessleroad guy works with, or even if you could patent the combination of two fairly simple substances administered in conjunction like that...

Well, thanks for the tip dr. allan.

 

[Blanche]

Dr. Allen:
Your previous posts have helped us very much in dealing with the many complexities of anticoagulation. Many thanks.

In your recent post you mentioned that Vitamin K is water soluble. Is this what you wanted to say? I have always been told and read that it is fat soluble. I would appreciate your clearing us this seemingly difference of opinion for me.

Many thanks,
Blanche

 

[lcwhitney]

With A mechanical valve and coumadin most doctors will tell you to just keep you vitaminK consumption consistent.

Lettitia

 

[Guest]

Pure vitamin K is almost insoluble in water. It is manipulated chemically to a water soluble product for injection. However, this manipulation is rapidly metabolized in the body to the fat soluble form.

Oral tablets are not manipulated and are only fat soluble.

It will accumlate with large doses.

However, loading up on vitamin K for a trip etc is not a good idea. There is no way to predict outcomes.

My thinking is that almost any bleed is better than almost any clot.

 

[Cris N]

While you will read here that many people do not have their INR fluctuate greatly with dietary intake of Vit K I am one of those who fluctuates greatly. Thus, I take a multi vitamin with the full RDA of Vit K (80 mcg) and have adjusted my warfarin dosage to that intake. Myy dietary intake has much, much less affect on my INR since the percentage of increase (or decrease) in total Vit K is much smaller. My INR has become significantly more stable.