Warfarin, Vit. K, Healthy Bones and Arteries

[Janet]

Hello, Everyone!

Last year several of you convinced me to eat greens and "dose the diet", which I eventually did and am grateful for your advice. Now I have a related question. (I think this is the right forum for it.)

Since warfarin opposes (or inhibits?) the clotting factors in Vitamin K, will it also inhibit the other benefits of Vitamin K (such as its aiding in the absorption of calcium in the bones and the reduction of arterial calcification)? I increased my warfarin dose when I increased my Vitamin K intake (enough to keep my INR in range). Does the warfarin cancel out (or diminish) all of the Vitamin K's effectiveness or just the clotting factors? Am I still getting the bone and heart health benefits of Vitamin K while on warfarin?

I'm not sure I am expressing myself as I wish to. I hope you understand what I mean. (My concerns are related to osteoporosis and calcification of heart arteries; both are risk factors for people taking warfarin.)

I hope someone has the knowledge and understanding to address this. Thanks in advance.

Janet

 

[Cooker]

I don't know, never thought about it .... great question ... I look forward to response from those more learned than the Chimp in resident:tongue2:

 

[dick0236]

I was asked by Al Ludwick (our now retired anti-coagulant expert) several years ago about osteo and warfarin. He was curious if I had osteo after being on warfarin for such a long time. For me, warfarin use has not contributed to bone problems. I have never had a broken bone and have never had any indication of an osteo problem. I eat a normal diet which includes a good amount of vit K vegs. My wife eats the same diet, but has been put on Calcium and some other OTC pills to counter potential "senior" osteo problems. I have never had a physican mention any possible problems in those areas. I have disc problems in my spine, but it has nothing to do with warfarin or vit K.....as far as I know.

 

[Protimenow]

No, the effect of warfarin/coumadin does not negate the positive effects of Vitamin K. (I did some research on this this morning, so I'm on pretty solid footing to say this). There are a few variations of K - K1 and K2 being perhaps the best studied. It's only the pro-coagulation effects of Vitamin K that Warfarin interferes with -- the other benefits of K are still in full effect. That's one of the reasons why some experts say that you MUST take Vitamin K, even if you're using coumadin/warfarin. According to earlier threads, having a steady level of K also makes it easier to manage your INR.


Years ago, there was a book called 'The Coumadin Cookbook.' This was based on the theory that NO K was good, and the recipes avoided Vitamin K. This thinking was wrong. Go ahead, continue with your Vitamin K. As you've already done, keep it consistent, dose the diet, and appreciate the many benefits related to Vitamin K (and these benefits are NOT negated by warfarin).

 

[Lynlw]

No, the effect of warfarin/coumadin does not negate the positive effects of Vitamin K. (I did some research on this this morning, so I'm on pretty solid footing to say this). There are a few variations of K - K1 and K2 being perhaps the best studied. It's only the pro-coagulation effects of Vitamin K that Warfarin interferes with -- the other benefits of K are still in full effect. That's one of the reasons why some experts say that you MUST take Vitamin K, even if you're using coumadin/warfarin. According to earlier threads, having a steady level of K also makes it easier to manage your INR.


Years ago, there was a book called 'The Coumadin Cookbook.' This was based on the theory that NO K was good, and the recipes avoided Vitamin K. This thinking was wrong. Go ahead, continue with your Vitamin K. As you've already done, keep it consistent, dose the diet, and appreciate the many benefits related to Vitamin K (and these benefits are NOT negated by warfarin).

I'm not sure what studies you read, but I'm pretty sure that is NOT true, (that Coumdin only inhibits vit K role in anticoagulation). Coumadin DOES inhibit Vit K (K1-2) from doing ALL of its jobs, it inhibits Vit K from activating the Vit K dependent proteins (like Matrix Gla Protein) to do their jobs (coagulation, protect from calcification etc)

There are some threads with different studies, if you search vitamin K2 thy should come

here is one of the studies http://cjasn.asnjournals.org/content/3/5/1504.full

from the abstract.
"Vitamin K-dependent proteins (VKDPs) require carboxylation to become biologically active. Although the coagulant factors are the most well-known VKDPs, there are many others with important physiologic roles. Matrix Gla Protein (MGP) and Growth Arrest Specific Gene 6 (Gas-6) are two particularly important VKDPs, and their roles in vascular biology are just beginning to be understood. Both function to protect the vasculature; MGP prevents vascular calcification and Gas-6 affects vascular smooth muscle cell apoptosis and movement. Unlike the coagulant factors, which undergo hepatic carboxylation, MGP and Gas-6 are carboxylated within the vasculature. This peripheral carboxylation process is distinct from hepatic carboxylation, yet both are inhibited by warfarin administration..."

ps here is one of the threads this was discussed, it might be a little long and confusing, but alot of good info about it. http://www.valvereplacement.org/for...-Vitamin-K2-and-Warfarin&highlight=vitamin+k2

 

[Janet]

Thank you Cooker, Dick0236, Protimenow, and Lyn,

I found the links particularly helpful. It seems that the risks for vascular calcification and declining bone density may have genetic causation and may not totally be caused by, but rather increased by, warfarin. In Lyn's first link the author states that K1 has the clotting factors, while K2 has to do with vascular calcifiationt. He also states that both K1 and K2 are inhibited by warfarin (as Lyn quoted). Later he goes on to write "Vitamin K2 supplementation to those who require warfarin may provide a novel method to protect the vasculature while allowing anticoagulation." This seems to contradict what he said earlier. Clearly more research needs to be done, but I just may start supplementing with K2 and monitoring closely to see what happens to my INR, as someone in Lyn's second link was proposing to do. If anyone comes up with new information about this, please post it.

Thank you again, Lyn, for directing me to the previous forum conversation that I had missed, and to the research study.

Janet

 

[Lynlw]

Thank you Cooker, Dick0236, Protimenow, and Lyn,

I found the links particularly helpful. It seems that the risks for vascular calcification and declining bone density may have genetic causation and may not totally be caused by, but rather increased by, warfarin. In Lyn's first link the author states that K1 has the clotting factors, while K2 has to do with vascular calcifiationt. He also states that both K1 and K2 are inhibited by warfarin (as Lyn quoted). Later he goes on to write "Vitamin K2 supplementation to those who require warfarin may provide a novel method to protect the vasculature while allowing anticoagulation." This seems to contradict what he said earlier. Clearly more research needs to be done, but I just may start supplementing with K2 and monitoring closely to see what happens to my INR, as someone in Lyn's second link was proposing to do. If anyone comes up with new information about this, please post it.

Thank you again, Lyn, for directing me to the previous forum conversation that I had missed, and to the research study.

Janet

Tha sounds like a plan, the only thing is "Vit K2" is more a group of vitamins and not just one I believe there are 14? menaquinone MK-4 , MK-10, MK 7 etc. Vit K1 is the one found in plants, greens and i believe Vit K2 are made in the intestines, but I dont know if they all give the same benefits or different ones have different functions. From what i remeber I think M-7 or 4 might be one of the ones they believe helps with bone density.
.. Alot of it is pretty new and there is still alot to learn

If you do start taking Vit K2, I would keep an eye on your INR, I'm not sure if increasing the amount of K2 would effect your INR or if you might have to increase your Coumadin and if it could be a catch 22

 

[Protimenow]

If I can reopen the links I got this morning, I'll copy some excerpts or provide the links.

 

[chaconne]

For whatever this is worth, I asked my cardiologist the question about long term Warfarin leading to Osteoporosis. He said he wasn't aware of it being as much of a problem, and that long term Heparin use was more the cause of this.

 

[Protimenow]

There was speculation at one time that long term warfarin use caused calcification of arteries. With proper diet and non-avoidance of Vitamin K (and I'm not sure what else - I'll have to look this up), this 'side effect' can be completely avoided - if it actually exists. Vitamin K is NOT the enemy.

 

[dick0236]

Vitamin K is NOT the enemy.

AGREED!!!!! Life would be extraordinarilly DULL without a big bowl of "greens":tongue2::wink2:......and a slab of sugar cured Country Ham.

 

[Lynlw]

Thank you Cooker, Dick0236, Protimenow, and Lyn,

I found the links particularly helpful. It seems that the risks for vascular calcification and declining bone density may have genetic causation and may not totally be caused by, but rather increased by, warfarin. In Lyn's first link the author states that K1 has the clotting factors, while K2 has to do with vascular calcifiationt. He also states that both K1 and K2 are inhibited by warfarin (as Lyn quoted). Later he goes on to write "Vitamin K2 supplementation to those who require warfarin may provide a novel method to protect the vasculature while allowing anticoagulation." This seems to contradict what he said earlier. Clearly more research needs to be done, but I just may start supplementing with K2 and monitoring closely to see what happens to my INR, as someone in Lyn's second link was proposing to do. If anyone comes up with new information about this, please post it.

Thank you again, Lyn, for directing me to the previous forum conversation that I had missed, and to the research study.

Janet

I could be wrong, but I THINK, what he meant, (or at least how I took it, and for the most part these are my words, not the technical ones ) when he said "Vitamin K2 supplementation to those who require warfarin may provide a novel method to protect the vasculature while allowing anticoagulation."wasn't a contradiction, but he was suggesting/thinking that even tho Vitamin K-dependent proteins (VKDPs) require carboxylation to become biologically active, and Coumdin inhibits the carboxylation in the different areas of the body, liver veins, muscles etc, since vit K1 is needed for coagulation and K2s for anticalcification of the arteries, If you increased the amount of K2 it MIGHT help with the prevention of calification of arteries (and bone density) but shouldn't increase the coagulation.

But since there is a chance more K2 might "use up" more Coumadin, it possibly could effect the coag if you would end up needing to increase the amount of Coumadin

 

[Janet]

Tha sounds like a plan, the only thing is "Vit K2" is more a group of vitamins and not just one I believe there are 14? menaquinone MK-4 , MK-10, MK 7 etc. Vit K1 is the one found in plants, greens and i believe Vit K2 are made in the intestines, but I dont know if they all give the same benefits or different ones have different functions. From what i remeber I think M-7 or 4 might be one of the ones they believe helps with bone density.
.. Alot of it is pretty new and there is still alot to learn

If you do start taking Vit K2, I would keep an eye on your INR, I'm not sure if increasing the amount of K2 would effect your INR or if you might have to increase your Coumadin and if it could be a catch 22

Yes, so I have discovered; there is much to learn! MK-4 is the kind of K2 used in the Japanese studies on bone strength. It is very expensive. I only found one brand online. I will wait, and read, and wait. I have a home monitor so if I ever do take K2, I have an easy way to watch my INR. Thank you for your help, Lyn

 

[Janet]

For whatever this is worth, I asked my cardiologist the question about long term Warfarin leading to Osteoporosis. He said he wasn't aware of it being as much of a problem, and that long term Heparin use was more the cause of this.

I think the warfarin/osteoporosis link is relatively new. (My Gynecologist mentioned it to me, and then I found more information online.)

 

[Janet]

There was speculation at one time that long term warfarin use caused calcification of arteries. With proper diet and non-avoidance of Vitamin K (and I'm not sure what else - I'll have to look this up), this 'side effect' can be completely avoided - if it actually exists. Vitamin K is NOT the enemy.

Initially I was concerned about the medical news stating that calcium (not warfarin) contributed to calcification of blood vessels. I take calcium for osteoporosis. Vitamin K2 (not the kind from greens) is supposed to counteract the calcification of the arteries. My concern then became, can I take K2 with warfarin, or will the warfarin cause the K2 to be ineffective.

 

[Janet]

I could be wrong, but I THINK, what he meant, (or at least how I took it, and for the most part these are my words, not the technical ones ) when he said "Vitamin K2 supplementation to those who require warfarin may provide a novel method to protect the vasculature while allowing anticoagulation."wasn't a contradiction, but he was suggesting/thinking that even tho Vitamin K-dependent proteins (VKDPs) require carboxylation to become biologically active, and Coumdin inhibits the carboxylation in the different areas of the body, liver veins, muscles etc, since vit K1 is needed for coagulation and K2s for anticalcification of the arteries, If you increased the amount of K2 it MIGHT help with the prevention of calification of arteries (and bone density) but shouldn't increase the coagulation.

But since there is a chance more K2 might "use up" more Coumadin, it possibly could effect the coag if you would end up needing to increase the amount of Coumadin

I thought these two ideas contradict each other:

1. both K1 and K2 are inhibited by warfarin
and
2. Vitamin K2 supplementation. . .may provide a novel method to protect the vasculature while allowing anticoagulation (for people on warfarin)

I thought that if warfarin inhibits the action of K2, it is inhibiting protection of the vasculature (not coagulation), since that is the action of K2, as I understand it.

Your interpretation may be better. And yes, I was wondering about needing more warfarin while taking K2. That remains to be seen.

Thanks, again.

Janet

 

[Lynlw]

I thought these two ideas contradict each other:

1. both K1 and K2 are inhibited by warfarin
and
2. Vitamin K2 supplementation. . .may provide a novel method to protect the vasculature while allowing anticoagulation (for people on warfarin)

I thought that if warfarin inhibits the action of K2, it is inhibiting protection of the vasculature (not coagulation), since that is the action of K2, as I understand it.

Your interpretation may be better. And yes, I was wondering about needing more warfarin while taking K2. That remains to be seen.

Thanks, again.

Janet

I think we are both thinking the same way. but i took it to mean, since coum inhibits the vit k2 you currently have in your body, maybe taking extra would help ..but i do thinktaking more would only work until you probably had to raise the amount of coum you take

 

[Protimenow]

Once you've balanced the effects of warfarin with the effects of K2, there should be residual benefit from K2 (in other words, if you take a lot of K2, you may need more warfarin to stay in range (maybe) but the bone protecting (and other) benefits of K2 will be greater). The key, once again, is trying to maintain consistency -- even if it means more Vitamin K and more warfarin to counter the coagulation effects.

And Dick - I don't think I've EVER had a country ham, and will probably die without ever having tried it. (One man's pleasure is another's no no)

 

[Janet]

Once you've balanced the effects of warfarin with the effects of K2, there should be residual benefit from K2 (in other words, if you take a lot of K2, you may need more warfarin to stay in range (maybe) but the bone protecting (and other) benefits of K2 will be greater). The key, once again, is trying to maintain consistency -- even if it means more Vitamin K and more warfarin to counter the coagulation effects.

I really hope you are right about the bone and vascular benefits of K2 after balancing the coagulant/anti-coagulant effect of it with warfarin. Now if I could only find the MK-4 type of K2 at a reasonable price. Back to more research (especially on MK-7! Thanks for your input.

 

[Protimenow]

Of course, you can check with your doctor or a pharmacist -- or, perhaps, a nutritionist. From what I understand, though, our bodies NEED Vitamin(s) K - and eliminating or avoiding them in order to get control of our INRs is NOT the right way to go.