Increasing Dietary Vitamin K Intake Stabilizes Anticoagulation Therapy in Warfarin

[Chuck C]

Some old school physicians warn patients on warfarin to limit vitamin k intake. This study suggests that vitamin K can help stabilize INR. The often repeated phrase of "dose the diet don't diet the dose" not only applies, but a healthy dose of vegatables rich in vitamin k, in addition to correlating with good health in general, may help stabilize INR

https://www.eventscribe.com/2019/ASN/fsPopup.asp?Mode=presInfo&PresentationID=545052

 

[pellicle]

Hey Chuck

a healthy dose of vegatables rich in vitamin k, in addition to correlating with good health in general, may help stabilize INR

I agree, and I think some studies have been posted here supporting this in the past (meaning there is more than what you've cited).

The message however needs to be continually repeated because there just still needs to be some "professionals" retired (I'm thinking of Blade Runner here).

 

[pellicle]

some additional supporting references

https://www.cochrane.org/CD009917/V...-for-patients-starting-or-already-on-warfarin
which I suspect drew upon these studies but was unclear:

https://pubmed.ncbi.nlm.nih.gov/27346552/

...We conclude that LDVK administration did not increase mean TTR, but did decrease the number of INR excursions. The observed improvement in mean TTR in both groups suggests that more attentive monitoring of warfarin therapy, rather than LDVK, was responsible for the improvement in TTR observed. The reduced excursions suggest that LDVK did reduce extreme INR variation.​

emphasis mine because the best thing you can do is

1. take your pills
2. make sure you take your pills
3. measure weekly
4. adjust if needed (keep a steady hand on the tiller)

and even way back in 2005

https://pubmed.ncbi.nlm.nih.gov/16305294/
Conclusion: Supplementation with daily low-dose oral vitamin K significantly increased the number of INRs in range as well as the time in range, and decreased INR fluctuation in this small series of selected patients.

one can only wonder why the clinics continue to miss out on the actual relevant literature and instead push people away from self testing and self management

indeed these guys wondered the same
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998867/

In conclusion, the available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, thus avoiding wide changes in the intake of vitamin K. Based on this, until controlled prospective studies provide firm evidence that dietary vitamin K intake interferes with anticoagulation by VKAs, the putative interaction between food and VKAs should be eliminated from international guidelines.​

again, my emphasis. So if you like greens then eat them because they are good for you.

 

[Chuck C]

So if you like greens then eat them because they are good for you.

Indeed they are. They correlate with lower rates of cancer, and they are especially good for our hearts. And our group, in particular, in that we already have a risk factor in that area, should be doing all that we can to keep our hearts healthy.

 

[vitdoc]

The underlying question is why are there significant fluctuations in the INR while taking warfarin. There are probably a few reasons assuming a constant warfarin dose. Probably predominately it is the amount of Vit K consumed and how the body deals with it. Other issues are other concomitant drugs used and probably other non Vit K foods. Use of alcohol is another variable. So if you up the baseline Vit K dose and adjust your warfarin dose to that level than the variations in dietary Vit K will be smoothed over since they will be a smaller percentage of the baseline Vit K level. So the study makes some sense in reducing wide swings.

 

[ClickerTicker]

Although it's naturally somewhat subjective, I feel my INR has been more stable since taking a Vitamin K supplement (200ug as MK-7) daily. I was surprised that my dose didn't need much, if any, alteration. Even went on a week-long holiday to France, which normally sends my INR shooting up, with little fluctuation. Been taking it for 7 or 8 months now and intend to continue in the hope of lessening calcification in my arteries.

 

[Sheenas7]

The underlying question is why are there significant fluctuations in the INR while taking warfarin. There are probably a few reasons assuming a constant warfarin dose. Probably predominately it is the amount of Vit K consumed and how the body deals with it. Other issues are other concomitant drugs used and probably other non Vit K foods. Use of alcohol is another variable. So if you up the baseline Vit K dose and adjust your warfarin dose to that level than the variations in dietary Vit K will be smoothed over since they will be a smaller percentage of the baseline Vit K level. So the study makes some sense in reducing wide swings.

I love salads and greens but usually have one salad a day and I mix romaine with iceberg which is lower in vitamin k. But I have osteoporosis and would benefit from increasing my vitamin k intake. I have talked to my cardiologist about this but he won’t work with me on that. I had been with a stable INR and he said I couldn’t have it both ways. He said if you are looking to increase vitamin K « you can’t have it both ways ».
In August I got Covid-19 after being double vaccinated ! So I was sick and could not eat for a few days and have been experiencing some swings in my INR. He had to lower my dose and slowly bring it back. Now I caught a stomach virus and haven’t eaten in two days. I wish I could increase greens. But if you take a supplement then you know how much you are getting each day. I suppose then you couldn’t add greens to diet and a supplement. When I go to a restaurant I have choices if sides such as spinach, broccoli or mixed greens. Always hard to figure out what I can order and it truly frustrates me.

 

[vitdoc]

I love salads and greens but usually have one salad a day and I mix romaine with iceberg which is lower in vitamin k. But I have osteoporosis and would benefit from increasing my vitamin k intake. I have talked to my cardiologist about this but he won’t work with me on that. I had been with a stable INR and he said I couldn’t have it both ways. He said if you are looking to increase vitamin K « you can’t have it both ways ».
In August I got Covid-19 after being double vaccinated ! So I was sick and could not eat for a few days and have been experiencing some swings in my INR. He had to lower my dose and slowly bring it back. Now I caught a stomach virus and haven’t eaten in two days. I wish I could increase greens. But if you take a supplement then you know how much you are getting each day. I suppose then you couldn’t add greens to diet and a supplement. When I go to a restaurant I have choices if sides such as spinach, broccoli or mixed greens. Always hard to figure out what I can order and it truly frustrates me.

Basically eat what you want adjust the warfarin accordingly and forget about the cardiologist telling you not to. As long as you can self test you will be fine.

 

[Chuck C]

Although it's naturally somewhat subjective, I feel my INR has been more stable since taking a Vitamin K supplement (200ug as MK-7) daily. I was surprised that my dose didn't need much, if any, alteration. Even went on a week-long holiday to France, which normally sends my INR shooting up, with little fluctuation. Been taking it for 7 or 8 months now and intend to continue in the hope of lessening calcification in my arteries.

I also take Mk-7, which is actually Vitamin K2, and have been doing so for about 2 years. I stopped taking it for a couple months after surgery, then reintroduced it, starting at 100ug/day. I just increased to 200ug/day a week ago, so I am taking the exact same dose as you do.

 

[Chuck C]

I wish I could increase greens.

You can. I eat two huge Mediterranean salads per day, loaded with vitamin k rich greens and my INR is very stable.
When I first started taking warfarin I read many posts from others here on the forum, some of whom had been taking it for decades, and they would almost always say you dose the diet, don't diet the dose. Meaning, eat what you want and, if you need to take a little more warfarin to keep your INR in range, then you just adjust your dose of warfarin to whatever it needs to be to keep your INR in range.

I have tested after a week of eating one salad per day and tested after a week of eating two salads per day and have seen no difference in my INR. Now, if I did notice a drop in my INR when I moved to two salads, I would just adjust my warfarin accordingly. As it turns out I did not need to. So, I eat a lot of greens daily, as well as other vegetables high in vitamin K and I have personally found no need to try to eat the exact amount each day. It just does not move my INR needle enough to worry about it.

If there is any take away from the study, which I posted and the ones which Pellicle posted, I think that it is to not limit our amount of vitamin K containing foods and having regular vitamin K intake just might help keep our INR more stable.

 

[Chuck C]

Speaking of salads, I'm enjoying my world famous Mediterranean salad this very moment.

-Spring mix of greens, with 10 leafy green varieties and a couple purple leaf ones
-avocado
-Red, orange and yellow bell peppers
-Kalamata and green olives
-garlic
-sundried tomatoes
-chia seeds
-extra virgin olive oil
-black beans
-low carb Caesar dressing with avocado oil base
-Romano cheese

I'll eat another one of these before the end of the day. Yum!

 

[pellicle]

I have talked to my cardiologist about this but he won’t work with me on that.

easy, stop talking to your cardiologist, eat as you want and then they'll dose you as you need to be ... don't tell them what you're eating ... its a mystery.

 

[pellicle]

Speaking of salads, I'm enjoying my world famous Mediterranean salad this very moment.

you bastard ... I fogot to get Avacado on Saturday, I'm out and its peak season!!

I'll be having a late "second breakfast" I suspect ;-)

Oh, and I've finally found something which is a bread (not packaged as bread but actually spun recycled cardboard) that is 1.5g of carbs per slice!!

Happy Days

 

[Chuck C]

you bastard ... I fogot to get Avacado on Saturday, I'm out and its peak season!!

That's a good excuse to take a long scooter ride. Just watch out for the kangaroos this time.

 

[pellicle]

That's a good excuse to take a long scooter ride. Just watch out for the kangaroos this time.

mate, I get so many facebook likes from my punch-ups with them ... its my bread and butter ;-)

 

[coffeelover]

When I first started on warfarin I really limited my intake of green veggies .I felt that if I limited my greens I would be in my target range most of the time. Well, that just wasnt the case. Anyways, now I eat way more green veggies, I eat a nice romaine salad everyday..and I everyday I enjoy Blueberries, Pomegramate Juice. I dont eat Kale or Spinach, but enjoy most other veggies! I've more than doubled my daily Vitamin K intake and only had to add a very small amount of warfarin to my dose. Now I'm almost always in range.