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rajeevgoswami

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Has any one tried or is regularly using Herbalife protein shake and other nutrition supplements.

I want to understand impact of herbal nutrition supplements on anticoagulation.

I had AVR with at Jude mech valve in 2003. I am 62 years young.

1. I tried multivitamin along with protein shake my INR dropped. I checked and found multivitamin supplement from Herbalife has lot of vitamin k. I have stopped multivitamins but continuing shake.

2. I take protein shake twice a day. It has boosted my energy also helped me in controlling my sugar levels. But I am little worried about it’s affect on anticoagulation in long term.
3. My joints are weak and my back muscle gets pulled often causing to back pain. I have been advised to take calcium supplements

I am curious if any one has any experience with these products from Herbalife or any other similar supplements

1. Herbalife Protein shake
2. Calcium supplement
3. Nite life ( L-Arginine)
4. Joint support (Glucosamine with scutellaria extract)
5. Omega3 supplement

Thanks for support.
 

tom in MO

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Jan 17, 2012
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I was on a cardio multivitamin and fish oil prior to my AVR with a St. Jude mechanical. Afterwards, my cardio said to stop taking both products he previously had suggested. I was also told to get in touch if I planned to take any supplements and vitamins. I was asked to take Vit D and B12. Since I am now home testing, I asked the prescriber if there would be any impact to my INR and they said no and I checked my INR myself. I did not contact my cardio.
 

carolinemc

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May 31, 2010
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Location
kansas city, mo
Has any one tried or is regularly using Herbalife protein shake and other nutrition supplements.

I want to understand impact of herbal nutrition supplements on anticoagulation.

I had AVR with at Jude mech valve in 2003. I am 62 years young.

1. I tried multivitamin along with protein shake my INR dropped. I checked and found multivitamin supplement from Herbalife has lot of vitamin k. I have stopped multivitamins but continuing shake.

2. I take protein shake twice a day. It has boosted my energy also helped me in controlling my sugar levels. But I am little worried about it’s affect on anticoagulation in long term.
3. My joints are weak and my back muscle gets pulled often causing to back pain. I have been advised to take calcium supplements

I am curious if any one has any experience with these products from Herbalife or any other similar supplements

1. Herbalife Protein shake
2. Calcium supplement
3. Nite life ( L-Arginine)
4. Joint support (Glucosamine with scutellaria extract)
5. Omega3 supplement

Thanks for support.
Talk to your doctors before taking anything like this if you are on warfarin.
 

pellicle

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I want to understand impact of herbal nutrition supplements on anticoagulation.
more or less the impact of these things is nearly zero on ACT. Wearing my biochemist hat I'd say there is no evidence that these things do anything except lighten your wallet and worse I'd say there is no requirement that they actually contain any specific amount of nutrients *because* they are not held to the same standards as medical compounds.

You mainly need to avoid grapefruit and to a lesser extent cranberry (I have less evidence on that one) as foods because they will have an influence in your INR

The ones you've mentioned will be benign to your INR.

What Anticoagulant are you taking? Acenocoumarol (Sinthrome®) or Warfarin?

Best Wishes

PS: I have occasionally dabbled with glucosamine sulfate after I hurt my back (SI joint) a couple of years ago and can say that I identified anything INR related worth mentioning.
 
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pellicle

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Good morning from Australia :)

I am on a Acitrom which is available here in india …I guess. some thing similar to warfarin.
I was concerned you may be on that drug (being, as it seems, in India)


Pharmacokinetic data
Elimination half-life
8 to 11 hours

Acitrom is nothing like warfarin in the most important way: half life. It has a very short half life and will therefore create a highly unstable situation in your body. If you miss a dose you will quite likely find yourself at INR 1.2 and even varying the time taken of the drug will result in variation in INR.

To clarify what half life means it is the time taken for half the drug to be still remaining in your system so in (on average) 9 hours there will be half of your dose in there doing anything, in (say) 20 hours 1 quarter of that, so by the time you take your next dose you are nearly running dry.

I liken it to having a 2liter tank on your motorbike to having a 10liter tank. For a trip to the shops a 2L will do fine, for a trip to the next town it won't. I totally do not understand why that drug is prescribed for anything other than DVT issues.
 

pellicle

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PS I banged this through a simple data model on half life to show you what I mean
a vs b.png


now the doses don't actually matter because this is a simple model to show the effects of a missed dose on the drug in your body and your INR will probably follow this with a day lag to the actual changes. The dose of either drug is the dose you need to obtain a stable INR of your target (say, INR=2.5)
Below is a recent "missed dose" situation which I chose to gather data on (NB: I always gather data on events as well as weekly measurements)

1661119356547.png


so not a bad outcome in INR really.

Its worth noting that very few places in the world use Acitrom (or acenocoumarol) for valve patients because its of its unstable


Patients and methods: Sixty-eight subjects treated with acenocoumarol for 5 months or more and displaying intraindividual variability of international normalized ratio (INR) results were switched to warfarin. Unstable anticoagulation was defined as a failure to achieve a target INR within the preceding 3 months, i.e. > or = 50% of 8 or more INR values below 2 or above 3.5. Patients with stable anticoagulation (<20% of out-of-range INRs), matched for age, gender, and anticoagulation indications, served as a reference group.​
Results: Patients with unstable anticoagulation on acenocoumarol had higher body mass index (p<0.01) and serum C-reactive protein levels (p<0.01) compared to stable counterparts. The transition factor between acenocoumarol and warfarin was 1.8 (95% CI 1.69-1.96). The percentage time within the target INR range in patients with unstable anticoagulation was 40.2% at baseline and increased to 60.4% following 6 months on warfarin therapy (p<0.05). The number of subjects with <20% of out-of-range INRs among individuals switched from acenocoumarol to warfarin was 22 (32.4%) vs. 63 (92.6%) in patients on stable anticoagulation after 6 months of follow-up (p<0.001).​

underline mine to draw attention to what I consider are critical points
  • those levels of INR time in range are dreadful and "no wonder so many surgeons prefer tissue valves"
  • their determination of stable is reasonable (<20% or 80% in therapeutic range) but still with the variations seen in the above model of the half life I'm expecting we'll see a lot more if we looked closely
 
Last edited:

Protimenow

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more or less the impact of these things is nearly zero on ACT. Wearing my biochemist hat I'd say there is no evidence that these things do anything except lighten your wallet and worse I'd say there is no requirement that they actually contain any specific amount of nutrients *because* they are not held to the same standards as medical compounds.

You mainly need to avoid grapefruit and to a lesser extent cranberry (I have less evidence on that one) as foods because they will have an influence in your INR

The ones you've mentioned will be benign to your INR.

What Anticoagulant are you taking? Acenocoumarol (Sinthrome®) or Warfarin?

Best Wishes

PS: I have occasionally dabbled with glucosamine sulfate after I hurt my back (SI joint) a couple of years ago and can say that I identified anything INR related worth mentioning.
I have a handful of dried, sweetened cranberries in my morning oatmeal (or oatmeal with ancient grains) almost every morning. It has done nothing to my INR.

Of course, a handful of cried cranberries can't be compared to cranberry sauce or cranberry relish, so the comparison my not really capture the effects. (I'm tempted to say comparing berries to sauce is apples to oranges, but I guess it's cranberries to cranberries).
 

rajeevgoswami

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Bangalore, India
Thanks Pellicle for a detailed description. Warfarin is not available in india. So only option we all have is acitrom. I was able to control my INR far of late I am facing some stability problems which I am trying to work with my doc.
I have an unusual situation. I have been using 4mg acitrom since my surgery in 2003. But Since last 2 years I am having challenges with INR. Now if I take 4 mg my INR goes way beyond up to 6 some-times. With 3-3.5mg I am fine. I am still figuring out the reason. So far clue less.
 

pellicle

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Thanks Pellicle for a detailed description. Warfarin is not available in india. So only option we all have is acitrom. I was able to control my INR far of late I am facing some stability problems which I am trying to work with my doc.
I have an unusual situation. I have been using 4mg acitrom since my surgery in 2003. But Since last 2 years I am having challenges with INR. Now if I take 4 mg my INR goes way beyond up to 6 some-times. With 3-3.5mg I am fine. I am still figuring out the reason. So far clue less.
sorry to read that.
However I'm pretty sure warfarin is available in India and if you press your GP they may confess it is.

I can't really help much with acitrom, but I'm willing to give it a go. Me helping you would require:
  1. 100% commitment to follow through on your part
  2. ability to self test, and willingness to do so perhaps daily if needed (and it will be at first)
  3. full and honest disclosure of what has been happening and the 100% accurate reporting of your drug taking (all kept in a spread sheet) including notifying me of any "whoopsies" so we can calculate that...
  4. at first probably daily interaction (shouldn't be much time involved)
  5. you filling out and taking responsibility for the accuracy and integrity of data in a shared spreadsheet (google sheets)
  6. a pill box of pills with daily labels placed in a visible and prominent place in a part of your house that you frequent in the day (to ensure those times when the alarm is missed you stand a chance of seeing "oh, bugga, I missed my pill)
  7. an alarm on your phone to remind you of the daily taking time
  8. discussion between us of exceptions to this before hand.
Because of the incredibly short half life of acitrom your INR will be up and down like a brides nightie over a 24 hour period we'll probably need to establish a protocol for consistent measurement. Something like:
  • dose taking in the PM at a specific time (of your choosing)
  • INR measurement in the AM at a specific time (also of your choosing)
These can be switched around but because of the nature of your poison of choice (to coin a phrase ;-) I believe we can do this to some manner of effectiveness.

Obviously it would be ideal for stability to move to Warfarin.

Reach out if you want to "give this a go" and we can set it up.

Best Wishes
 

rajeevgoswami

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Messages
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Bangalore, India
Thanks pellicle. I really appreciate your helping out. I am willing to give this a go. First of all I need to get ability to self test which I don’t have right now. Let me look around and check what self check devices are available here in india. I haven’t seen self testing equipment for inr here in india. Home testing for blood sugar are very common here but not inr checking. Hospitals also draw blood from your veins for testing. Let me do some home work and then I will reach out to you.

Thanks.
 

carolinemc

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kansas city, mo
Thanks pellicle. I really appreciate your helping out. I am willing to give this a go. First of all I need to get ability to self test which I don’t have right now. Let me look around and check what self check devices are available here in india. I haven’t seen self testing equipment for inr here in india. Home testing for blood sugar are very common here but not inr checking. Hospitals also draw blood from your veins for testing. Let me do some home work and then I will reach out to you.

Thanks.
Check with your PC before doing this. It might affect your INR.
 
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