This man had just started taking a boiled mixture of cinnamon and ginger. He was given reversal agents, but this didn't stop the gastrointestinal bleeding and he died 3 days later.
It doesn't say whether this could apply to warfarin as well. I used to drink ginger and lemon tea (before reverting to the real stuff) and use cinnamon a lot in food and mulled wine but I can't say I've ever noticed any symptoms. I guess this man may have taken a much larger quantity.
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Thank you so much for that Mark. Stark warning! As we keep saying, "natural" products should never be taken without consultation with one's medical team.
When I asked my doc if I could continue with curcumin after starting Apixaban he said yes. He seemed quite keen on curcumin because of its anti inflammatory properties. I suspect that he does not know it has "thinning " properties. I do not know if they are anti aggregant or anti coagulant. Most docs know zilch about the properties of natural medicines whether they be food derived or from herbs that are not normally used in cooking. They get no training in this . So their response is more likely to be negative rather than admit their ignorance.
Both ginger and cinnamon are used widely in cooking. Does this mean we should not be eating Chinese or North African meals?
Everything in moderation. I don't think the poor chap was taking his in small doses from the transcript. You will sepearte me from my curries only with a few feet of earth.
I too take Curcumin and have the odd herbal tea with lemon and ginger and sometimes make teas from the herbs in my garden, thyme, oregano, mint, Rosemarie, or sage, Pop some cinnamon into my lentils with almond milk for breakfast. I also take omega 3 and vit C and a multi vit glucosamine with chondroitin, and marine collagen etc and am on Apixaban. It is helping my inflammation, arthritis and my back no end. In fact my knees, ankle, hip, and back are miles better for doing so. I can play golf without pain so no painkillers any more. I am so pleased. Will run these past my EP when I see him but will he know about these supplements, spices, herbs etc? I don’t want to go back to being in pain again. Perhaps I could continue taking my minerals and supplements and reduce my apixaban to 2.5mg twice daily instead of the 5mg? Will ask.
I expect the answer will be no. The problem with the NOACs as opposed to Warfarin is the one size fits all. There is no allowance for sex or genetic differences in metabolism. Women were not allowed in clinical trials till after the mid nineties so any drug developed before then was never tested on half the people it was destined for! Even now women are often a minority in clinical trials and there are no requirements for analysis of results by sex. It was discovered that for many years women had been overdosed by 100% with the standard dose of Ambien because they did not metabolise it like men! How many more drugs are being prescribed to us in doses that are not suitable for our physiology? At least with Warfarin there is a testing method to see how well it is working. There is an enormous difference between individuals as to how much Warfarin they need to take to be in the correct INR band. If there was such a system for NOACs then they would safer. But one of their marketing points was that testing was unnecessary.
Is there any way to test how the Apixaban plus vits, herbs, minerals etc are affecting the blood thinning. I don’t appear to bleed too much. I used to get burst capillaries in my hands when I used them too much. Now with these supplements I am OK.
I don't know. There is for Pradaxa but it is not widely available. One of Bohringer's own scientists suggested that it would make Pradaxa use safer but he was hushed up as the lack of testing was a primary marketing pointin comparison with Warfarin.
Hi, I'd be interested in hearing his answer. I can tell you that everyone from the drug company to the various doctors and pharmacists all refer me back to "your doctor, your pharmacist, or the drug manufacturer " My internist said "I leave it up to you and your list of 16 supplements as I'm not sure."
So, what do you do.
Bistol Myers Squibb couldn't supply me with any answers.
Yet like you I have been taking many supplements from COQ10 to fish oils, to cinnamon to turmeric plus, plus. Now I'm on ZERO !
Just a post script to the above. I ran what I was doing past my EP and when I took what and he approved. What is more he actually described me as ‘very sensible’ I am taking Apixaban 5mg x2 daily but my kidney function is being monitored on a regular basis. It is possible that in a few years he may reduce my Apixaban to 2.5mg x 2 daily because of my age and because I am only 7stone 3 - 5lbs.
Oops we both drink lemon and ginger on occasions and as one "bag" does several drinks I guess not too much of an issue. I use cinnamon in cooking maybe once a week. The strap line "no food restrictions" for DOACs may have lulled folk into a false sense of security perhaps. However I would think it is therapeutic levels of herbs to which they refer.
It appears as though the man had been taking 2 lots of 200ml boiled ginger and cinnamon for the previous 3 days. It's unclear just how much of each was used.
Cinnamon can contain coumarin, from which warfarin is derived. His INR was 1.9 whereas it's usually 1 with the dabigatran he had been taking. Presumably that increase was the effect of the coumarin. So he was effectively taking a mixture of warfarin and dabigatran. And added to that the ginger acts as an anti-platelet.
If he'd been on warfarin, an INR test would probably have given a warning with an elevated reading.
I think tea bags of ginger and the pinches of cinnamon used in cooking are too small to have much effect. But as Bob says, be very careful about taking "natural" products with anticoagulants, particularly in the belief that it might do you some good.
Well it sounds like it's lucky I'm still alive. Watched several talks about herbs and spices over the last 2 weeks and how healing they were. Was putting cinnamon in my muesli and then changed to ginger. My INR had dropped when I had it checked last week and I couldn't think why (ginger). Am having it checked every week at the moment pending a cardioversion.
Then as turmeric was almost proclaimed the wonder drug for curing inflammation, I started taking some capsules containing it a few days ago - then I saw it can increase INR. Felt quite ill yesterday and had to go to bed early (not me at all), but better today.
The thing is that for curing inflammation these spices, within days had proved miraculous and for the first time in years I had no soreness.
We really should have been given more information, right at the start of taking anticoagulants, on how spices and herbs can affect our blood viscosity.
Oh Jean!!feel your pain..merrily tossing cinnamon and ginger into recipes thinking you are adding to your healthy lifestyle and maybe dicing with death ..as have I and also a gar!ic addict.....mea culpa! (no disrepect to the poor gentleman) I totally agree...give us the information,we are not reckless or stupid!! Mrs Equally Angry of Warwickshire...
Yes, I've been heavy on the garlic too - well we've always been told how healthy it is! Now I know why my INR is always too high or low, must order my Coaguchek machine today.
Go for it Jean, it means total freedom for me. I am on 8 weekly official INR tests but usually do it every 2 or 3 weeks. I adjust my warfarin when needed by varying the quantities of green leafy vegetables which then impacts on my INR.
I will, John, just got to check with my GP re the strips and lancets. I did ask him a few years ago and he okayed it, but things may have changed. Trouble is my INR readings vary so much from week to week. So fed up with always having to go to my surgery for these tests!
Yep Jean, that's it's beauty, you can more closely monitor what's going on, particularly with food and drink. Hopefully you find it is something that you regularly eat, so innocently that's the cause of all these variations. Its other advantage is you can have it with you whenever you are away from home. I take mine to Australia when I go, it goes everywhere with me.
I eat raw garlic regularly and always put several cloves into stews. So do most French people. I doubt any doctors here would ever caution people against garlic use . It's too ubiquitous. But because it is most people would probably not bother with concentrated capsules which would count as a herbal medicine. Having garlic breath is normal here and not frowned upon!
I agree with Jalia; once you get the knack (and there is a knack) of testing then you have control. I test myself about every 10 days, more if I am unwell as that can cause my INR to rise quite dramatically. I self-adjust by tiny amounts if needed and am mostly in therapeutic range. I would be far too worried to be tested only every eight weeks or so.
What concern s me is that on the noacs we have no measurement means..no blood tests/ INR readings. I mentioned this to GO who seemed unconcerned...good luck with the coagucheck! X
This is a device which enables you to monitor your INR levels whilst taking Warfarin.
I obtained mine from Roche pharmaceuticals a few years ago at a cost of £300.
My GP surgery issues prescriptions for the testing strips which are needed . If your surgery is not prepared to do so they can be quite expensive so do check with your GP that they are in agreement for you to self test.
I find it so convenient it's almost life changing! Worth every penny .
I would have a go at them. The strips are recommended by Nice. The cost of warfarin + strips is a fraction of the cost of NOACs and gives as good, if not better, results.
I use a Coaguchek. It only works for warfarin. You prick your finger and it checks the INR. I use it once every 1-2 weeks and it keeps my INR in range 99% of the time. It costs around £300 but the test strips should be free on the NHS.
For me, it's the best thing I've ever bought as it cuts my risk of stroke and puts me in control of my medication.
The way these DOACs are handed out without full answers is criminal in my opinion.
My internist had my list of supplements infront of him as did the Cardiologist in the emerg
and both said to take the Eliquis as directed and they "WILL leave it up to me about my 16-20 supplements from COQ10 to fish oil to turmeric to cinnamon and vitamin E to name a few.
How is this right ??? The Pharmacist didn't know as didn't Bristol Myers Squibb.
As someone mentioned on here recently, they list the side effects of each drug we take in the package leaflet, but never the side effects of taking a combination of several drugs!!
Ooh er!!! I make my own curries with fresh ginger,as you say I expect in the quantity needed for that should be ok.This has always been my concenr with NoAcs,as unlike warfarin,we have no idea how our blood is behaving! Thanks for the heads up xx
Wow- sobering information. Thanks for sharing this, Mark.
I find it very disturbing that what they are terming a ‘herbal products’ is what I would call food or drink...
Besides fresh herbs and spices daily in healthy (I thought!) meals, I regularly brew fresh ginger tea for myself - and in having to avoid pharmaceutical cold remedies, I drink vats of the stuff when I’m ill...
As Jeanjeanie says, we really do need clear medical advice on this stuff. That poor man and his family- this could have been so easily avoided
This is shocking how "natural" things that we think are doing good for our body can interact with anticoagulant drugs, i hear that to much vitamin K can interact with warfin, just ridiculous i wonder if deep fat fried food interacts with blood thinners? just a thought
I use it to help with bloating/stomach issues. Ginger and lemon, home made. My other half uses lots of fresh ginger in curries so I suppose I need to watch it. What a bummer and poor man.
❗️Oh dear! I make a strong ginger by boiling the ginger root, and letting it seep. Sometimes I add lime or lemon. I take Pradaxa-same as the patient in the study.
This has caused me serious pause!!!!!!!
Thank you for this post. Just had a huge cup of it with my Pradaxa and hope I escape any consequence for tonight. Will avoid. I’m shivering learning about this!
Hi Mark , I have a feeling that the poor man died because there was some other underlying condition or factor of which we know nothing.
Is curry now , going to be a no no? Tagine ? Ginger cake, Parkin , ginger snaps, all the cinnamony cakes . All to come with a health warning??
We do have medical evidence that St John’s Wort has health warning for those with heart problems but what about health shop sleep aids? I have tried them and they have no effect st all on me sadly.
Does any one else ( on Xarelto , Losartan and steroids ) lie awake most of the night ?
For me no ! I started on Xarelto last September post ablation , for me , the relief of a diagnosis (PAF) and medication , means that I no longer carry that worry that I did pre diagnosis( I had had so many previous tests over the years)
Am careful with diet, don’t eat late at night, grateful for all the shared info here, which has helped me tremendously !
Luckily, I mostly sleep well, it’s always better after the days when I put in the exercise too, so my trusty sleep
You could be right about another condition, though if so it's odd it's not mentioned. Gastritis could be the culprit.
From my own experience I suffer occasionally from Gastritis (painful inflammation of the stomach) initially triggered by daily enteric aspirin over 4 years for AF - that was the treatment then. Anyway it was diagnosed by endoscopy, aspirin was stopped, PPI prescribed. BUT although I thought I was better it came back severely with Flecainide taken on an empty stomach. So much so I had to stop taking Flec.
I can now a couple of years later take Flecainide with no problems.
The point is that gastritis can take a long time to heal and can provoke ulcers and bleeding and if you have a sensitive stomach its it's worth being careful with supplements.
But I am not a doctor, so what do I know. Just offering my experience of a condition that is little discussed and could cause stomach bleeding and problems with other medications.
Do you think the gentleman’s age could also be contributory? I was advised that frail elderly people have to stop Dabigatran at 75.
Maybe because of all the NOACs it is the most likely to cause intestinal bleeding. Also was he on the full dose of 150 mg twice a day rather than the lower dose for oldies?
Very worrying. Like others I use lots of garlic, ginger turmeric and other spices and herbs in cooking. I am taking Edoxaban at present. Maybe a curry a day would keep our blood flowing without the need for DOACS! (tongue in cheek). I will explore further. Thank you for the information. Colette
I've delved a bit deeper into the quantities of ginger and cinnamon required to have an effect. A teaspoon of cinnamon contains 5mg of coumarin, which is equivalent to a day's dose or more of warfarin for many people (but only half a day for me!). 5g of ginger divided into two doses and consumed with a fatty meal significantly inhibits platelet aggregation in healthy males. 5g is 3 teaspoons of dried ginger. One piece of root ginger measuring 1 inch by 1 inch is equivalent to one teaspoon (about 1.6g) of dried ginger.
When I cook pheasant or venison casserole I use about a quarter teaspoon of cinnamon. In a tagine I use half a teaspoon of ground ginger and half a teaspoon of ground cinnamon. So if I were to eat all that myself then that could have some effect but it's divided between 6 or more people, and is a one off. In curries I would use a root of grated ginger - about 1 inch by half an inch. Those quantities are all well below what would have an effect. So I think as long as you don't go overboard with your use of spices, I think you're fine. I will be stuffed if red chillies prove to be a problem though!
If you do boil up root ginger to make tea then you may need to be more cautious.
Thanks for the info. on quantities - this is what we need to know.
The link in jeanjeannie50 's post lists almost all foods / herbs as having potential effects, which is not very helpful in knowing what quantities or concentrations are likely to cause harm. This approach could almost be classed as 'scaremongering'.
Personally, I have one mug of Green Tea / day in which I infuse a small (8mm x 20mm av.) piece of chopped ginger root. I also have a mug of Cammomile tea before bed.
I'm confident neither will harm me (though I've no evidence !) but both are listed as having potential side effects for Warfarin users.
I'm sure different people have different sensitivities to the compounds contained in these 'potentially harmful' foods / herbs. I self-monitor my INR with a Coagucek machine and am almost always within range.
Thank you for all this information. And should we assume that Ceylon cinnamon is better too, seeing the it has much less coumarin content? I remember telling my daughter, who is on Apixaban, that she should check the source of the cinnamon.
It would be interesting to know if people in North Africa had a preponderance of haemorrhagic strokes rather than ischaemic. This used to be the case in Japan till a more Westen diet crept in and was possibly due to consumption of natto on a daily basis- apparently traditional breakfast fare.
This is an eye opener for me as I did notice that my INR went up when I checked it by chance a day after had made a spicy curry but did not link it with the curry. I'll be more careful with the spices in future!
Surely we need to simply remember ‘moderation’ when it comes to using these common foods like ginger, cinnamon, turmeric etc in meals, but avoid taking them as supplements without taking medical advice?
This man had serious conditions and serious ill health. Wonder why he thought to use cinnamon and ginger? This is a worst case scenario. Good warning but shouldn’t scare those who only drink ginger and lemon for a sore throat. A well qualified Herbalist should give advice and will refer you to your GP to check your health.
GP’s are not herbalists but hopefully have some knowledge.
I am on Xarelto and I started taking Flaxseed every day but after a while I couldn't understand why I kept feeling so dizzy as if I was going to pass out. It turns out that it can thin your blood and since stopping taking it have felt much better.
Lesson learnt, never take natural products without consulting gp first.
I stopped taking garlic & cayenne pepper as natural blood thinners when I started Apixaban simply to save wasting money by using both. Now I've seen this I intend to stop the drug asap (4 weeks post cardioversion) and go back to natural but how do you test INR as it's never been mentioned to me ?
You only need to have your INR tested if you are on the anticoagulant Warfarin (or so we're told). This test shows how quickly your blood will clot. It means visits to the doctors surgery for a nurse to check this with a machine called a Coagucheck, cost of machine if you want your own is about £300 in the UK.
I'm thinking of buying my own and then perhaps using natural blood anticoagulants like ginkgo biloba or turmeric etc. I'm absolutely fed up with all the drugs we take suddenly having serious side effects! I just can't believe how we've all been prescribed these pills but not informed on how herbs, spices etc can affect our blood clotting ability.
I'm not sure that is viable. The problem is that the natural products have a blood "thinning" effect but one needs to know if this is anti coagulant or anti aggregant ( like aspirin) . It is often not easy to find out which. The only definite anti coagulant I know of is nattokinase. This is derived from natto , something the Japanese eat for breakfast. Studies have been done into nattokinase showing that it has clot busting properties but there seems no real info on dosing for afibbers. I was taking nattokinase myself ( but not a very high dose) but still had a TIA so I bit the bullet of Apixaban. I hate taking it.
Also I am not sure if INR only measures the blood's "thinness" in relation to the effect of Warfarin and that other tests would be needed for substances that act on different elements of the clotting "cascade" .INR testing is no good for NOACs so would it be any good for natural substances? It's all so complicated!
You're probably right! So difficult to know what to do! I guess after your stroke you're very pro anticoagulants. I always have been too, but my INR results are never consistent and I have a sore stomach that may need an op if I can't clear it up with spices. Antibiotics didn't help.
I'm not really ! I still am quite ambivalent. I firmly believe that most pharmaceuticals are poison and many just sticking plasters that cover up symptoms but in no way "cure" the underlying problem. Pharma are not interested in real cures. There is no money there. The TIA was very subtle and if it was not for the fact that the next day I could not write other than in squiggles I might well have ignored it as the leg weakness was very fleeting. The only other symptoms were some extra clumsiness and just not feeling quite right. But my GP was sure that was what it was even though the brain scan showed no damage. I found my digestion better with Bromelain. If you take it with meals it acts as a digestive enzyme. In between meals it is supposed to help with infammation and joint pain. But it too is a "thinner". It is derived from the tough bit in the middle of pineapples.
I buy it at our local pharmacy. It is used here in France to reduce swelling after surgery and was suggested to me by a locum doc I saw after being stung by a bee on my inner lip. I looked like someone with lip augmentation surgery that had gone seriously wrong! But you can get it on Amazon or ebay.
I ditched aspirin years ago and switched to natural but with AF was told I had to take Apixaban. Switching back asap. Docs only understand drugs imo. To go the natural route you have to do your own research which it sounds as though you have.
Mark, this was emailed to me yesterday by a US doctor, with no warnings about taking with anticoagulants at all. He was trying to sell his cookery book. No wonder we're all so confused:
Hey Jean,
In a world flooded with packaged artificial food, filled with chemicals and labeled with false gimmicks, it might be surprising that food can act as medicine.
But when you choose REAL food you are actually feeding your body medicine; you’re using your kitchen as a farmacy to create great health and prevent dis-ease.
I find that my patients get really excited when I tell them this, but they feel a little lost about where to start and usually want to know more about the components of their food that are providing the actual benefits. I have two favorite areas to start with when it comes to using food as medicine: herbs and spices, and color.
Herbs and spices have been used as medicine all over the world for as long as humans have been eating (that’s a pretty good sign that they work!). As an extra bonus, they make our food taste amazing. And though centuries ago different cultures were limited to what they could grow themselves or trade with nearby villages for, we have the advantage of accessibility to a huge variety of fresh and dried herbs and spices to cook with whenever we want. From cardiovascular health to digestive support, fertility, immunity, and so much more, the way we season our food can work wonders on our health while making eating well satisfying and sustainable.
Here are a few of my favorite herbs and spices and the benefits they offer:
•Cinnamon: a powerful antioxidant that fights inflammation, lowers cholesterol, and balances blood sugar.
•Peppermint: can improve pain and other associated symptoms of irritable bowel syndrome or other digestive issues and soothe nausea.
•Cayenne: boosts metabolism and increases circulation (as do other hot peppers).
•Sage: can improve memory and enhance brain function.
•Garlic: supports heart health and has antibacterial properties.
These five are just a snapshot of the incredible variety of herbs and spices we can use to make each meal unique, super tasty, and nourishing.
Now, let’s move on to color. I always tell my patients to eat the rainbow, and I’m not talking about candy. The different colors we can see in fresh vegetables and fruits are a sign of the different nutrients they contain:
•Blue and purple mean a type of antioxidant called anthocyanins are present. These have been linked to anti-viral, anti-cancer, and even anti-dementia benefits.
•Orange represents the presence of carotenoids, like alpha- and beta-carotene that benefit the immune system, some of which can be converted to vitamin A for essential functions like vision and cell growth.
•Green fruits and vegetables have a variety of compounds like isothiocyanates and nutrients like vitamin K and folate, which support detoxification, bone and blood health, and nervous system development, among other functions.
Again, just a quick look at the vast medicinal benefits we can get from a diet rich in real colorful foods.
As a one-time immigrant to the US, I was struck by a myriad of cultural differences. One of these was the perceived added value of mixtures. For instance, mixing honey and all sorts of stuff in beer and lots of other drinks/food. I like my food and booze (IPA), plain and adulterated. I don't even like false eyelashes on women ....lol. Even toast has to have a load of 'enhancing' ingredients spread on it. I am fine with just plain margarine... Anyway, I have found my way past the mixture problem and now the only cultural differences I struggle with, are the total prohibition on giggling at silly names like "Gerty Pinkelpopper the Fifth", and the wildly un-English "Hello Alan, I love you" from my new Moonie relative at every family gathering
I use 1" of fresh ginger every day in my morning and afternoon vegetable juice, not sure how safe that is I use a 1/4 tsp ceylon cinnamon daily in my oatmeal (regular cinnamon is really cassis and large doses over time can cause liver damage, its more popular because it has a stronger taste). I was prescribed 5mg Eliquis bid but (as I have mentioned before) my male neighbor weighing 175lbs also takes that dose so I decided as I weigh 145lbs to only take 2 1/2mg bid (I am also 80yr). When I go into AF I do take a full dose. I do not trust these new drugs, I feel like any day now some nasty news will come out about them
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