Traditional Mediterranean diet and warfarin

[Pefki]

I am 5 weeks post mechanical valve replacement. I'm on 8/7 alternating warfarin. I am 26 and was brought up on a Mediterranean diet which I have not been following since discharge because I have been avoiding the higher vitamin K foods. I have also been eating much more meat and high protein food than I would normally to help build me up after losing so much weight and muscle. I am going to Greece for summer and want to know what I should do with my diet. I normally eat alot of fresh fruit and veg and have meat free days several times a week. Is there anyone else on warfarin who follows a Mediterranean diet that can advise? Should I keep playing it safe? I know the main thing is consistency but I am 26, studying, working, travelling, socialising- consistency is not really a thing in my life. How can I make sure I am having exactly the same amount of vitamin k every day?

[moo196]

I'm a vegetarian and had a cvst - blood clot on the brain - back in 2014 necessitating warfarin.I had a long chat with my local coagulation clinic as there's no way I could not eat the items on the "banned" list. Literally eat them all together most days.... broccoli and Stilton soup, salad with chickpeas and spinach etc

the best advice I was given was to dose the diet not diet the dose.

By the time I travelled to China 18 months on I had a really good idea of how much my diet had an effect on my INR and I self dosed according to my diet over the previous couple of days.

is your INR stable? Worth a chat with your clinic perhaps.

[IanredUK in reply to moo196]

I haf a replacement valve 25 years ago. My cardiologist told me there were no banned foods or drink.

The important thing is vonsistancy . If you eat a lot of green veg that needs to be consistant.

I used to travel eprdeide for my work and staying in hotels was difficult as they dont tend to serve much in the eay of greens.

I purchased a INR test machine and working with my GP practice INR nurses, learned how to monitor my INR and adjust my warfarin as needed.

It will take time to learn what affects you INR, but it isnt just food and drink. Time zones and jet lag have an effect ad well.

You need to consilt your cardiologist and INR team for more advice on self testing.

[moo196 in reply to IanredUK]

yes, I looked into that but my consultant and team suggested that it wasn't necessary to go that route as generally my INR was stable and then I had a good idea of what effect 1 or 2mg extra/less I would need.

[Pefki in reply to moo196]

Thankyou for your advice. I intended to get some more detailed dietary advice at cardiac rehab if it was possible. I keep hearing that I should dose for diet. I like that because I have to do this for life which at 26, is alot of years. The consistency is the thing. My mother is vegetarian and has always made alot of those sort of dishes, plenty of pulses, all types of greens in pies or risotto, soups etc. My INR has now stabilised after an early hiccup which I think was caused by completing the antibiotic course I was given after discharge-not food related. As I am only 5 weeks post surgery and that hiccup requiring injections for a couple of days, really scared me, I am still being cautious.

[Pefki in reply to moo196]

Thank you. Just out of curiosity, what is your usual warfarin dose if you don't mind me asking? Just wondering how much vegetarians need to keep them within range.

[moo196 in reply to Pefki]

my dose was usually 7/8mg but I no longer take warfarin

[Pefki in reply to moo196]

Lucky you. That's great.

[Soben52 in reply to moo196]

lucky!! I hate it and want to stop it. Drs are putting fear in me. And I hate that. I never had a clot just paroxysmal AFib. They want me to do the Watchman thing. Anyone had it done?? Scary. Already had a cardiac ablation!! What to do!?!

[moo196 in reply to Soben52]

I don't consider myself lucky to have suffered a cvst in the first place, but lucky to have survived thanks to warfarin, friends and determination. It took over a year to improve enough to be able to function as an adult again ie drive, have a bath, travel, go back to work part time, read a book.I didn't even know my name for quite some time.

I don't think I had any bad side effects from the warfarin and the risk/benefit analysis was very narrow when I discussed stopping it with my consultant 2 years in. And at times I was (am) scared of it recurring and wish I was still taking the warfarin.

It sounds like your risk benefit analysis is much clearer.

[Pefki in reply to moo196]

I'm pleased you are doing better. Yes, my risk is very high if I don't take warfarin so there is no question. The mechanical valve makes me high risk for strokes because it was explained that the body tries to 'fix' the foreign body being the new mechanical valve, so it pools blood around the valve which form clots, potentially able to break off and you know the rest. The warfarin makes the blood less sticky and keeps clots from forming around the valve. I wish their was a better alternative to warfarin but unfortunately nothing has been approved yet. This will be forever. As far as a self tester at home, so far, I have been unlucky as the pin prick testing at the anticoag clinic has not given a true reading, up to .6 difference in INR so I am on blood tests and hoping at some stage the pin prick test will start to match the blood test, or only have a small difference. Otherwise, I am in the 1% who will never be able to rely on the pin prock testing. I'm still hopeful so that I can have some of my independence back.

[Rassociates]

Hi Pefki

The fact is it is very difficult to keep your vitamin k intake at a specific level, probably the best is a good guess! Warfarin is a notoriously volatile drug. I've been taking it for 19.5 years now. I invested in a Coaguchek self test monitor early on and have found that a real confidence booster and I check once a week. Even then I get totally unexplainable variances and just have to adjust the rate to suit.

Hope this is of help to you.

Regards

Richard

[GillyA]

Perhaps worth letting you know that (although not 26) I have a job which involves flying regularly, extended periods out of the U.K. and working in a developing country. With the support of my anticoagulation clinic I’ve managed this by either self testing or local draws, emailing the result to them and they email me the dose.

They did ask me to stay home for the first few months while everything stabilised, and I think it helps that they are in central London where they have a higher number of patients whose lives are complicated by regular overseas travel.

I have had to work with my employer’s OH team on which countries they are prepared to let me travel to, so there has to be an ok level of healthcare (even if not U.K. standards). But I’ve managed to do it by being a well behaved patient and working in partnership with them and OH.

One thing you do need to be careful about is travel insurance. Make sure you declare everything to them, you may well need to pay extra and/or find a specialist insurer.

I suspect it all feels pretty bleak to you at the moment, but it’s is manageable and not just once a year.

[GPearl01]

I had a mechanical as well installed about 8 years ago. My doctors and Coumadin nurses tell me to eat what I want. They say, but be consistent. They emphasized I can eat as usual but be consistent. I have salads, tonight I had cooked kale. I don’t do this every night. Sometimes I have veggies that do not have Vitamin K, like cauliflower or carrots. I check my inr weekly but will add warfarin to my dosage if I feel I went too far. I would recommend getting a meter to check your level if you are going to change what you normally do.

I once had to go out of town and ate restaurant food and lots of salads. This was 7 years ago. I got back home, ran by the hospital to get blood drawn and they wanted me in the emergency room asap. It dropped below 2.0. I wound up getting the shots in the belly instead for a few days.

Monitoring is recommended if traveling.

[Pefki in reply to GPearl01]

Thanks for your experience. Could I ask as I am feeling a little anxious again. Yesterday, I had an INR reading of 2 at the anticoag clinic. That is a .6 drop in a week. I am assuming it was because I was finally able to stop taking maximum doses of painkillers which ones on since surgery. I finally started feeling better, no more pain, much more walking every day, back to being involved in my various groups and socialising. The thing is that the anticoag staff are not concerned and do not believe I should change my dose. I am still restricting vitamin k foods on the whole so no change there. I have made it clear that I don't feel comfortable to come back in a week but I am being convinced that it is ok. I don't see how the same dose will bring my INR up and what if it drops further? I want to trust the process but last time I did that, I was on emergency injections in the stomach.

[Mydvt]

I have been on warfarin for 16 years now and initially changed what I thought was a healthy diet to cut out eating green food, however I found that this was not good for my overall health and changed back to a healthy diet eating tons of green stuff, broccoli, asparagus, salads, avocadoes etc. etc. As some one else said dose to the diet and not diet to the dose. I certainly don't try to count my vitamin K intake. So now my normal dose is 4 days of 9 mg and 3 days over the weekend period of 8mg. The reason for the difference is because my life style and diet and alcohol intake at the weekend is different to the rest of the week so my dose at the weekend reflects this. What I wanted to add was when you go away on holiday especially to a hot climate, I find that my diet is often out of my control and like most people my alcohol intake is increased which obviously has an effect on my INR. My routine for self checking when I am home is once per week and my INR hovers between 2-3 however when I am on holiday I test every 3 days and adjust my dose accordingly. The secret to keeping on top of your INR is self testing which helps to protect you and gives you peace of mind.

[Pefki in reply to Mydvt]

Thank you for your reply. I too decided to eat greens without going overboard on the amounts but certainly eating some good greens every day. I don't drink so that isn't an issue. My dose is 7 every day except 6 on Friday. I do not self test yet. The pin prick coagcheck was not providing accurate results for me at the clinic but I will try again at some stage and then consider buying a home machine. For now, it is a blood test at a private diagnostic centre every 3 weeks while I am away from London. Quite doable.

[Jennifer53]

You can't. You need to eat what is good for you and adjust your warfarin accordingly. I avoid cranberry and grapefruit and eat normal amounts of green veg

[Pefki in reply to Jennifer53]

Thankyou for your reply. I eat healthily but the INR jumps around a bit within range. That ideal 2.5 has become a pipe dream. I am back at testing every 2 weeks again.

[Kabalino]

Hi ! Enjoy your holiday, I would stay on a Mediterranean diet, I have done this for years, no problem. The real risk perhaps is booze - keep it moderate (if you drink).

[Pefki in reply to Kabalino]

Thanks for your reply. I seem to be staying within INR range but I go from one end of the range to the other. I can't really understand why. Do you have any tricks you use to know how much vitamin K you are having? How can you possibly stay consistent unless you eat the same every single day. The alcohol is not an issue, I have a few sips now and then.