Diabetes and APs / Keto

[Davideccroft]

i was diagnosed as APS back in 2005 and had stable INR controlled with warferin since then.

A few months ago my cholesterol and glucose levels were high. just on the cusp of Type 2 diabetes.

I lost 10kg weight with mix of diet and a lot more exercise. My cholesterol and glucose levels fine again. I lowered carbs a lot and tried to keep vitamin k still consistent. With a keto diet the last 2 or 3 weeks.

However this week my monthly inr went down to 1.4 so GP has me taking heparin and slightly higher warferin to get back in my inr range.

Did anyone else ever have similar? I’m rethinking my whole diet. My GP seems to have no experience of diabetes plus APS and fairly little on APS. looking for a dietician that understands both as so far I’ve learned APS diet from research and this forum. a lot of diabetes diet suggestions I’m getting is lots of vitamin k.

[Zamalek]

Hi there I am sorry I can't be helpful. I have APS 3-4 range, with 85% in range the clinic tells me. On warfarin since 2008. However my cholesterol and glucose are just ok at the moment. Very interested to hear any info you may collect on a diet. I am not overweight but have collected a cancer and osteoporosis very recently. My diet needs to be more organised I know that, just not figured it out yet.

[Star13]

From what I understand of Keto type diets they are high in protein. I can't think why protein would affect INR or APS in anyway. Obviously if you are eating lots of salads and veggies you would have to watch that. Also I don't know the relationship with things like soya beans and other beans. You may have to research that.

[Davideccroft in reply to Star13]

Thanks - I was thinking the same. I didn’t increase greens. I tend to avoid soya. guessing it’s maybe the exercise and less food in general changing things so producing different amounts of vitamin k - with maybe changes in my gut micro biome? Had another low inr reading today at my gp and given another week of heparin injections with slightly higher does of warferin. First time since I started on warferin almost 18 years ago I’ve had this. Trying to research this and no luck so far.

[Star13 in reply to Davideccroft]

check you have not got an underlying virus or some inflammatory process going on.

[Star13 in reply to Star13]

oh and maybe get your waterworks checked. Keto can sometimes help produce kidney stones, so if you have a mild infection that might do it.

[GinaD]

Vitamin K regulation can be so confusing! One doctor who treated me years ago explained to me that regulatory factors in the body will aim to maintain a steady level of K. If K levels go down, K absorption will go up. And vice versa. " So if you want lower K levels your body may do her best to raise them. And how to successfully moniter K levels are highly individualistic." The doc went on to urge that I keep a meticulous log of food, activity and subjective energy levels. After sharing that log he suggested that I was one of those who would most profit from eating 2-3 servings of high K greens a day. And voila! My INR levels remain boringly stable. For over 20 years! For me, I have found that sunshine exposure raises my INR. ( vitamin D? --probably.) I also found that myINR varies also with activity levels. So I try to be consistent with my daily exercise and activities.

Keeping that food, activity, warfarin dosage and INR log can be challanging and time consuming. But the human body is complicated and individual. And that log can help you get a better grip on how to manage treating YOUR APS.

[Davideccroft in reply to GinaD]

Thanks - this all makes sense. Keeping a food and exercise, and blood pressure, sleep, heart rate and glucose and INR and weight and water log. adding sunshine. too many variables after so many years of a stable inr

[Sand1985 in reply to GinaD]

This doctor seems really good - is he still practising! My INR has been dropping for the last month and I’m getting nervous about it. Reading through the forums I’m not getting any ideas. I had bad flu a month ago but feel like I’ve fully recovered.

[GinaD in reply to Sand1985]

Dr. Winkelmann was a fabulous docor but he has. retired.

[MaryF Administrator]

Hi, I am not on Warfarin, but I do eat Mediterranean and low G.I and gluten free. I think it is a good idea to keep checking in with your GP whilst your INR settles down, as you have lost weight and made changes, it may settle down but great to be having it monitored. Vitamin K is not great with Warfarin, has your GP checked this part of your diet? MaryF

[Ray46]

Pretty sure I've read various places that keto diet is contraindicated on warfarin, because it messes up INR - I've certainly been told not to do it, same with intermittent fasting, 5/2 etc.

But regardless of that, I find weight changes (and 10kg is quite a bit) and exercise changes definitely affect INR (and, weirdly, losing weight seems to mean you need more warfarin not less - definitely not a dose-per-kg). If I am changing weight or exercise patterns, testing is definitley once a week, a month is way too long.

Also, just on the off chance, have you by any chance had Covid recently? I have had stable dose for years and kept myself in range >95% (poster child for self testing). April I got covid and since then around 50% in range and mostly low, dose keeps being increased and increased again, but INR will not come up.

[Davideccroft in reply to Ray46]

not had covid this year luckily. had it last year and was rubbish for 3 days and no effect on inr. Now well into week 2 of heparin jabs and slight increase in warferin so hoping back to normal next week. I do self test but not since I stopped travel overseas for work a few years ago. My gp won’t pay for the strips for me and normally I’m stable too. I’ve almost got my BMI out of the red and into the orange - when that happens I’ll slow the weight loss rate.

[myarabella]

Hello- I ha e APS and was diagnosed as a type 2 diabetic during pregnancy. I have 2 of 3 APS markers so my regimen is an aspirin a day which works for me. I recently read a post here of a member that went on a gluten free diet and had miraculous results. Being gluten free, which I am not, is an excellent way to avoid diabetes type 2 also.

[Davideccroft in reply to myarabella]

Let’s hope. I’m learning a lot in the last few months about diet and fitness and it seems to be working. Gone back to basics and stopped ready meals and take outs.

[user666]

Exercise is the greatest contributor to a fluctuating INR. If I skip a work out my INR goes up if I am extra active mine goes down. Keep doing the exercise but try and be consistent and frequent testing with dose increases when beginning a new exercise and diet routine. Exercise increases your rate of metabolizing warfarin.

[Davideccroft]

ooh. Thanks. I went from not a lot to building up over the last 3 months to about 7 hours a week with my new home gym. I am seeing my gp on Monday and will suggest a small warferin increase if same low inr. not enjoying heparin daily injections - I’m not complaining but something I’d prefer to stop. I also found a medical paper on lowering carbs and inr increase. So add that to a touch of the covids a few variables to digest so I don’t get swings in INR.