Vitamin K is important in the formation of clots. Warfarin blocks the action of vitamin K in the chemical reactions involved in the clotting process. Vitamin K is obtained from green, leafy vegetables including broccoli, kale, and spinach. Variations in dietary intake, especially of vitamin K-rich foods, may alter the anticoagulant (blood-thinning) effect of warfarin. Other factors that interfere with the effect of warfarin include interactions with other medications as well as the patient’s genetically determined ability to metabolize (or use) warfarin. In the liver there are chemical systems that process medications, and the system for warfarin varies genetically from patient to patient. For these reasons, warfarin treatment needs to be very carefully controlled with blood tests that measure the ability of the blood to clot. This test is called the INR (international normalized ratio).

 

There are standard precautions given to all patients on warfarin, and these warnings should be taken seriously. This includes consulting one’s physician before taking any medication, including over-the-counter preparations for pain, flu, and allergies.

 

To more specifically answer your question on diet: vegetarians can comfortably remain vegetarians while on warfarin. It is not so much that the foods you mentioned are “banned” but that any extreme variations will alter the therapeutic effect of warfarin. In my own practice, I would inform and educate my patients on all the benefits, dangers, and dietary aspects of warfarin therapy. I would encourage them to have a consistent intake of all the healthful foods that vegetarians eat, including soy products. I would then introduce the warfarin therapy and control the anticoagulant effects (INR) with the patient eating their normal diet. We would establish an interval for follow up INR testing as long as the patient remained on warfarin (some remained on it for life). If they were to face dietary changes (travel or seasonal food variations), we would then check the INR more frequently as needed. (Careful control of the INR and cooperation between patient and caregiver are very important. Many laboratories run a consultative service to patients for optimal INR management.)

 

If the warfarin effect is not carefully managed, patients can have excessive bleeding if the blood becomes too thin. They may experience an increased tendency to form clots if there is too much variance or change in the INR.

 

In summary, cooperate closely with your physician. Have a consistent and well-balanced diet. It can be vegetarian and include soy products. Any variance in diet (sustained) or medical treatment (i.e., antibiotics, anti-inflammatory medications) will require more frequent INR monitoring over those periods. Be careful and compliant--your life depends on it! 

 

Researchers in Denmark have shown that high triglycerides in women who have reached menopause and have an expanding waistline indicate increased risk for CAD (Circulation, 2005). These women had a five times higher risk of having a fatal heart attack or stroke than women without these factors. The high-risk women had a waist circumference of at least 35 inches (89 cm), and a triglycerides level of 128 mg/dl or more. Another study showed that modestly elevated triglycerides can be harmful to your health if you have a strong family history of CAD (before age 55 in male relatives and age 65 in female relatives).

 

It is important to know your numbers. The recommended level is less than 150 mg/dl. Between 150 and 199 mg/dl is considered “borderline high”; over 200mg/dl is considered high! There is some good news. In many cases high triglycerides can be lowered through lifestyle changes without medications.

    • Reduce calorie intake and strive to reach your ideal weight.

 

The bottom line is that you cannot ignore your triglycerides level and the implications it may hold for your health.

 

 

Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland, 20904. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.