Coumadin and Vitamin K: No Need to Skip Your Supplements

Coumadin and vitamin K is an important topic in modern nutritional therapy. If your supplement is made outside the USA and contains vitamin K, Coumadin isn't a reason to give up your vitamin supplementation routine.

In fact, taking Coumadin is a reason to make sure you take exactly the same vitamin supplements every day. Let's take a look at the reasons why.

Coumadin is the trade name for the chemical warfarin. For nearly 50 years, doctors have used Coumadin safely and effectively to prevent strokes, heart attack, deep vein thrombosis, blood clots to the lungs, and other circulatory disorders. Coumadin reduces the tendency of the blood clot?and it is extremely potent in doing so. Coumadin always has to be taken with care, especially when the combination is Coumadin and vitamin K.

Why? The way the liver makes clotting factors depends on a balance of your prescribed Coumadin and vitamin K. Even if you are on Coumadin, you need a base level of these clotting factors to keep you from having excessive bleeding. That means that even people who take Coumadin still need their vitamin K.

There are two opposing "systems" of clotting factors in your blood. One is activated when there is a cut or tissue damage so you don't lose too much blood. The other is activated after clots begin to form to keep the clot from causing damage of its own. Doctors prescribe Coumadin to shift the balance away from clot formation and toward increased circulation. You still need the right balance of Coumadin and vitamin K, however, to keep bleeding from becoming excessive.

The critical consideration in managing Coumadin and vitamin K is keeping the levels of vitamin K constant so your doctor doesn't have to constantly change your dosage of Coumadin. If you're on Coumadin, you've almost certainly been advised that certain foods are high in vitamin K. These include:

  • Kale
  • Spinach
  • Most green leafy vegetables and
  • Green Tea

but it's a good idea also to be even more careful with collards, mustard greens, turnip greens, watercress, endive, Swiss chard, parsley, and the Asian vegetable amaranth (tsing-mai). Cooked vegetables contain more vitamin K than raw vegetables, and adding olive oil or other fats to vegetables increases the absorbable amount of the vitamin.

There's also a lot of vitamin K in basil, green onions, fat-free mayonnaise, most kinds of baby food, and even poultry seasoning. Many herbs can alter your prothrombin time, including arnica, bilberry, butcher's broom, cat's claw, dong quai (also known as tang-kuei), feverfew, forskolin, garlic, ginger, ginkgo, horse chestnut, licorice, melilot (sweet clover), pau d'arco, red clover, St. John's wort, sweet woodruff, turmeric, woodruff, barley shoots, and wheat grass.

On the other hand, people given prescriptions for Coumadin (and vitamin K) are usually advised that the following foods are safe:

  • Bread, crackers, bagels, and pastries
  • Butterhead lettuce although not the other lettuces
  • Coffee and black (although not green) tea
  • Coleslaw, red cabbage, carrots, cucumbers, and sauerkraut
  • Dairy products
  • Fruits eaten without the skin
  • Meat, poultry, fish, and shellfish
  • Pasta
  • Potatoes, tomatoes, eggplant, mushrooms, white onions, pumpkin, and squash, and
  • Rice.

These foods are low in vitamin K, but if you aren't very careful to eat pumpkin and squash just about every day, you'll be missing alpha- and beta-carotene. Moreover, many people are sensitive to potatoes, tomatoes, and eggplant. Is it meat and rice for you?

The fact is, everybody needs some vitamin K. Your doctor can adjust your Coumadin and vitamin K in your diet if you make a point of consuming the same amount of vitamin K every day. The simplest way to get your K is to take the same amount of the same supplement containing vitamin K each and every day.

Just as there's no particular time of day to take your Coumadin, there's no particular time of day you need to take your vitamin supplements, providing they are manufactured for easy absorption. Don't rely on a nutritional supplement that has to be taken with food.

And in addition to sticking to your Coumadin dosage and taking your vitamins every day, you need to be careful with alcohol. More than two drinks a day can "shock" your liver into making fewer clotting factors. (One drink is 1-1/2 ounces of liquor, 5 ounces of wine, or 12 ounces of beer.) Your pro time will go up and your risk of bleeding will, too, whether or not you are taking your vitamin K.

People and their livers vary in their responses to Coumadin and vitamin K. The key is consistency. If your doctor gives you "odd doses" of Coumadin such as 5 mg on Tuesday and Thursday and 2.5 mg on Friday, that's what's needed for to keep your clotting factors constant. Don't adjust your vitamin K to your Coumadin.

The way to keep track of your Coumadin and your vitamin K is with a calendar. Here are the basic rules for anyone who takes Coumadin:

  • Always tell your doctor you are taking vitamins.
  • Always keep a calendar with your current dosage of Coumadin.
  • Every time you take Coumadin, mark the time and amount you took on the calendar.
  • Every time you take your vitamins, mark the time and the brand on the same calendar.
  • If you indulge in basil pesto, green leafy vegetables, green tea, or green tea ice cream, mark that on the calendar, too. This can help you track down the cause of unusual bleeding later should it occur.
  • Report ANY unusual bleeding to your physician or your physician?s assistant immediately, even if doesn't look like a lot.
  • Don't take aspirin or acetaminophen (Tylenol) unless your doctor knows you are taking it. Aspirin and acetaminophen can make Coumadin work "too well."
  • If your doctor lowers your dosage of Coumadin, be especially sure not to raise your dosage of vitamin K.

It's always better to call the doctor sooner rather than later.

Does all of this sound complicated? Well, it is. Coumadin and vitamin K may be something you can't live without, but that doesn't mean it's easy to live with it. And vitamin K is similarly essential to your good health - just in measured doses!

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