To Broccoli or Not To Broccoli: Managing Your INR

“It is interesting how quickly we become experts in our own health when we are forced to do so,” remarked Eliz Greene, who survived a heart attack at age 35.    “When you are put on a blood thinner like Coumadin® you have to be very proactive to maintain the right level in  your system.” 

Regular blood tests monitor the patients International Normalized Ratio (INR) which measures the thinness of the blood.  Patients must maintain an INR thin enough to provide therapeutic benefits, but not too thin. 

Excessive bleeding and even life threatening spontaneous bleeding can result from a high INR.  “The best way to be proactive is to be well informed,” said Eliz.

I've talked to other patients who say 'I can't eat broccoli, that will affect my numbers.'  But that's not the point,” said Patty Borkowski.  Patients are often told to avoid foods high in Vitamin K, which regulates the clotting of blood.

“We need certain amounts of vegetables to maintain a healthy heart,” according to Mellanie True Hills, a heart disease survivor and Founder of the American Foundation for Women's Health during the Patient's Perspective Teleconference presented by the Embrace Your Heart™ Wellness Initiative. 

“Without those vegetables we are doing our bodies more harm than good.  It really is a case of being consistent in the amount you eat from day to day and getting your Coumadin® level adjusted to fit what you eat.”

“Typically we think of the green things as being an issue for Vitamin K.  Things like broccoli, spinach, and green beans all contain vitamin K.  But there are a lot of things we don't think about like olive oil.  It stands to reason when it comes from green olives, that there would be a vitamin K issue there.  Even walnuts and other nuts have an impact due to  high levels of vitamin K,” advised Mellanie.

Registered dietitian, Jill Fleming, agrees, “The main thing is that you don’t drastically alter your green veggie intake. Some people run into problems when they go crazy eating produce out of the garden during the summer months and then drop way off in their consumption during the winter season.   Consistency is the goal.”

In addition to foods containing vitamin K other items impact a patients INR such as alcohol, vitamin and mineral supplements, herbs and over-the-counter medications. 

In addition, any time a patient is prescribed a new medication they should check to see how it will affect their INR.  “Pharmacists try to point out interactions, but may not always catch them.  We have to be proactive  in our own health,” said Mellanie who offers two on-line resources which allow patients to check drug and supplement interaction:
DrugDigest
MedlinePlus

“The bottom line is to be smart, pay attention and be well informed,” concluded Eliz.

Even when patients do everything right, sometimes they are unable to become stable on Coumadin®.  After trying for two years in which Mellanie was never able to be stable, she thought, “what is wrong with me? Everybody else is stable, so why can't I be stable?”  Then she found research indicating that about one-fourth of patients are never able to be stable on Coumadin® due to genetic reasons.  “So for those of us who are having trouble being stable on Coumadin®, it may not be our fault!”  Mellanie found a surgical solution to her Atrial Fibrillation and is able to live without blood thinners.

Tips for a Consistent INR:

Eat a healthy and consistent diet:
Don't ban the leafy greens.  Choose a well-balanced diet and work with your health care professional to adjust your Coumadin® to match what you eat.

Watch the sneaky foods: 
Any food high in Omega 3 fatty acids such as nuts, soy beans, olives and chick peas, are also high in Vitamin K.  Include a healthy and consistent amount in your diet.

Drink wisely and consistently:
One glass of red wine each day has been shown to be good for your heart, but too much alcohol or an  inconsistent level of alcohol will lead to an inconsistent INR.  Keep your alcohol consumption moderate and even from day to day.

Use a pill case:
Make sure you take your medication every day.

Check the label on supplements: 
Many multivitamins contain vitamin K.  Herbal remedies with ginseng, gingko biloba, ginger, garlic, St. John's Wort and green tea will impact your INR.  Check with your pharmacist before taking a supplement or over-the-counter medication.

Be in control:
Be vigilant in keeping INR testing appointments.  Inform your health care provider about any changes in your diet or medications, including herbal and over-the-counter.

Pay attention to bruising and your menstrual cycle:
Excessive bruising and overly intense menstrual flow may be signs your INR is too high.

Read more about the Patient's Perspective on Blood Thinners in the Patient's Perspective Magazine or  download the Special Report on Managing your INR.  You may also listen to the discussion on managing your INR or the full conversation on blood thinners. 

Please share your thoughts on managing your INR or suggest topics for future Patient's Perspective calls by making a comment below.  Thanks!

The Patient's Perspective is a monthly teleconference addressing the challenges faced by women living with heart disease.   The teleconferences are hosted by Eliz Greene, Director of the Embrace Your Heart™ Wellness Initiative. Find out more at www.EmbraceYourHeart.com 

Comments

[linda cornett]

my mother had a large stroke, 5-6 inches, which the doctor said came from the heart to the brain. she lived only a few days. her coumadin level was 1.3. she had been on chemo for 6 months and after chemo was not advised to continue getting inr checked. when she was taking chemo they checked it weekly.

[Eliz Greene]

Linda, I am so sorry for your loss. Thank you for sharing what happened to you mother -- stories like yours are what keeps me in the fight for better treatment.

[Puma Shoes]

This can be absolutely just one for this more effective blogs I've view. You are so insightful, have a lot genuine stuff to provide towards table.

[cardiology emr]

One glass of red wine each day has been shown to be good for your heart, but too much alcohol or an inconsistent level of alcohol will lead to an inconsistent INR.

Kevin