Silvia Herszkopf, MS, RD, LMNT, LD
Amazing Angels Home Health and Hospice would like to provide you with some important information about Warfarin (Coumadin®) and diet. Warfarin (Coumadin®) is an anticoagulant, which means it reduces the body’s ability to make blood clots. Your healthcare provider may prescribe this medication temporarily after a surgery or make it a permanent part of your medication regimen following episodes of abnormal blood clotting or some procedures such as mechanical heart valve replacements. When taking Warfarin (Coumadin®), the most important thing is to maintain your levels within a therapeutic range (a range that will prevent clotting) that is monitored by a blood test called an INR (International Normalized Ratio). If your level goes too low, you are at risk for blood clots. On the other hand, if your level goes too high, you are at risk for bleeding.
You should always tell your healthcare provider which medications and herbal products you are currently taking before starting on Warfarin (Coumadin®) and notify them of any changes. Several prescription medicines and over-the-counter products can interact with Warfarin (Coumadin®), potentially affecting your INR and the way you clot
You may be wondering why diet would interact with your INR levels. Some foods, especially the dark green leafy vegetables (see below), are high in vitamin K. Vitamin K plays a key roll in the blood clotting process through a similar mechanism as the drug Warfarin (Coumadin®). You should not stop eating these foods since they are heart healthy and provide a good source of fiber and lutein. However, the recommendation is to be consistent with the intake of foods that are high in vitamin K. This means that you should eat small and similar amounts of dark green leafy vegetables each day. Avoid eating a lot of these vegetables one day and none the next day. If the intake of your vitamin K fluctuates, your INR levels will fluctuate as well.
Below you can find some examples of vegetables that are high and low in vitamin K.
Vegetables HIGH in Vitamin K
• Brussels sprouts
• Cauliflower (same family as broccoli)
• Greens (collard greens, turnip greens, mustard greens)
• Lettuce (except iceberg lettuce)
• Swiss chard
Vegetables LOW in Vitamin K
• Green beans
Other Products and Vitamins That May Interact With Warfarin (Coumadin®)
• Many nutritional supplements such as Boost®, Ensure®, and Carnation Instant Breakfast® contain vitamin K. If you are currently taking any of these supplements, just make sure you take them regularly and inform your healthcare provider to adjust your medication or supplements as needed based on your INR levels.
• Vitamin C: Doses above 500 mg per day may lower your INR level.
• Vitamin E: Doses above 400 IU per day may increase your INR level.
• Multivitamins: Most multivitamins have vitamin K. If you are already taking them, it is recommended that you take them every day to maintain your vitamin K levels consistent. Always check with your healthcare provider to maintain your optimal INR levels.
• Alcohol: Drinking more than 2 drinks per day may elevate your INR levels and put you at risk for bleeding. One serving size of an alcoholic beverage is considered 12 oz beer or wine cooler, 8 oz malt liquor, 5 oz wine, or 1.5 oz of 80 proof distilled spirits (gin, vodka, whiskey, etc). Contact your healthcare provider if you drink alcohol in excess.