Did you know some doctors tell their patients not to eat vegetables? It's true! Of course, they don't tell all of their patients to avoid them - just the ones who are on blood thinners, such as coumadin.

Unfortunately, these doctors have a good reason for giving this advice (at least in theory). Your liver makes clotting proteins. This requires vitamin K. Coumadin blocks vitamin K's action by competing with its liver-binding sites. Theoretically, more vitamin K could make coumadin less effective.

And coumadin already has a very narrow margin of safety. We know that coumadin users must get regular tests to assess blood thinness. If your blood is too thin, your risk of bleeding and stroke go way up. If too thick, it increases your risk for life-threatening blood clots. So doctors said it was better to be safe and avoid vitamin K-rich foods.

In spite of their reasoning, I've never liked this advice. It robs you of all the great nutrients in the vegetables. Plus I've never been a fan of blood thinners. For those on blood thinners, though, it may have been necessary.

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But now there's something you can take that will allow you to eat veggies - and get all the other great nutrients they contain. A new study shows that vitamin K supplements actually stabilize the effect of coumadin - and make it safe for you to eat veggies.

In this study, researchers chose 200 patients with a genetic risk of clotting. They placed all of the patients on coumadin. Then they randomized half to receive either supplemental vitamin K (100 mcg) or a placebo. The study lasted 24 weeks. That's plenty of time to assess the effects.

The goal of blood thinning drugs is to get the INR (International Normalized Ratio) test into the "therapeutic" range. Therapeutic range minimizes risk, while maximizing effectiveness. Doctors were always afraid the vitamin K would take users outside of this range. But this study found just the opposite. They discovered that those in the supplemental K group were in the range 89.5% of the time. But those in the placebo group were in it less often - 85.5%.

The authors of this study said vitamin K improves the stability of coumadin. They also said, "The improvement is likely to reduce the number of bleeding and thrombotic events."

Here's why the vitamin K works. If you have only a small amount of competing compounds, a slight difference in the availability of one might dramatically throw one out of kilter. So if you don't have much vitamin K in your system to start with, the small amount of vitamin K in your veggies might throw your coumadin effects off balance very easily.

However, if you boost the amount of vitamin K in your system first, and then balance your system with the right dose of coumadin, the balance will be far more stable. And the small amount of vitamin K in your veggies will have an almost insignificant effect.

So, if you must go on coumadin, here's what you need to do: Take supplemental vitamin K (100 mcg daily). Then get stabilized on the therapeutic dose of coumadin. Once you do that, should you eat kale or other "forbidden" veggies, the effect on your INR should be minimal. You don't have to sacrifice all the other priceless nutrients in the veggies simply because you're on coumadin.




Ref: "Daily vitamin K supplementation improves anticoagulant stability," Rombouts EK, van der Meer FJ, et al, J Thromb Haemost, 2007; 5(10): 2043-8.
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