Marshall Lev Dermer
Because I have atrial fibrillation, I take Warfarin so my blood coagulation rate is between 2.0 (slower) and 3.0 (faster) on the INR scale. To remain in range, I daily balance my doctor-prescribed dose of Warfarin with my Vitamin K consumption. Vitamin K control is critical because Vitamin K reduces the effectiveness of Warfarin.
Daily, I consume about 150 micrograms of Vitamin K from salads, asparagus, avocados, prunes, kiwis, a multiple vitamin, etc. How do I know?
First, I read labels. In particular, my multivitamin includes about 25 micrograms of Vitamin K. For other sources, I found an app that accesses the Food and Nutrient Database of the USDA. As I have an Android smartphone, I have been using “Nutrition Facts.” Otherwise, you can access the database here.
If I wonder about the values that I see for a particular food, I will compare the values for the raw and frozen food as apparently freezing does not much affect Vitamin K. Or I might find another source for the value on the WWW, but it is possible that the other value also came from the USDA database!
Besides food, drugs and herbs also affect INR values. So, I consult with my physician about these. When in doubt my physician asks me to consume the new addition for three days and then have my INR assessed. BTW, this is what occurred for brewed oolong tea, my favorite tea. The brewed tea did not affect my INR scores. Worth noting, the USDA database reports that neither brewed oolong nor brewed black tea contain Vitamin K.
Besides the biomedical aspects of managing Warfarin there are social medical aspects. About a year ago, my wonderful family physician left to practice medicine closer to home and I wanted to somewhat increase my consumption of lettuce. But, my new, highly recommended physician was uncomfortable prescribing Warfarin with variable dosing. Specifically, I wanted the dose to be 2 mg for Monday and Thursday and 1.5 mg for the other days of the week.
She insisted on prescribing a constant dose of 2 mg daily despite my showing her articles from referred journals that included variable dosing. Bottom line, if I were to take 2 mg daily my consumption of Vitamin K would have to dramatically increase.
What did I do? I asked my physician if I could have a hematologist prescribe Warfarin and monitor my INR values. My physician agreed and I think the hematologist (also an oncologist) was happy to see me, as my problem, so far, is only atrial fibrillation!
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