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ICEDEMETER Posts: 1,332
8/22/13 11:09 A

With your original post saying that it seemed weird not to have veggies with every meal, and seemingly having an issue with not having a lot of variety with veggies, it seemed like you were looking for options to increase your veggie intake. One of the easiest options is to have them change the dosage to match the veggies that you want to eat. Since you choose not to do that, then you'll have to do a bit of work to figure out what you can or can not add.

Please refer to the listing here of what the Vitamin K levels are for various foods:

As you'll see, there are many veggies that are actually fairly low in Vitamin K that you could add for more variety in your diet: carrots, cauliflower, celery, leeks, onions, mushrooms, sweet peppers, squashes, sweet potatoes, and tomatoes are all examples.

You'll find that you can actually have a variation of approximately 250mcg each day and still be considered "consistent" for the purposes of warfarin dosage. In other words, your average day as shown above would be around 300mcg or so, so you could go up to 550mcg if you chose. This would allow you to add a huge amount of low Vitamin K veggies.

All of your meats and grains are low in Vitamin K as well, so you can add or delete those as you like. Since you don't want carbs, and don't want veggies --- well, I guess that leaves you with proteins (meat, eggs, cheese, milks, nuts, yogurts) to get your variety.

Sorry you didn't get the answer you were looking for.

Good luck!

8/22/13 7:52 A

If you have already used your moderate and high vitamin K veggies for meals earlier in the day; then use the low vitamin K foods for this other meal.

THEPIA Posts: 298
8/21/13 11:36 P

Thank you everyone for your advice. I have asked my doctor - she said to keep the amount of vitamin k consistent, as did the RD, as did everyone else I've spoken to. With my current dose of Coumadin I have been hitting 2.0 exactly so eating 2-3 cups per day is working. I guess I wasn't clear enough in my OP. Sorry.. I guess I am just wondering what kind of 'healthy' meals I can make that aren't too carb-heavy, are filling, and don't include vegetables.

RUSSELL_40 Posts: 16,826
8/21/13 4:58 P

I've been on Coumadin for over a year now, due to risk of stroke, from my A-fib. My INR has fluctuated from 1.6-2.5, but is almost always 2.2-2.4.

You are right that you need to keep vegetable levels the same, but it isn't that strict. Most of all watch out for leafy greens, and mayo. I eat 1 large salad a week if I want, but a lot of the time I will substitute tuna and mayo. the rest of the week I eat 6-10 servings of veggies that are not leafy greens. If you cut the amount of Vitamin K, they will reduce your dose of Coumadin.

Try to think of it as low, moderate, and high Vit. K servings. I avoid the high category except for the one serving a week, and then limit moderate , and eat mostly the low K foods. I may have 7 low K, then 2 moderate K, and on the one day I eat a high K serving, I will replace one of the 2 moderate ones with it. If I continue to eat 7 servings of low K vegetables, then what they are usually isn't enough of a variance to matter. When I get tripped up is when I forget to eat any Vit. K. Two days a week, they give me a 1/2 pill extra, so that I can indulge, and if I don't, my INR goes up to 3.0. If I eat 3 salads, it will drop to 1.7. All the tester wants is for you to stay at 2.5. My brother is all over the place, recently 5.6 , and was almost hospitalized for it, but mine is pretty consistent. I admit, I eat the same meals every day for a week, and then change it just a little to keep me sane, but it is a small change, like having peas, instead of onions.

Just keep your servings of low, moderate, and high K foods the same, and you will be able to vary some. If you don't want to eat 3 cups of greens a day, explain that to the person drawing your INR, and work up a plan to reduce your consumption of greens, and you may have to test more often, until you slowly drop down to the levels you want.

When I started, they just dosed me based on what I was already eating, so I did not have to make changes. I find it weird that they tried to set your Vitamin K consumption, and then set a dose of Coumadin. They are supposed to manage your INR level, not create it.

Get a level of vegetable intake where you are comfortable, and maintaining a stable INR should be easier.

ICEDEMETER Posts: 1,332
8/21/13 4:05 P

I'm on warfarin for at least the next few years, if not for the rest of my life. The trick is to work with your doctor to manage the dose around your lifestyle and diet, and not the other way around.

You might find it useful to take the "Vitamin K Points" idea from this attachment to discuss with your doctor:>

Using the "Points" makes it easy to have a much greater variety in your diet, without a lot of tedious calculations. Personally, I eat right at the top end of the points (usually 13-16 daily), and am on a high dose of warfarin because of that. I prefer the higher dosage so that I can eat the foods that I really like (I'm a veggie-holic), and my doc is perfectly fine with that.

Maybe sit down and figure out what would be an "ideal" week of menus for you, and see what the "points" would be for each day. Tweak if you need to so that you're at close to the same level every day. Then compare that to the "points" of what you are eating now.

Take that information in to your doctor, explain that you're feeling extremely limited at the level you're at now, and see if you can work with them for the next few weeks to change your diet and modify the warfarin dosage to suit how you want to eat. It'll mean more frequent blood tests for the next month or so, but they should be able to get your INR stabilized with you having a lot more freedom with your diet.

If you're going to be on warfarin for long-term, it might be worthwhile looking in to getting a home testing machine for your INR, and working with your doc to set up a system for you to test frequently and modify your dosages to suit your life.

Hope this helps!

LOVE4KITTIES Posts: 4,690
8/21/13 2:19 P

I think that seeing a dietitian once, before you left the hospital, probably wasn't enough and that you might want to contact your doctor's office and ask for a referral to a dietitian than you can see on a regular basis until you get the hang of things (and can continue to see periodically thereafter, as needed). I know you said the dietitian you saw in the hospital wasn't very helpful, but I think that maybe you should just think of her as someone who was there to give you a little starting-out information.

I think that, as a general rule, anyone who needs to see a registered dietitian definitely needs several appointments, at a minimum. When my husband was first diagnosed with diabetes, he had one appointment with a RD. I went with him and we both thought that it wasn't helpful. So, he didn't ask to go back. I think he should have because I always have felt that she would have given more help and more info specific to him if he'd had more appointments.

My doctor was talking with me about my weight during an appointment and he asked me if I wanted to see a RD. I said "sure." I'm SO glad I went. She helped me lose a lot of weight and the information and help she gave me were incredibly useful. I had regular appointments for about 10 months until I had to change insurance companies and couldn't see her anymore. So, I guess I'm saying is that I'd give it another try if you can and to set up regular appointments if at all possible.

Wish I could give you some specific advice about your meals, but, I just don't have any knowledge about food choices while on coumadin.

8/21/13 2:09 P

Usually one's coumadin amount is "adjusted" based on one's typical veggie intake. So I find it unusual that you were give coumadin and then told what to eat???

Also the company that makes coumadin has an excellent eduction brochure that lists low, moderate and high "vitamin K" foods and provides instruction on how to keep vitamin K intake consistent while using coumadin. Call your doctor and ask for more clarification. The staff should be able to provide the education/brochure/handout, etc. The company provides this literature free of charge.

Your SP Registered Dietitian

DIDS70 Posts: 5,368
8/21/13 1:33 P

My brother is on Coumadin for similar issues. he was in an extremely bad car accident and has pulmonary embolisms and blood clots in his calves. he chooses not to eat the dark green veggies-- no broccoli, no kale, no lettuce. his choice. I spoke to a nurse friend about the effects. She said it is completely possible to eat the dark green veggies as long as the coumadin dosage is being adjusted.

I am sure you know that already. She also recommended that my brother talk to an RD. they would be able to help determine how much and how to spread the food over the day, week, month.

BEARCLAW6 SparkPoints: (0)
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Posts: 1,939
8/21/13 1:23 P

First, ask your doctor this.

Second, there are plenty of resources on the internet that give amounts of vitamin k in various foods. My uneducated guess is that it doesn't really matter what you eat just as long as the total daily vitamin k amount fits in your prescribed range. Fit that into a healthy day of eating as best as you can. I am a firm believer that you should eat right for your coumadin level and worry about the details about nutrition second.

MEGAPEEJ Posts: 732
8/21/13 1:13 P

If you want to eat veggies throughout the day, could you maybe only do 1.5 or 2 cups of salad greens at lunch, or maybe do a side salad instead of it being the main course? That could free you up for maybe doing some swiss chard with dinner, or giving you some room to play with veggies in other meals.

Of course, if you want to eat all your leafy greens at lunch (and there's nothing wrong with that!) you could keep your basic format for dinner of having a pasta or rice dish with a serving of protein. When I do pasta I like to mix it with tomato, avocado, herbs, a little bit of spinach, and a little olive oil - and you can mix your meat right in there too.

Hopefully that helps a bit - without knowing your specific needs I don't want to go too crazy with suggestions! Good luck!

THEPIA Posts: 298
8/21/13 1:05 P

I have checked out the message boards and haven't found anything helpful yet.. so here goes...

I am 24 and on blood thinners. I am taking Coumadin because my lungs were filled with clots. It was traumatic to say the least. I am having a very hard time adjusting to life on blood thinners. My doctor does not want me to do my usual exercise (running at night with the dog - understandable, I can't see very well and I do risk a fall). I am also having a very hard time watching what I eat while maintaining my INR level. I have to eat the SAME amount of veggies each day. Doesn't seem too hard, but I tend to go overboard some days. I do love veggies and have done really well with healthy eating lately.

Yes, there is a question in all of that..

I need to eat 2-3 cups of dark leafy veggies each day to meet my vitamin k requirement for my current Coumadin dose. I usually will have a salad as a meal each day. This is fine, I LOVE salad.. but then I am lost as far as what to eat the rest of the day. Usually I would have chicken breast or fish and steamed veggies. I can't do this unless I either have a smaller salad, which wouldn't keep me full, or I do not have a salad in which case I would need to make up the 2-3 cups of veggies during the day.. that's a lot of veggies.. Do you guys have any suggestions on healthy eating without vegetables for my other meals throughout the day? It feels weird to not eat vegetables with each meal.

Here is a general idea of what I normally would eat:

1 banana
1 container chobani yogurt
1/2-2/3 cup berries (frozen or fresh)
1 cup apple juice
That all goes in a blender and I have a great breakfast

3 cups romaine lettuce
1 chicken thigh
1/4 cup parmesan cheese
2-4 tbsp. light Caesar dressing

Taco soup (3 kinds of beans, chicken broth, corn, and taco seasoning.. YUM)
Pasta (whole wheat pasta, ground turkey, and sauce)

As you can see this can get a little boring. It has been two weeks of eating this. I do try and mix things up a bit, but I don't have a lot of freedom with my vegetable requirements.

*I have spoken with a dietician before I left the hospital. She was not much help. I also have spoken with two of my family members that are on the same medication for advice*

Sorry for the long post, but you guys have really good advice and I am just needing some new ideas.

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