SAMMC Departments: Coumadin - Dietary Considerations

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Coumadin

Dietary Considerations in Coumadin® Patients

Coumadin® acts by impairing the utilization of Vitamin K. The liver requires Vitamin K for the manufacturing of certain key proteins in the native clotting mechanism. When Vitamin K is not made available, these clotting factors are not manufactured, and blood clotting is impaired. At the same time, oral intake of Vitamin K will thus counteract the medicinal purpose of Coumadin®, essentially acting as the antidote for Coumadin®. Sudden intake of large amounts of Vitamin K can diminish the effect of Coumadin®, permitting the blood to clot. Some physicians place Coumadin® patients on strict Low-Vitamin-K diets. Foods that are high in Vitamin K are discouraged. However, dietary restrictions rarely succeed over a long period of time. Most patients return to eating their favorite foods, gradually at first. Thus the more prudent approach for Coumadin® maintenance is to adjust the medication, not the diet. That is one of the very reasons for repeating the Pro-Time until a steady dose is found that provides the right anticoagulation regardless of the dietary intake of the patient. For your information, the following lists presents foods known to be high in Vitamin K:

Kale
Spinach
Broccoli
Turnip greens
Cauliflower
Chick peas
Brussels sprouts
Green tea
Beef, pork, or chicken livers
Soybean oil
Soy protein products (including tofu)
Vitamins A & E (large doses)

If your regular diet already contains these food items, Don't Change Your Eating Habits. Consistency in your daily eating pattern is the key. If you move to a new climate, or change your eating habits for any other reason, a new series of Pro-Times will be needed to make certain that your Coumadin® requirement has not changed. However, even if it has changed, the best option is to change the dose which you take.

Disclaimer: The information provided in this educational forum is solely for your information, and is not intended to replace actual recommendations or advice given by your treating physician.

Your Diet & Vitamin K

Rationale: Why do I need to pay attention to my diet while I am on Coumadin®?
1. Coumadin works to keep your blood from clotting by decreasing the availability of vitamin K. Vitamin K helps your blood to clot. These are opposing actions.
2. Excessive vitamin K intake can interfere with the Coumadin® and allow your blood to remain susceptible to clots. Likewise, if you eat too little vitamin K, the excess medication may cause your blood to become too thin.
3. Your medication will be adjusted to the amount of vitamin K typically in your diet. If you suddenly increase or decrease the amount of vitamin K in your diet, your medication will not work properly.
What is the best diet to follow while I am on Coumadin®?
1. A healthy, low fat diet following the Food Guide Pyramid is the best diet to follow.
2. It is important for you to keep the vitamin K content of your diet consistent. The amount of vitamin K you eat affects the amount of Coumadin® you require.
3. Be sure to tell your healthcare provider if you change your diet. The medication will need to be adjusted to the amount of vitamin K in your diet.
Does this mean I should avoid foods with a lot of vitamin K?
Absolutely not! Some foods that are high in vitamin K (i.e. leafy, green vegetables, broccoli, and cauliflower) can contribute to a healthy diet. Your efforts should be focused on keeping your intake of vitamin K consistent from day to day. The first step is to evaluate your typical intake of vitamin K foods by reviewing the food list in this packet.
Does cooking, freezing, or drying foods change how much vitamin K is in them?
Although there is little information about the effects of cooking, freezing, or drying on the vitamin K content of foods, it appears that the vitamin K content of cooked, frozen, or dried foods is about the same as fresh foods.
What to do from here.
Evaluate your typical vitamin K intake by reviewing the food list provided. The list contains foods that are known to be high in vitamin K, as well as a few others that are not very high, but are often asked about by Coumadin® patients. If you do not see a particular food on the list, it most likely contains very little vitamin K, however, be sure to ask you dietitian about the food if you are concerned.
Using the Vitamin K food list:
1. First, review the list to find foods that you are presently eating. Each list is identical. The first organizes foods from the highest vitamin K content to lowest, while the second is in alphabetical order. Observe the amount of vitamin K contained in the foods you eat. If you typically eat a larger portion than what is listed, be sure to increase the vitamin K value proportionally. (i.e. there is 40ug of vitamin K in ½ cup of lettuce, but you eat 2 cups worth in your salad, so you would actually have 160ug of vitamin K in total). Add up the total amount of vitamin K that you typically consume in a day. Whatever it may be, 100, 200, 300, 400ug, etc., your job is to keep this daily intake as consistent as possible. By selecting combinations of foods, and/or adjusting portion sizes you should be able to consume about the same amount of vitamin K each day.
2. If you should ever decide to dramatically change your typical daily intake of vitamin K, be sure to inform your Doctor or pharmacist BEFORE making the change. They will most likely need to adjust your Coumadin® dosage.
  
  CAUTION -:the following should be taken only with your physician’s approval, because they also thin your blood, thus increasing the effect of your medication: alcohol, garlic pills, fish oil capsules, vitamin E.
  
  * Vitamin K tablets can also interfere with your Coumadin® medication. Be sure to get your physician’s approval, if you take vitamin K tablets or a multi-vitamin pill with vitamin K included.
  
  If you should have any additional questions or concerns regarding your daily intake of vitamin K, please contact a dietitian at phone number (210) 292-7587 or 7472.

Highest to lowest vitamin K content
Food Item	Portion Size	Vit. K Content (ug)
Seaweed (Nori)	2 sheets (shredded)	511
Turnip greens	½ cup	470
Collard greens	½ cup	440
Spinach	½ cup	360
Brussels sprouts	½ cup	289
Kale	½ cup	270
Swiss chard	½ cup	249
Green tea	1 oz (leaves) **	199
Parsley	½ cup	162
Green scallion	½ cup	155
Broccoli	½ cup	113
Cauliflower	½ cup	96
Cabbage	½ cup	80-100
Liver (beef, pork, chicken)	3.5 oz	80-100
Soybean oil	1 Tbsp	76
Endive	½ cup	69
Avocado	½ cup	57
Coriander	½ cup	52
Asparagus	½ cup	51
Mustard greens	½ cup	51
Green tomato	½ cup	50
Watercress	½ cup	42
Artichoke	½ cup	42
Lettuce	½ cup	40
Okra	½ cup	40
Soybeans	½ cup	34
Green beans	½ cup	33
Nettle leaves	½ cup	31
Red tomato	½ cup	25
Garbanzo beans	½ cup	22
Green peas	½ cup	22
Alfalfa sprouts	½ cup	16
Celery	½ cup	16
Cucumber (sliced with peel)	½ cup	6
Green pepper	½ cup	5
Tofu	½ cup	2.5
Lima beans	½ cup	2

Vitamin K content by Food Item
Food Item	Portion Size	Vit. K Content (ug)
Alfalfa sprouts	½ cup	16
Artichoke	½ cup	42
Asparagus	½ cup	51
Avocado	½ cup	57
Broccoli	½ cup	113
Brussels sprouts	½ cup	289
Cabbage	½ cup	80-100
Cauliflower	½ cup	96
Celery	½ cup	16
Collard greens	½ cup	440
Coriander	½ cup	52
Cucumber (sliced with peel)	½ cup	6
Endive	½ cup	69
Garbanzo beans	½ cup	22
Green beans	½ cup	33
Green peas	½ cup	22
Green pepper	½ cup	5
Green scallion	½ cup	155
Green tea	1 oz (leaves)**	199
Green tomato	½ cup	50
Kale	½ cup	270
Lettuce	½ cup	40
Lima beans	½ cup	2
Liver (beef, pork, chicken)	3.5 oz	80-100
Mustard greens	½ cup	51
Nettle leaves	½ cup	31
Okra	½ cup	40
Parsley	½ cup	162
Red tomato	½ cup	25
Seaweed (Nori)	2 sheets (shredded)	511
Soybean oil	1 Tbsp	76
Soybeans	½ cup	34
Spinach	½ cup	360
Swiss chard	½ cup	249
Tofu	½ cup	2.5
Turnip greens	½ cup	470
Watercress	½ cup	42

Ensure 8 oz can 18

** Current analytical findings indicate that the brew form green tea leaves has negligible vitamin K content.

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