Eating well with warfarin

Size: px

Start display at page:

Download "Eating well with warfarin"

Melinda Dennis
6 years ago
Views:

1 Eating well with warfarin A

B Introduction H ave you recently started taking anti-coagulation or anti-clotting medication? Are you confused about how to eat well while on warfarin?

In this booklet you will find the latest evidence-based nutrition advice, plus important tips, tables and hints to help you get the most from your warfarin therapy.

Read the information on eating well with warfarin carefully, along with any other advice on taking warfarin.

2 B Introduction H ave you recently started taking anti-coagulation or anti-clotting medication? Are you confused about how to eat well while on warfarin? Or has it been a long time since you had an update on the latest dietary advice? If so, this booklet is perfect for you. In this booklet you will find the latest evidence-based nutrition advice, plus important tips, tables and hints to help you get the most from your warfarin therapy. Getting started on warfarin can be a little overwhelming at first, but rest assured we are here to help. Read the information on eating well with warfarin carefully, along with any other advice on taking warfarin. Use this booklet to record your diet and then discuss any questions with your doctor. I would like to acknowledge my colleagues and fellow dieticians Virginia Fazio APD and Emma Stirling APD for their professional expertise and valuable contribution to the researching and writing of this book which we hope will help you enjoy a more interesting and nutritious diet while taking warfarin. Karen Inge APD FSDA Consultant Dietician

3 Contents 1 Why do I need to look closely at what I eat? 2 Where can I find foods containing vitamin K? 3 Keeping vitamin K levels steady 4 How to follow the vitamin K exchanges system 5 The Vitamin K ready reckoner 7 Mix & match meal ideas 8 Sample meal plans 9 Food tracker diary 12 References 3

4 2 Why do I need to look closely at what I eat? It s common for medications and food to interact when taken together. While some of these interactions may be minor, it is still important to understand which foods may alter the effectiveness of your medication. Warfarin interacts with an essential nutrient in the food we eat every day, vitamin K. It is very important to plan, monitor and balance the amount of vitamin K you eat to make sure it has minimal impact on your warfarin therapy. How do you know if warfarin is working? The only way your doctor can tell if your warfarin is working safely and effectively is by a blood test called the International Normalised Ratio or INR. In the early days of taking warfarin you will likely have this test every few days, then weekly or perhaps monthly as your dose is adjusted to achieve the right balance between bleeding and clotting, known as the target INR range. When you first start taking warfarin, your job is to carefully plan and record what you eat and drink, particularly foods containing vitamin K and alcohol. There is one key rule to follow when eating well with warfarin, according to the latest evidence-based nutrition advice: Keep your intake of vitamin K containing foods steady and balanced. Remember, if your vitamin K intake is out of balance, your INR may be out of balance too. Through this booklet you will learn how to track and adjust your vitamin K intake. It s important to realise that reducing your intake of vitamin K foods is definitely not the message. If you have heard this in the past, it is now outdated advice. In fact, going too low on intake of vitamin K may cause more problems with your INR balancing act, as a certain amount of vitamin K is required for steady clotting and stable control of anticoagulation. 1-9

You ll find a handy vitamin K ready reckoner and a food tracker diary in this booklet.

3 You should always tell your doctor about changes to your health and other medications you may be taking, including

Where can I find foods containing vitamin K?

broccoli, chinese cabbage, parsley and certain lettuces.

Use the vitamin K ready reckoner on page 7 as your daily guide to the vitamin K content of common foods.

The foods are ranked from the highest source of vitamin K (6 exchanges) to the lowest source (1 exchange).

5 You ll find a handy vitamin K ready reckoner and a food tracker diary in this booklet. Learning about dietary sources of vitamin K and a way to balance your intake is vital to ensure your warfarin works properly. If your vitamin K intake is out of balance, your INR may be out of balance too and your warfarin may not work effectively. 3 You should always tell your doctor about changes to your health and other medications you may be taking, including herbal supplements. Based on this information your doctor may adjust your warfarin dose to find the right balance for you. Where can I find foods containing vitamin K? The richest dietary sources of vitamin K are dark, green leafy vegetables such as spinach, silver beet, brussels sprouts, broccoli, chinese cabbage, parsley and certain lettuces. Generally, the greener the vegetable, the higher the vitamin K content. Use the vitamin K ready reckoner on page 7 as your daily guide to the vitamin K content of common foods. We have included the serve size, amount of vitamin K and a handy exchanges system. The foods are ranked from the highest source of vitamin K (6 exchanges) to the lowest source (1 exchange). Remember, not all green fruits and vegetables are rich in vitamin K. For example, cucumber, avocado and capsicum in serves of half a cup or less are low in vitamin K. If you have a favourite dark, green plant-based food not on this list, talk to your doctor or an accredited practising dietitian to find out how much vitamin K it contains. DID YOU KNOW? It s a common myth that people taking warfarin should cut down on vitamin K foods. In fact, greater body stores of vitamin K allow for steady clotting and stable control of anticoagulation. 1

6 4 Keeping vitamin K levels steady Keeping your vitamin K levels steady and helping your warfarin work effectively means: Enjoying a variety of food while tracking consistent vitamin K intakes. Planning your meals and snacks to ensure balanced intakes of vitamin K exchanges each day. Avoiding fasting, fad or crash diets, which cut out foods or focus on large amounts of one food, like a juicing regimen. There have been reports of changes in INR when people have consumed very large amounts of avocados, mangos, soy drink, green tea, or cranberry or grapefruit juice Moderating your alcohol intake within recommended limits of 1 2 standard drinks per day. Alcohol can affect blood clotting when consumed in large amounts. A standard drink is 1 ml of wine, 285 ml of standard beer or 3 ml of spirits. Adjusting your set vitamin K intake from your usual pattern, in consultation with your doctor. You may like to do this if, for example, you re planning an extended holiday in Asia and will be eating more stir-fries and dishes with Asian greens. Talking to your doctor about any digestive issues, such as constipation or diarrhoea, because a healthy gut also makes a form of vitamin K (vitamin K2 or menaquinones). Always inform your doctor or healthcare professional that you are taking warfarin, including visits to the dentist or hospital. Alerting your doctor to any other medications, vitamin or herbal supplements you are taking, including fish or krill oils, Chinese herbs, coenzyme-q, ginkgo biloba, ginseng, turmeric, willowbark, wheatgrass, garlic or red clover. Talking to your doctor about taking vitamin K supplements. If you take a multivitamin which includes vitamin K, ensure that you take it consistently every day. Avoiding large doses of vitamins A, C and E as these can affect blood clotting. In general, avoid supplements which contain more than 1, IU of vitamin A, 1, mg of vitamin C or 4 IU of vitamin E.

7 How to follow the vitamin K exchanges system 5 You can select any number of exchanges you like to eat each day but the key issue is to be consistent. Try to eat around the same number of vitamin K exchanges every day. However, it is recommended you eat at least 2 micrograms (mcg) per day, which is approximately 4 exchanges. Why? Because people with a low daily vitamin K intake are more likely to have variations in their INR. 2 Talk to your doctor if you typically have a very low intake of, or dislike, these foods. You may be advised to take a low level vitamin K supplement each day, instead. Step 1: Work out your daily intake of vitamin K Look at the vitamin K ready reckoner table (see page 7). Highlight the foods you like. Work out the amount or number of exchanges of vitamin K you usually eat each day (minimum 2 micrograms or 4 exchanges). Step 2: Keep the number of exchanges steady and balanced Track all the foods and drinks you have each day using the food tracker diary (starts on page 14). Keep doing this until you feel confident of the amount of vitamin K in certain foods and your doctor is happy that you are achieving a steady INR. Go back to tracking if your INR levels become unstable.

6 It is important to be consistent with your daily intake of vitamin K or number of exchanges. Some variation is acceptable but try not to vary up or down by more than one exchange on any day.

8 6 It is important to be consistent with your daily intake of vitamin K or number of exchanges. Some variation is acceptable but try not to vary up or down by more than one exchange on any day. For example: if your usual intake is 2 mcg of vitamin K per day, which is equal to four exchanges, it would be acceptable to vary your exchanges by one, i.e. you could have three exchanges (15 mcg) or five exchanges (25 mcg) in a day as an occasional change. If you start to regularly eat more or less vitamin K then your doctor may need to alter your warfarin dose. The Australian Guide to Healthy Eating recommends 5 to 7 serves of vegetables per day for adults. 15,16 Count your vitamin K vegetables towards your daily tally, as well as any other favourite vegetables like pumpkin, cauliflower, carrots and tomatoes as you desire. Remember, not all green fruit and vegetables are rich in vitamin K. SPECIAL OFFER: To assist you with monitoring your INR, check out the special offer on page 31.

9 Vitamin K ready reckoner 7 Make sure you use household measuring cups to calculate your serving sizes, as guessing the quantities could affect your vitamin K intake. Vit. K Vit. K Food Serve (mcg) Exch Silver beet raw 1 cup Silver beet cooked ½ cup Kale cooked ¼ cup Turnip greens cooked ½ cup Parsley raw ¼ cup Spinach cooked ¼ cup Collards cooked ¼ cup 29 4 Mustard greens raw 1 cup Asian greens raw ½ cup 12 2 Endive raw 1 cup Broccoli cooked ½ cup 11 2 Brussels sprouts cooked ½ cup 19 2 Broccoli raw 1 cup 89 2 Cabbage cooked ½ cup 82 2 Spinach raw ½ cup 72 1 Dark green leaf lettuce 1 cup 71 1 Green peas 1 cup 63 1 Chinese cabbage* cooked 1 cup 57 1 Cos lettuce raw 1 cup 57 1 Green beans 1 cup 53 1 Spring onions raw ¼ cup 5 1 Asparagus spears Sprouted mung beans 1 cup 34 1 Okra ½ cup 32 1 Avocado chopped 1½ cups 32 1 Sauerkraut ½ cup 31 1 Celery raw, chopped 1½ cups 3 1 Mark out the foods you like by highlighting the bullet points in the table. *Pak-choi

10 8 Mix & match meal ideas Take a look at our breakfast, lunch and dinner ideas to get an idea of how to track your vitamin K exchanges. Remember, learning about dietary sources of vitamin K and balancing your intake is important to help optimise warfarin therapy. Breakfast ideas Vitamin K exchanges shown [in brackets] Oat porridge, stewed apple, cinnamon and reduced fat milk Poached egg on wholegrain toast, ¼ cup sautéed spinach [5], grilled tomato Omelette with mushroom, 4 spears asparagus [1], reduced fat tasty cheese, ¼ cup parsley [5], wholemeal crumpet Lunch ideas Vitamin K exchanges shown [in brackets] 1 cup mixed green salad [1], tuna in brine, cherry tomatoes, canned chickpeas and light vinaigrette dressing Vegetable minestrone soup with ½ cup savoy cabbage [2] and wholemeal penne pasta Egg, beetroot and 1 cup cos lettuce [1] in a wholemeal tortilla wrap Dinner ideas Vitamin K exchanges shown [in brackets] Grilled fillet steak, steamed new potatoes, honey carrots and 1 cup steamed broccoli [4] Herb and garlic roast chicken, baked pumpkin and ½ cup steamed brussels sprouts [2] Stir-fried honey, soy and ginger pork, with red capsicum, carrot, ¼ cup spring onions [1] and ½ cup pak-choi cabbage [2], served with hokkien noodles Total Vitamin K Exchanges 5 6 Total Vitamin K Exchanges Total Vitamin K Exchanges 4 2 3

Sample meal plans* 9 1 High vitamin K intake. If you are aiming for a high vitamin K intake (approximately 65 7 mcg vitamin K per day): approximately 14 exchanges per day.

Wholegrain bread ½ cup tuna Banana 1 1 Dinner Steak Steamed new potatoes Carrots ½ cup cooked broccoli Yoghurt & fruit 2 Total vitamin K mcg for day EXCHANGES 14 * Note: These sample meal plans have

11 Sample meal plans* 9 1 High vitamin K intake. If you are aiming for a high vitamin K intake (approximately 65 7 mcg vitamin K per day): approximately 14 exchanges per day. Sample meal plan: High vitamin K intake Vitamin K mcg Exchange Breakfast ½ cup spinach, cooked 2 poached eggs Hollandaise sauce Toast Cup of tea 1 Lunch 1 cup mixed salad greens 4 spears asparagus Wholegrain bread ½ cup tuna Banana 1 1 Dinner Steak Steamed new potatoes Carrots ½ cup cooked broccoli Yoghurt & fruit 2 Total vitamin K mcg for day EXCHANGES 14 * Note: These sample meal plans have not been designed to meet Australian Recommended Daily Intake (RDI) guidelines for nutrients. They are supplied purely to illustrate a range of levels of vitamin K intake. 1 cup of green peas equals 1 exchange A quarter cup of raw parsley equals 5 exchanges

1 Sample meal plans* 2 Moderate vitamin K intake. If you are aiming for a moderate vitamin K intake (approximately 3 mcg vitamin K per day): approximately 6 exchanges per day.

12 1 Sample meal plans* 2 Moderate vitamin K intake. If you are aiming for a moderate vitamin K intake (approximately 3 mcg vitamin K per day): approximately 6 exchanges per day. Sample meal plan: Moderate vitamin K intake Vitamin K mcg Exchange Breakfast Cereal & milk Stewed fruit Toast Cup of tea Lunch 1 cup mixed salad greens Wholegrain bread ½ cup tuna Banana 1 Dinner Steak Steamed new potatoes Carrots ¼ cup cooked spinach Yoghurt & fruit 5 Total vitamin K mcg for day EXCHANGES 6 * Note: These sample meal plans have not been designed to meet Australian Recommended Daily Intake (RDI) guidelines for nutrients. They are supplied purely to illustrate a range of levels of vitamin K intake. Half a cup of cooked broccoli equals 2 exchanges 1 cup of green beans equals 1 exchange

13 Sample meal plans* 11 3 Low vitamin K intake. This sample meal plan shows a vitamin K intake below the recommended minimum level of 2 mcg (approximately 4 exchanges) per day. You should discuss this with your doctor as you may need to take a vitamin K supplement. Sample meal plan: Low vitamin K intake Vitamin K mcg Exchange Breakfast Cereal & milk Stewed fruit Toast Cup of tea Lunch Ham, cheese & salad sandwich Banana.5 Dinner Steak Steamed new potatoes Carrots ½ cup peas Yoghurt & fruit.5 Total vitamin K mcg for day EXCHANGES 1 * Note: These sample meal plans have not been designed to meet Australian Recommended Daily Intake (RDI) guidelines for nutrients. They are supplied purely to illustrate a range of levels of vitamin K intake.

12 Food tracker diary You can track your daily food intake and vitamin K exchanges in the food tracker diary provided. Take along this booklet when you next see your doctor.

14 12 Food tracker diary You can track your daily food intake and vitamin K exchanges in the food tracker diary provided. Take along this booklet when you next see your doctor. Don t worry if it seems a little tricky at first you ll soon get the hang of eating well while on warfarin. Once your INR levels are within your target range, you will not need to track and record every day. Very soon, eating well with warfarin will become second nature and you will be free to focus on getting the most out of your healthy lifestyle.

15 Sample diary page 13 Sunday 12 June DINNER LUNCH BREAKFAST Foods Cereal Stewed fruit Toast Cup of tea 1 cup mixed salad greens ½ cup tuna 1 banana Steak Steamed new potatoes Carrots ¼ cup cooked spinach 1 scoop ice cream Exch

16 14 Food tracker diary Foods Exch. Foods Exch. DINNER LUNCH BREAKFAST

17 Food tracker diary 15 Foods Exch. Foods Exch. BREAKFAST LUNCH DINNER

18 16 Food tracker diary Foods Exch. Foods Exch. DINNER LUNCH BREAKFAST

19 Food tracker diary 17 Foods Exch. Foods Exch. BREAKFAST LUNCH DINNER

20 18 Food tracker diary Foods Exch. Foods Exch. DINNER LUNCH BREAKFAST

21 Food tracker diary 19 Foods Exch. Foods Exch. BREAKFAST LUNCH DINNER

22 2 Food tracker diary Foods Exch. Foods Exch. DINNER LUNCH BREAKFAST

23 Food tracker diary 21 Foods Exch. Foods Exch. BREAKFAST LUNCH DINNER

24 22 Food tracker diary Foods Exch. Foods Exch. DINNER LUNCH BREAKFAST

25 Food tracker diary 23 Foods Exch. Foods Exch. BREAKFAST LUNCH DINNER

26 24 Food tracker diary Foods Exch. Foods Exch. DINNER LUNCH BREAKFAST

27 Food tracker diary 25 Foods Exch. Foods Exch. BREAKFAST LUNCH DINNER

28 26 Food tracker diary Foods Exch. Foods Exch. DINNER LUNCH BREAKFAST

29 Food tracker diary 27 Foods Exch. Foods Exch. BREAKFAST LUNCH DINNER

30 28 Food tracker diary Foods Exch. Foods Exch. DINNER LUNCH BREAKFAST

31 Food tracker diary 29 Foods Exch. Foods Exch. BREAKFAST LUNCH DINNER

32 3 References 1. de Assis MC, Rabelo ER, Ávila CW, Polanczyk CA, Rohde LE. Improved oral anticoagulation after a dietary vitamin K-guided strategy. Circulation 29;12: Rombouts EK, Rosendaal FR, Van Der Meer FJM. Influence of dietary vitamin K intake on subtherapeutic oral anticoagulant therapy. British Journal of Haematology 21;149: Review of Anticoagulation Therapies in Atrial Fibrillation. 3. Khan T, Wynne H, Wood P, et al. Dietary vitamin K influences intraindividual variability in anticoagulant response to warfarin. British Journal of Haematology 24;124: Franco V, Polanczyk CA, Clausell N, Rohde LE. Role of dietary vitamin K intake in chronic oral anticoagulation: prospective evidence from observational and randomized protocols. The American Journal of Medicine 24;116: Lurie Y, Loebstein R, Kurnik D, Almog S, Halkin H. Warfarin and vitamin K intake in the era of pharmacogenetics. British Journal of Clinical Pharmacology 21;7: Sconce E, Khan T, Mason J, Noble F, Wynne H, Kamali F. Patients with unstable control have a poorer dietary intake of vitamin K compared to patients with stable control of anticoagulation. Thromb Haemost. 25 May;93(5): Sconce E, Avery P, Wynne H, Kamali F. Vitamin K supplementation can improve stability of anticoagulation for patients with unexplained variability in response to warfarin. Blood. 27 Mar 15;19(6): Epub 26 Nov Holmes MV, Hunt BJ, Shearer MJ The role of dietary vitamin K in the management of oral vitamin K antagonists. Blood Rev. 212 Jan;26(1): Epub 211 Sep Kim KH, Choi WS, Lee JH, Lee H, Yang DH, Chae SC. Relationship between dietary vitamin K intake and the stability of anticoagulation effect in patients taking long-term warfarin. Thromb Haemost. 21 Oct;14(4): Epub 21 Jul Issues and Options Paper: Review of Anticoagulation Therapies in Atrial Fibrillation. Australian Government Department of Health and Ageing Hamann GL, Campbell JD, George CM. Warfarin-Cranberry Juice Interaction. Ann Pharmacother 211; 45:e Aston JL, Lodolce AE, Shapiro NL. Interaction between warfarin and cranberry juice. Pharmacotherapy 26; 26: Schwartz A&M. Am J Health Syst Pharm 27; 64 (5): Chan HT, So LT, Li SW, Siu CW, Lau CP, Tse HF. Effect of herbal consumption on time in therapeutic range of warfarin therapy in patients with atrial fibrillation. J Cardiovasc Pharmacol. 211 Jul;58(1): The Australian Guide to Healthy Eating. au/internet/main/publishing.nsf/content/e384cfa588b74377 CA256F19459B/$File/fd-cons.pdf 16. A modelling system to inform the revision of the Australian Guide to Healthy Eating. DAA default/files/files/public_consultation/n55a_dietary_guidelines_food_ modelling_ pdf 17. Sarah L. Booth. Vitamin K: food composition and dietary intakes Food Nutr Res. 212; 56: 1.342/fnr.v56i USDA National Nutrient Database for Standard Reference, (23) Release 25. Content of Selected Foods per Common Measure, Vitamin K (phylloquinone) sorted by nutrient content. Accessed 17 August sr25w43.pdf Accessed 12 November 212.

Compliance and effective monitoring... 31 Purchase a CoaguChek XS from your pharmacy and receive a complimentary box of test strips from Roche Diagnostics Australia.

rebatable by some Health Funds The obvious choice is partnering Warfarin & CoaguChek XS for improved compliance To redeem your complimentary box of CoaguChek XS test strips: Simply tear

Australia Name: Address: OFFER IS VALID UNTIL 3 JULY 216 City Postcode: Phone no. Pharmacy of Purchase: Signature: Serial No.

By providing your information, you agree to RDA contacting you for direct marketing and research purposes by RDA for an indefinite period.

33 Compliance and effective monitoring Purchase a CoaguChek XS from your pharmacy and receive a complimentary box of test strips from Roche Diagnostics Australia. CoaguChek XS* includes CoaguChek XS, carry case and CoaguChek XS Softclix lancet CoaguChek XS 6 PT Strips 6 INR finger prick testing with results in 1 minute *The CoaguChek XS may be rebatable by some Health Funds The obvious choice is partnering Warfarin & CoaguChek XS for improved compliance To redeem your complimentary box of CoaguChek XS test strips: Simply tear off this coupon, fill in the information below, attach this original coupon with your CoaguChek XS warranty card, a copy of your receipt of purchase and mail to Roche Diagnostics Australia Name: Address: OFFER IS VALID UNTIL 3 JULY 216 City Postcode: Phone no. Pharmacy of Purchase: Signature: Serial No. UP: PRIVACY STATEMENT: Roche Diagnostics Australia (RDA) guarantees that the information collected by this form is confidential and will not be disclosed to other parties. By providing your information, you agree to RDA contacting you for direct marketing and research purposes by RDA for an indefinite period. Opt Out if you do not wish to receive future marketing material from RDA. If you have ticked the Opt Out box, please fax back to RDA. Fax Number: COAGUCHEK and BECAUSE IT S MY LIFE are trademarks of Roche. 212 Roche. Roche Diagnostics Australia Pty Limited, ABN Victoria Avenue, Castle Hill NSW Phone:

34 32 Notes

C Copyright 213 Aspen Pharma Pty Ltd. No part of this publication may be reproduced by any process in any language without the written consent of Aspen Pharma Pty Limited.

35 C Copyright 213 Aspen Pharma Pty Ltd. No part of this publication may be reproduced by any process in any language without the written consent of Aspen Pharma Pty Limited. This booklet is intended to provide information of a general nature only. It does not replace advice from your healthcare professional. Please consult your doctor or pharmacist if you have any questions in relation to warfarin. This is particularly important if you are taking any other medication in combination with warfarin. Also refer to any information your doctor or pharmacist may have provided you including any Consumer Medicine Information (CMI) sheets. Immediately telephone your doctor or the Poisons Information Centre (telephone ) for advice, or go to the Accident and Emergency at your nearest hospital if you think that you or anyone else may have taken too much Warfarin, even if there are no signs of discomfort or poisoning. This booklet has been developed and written by Karen Inge, an accredited practising dietician with funding provided by Aspen Australia, suppliers of Coumadin and Marevan in Australia and New Zealand. Aspen Australia comprises Aspen Asia Pacific Pty Ltd (ABN ) and its subsidiaries, including Aspen Pharmacare Australia Pty Ltd (ABN ), Aspen Pharma Pty Ltd (ABN ), Aspen Nutritionals Australia Pty Limited (ACN ), Orphan Holdings Pty Ltd (ABN ), and Orphan Australia Pty Ltd (ABN ). Aspen Pharma Pty Ltd Chandos St, St Leonards NSW FD1367 ASP822 Prepared: Aug 215

36 D

My Diabetic Meal Plan during Pregnancy

My Diabetic Meal Plan during Pregnancy When you have diabetes and are pregnant, you need to eat small meals and s throughout the day to help control your blood sugar. This also helps you get in enough