Diet while taking Warfarin. List of prohibited foods, table, recommendations for arrhythmias, after surgery

Warfarin is an anticoagulant or blood thinner. It is prescribed to prevent the appearance of blood clots in the vessels and to eliminate the already formed ones. The smaller the size of the thrombus, the more likely it is to dissolve. If left unattended, they can cause heart attack or stroke.

Despite the fact that doctors have not developed any specialized diet when taking Warfarin, some foods and drinks can reduce the effect of the drug, which is important to consider for patients taking a drug.

Essence and basic principles

The diet when taking Warfarin is based on reducing the intake of foods that contain a lot of vitamin K.

At the same time, you should make proper nutrition a daily habit and strive to eat only healthy foods. In addition to foods high in vitamin K, green tea, certain fruits, condiments, and alcohol should be avoided.

It is important to maintain stable PT / INR levels when taking any anticoagulant or blood thinner (prothrombin time and international normalized ratio) - indicators of blood coagulation factors. To do this, you should consume no more than 1 portion of food with a high vitamin K content (200-600% of the daily value) and no more than 3 portions with moderate (60-200%).

It is important that the consumption of a given connection remains consistent. It is highly undesirable to eat a large amount of foods rich in it at once (for example, eat spinach dishes all day).

A low INR indicates an increased risk of blood clotting, and a high INR indicates an increased risk of bleeding. Warfarin increases the INR level, while vitamin K decreases it. Therefore, when the drug is prescribed, in all cases it is necessary to balance it with the consumed vitamin K.

Most doctors aim to maintain an INR of 2-3, but for people with work problems heart valve or in other extreme cases (for example, after heart surgery), you can increase it up to 2.5-3.5. This indicator should be checked regularly.

If possible, it is recommended to give up alcohol or limit its consumption as much as possible. This is due to the increased stress on the liver when taking the drug.

Vitamin K content in food

Warfarin affects one of the blood coagulation factors, reducing its activity. They are substances that help blood to clot, forming clots. The clotting factor that warfarin is used to counter is vitamin K-dependent.

Therefore, the drug reduces its amount in the body. Without sufficient intake of this compound, the dependent clotting factor is unable to function and clots do not form.

The human body synthesizes vitamin K on its own, but at the same time it receives it from certain foods. The most effective way to improve the effect of warfarin is to avoid fluctuations in the amount of this compound taken from food.

The drug is effective when the vitamin K content does not change in the body. But when the level of the compound rises, it often weakens the effect of warfarin. Conversely, if the amount is reduced, the risk of drug overdose increases.

Products	Vitamin K content
low	moderate	high
Vegetables
green beans	asparagus	broccoli
carrot	avocado	Brussels sprouts
cauliflower	red cabbage	White cabbage
celery	green pea	kale
corn	salted cucumbers	kale
cucumbers	iceberg lettuce	lettuce (green and red)
eggplant	mustard greens
mushrooms	spinach
onion	turnip greens
Green pepper	watercress
potatoes	chard
pumpkin
sauerkraut
tomatoes
Fruits
apples	kiwi
bananas
blueberry
grape
oranges
Meat, fish and poultry
beef	ham and pork sausages	pork liver
chicken
pork
tuna
Turkey
Fats and oils
corn oil	margarine	mayonnaise
peanut butter	olive oil	rapeseed oil
sunflower oil	soybean oil
Sesame oil
safflower oil
Dairy
butter
hard cheese)
eggs
sour cream
yogurt
The drinks
coffee	green tea
fruit juices
milk
Black tea

Contraindications and dangerous interactions

The diet when taking Warfarin should be made taking into account contraindications. Possible interactions between medicinal product and high protein diets, foods with antiplatelet effect or affecting the cytochrome P450 enzyme, has not been studied to date too good.

Enzymatic interaction

Warfarin is predominantly metabolized by cytochrome P450 of the enzyme system, which includes various isozymes. Foods that induce these isoenzymes can reduce the effectiveness of the drug, and suppressing them can increase its effect. The significance of this interaction will depend on which isoenzymes the food affects, how and how much it is consumed.

Foods such as cranberry and grapefruit juice, mangoes, charcoal-based foods, alcohol and caffeine can affect the metabolism of warfarin through the CYP450 enzyme system and potentially alter it impact.

Protein diets

In the past few years, the popularity of low-carb protein diets (Atkins, South Beach, and so on) has skyrocketed. All of these nutritional systems prescribe an increase in dietary protein intake and a decrease in carbohydrate intake. Many of them have an induction phase, which requires the elimination of almost all carbohydrates from the diet for a long time (often about 2 weeks).

It was noted that with such dietary restrictions, the INR value often decreases. In some cases, prolonged adherence to a low-carb diet even leads to the need for anticoagulants to reduce the risk of blood clots. However, the effectiveness of Warfarin may be reduced in this case.

The decrease in INR on low-carb diets may be related to the effect of protein intake on albumin levels. The amount of this substance increases within 10 days after the start of such a diet.

As a result, it binds to warfarin and reduces its anticoagulant effect. Some experts suggest that a diet high in protein and low in carbohydrates may also affect the metabolism of Warfarin via the cytochrome P450 system.

Because of the potentially significant decrease in INR, some people are at increased risk of developing thromboembolism soon after starting a protein diet. Therefore, it is imperative to consult a doctor before drawing up a new menu.

Side effects

Interaction with food, drugs and various food additives can increase the risk of side effects of the drug:

• allergic reactions;
• gastrointestinal disorders;
• rash;
• hair loss;
• itchy skin;
• chills;
• inflammation of the blood vessels;
• liver or gallbladder disease.

Some of the serious side effects of Warfarin are as follows:

• Significant bleeding from cuts and scrapes.
• Dying off of skin tissue. It can be caused by small blood clots blocking oxygen supply to the skin. Therefore, you should carefully examine your toes, especially if you feel discomfort. The appearance of pain in the specified part of the body is sometimes a sign of skin death.

List of prohibited foods

The diet while taking Warfarin suggests the importance of continuing the same amount of vitamin K foods as usual. You cannot drastically increase or decrease its amount.

It is worth cutting back on leafy vegetables and greens, as they are very high in this compound:

• cabbage;
• spinach;
• Brussels sprouts;
• parsley;
• kale;
• mustard greens;
• endive;
• leaf salad;
• chard.

If these products are on the menu, you must adhere to approximately the same amount every day (no more than 1 serving). You should definitely consult with your doctor before making major changes to your diet (for example, switching to a weight loss diet).

In addition to foods rich in vitamin K, you should limit your intake of some other foods.

Their list includes:

• grapefruit and cranberry juice;
• mango;
• garlic;
• ginger;
• soy;
• products cooked on charcoal.

Cranberry juice

It is not uncommon to see a warning about the interaction of cranberry juice and warfarin, which can cause bleeding. This is thought to be due to the flavonoids found in cranberries. These compounds can inhibit the metabolism of Warfarin, and therefore increase INR.

Another component of cranberry that has an antiplatelet effect is salicylic acid. Berry juice contains approximately 7 mg of this substance in 1 liter. Consuming 3 servings of cranberry juice (250 ml) daily for two weeks significantly increases INR levels.

Thus, the salicylic acid in cranberries may enhance the anticoagulant effect of warfarin. At the same time, it is rather difficult to adjust the dosage of the drug in order to avoid unwanted effects. Therefore, it is recommended that you avoid or limit your intake of cranberry products while taking Warfarin.

Grapefruit juice

Grapefruit juice contains flavonoids that inhibit many isoenzymes and reduce drug metabolism. However, the effects of grapefruit are difficult to predict because the amount of flavonoids can vary. from product to product, and metabolism and their assimilation in the body can have individual peculiarities.

This means that grapefruit juice and the fruit itself can increase the effect of Warfarin, significantly increasing INR levels. Therefore, it is recommended to avoid these foods or significantly reduce their consumption while taking the drug.

Mango

Experiments and observations have shown a link between consumption of mango fruit and increased INR levels. The subjects ate 1 to 6 fruits per day for 2 days to 1 month. The average increase in INR was 38%.

This is because mango inhibits certain enzymes and slows down the metabolism of Warfarin. Therefore, when taking the drug, it is recommended to reduce its consumption.

Garlic

Garlic may inhibit platelet aggregation and may enhance the effects of warfarin. There have been reports of cases of excessive consumption of this product or food additives with it, resulting in a change in the composition of the blood and the development of prolonged bleeding.

In addition, there has been evidence of an increase in the level of INR in people taking warfarin, when a large amount of garlic is added to food. However, a small amount of this product does not affect the effect of the drug in any way; in all cases, obvious abuse was noted.

Ginger

Ginger is thought to reduce platelet aggregation. In theory, excessive consumption can increase the risk of bleeding. There have been cases of an increase in the INR level with constant consumption of ginger simultaneously with fenprocoumon, a derivative of Warfarin.

However, the regular addition of ginger to food as a seasoning is not able to significantly affect the effect of the drug. Only the extract of this root and nutritional supplements based on it, containing a high concentration of its active substances, can enhance the effect of Warfarin and greatly reduce blood clotting.

Therefore, when taking them simultaneously, it is necessary to constantly monitor the INR level and monitor your condition (pay attention to the appearance of bruising or prolonged bleeding from small wounds).

Soy

Soybeans and soy products contain vitamin K and can inhibit platelet aggregation. There have been cases of significant decreases in INR after consuming soy milk daily for 4 weeks. However, its vitamin K content is so low that other mechanisms of interaction between warfarin and soy foods have been suggested.

It is believed that soy may reduce absorption of the drug, but the exact mechanism of interaction is unknown. Therefore, it is recommended to reduce the consumption of products based on it and constantly monitor the level of INR.

Charcoal products

Charcoal foods have an effect on the enzyme system and could theoretically affect the metabolism of Warfarin. It is believed that such food can induce CYP1A2, which reduces the effect of the drug. However, no reliable evidence has been obtained to date.

Other products

Black tea leaves contain vitamin K before they are brewed in water, but a small serving of the hot drink does not. Green tea contains this compound and may decrease the effectiveness of warfarin. In addition, the drink contains components that have an antiplatelet effect and theoretically can change the effect of the drug.

It is often recommended to limit the consumption of not only grapefruits, but also oranges and other citrus fruits. You should also be careful when adding blueberries and pomegranates to your menu, as these fruits can affect PT / INR levels even though they contain little vitamin K.

List of approved products

When taking Warfarin, it is recommended to follow a diet based on foods that are low in vitamin K, from which you can create a balanced and complete menu.

Vegetables permitted for consumption without restriction include:

• turnip;
• beet;
• Sweet corn (fresh or canned)
• onions (raw or cooked);
• swede;
• pumpkin;
• zucchini;
• zucchini;
• potato;
• sweet potato;
• eggplant;
• bamboo shoots (fresh or canned);
• champignons;
• porcini mushrooms (fresh or canned);
• shiitake mushrooms;
• tomatoes;
• cucumbers (fresh);
• artichokes.

Fruits that are low in vitamin K are as follows:

• lychee;
• bananas;
• a pineapple;
• apples;
• nectarines;
• Strawberry;
• peaches.

All cereals and cereals contain little vitamin K, therefore, when taking Warfarin, they can be eaten without restrictions:

• white and brown rice;
• couscous;
• corn flour and grits;
• bulgur;
• barley (pearl barley and barley groats);
• pasta;
• whole wheat bread;
• buckwheat;
• millet;
• quinoa.

In addition, all types of meat, fish and poultry and by-products from them (with the exception of pork liver and pork sausages), eggs and milk and products based on them are allowed. They are all low in vitamin K, like most legumes (with the exception of soy and green beans).

Recommendations for atrial fibrillation

In addition to excluding or limiting the consumption of foods that affect the action of Warfarin, diet for atrial fibrillation should include the following principles:

• It is recommended that you choose whole grains over simple carbohydrates.
• It is necessary to monitor the glycemic index of foods and add mainly non-starchy vegetables and fruits with a low sugar content to the menu.
• Protein sources should be used every day, and it is advisable to opt for fish and poultry rather than red meat.
• Use only healthy fats such as olive, coconut, and grape seed oil.
• Sources of caffeine, alcohol and savory snacks (kimchi, Korean salads, pickled hot peppers) should be completely eliminated or limited as much as possible.
• The consumption of processed foods, sugar and carbonated drinks should be minimized.

Recommendations after heart surgery

When prescribing warfarin after heart surgery, a more restrictive diet is required. As a rule, in such cases, the principles of table No. 10 according to Pevzner and the nutritional characteristics when taking the drug are combined.

The main principle of the diet is to minimize salt intake. Therefore, fast food, any salty snacks, canned food and convenience foods are excluded from the menu.

Other restrictions apply to fat and sugar, since their consumption increases the load on the vascular system. To avoid this, you need to give up sweets, baked goods, fried foods, smoked meats and sausages.

As with atrial fibrillation, you should not consume salty, pickled and fermented foods, caffeinated drinks and alcohol. Onions, garlic and all types of legumes are also not recommended. The basis of the diet should be low-fat sources of protein (fish and poultry, dairy products) and vegetables and fruits that do not affect the effect of Warfarin.

Main menu

To maintain approximately the same level of vitamin K intake, you should consider its content in various foods:

Product (no salt)	Quantity	Vitamin K content, μg
Kale, boiled, drained	1 tbsp.	1062
Frozen spinach, boiled	1 tbsp.	1027
Fresh spinach, boiled	1 tbsp.	889
Boiled cabbage	1 tbsp.	773
Boiled broccoli	1 tbsp.	220
Brussels sprouts, boiled	1 tbsp.	218
Egg noodles with spinach, cooked	1 tbsp.	162
Spinach, raw	1 tbsp.	145
Broccoli, raw, chopped	1 tbsp.	92
Green leaf lettuce, raw	1 tbsp.	46
Sauerkraut	1 tbsp.	135
Boiled okra	1 tbsp.	64
Green peas, canned, no marinade	1 tbsp.	63
Romaine lettuce, raw	1 tbsp.	48
Mixed vegetables, frozen, boiled	1 tbsp.	43
Lettuce, raw	1 tbsp.	56
Blueberries, frozen, sweetened	1 tbsp.	41
Snow peas, boiled	1 tbsp.	40
Frozen green peas, boiled	1 tbsp.	38
White tuna, canned in oil	85 g	6
Raw celery	1 tbsp.	30
Iceberg lettuce, raw	1 tbsp.	17
Kiwi fresh	1 PC.	5
Boiled asparagus	1 tbsp.	92
Fresh blackberries	1 tbsp.	29
Fresh blueberries	1 tbsp.	29
Pasta marinara sauce, ready to eat	125 ml (0.5 tbsp.)	18
Peeled cucumber, fresh	0.5 tbsp.	9
Rapeseed oil	1 tbsp. l.	10
Olive oil	1 tbsp. l.	8
Dry roasted pistachios with added salt	28 g (about 47 nuts)	3,7
Black tea brewed in tap water	175 ml	0

An approximate daily menu when taking Warfarin, calculated for an adult of average weight, leading a not too active lifestyle, it looks like this:

• Breakfast: high fiber flakes (no dried fruit and oats) + 200 ml skim milk + 1 tsp. l. sugar, banana, filtered water.
• Snack: 2 whole grain biscuits, banana or pear, water.
• Dinner: sandwich of 2 slices of bread + spread in vegetable oil + pieces of chicken or smoked salmon, salad with a small amount of tomatoes, 1 tbsp. l. seeds, water.
• Snack: cashews, banana or pear, water.
• Dinner: large chicken breast or white fish fillets, basmati rice (or pasta or potatoes), carrots (or rutabaga or corn), water.
• At night: rye bread with low-fat soft cheese, banana or pear, water.

It is recommended that you use this example to get an idea of ​​what healthy and nutritious foods to include on your diet while taking Warfarin. It is also important to drink plenty of water throughout the day.

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