Re: Re: Coumadin / Vitamin E

May 16, 2002

In a message dated 5/16/2002 6:59:49 PM Pacific Daylight Time,

madisonn99@... writes:

> Received my INR reading, and again slightly under 2. Less than I

> anticipated, and that with a somewhat reduced dosage of Coumadin and

> a full dose of 400 iU of natural Vitamin E.

>

Correct me if I am wrong here, I had a bit of a " discussion " with

my cardiologist today about this. Coumadin is an anti-coagulant

and the INR reading measures its effect. Vitamin E tends to

thin the blood, and that is NOT reflected in the test for INR.

Today I specifically asked him about measuring for aspirin's

effects on blood " thinning " . He said that can be tested but it

is a different test than the one for INR and more difficult.

So what I am understanding is that the test for our INR number

is specifically measuring only the anticoagulation effects of

coumadin or warfarin and not any effects on the blood of taking

aspirin, Vitamin E, gingko biloba or other similar things.

Bill Utterback

South San Francisco

May 17, 2002

<< So what I am understanding is that the test for our INR number

is specifically measuring only the anticoagulation effects of

coumadin or warfarin and not any effects on the blood of taking

aspirin, Vitamin E, gingko biloba or other similar things.

>>

Bill, the prothrombin time test can detect any difference in your clotting

mechanism due to variations in your Vitamin K level, and this is usually

reported as the INR. Anything that would reduce your Vitamin K level (as

Coumadin does) would show up in a higher INR. The other things you mention

do not prolong your coagulation time ( " thin " your blood) by interfering with

Vitamin K; they do other things to what is a very complicated coag process

with many steps and many places along the way for something to affect it.

Bottom line, your doctor is right!

Brenta

May 17, 2002

I don't know for sure about vit E, but I do know that many vitamins cannot

be absorbed without the use of fats. I remember my father stopped eating all

forms of fat and my sister who is/was a nurse was really worried as she

thought it would make him malnourished.

I was also told this by my Dr when I went to see him about my high

choesterol. I told him proudly that I had cut out all animal fats and dairy

in a bid to bring it down. He said we need a certain amount of dairy fats to

absorb many vitamins.

Anyway it turns out my total choesterol was 7.2 which is generally regarded

as the danger zone. But as they have not worked out HDL and LDL yet we

cannot be sure that it is bad cholesterol that is making my total choesterol

high. As I have been eating loads of good cholesterol foods it remains a

possability that the high level may just be caused by the HDL. I have been

asked to fast for twelve hours to get this. Problem is that I have now

fasted twice and the nurse has been unable to get blood. She had three

attempts this morning, but my blood would not pull back. So third time lucky

on Monday now. So my fingers are crossed.

Fran

Re: Coumadin / Vitamin E

> Hi,

>

> Received my INR reading, and again slightly under 2. Less than I

> anticipated, and that with a somewhat reduced dosage of Coumadin and

> a full dose of 400 iU of natural Vitamin E.

> Looking for reasons - I came across many warnings about this

> combination, which is not working for me, and one article emphasizing

> to take Vitamin E with a 'fatty' meal, " it will triple absorption " .

> Now, my meals tend to be not 'fatty'.

> Could that be the reason?

> I welcome anyone's comment.

>

> /

>

> Web Page - http://groups.yahoo.com/group/AFIBsupport

> FAQ -

http://groups.yahoo.com/group/AFIBsupport/files/Administrative/faq.htm

> For more information: http://www.dialsolutions.com/af

> Unsubscribe: AFIBsupport-unsubscribe

> List owner: AFIBsupport-owner

> For help on how to use the group, including how to drive it via email,

> send a blank email to AFIBsupport-help

>

> Nothing in this message should be considered as medical advice, or should

be acted upon without consultation with one's physician.

>

May 17, 2002

I wouldn't say I was knowledgable, just widely read and heard a lot of

anecdotal evidence coming from a family with many medical and science

connections. I also really enjoy surfing the net and learning new stuff.

However, at times all this does, is serve to confuse me. The following might

help.

http://www.medformation.com/mf/stay.nsf/8dfb7a2ec561c3e4862567a2007b106a/8d3

f1ea5efed6990862567b700610211?OpenDocument

Do any other vitamins or drugs interact with vitamin E?

Effects of anticoagulant drugs (coumadin, warfarin) and vitamin K can be

potentiated by vitamin E. The anti-clotting action of aspirin can be

increased by vitamin E.

Vitamin E interacts with other antioxidant nutrients. Vitamin C, especially,

enhances the antioxidant properties of vitamin E. Adequate zinc in the body

is required to sustain levels of vitamin E in the blood. If you are taking

vitamin E and iron supplements, they should be taken at different times of

the day.

Also http://www.goaskalice.columbia.edu/0962.html I really don't know

anything about coumadin. I have never taken it and hope that I never need

too (the same goes for any tablets). Anyway..

LARGE DOSE SUPPLEMENTS OF VITAMIN E -- SAFE?

Vitamin E, also known as alpha-tocopherol, is an antioxidant (see archived

Alice: Antioxidants for more information on the role of antioxidants in

health and disease), fat-soluble vitamin. Fat-soluble vitamins are stored

( and accumulate) in the liver and adipose (fat) and muscle tissues, unlike

the water-soluble vitamins, such as Vitamin C, which are excreted.

Fat-soluble vitamins are also more easily absorbed by the body when consumed

along with some fat in the diet - he nce the name.

The effects of vitamin E are different depending on the amount consumed,

metabolized, and absorbed. Small doses of vitamin E, such as around the 15 -

45 International Units (IU) a day range [the U.S Recommended Dietary

Allowance (RDA) is 15 IU/day (1 IU = 1 mg dl-alpha-tocopheryl acetate)], are

considered necessary to prevent vitamin E deficiency. Larger doses (up to

1000 IU/day) are thought to be necessary to prevent degenerative disease.

Even larger amounts (up to 3200 IU/day) may hold some therapeutic benefits,

although this needs to be supported by further research.

Now, to get to your question - are large doses of vitamin E safe? Unlike

other fat-soluble vitamins, such as Vitamins A, D, and K, vitamin E

apparently is not harmful in large doses, even as high as 3200 IU/day.

Research has demonstrated that vitamin E is relatively non-toxic, and is not

mutagenic, teratogenic, or carcinogenic. Double-blind studies (when the

investigators and participants are unaware of what kind and how much vitamin

E are being used), in which large amounts of vitamin E were administe red

orally to humans, have shown no side effects. Outside of these studies, some

adverse effects have been reported, but the majority of these side effects

was reported in letters to the editor as individual case reports from

physicians or uncontrolled s tudies, and basically have not been observed in

the larger, well-controlled studies. Although more time is required for

research into the safety of long-term vitamin E supplementation to become

clear, it is likely to be relatively harmless, with minimal to no adverse

effects, and may even benefit health considerably.

Since vitamin E intake from diet alone may be difficult for some, or could

be highly caloric and fatty if derived primarily from the richer dietary

sources (i.e., vegetable oils and nuts), supplementation may be necessary to

meet the RDA. At least 20% of the U.S. population regularly take vitamin E

supplements, either as part of a multivitamin preparation or as a single

vitamin supplement. And, because of what vitamin E can do for your health,

such as enhance the immune system and decrease risk for chro nic diseases,

such as heart disease, cancer, and atherosclerosis, many people are

supplementing with vitamin E in high to mega doses believing that " more is

better. "

In addition, bioavailability (amount of vitamin E actually available for the

body to use) of each supplement is variable because the Food and Drug

Administration (FDA) does not regulate nutritional supplements since they

are not considered drugs. There i s also inter-individual variation among

humans in the amount of vitamin E that is actually absorbed by the body. So,

if you need help in deciding which vitamin E supplement to use, ask your

pharmacist for her/his recommendations.

It is important to know that high vitamin E supplementation is

contraindicated in vitamin K deficient individuals, caused by either

malabsorption or anticoagulant therapy, such as Coumadin (Warfarin). Vitamin

K is required for normal blood clotting time and formation, and high doses

of vitamin E apparently increase the vitamin K requirement several-fold by

exacerbating the blood coagulation defect of vitamin K deficiency and

thereby, can cause hemorrhaging. Vitamin E has not been found to produce

blood clotting ab normalities in individuals who are not vitamin K

deficient.

Overall, the messages Alice wants you to know are that a dosage of less than

or equal to 1000 IU/day is considered to be entirely safe and without side

effects, and that a dosage of up to 3200 IU/day has been found to be

relatively safe, with minimal adve rse effects, such as some

gastrointestinal discomfort (diarrhea and intestinal cramps), fatigue and

weakness, and breast soreness (for women only), although none of these have

been found to be consistent and/or reproducible in larger, well-controlled

stud ies. So, given the wide use of vitamin E, and the very few number of

reported adverse effects, large dose and/or long-term intake of vitamin E

appears to be safe.

Alice is not saying that you should now consider supplementing with more

than 1000 IU/day of vitamin E. She suggests you try starting at 1000 IU/day,

and if you desire to increase your vitamin E intake, to add more fresh foods

containing vitamin E , such as almonds, filberts, peanuts, wheat germ,

spinach, turnip greens, broccoli, peaches, and strawberries, to your diet.

As you can see, vitamin E can be found in cereal grains, green leafy

vegetables, egg yolk, milk fat, liver, nuts and seeds, and s ome fruits and

vegetables, but the richest dietary sources of vitamin E are vegetable oils,

such as wheat germ, sunflower, and safflower oil. These natural sources of

vitamin E are not very stable. How you store, prepare, and cook these foods

determine how much vitamin E will be bioavailable when eaten. For optimal

vitamin E content, keep storage and cooking times to a minimum. If possible,

try baking and broiling instead of frying, which results in a greater loss

of vitamin E and other nutrients (and extra calories too!).

Alice

Re: Coumadin / Vitamin E

> Hi Fran,

>

> You seem so knowledgeable on this subject. Can you

> recommand " something nutritional " that will bring my INR up and my

> Coumadin down.??

>

> /

>

> >

> > In a message dated 5/16/02 9:28:53 PM, moneypal@a... writes:

> >

> > << So what I am understanding is that the test for our INR number

> > is specifically measuring only the anticoagulation effects of

> > coumadin or warfarin and not any effects on the blood of taking

> > aspirin, Vitamin E, gingko biloba or other similar things.

> > >>

> >

> > Bill, the prothrombin time test can detect any difference in your

> clotting

> > mechanism due to variations in your Vitamin K level, and this is

> usually

> > reported as the INR. Anything that would reduce your Vitamin K

> level (as

> > Coumadin does) would show up in a higher INR. The other things you

> mention

> > do not prolong your coagulation time ( " thin " your blood) by

> interfering with

> > Vitamin K; they do other things to what is a very complicated coag

> process

> > with many steps and many places along the way for something to

> affect it.

> > Bottom line, your doctor is right!

> > Brenta

>

> Web Page - http://groups.yahoo.com/group/AFIBsupport

> FAQ -

http://groups.yahoo.com/group/AFIBsupport/files/Administrative/faq.htm

> For more information: http://www.dialsolutions.com/af

> Unsubscribe: AFIBsupport-unsubscribe

> List owner: AFIBsupport-owner

> For help on how to use the group, including how to drive it via email,

> send a blank email to AFIBsupport-help

>

> Nothing in this message should be considered as medical advice, or should

be acted upon without consultation with one's physician.

>

May 17, 2002

In a message dated 5/16/2002 7:00:09 PM Pacific Daylight Time,

madisonn99@... writes:

<< Now, my meals tend to be not 'fatty'.

Could that be the reason? >>

,

I take my vitamin E with breakfast, which consists of peanut butter on toast,

a " fatty " meal. As you know, I take a low Coumadin dose, 2.5 m.g. daily, but

maintain an INR between 2 and 3. Perhaps the fatty meal makes the

difference. Like Sandy, I have been eating only two meals a day in the

morning and about 4:00 p.m. Both are fatty meals, because I eat salmon in

the afternoon meal. All the fat is allegedly " good " fat for the heart,

though.

As my doctor explained the INR to me three years ago when I was just starting

Coumadin, the abbreviation stands for International Norm Reference, or

something similar. It is a number which was set up and agreed upon

internationally so that we afib sufferers and Coumadin users could have a

blood test anywhere in the world, and the test results would be evaluated

according to the same reference points or norms worldwide. As he put it, if

I were to travel to China, I could have the same PT test evaluated according

to the same criteria as would be the case at home in the states. He said the

Pro-thrombin Time test is a measure of the time required for clotting of the

blood on the day of the test, and the expression of that time factor and the

blood's clotting potential is in the form of the two numbers: the INR and the

other number, which is usually somewhere in the 20's for me. My

understanding of this is based on information I was given three years ago;

and, therefore, could be inaccurate. Please correct me if I'm wrong.

in sinus in Seattle (Day 10)

May 20, 2002

<< Brenta, you also pointed out, that many of the natural blood

thinners, would not affect Vit. K - INR test. Would you know of any

that do? >>

In addition to certain green leafy vegetables, I believe flaxseed/flaxseed

oil can have an effect, as can canola oil. Certain antibiotics, e.g.

amoxicillin, can do so as well. I'm sure there are a number of others that

other members of the group can recall, so please add to this list if you know

of others. The degree to which these substances affect the pro time/INR will

vary considerably from person to person, though. For example I take flaxseed

oil capsules with no effect so far on my INR.

Brenta

May 21, 2002

In a message dated 5/21/2002 1:40:56 PM Central Daylight Time,

Frances@... writes:

> Now can I ask a silly question here. If INR is so important in AF why don't

> Dr's test people's INR as a matter of course? I don't believe I have ever

> had this done. Just a thought.

>

Fran, the INR is only useful and meaningful if the patient is on an

anticoagulant. When folks *not* on an anticoagulant such as Coumadin are

tested for some reason then it is recommended that the INR calculation not be

done, and the test result is then reported as the number of seconds it takes

the patient's blood to clot (usually about 12 if they are normal) and this is

compared to a control for which the value is known.

Brenta

May 21, 2002

In a message dated 5/21/2002 2:07:05 PM Central Daylight Time,

Frances@... writes:

> Sorry for all the questions but, why would it only be meaningful to someone

> on an anticoagulent. What is it that coumadin does to the blood that is so

> different to normal clotting blood? Does it mean that the INR only reads

> the

> effects of coumadin on the clotting rate of the blood, and not the rate at

> which unadulterated blood would clot without coumadin. If that is the case

> then how would one know if they came off coumadin if their blood was thin

> enough. Sorry, but I am not quite grasping this.

>

> Fran

>

Fran, it's essentially a question of how accurate and standardized the

prothromibin time test (PT test) needs to be and this depends on the clinical

situation and the reason that the PT test is being done in the first place.

If the PT test is being used with a battery of other tests to discover why a

patient is bleeding (who is not on oral anticoagulants such as Coumadin) then

it's not necessary to have more than a normal/abnormal answer for the PT

test. This is because no medicine dosage is being determined and monitored,

but rather a diagnosis of a bleeding disorder is being sought. Such PT tests

are relatively inexpensive compared to the very accurate and standardized PT

tests that result in an INR. Bleeding problems that patients can have can be

very complicated and a whole battery of tests are needed to make a diagnosis.

On patients like us, however, who are on Coumadin therapy it is necessary to

have a very very accurate and standardized test perfomed because changes in

the dosage of a potentially dangerous drug are based on the PT test result

and we need more than a " normal/abnormal " answer. Such accuracy comes at a

price, however, so it is used only when necessary, as it is with us. To

report an INR on a patient not on anticoagulant therapy would be unnecessary

and therefore add unnecessarily to that patient's cost.

Fran, this is the *short answer*. If you'd like the long answer, please

email me privately and I'll provide the details.

Hope this helps.

Brenta

May 21, 2002