Blood Thinners and Supplements

Last week I had three bloody noses and ended up in surgery Friday night. Needless to say it was not only a frightful mess but I was very upset thinking it had something to do with the bone mets. Who knows what caused it but at least I am on the mend and hopefully able to resume a more normal life after next week. Since I am on Zometa which acts as a blood thinner and take supplements does anyone know of a site that gives info on supplements and how they react as far as blood thinnning agents. I know Bosweillia acts as a thinner and I take it for the lymphedema. Does curcumin act as a thinner? What about foods? Can anyone help me out. I don't want to go thru this again and the doctors I have consulted are not into supplements.

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I know Vitamin E and Fish Oil also act as blood thinners.
I hope this little bit helps. Good luck with your search.

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This is down the page on:
http://www.drlam.com/opinion/blood_thinners_and_nutritional_supplement.asp

Blood Thinners and Nutritional Supplement

Some natural substances have blood-thinning properties. A possible risk exists when taking such a product while also taking Coumarins (coumadin-like substances), salicylates (aspirin-like substances) and anti-platelets (substances that prevent blood cells from clumping together) as these are all considered blood thinners. Too much blood thinning can lead to excessive bleeding.

Herbs containing coumadin: angelica root, arnica flower,anise, asafoetida,celery,chamomile,fenugreek,horse chestnut,licorice root,lovage root,parsley,passionflower herb,quassia. red clover
rue,sweet clover
Herbs thought to contain salicylates: Meadowsweet,poplar,willow bark
Herbs with Anti-platelet properties: bromelain,clove,onion, and turmeric

There are no documented reports of a proven interaction between Coumadin and any of these herbs. However, patients taking these herbs while on Coumadin should be closely watched for signs of bleeding. Herbs that potentiall can increase bleeding time should be stopped at least 2 weeks before surgery and not be taken until approval of the treating physician.

Nearly all available information on herb-Coumadin interactions is based on lab studies, animal studies, or individual case reports. Cause and effect relationships have not been proven. Available reports give limited information about the severity of these interactions. There is little reliable information about the safety and effectiveness of most herbal products. There are no regulations governing purity and potency of herbal products during manufacturing.

Bleeding Risk

The following may increase bleeding risk: Angelica root, Arnica flower, Anise, Asafoetida, Bogbean, Borage seed oil, Bromelain, Capsicum, Celery, Chammomile, Feverfew, Garlic, Ginger, Ginkgo, Horse chestnut, Licorice root, Lovage root, Eadowsweet, Onion, Parsey, Passionflower herb, Poplar, Quassia, Red clover, Rue, Sweet Clover, Turmeric, Willow bark.

The following Does increase bleeding risk: Danshen, Devil's claw, Dong quai, Papain, Vitamin E

The following may lessen Coumadin's effect: Coenzyme Q10, Ginseng

Specific Supplements

Vitamin E

Vitamin E is usually taken as a food supplement. The RDA is 15 I.U per day. Most health conscious people take about 400 I.U. a day , and therapeutic dosages ranges from 400 to 1600 I.U. a day under the care of a knowledgeable physician.

As vitamin E is a fat-soluble vitamin, it is not recommended to consume a large dose of it when not under close supervision. The primary reason being that Vitamin E is a strong anti-oxidant and may slow down the rate of oxidation of vitamin K in the body. Vitamin K oxidation is essential to the body as it helps blood to clot. However, it must also be noted that the effects of vitamin E on PT time ( a measure of bleeding time and therefore the coagulation status) varies and is not constant. In other words, the reaction of each person may be different.

There was a case reported of a 55 year-old man who was on Coumadin and unknowingly took 1200 IU of vitamin E daily without the supervision of a doctor. The normal recommended amount is 400 IU to 800 IU a day and he was obviously taking an overdose of it. What happened then? The poor man developed blood vessel ruptures under the skin, had blood in his urine and a high PT time. When this happened, the doctor took him off vitamin E and his condition was stabilized. Later, he was again given a high dose at of vitamin E at 800 IU of vitamin E to provoke and confirm the response. Indeed, the provocation is positive and the same problems appear again. His intake of vitamin E was then stopped indefinitely. Within a week, his PT returned to normal.

A study was conducted on 12 patients who were on Coumadin. They were given 100 or 400 IU of vitamin E each day for a period of one month. The results showed no unusual bleeding in the patients who were given both dosages of vitamin E.

In another study, researchers Kim and White conducted a randomized, double-blinded study in which 4 patients were given 1200 IU vitamin E daily. Another 3 were given 800 IU daily and another 4 took placebo. All these patients took the vitamin E for a period of 4 weeks. During the study's second phase, which was single-blinded and not randomized, 6 of the subjects were given placebo or vitamin E. All of them were given 1200 IU daily for another 4 weeks. The results revealed that their INR did not increase to a point requiring Coumadin dose adjustment.

We can therefore safely conclude that taking Vitamin E up to 400 units per day does not affect the PT time in patients on Coumadin, generally speaking. But since each person is different, it is always good to consult your physician. A word of advise. If you are on blood thinners and taking vitamin E at the same time, do have your INR checked 2 weeks after embarking on this combination. Close monitoring every month, at least for the first 3 months should be carried out if you are on this combination therapy.

Green Tea

Green Tea (Camellia sinensis), also known as Chinese tea is famous for its unique abilities to prevent cancers, treat stomach disorders and improve mental function. Although dried green tea leaves contain substantial amounts of vitamin K and may work against Coumadin, brewed green tea does not contain a significant amount of the vitamin. However, large amounts of brewed green tea may alter Coumadin's effects.

Research on green tea and bleeding time is not widely available. There are periodic case reports. In one case, the INR of a 44 year-old patient with a mechanical heart valve dropped tremendously when he took a large amount of brewed green tea. This patient originally had a normal INR of 3.79. After taking � to 1 gallon of brewed green tea daily for about a week, his INR dropped to 1.37.

Nevertheless, if you drink brewed green tea in moderate amounts, your INR should not drop so drastically.


Ginkgo

Ginkgo (Ginkgo biloba) is a herb used to promote mental health and function. One of the components of Ginkgo called Ginkgolide B is known to reduce coagulation. It acts as a blood thinner, increasing blood flow to the brain and enhance memory. This herb have been used for centuries by Asians. When taking this supplement, we have to be very careful as several cases of bleeding were allegedly reported.

In one reported case, an elderly 70 year-old man took 40 mg of concentrated ginkgo extract twice a day for a period of one week. At the same time, he was also taking 325mg of aspirin daily. He complained of blurred vision and was diagnosed with a spontaneous hemorrhage in one eye.

A 33 year-old woman complained of headaches and was later diagnosed with bruises around her spine. She had been taking 60mg of ginkgo twice a day for 2 years.

In another report, a 72 year-old woman was diagnosed with a subdural bruise after taking 50mg of ginkgo 3 times a day for a period of 6 months. Interesting enough, she did not have any bleeding resulting from taking both Coumadin and ginkgo. However, it is strongly recommended those who are taking Coumadin avoid ginkgo-containing products.

Garlic

Over many decades, Garlic (Allium sativum) is believed to have several cardiovascular benefits, such as blood pressure lowering, cholesterol lowering, and anti-stroke activity. Additionally, garlic oil can also reduce blood coagulation.

A researcher had indicated that when essential garlic oil was mixed with blood samples from healthy individuals, cells were less likely to clump together (coagulate) in a laboratory setting. Although there had been no documented reports of any serious interaction effects when taking both Coumadin and garlic, studies had implied that a serious reaction might be possible.

As such, patients who are on Coumadin should avoid excessive garlic supplements. However, by just eating food containing small amounts of garlic and small amount of garlic pills should not be a problem.

Ginger

Traditionally, ginger (Zingiber officinale) has been taken to curb motion sickness and arthritis. Today, it has been reported to reduce blood clotting. Like the rest of the natural supplements mentioned above, taking ginger supplements, which contain a higher amount of ginger than any other food products may increase the risk of bleeding when taken with Coumadin.

It is therefore highly recommended that patients taking both Coumadin and ginger supplements have their INR checked regularly. They should also ensure that symptoms of bleeding do not develop.

Coenzyme Q10

Coenzyme Q10 (CoQ10) is a compound made naturally in the human body, plant and animals. This compound is involved in electron transport and may be a free-radical scavenger, an antioxidant and a potent membrane stabilizer. CoQ10 is highly reputed for treating heart disease patients. It can also help to stabilize high blood pressure and angina.

The structure of CoQ10 is very similar to that of vitamin K 2. As such, it may have blood-coagulating effects. The vitamin K-like effects of CoQ10 have since been demonstrated in a laboratory setting and in the following reports: -

1. In Denmark, a 72 year-old woman had a decreased response to Coumadin when she took CoQ10 as a supplement. Her normal INR was only achieved when she stopped taking this product.

2. A 68 year-old man with a history of stroke was stabilized with Coumadin for 6 years. His INR dropped after taking 30mg of CoQ10 daily for 2 weeks.

3. In another case, a 72 year-old man and a 70 year-old woman saw their INR going downwards within 2 weeks of starting on CoQ10. Their INR returned to normal after stopping the intake of CoQ10.

If CoQ10 and Coumadin are taken simultaneously, patients should be monitored carefully for the first few weeks.



Summary

Hypercoagulation is a state where the blood in the body has an increased tendency to stick together. The causes are many, and a state of hypercoagulation is a medical condition normally managed by the administration of blood thinners such as coumadin or warfarin. Herbs and selected vitamins also have blood thinning effect. The most common and well known ones include gingko, vitamin E, and garlic, among others. Most people taking low preventative dose of these do not experience any adverse health problem such as excessive bleeding. To be safe, all patients currently on blood thinner medications should let their physician know the precise type and dosage of nutritional supplements being taken to avoid any side effect. Side effect can vary from person to person, and each person is different.

Those preparing for surgery should also be mindful to stop intake of nutritional supplements that potentially have blood thinner effect as least 2 weeks before surgery.

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I didnt see that you take Coumadin, so it is just an issue if what supplements cause thinning. If you do take Coumadin as I have, the key is consistency. Curcumin does cause blood thinning.

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Sorry about the nose bleeds. Dr. Keith Block is an oncologist who works with supplements in Chicago. He has a website and book "Life Over Cancer". I saw that questions could be asked on his website www.lifeovercancer.com
Terri

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Thank all of you for the info. I am not on Coumadin. I am on Femara 2.5mg. daily and monthly injections of Zometa. Zometa has a blood thinning aspect. I find it interesting that Chammomile is a thinner. I have been drinking and taking 2 tablets each night to get some sleep. Guess that goes on hold. I also use Q10 daily. I am not sure if I understand what you are talking about when you reference Q10-what is INR? I was using Tumeric but quit that last week. The Dr. put me on Alieve just prior to these nosebleeds and I told him they acted as blood thinners but he said it would not affect my blood - so much for that. I think to be on the safe side I will discontinue all but my Vit D and Calcium and Multi-vitamin until I see my Onc. next month.

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The best thing to do is to talk to someone who is an expert on supplements. I rcommend you see a naturopath if you can find one near youl. I'm using Zometa and taking several of the supplements on the "no-no" list that Vicki posted above. My naturopath monitors the dosage carefully and switches things out now and then. So, rather than throw out the benefits of what you're taking, see someone first.

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How does your naturpath monitor your supplements? Thru blood work? What specific tests is this person running and what is he/she looking for? I just had my K level checked and it was okay. Yet I had three major nosebleeds within 24 hrs. and the last one could only be stopped in ER by inserting what they call a balloon.

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Yes. She looks at the weekly bloodwork I get with chemo. So far I've only had one week with low platelets, which is the major problem that causes unstoppable bleeding. She also controls the dosages so that I'm not getting a mega-dose of anything or taking two things that do the same thing. Those are the problems most people run into when they try to "supplement" themselves by just random reading.

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Oh, and she's checked my D levels, iron, blood saturation, I can't remember what else. She keeps a close eye on my platelets, which are what makes your blood clot. Did they check your platelets in the hospital? Zometa is associated with low platelets for some people.

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INR is International Normalized Ratio

The list is not really a no no list more of a things to consider list. It depends on whether you prefer to stick with the opinion of a doctor who is resistant to the use of supplements or seek out the advice of a naturopath. Your local hospice will probably be more open to including supplements in your treatment and they may be able to give you advice.

Try altering the amount of the supplements that you take. I can't take Camomile as I was using it to help calm me down in the last year of university a few years ago and I started to notice that when I had taken a tablet my throat started to swell up. Try reducing your intake.

To help you sleep do you keep some relaxing music within reach? I got a CD of music a couple of years ago and started to use that to move my mind away from my problems and use imagery to take myself to the forest that the music represents. Also if you can't sleep don't stay in bed. Get up and read etc and go back to bed when you are ready. That way you avoid associating bed with sleep, rather than not sleeping! Also don't worry too much is you don't sleep the hours that you need all in one go. It is recommended that we get 8 hours sleep, but some people need more, some less. Try and establish a pattern that works for you - a siesta at noon, nap in the afternoon or evening.

Vicki xxx

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My blood work has been normal since this occurance of mets. When I had the bleedout last week my hemoglobin was down 1.1 from 12.7 to 11.6. My platelets were good. I have yet to see my bloodwork reports as in Illinois you have to sign a release form and then request copies (bummer). Minn. drs. give you your reports before you leave the office or facility. I have a dr. in mind whom I saw years ago when she was under my ins. plan and now is on her own. I think I might make an appt. with her to see what she thinks of these supplements and how to take them as the Onc. and other western med drs. definitely do not get into supplements. They just push the FDA drugs. I don't sleep during the daytime unless I take muscle relaxers and pain pills, which I try to avoid at all costs. Nightly sleeping has improved. I find warm milk and graham crackers help.
Don't know of an ND in this area but will ask my LE specialist if she knows of one in the Chicago area. Has anyone ever gone to Dr. Mercola's facility in the Chicago burbs?

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