Ask Dr. Gourmet

Why is my INR fluctuating so much?

I take warfarin and am finding that my levels fluctuate heavily. I looked through the vitamin K level chart and find that I am not eating that many things that are high in vitamin K so I don't understand why my levels are fluctuating so much. I do eat green apples (Granny Smith) with the peel. But I don't eat them all the time. Would that make the difference? I don't eat any green leafy vegetables (or not that much at all). And it seems like I am taking a lot of warfarin, 7.5 mg six days a week and 5.0 mg one day a week. Is there any way you can help me understand why this is happening? I would certainly appreciate your input. Thank you for your assistance.

Dr. Gourmet Says...

Because Vitamin K can have an effect on how well your Coumadin® is working, it is important to try to eat foods with a consistent amount of Vitamin K each day.

One approach to this is to work at avoiding foods that are high in Vitamin K altogether. There are a lot of healthy veggies that you can substitute.

Another way is to eat foods that contain about the same amount of Vitamin K each day. So if you are going to have Granny Smith apples one day you could have broccoli the next and then spinach.

There is extensive information on the Dr. Gourmet website about the Vitamin K content of foods to help guide you. There is a very simple list to keep with you for quick reference here:

http://www.drgourmet.com/md/warfarinbrief.pdf

A more detailed list of foods is here:

http://www.drgourmet.com/md/relativewarfarinlist.pdf

You will also find a comprehensive list with the actual amount of Vitamin K in foods here.

http://www.drgourmet.com/md/warfarincomprehensive.pdf

This information can help you make sure that you are getting a consistent amount each day in the foods that you eat.

Thanks for writing,

Timothy S. Harlan, MD, FACP, CCMS
Dr. Gourmet

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