On Nutrition by Ed Blonz

When Medications and Green Veggies Don't Mix

DEAR DR. BLONZ: My partner had an emergency heart valve replacement and is now on the blood thinner Coumadin, perhaps for the rest of his life. The surgery saved his life, so we are extremely grateful, but he has been told not to eat green vegetables anymore. This is proving very hard, as we love our veggies. Eating just yellow and white ones doesn't allow much variety. Are there any web resources, books, charts or cookbooks that would show us how to insert some green veggies occasionally, while keeping his blood levels correct? -- J.B., Seattle

DEAR J.B.: I can only imagine the difficult times you have gone through, and am pleased to hear about the success of the procedure. There may be other anticoagulant (blood thinner) options to consider; your partner should discuss this with his physician. My answer will address Coumadin, since that is what he's currently taking.

First, some background. Coumadin, the brand name for warfarin, gets its abilities as a blood thinner from its opposition to vitamin K, which plays an integral role in blood clotting. The warning against green, leafy vegetables stems from the fact that vitamin K is present in these foods. By increasing the vitamin K in your diet, you could overwhelm the ability of the Coumadin to do its job.

The appropriate dose of Coumadin is determined through a series of blood-clotting tests. These are done with the patient's blood, so they will reflect his normal eating habits. From that point on, the key is to hold constant any substances that would affect blood clotting. It is not that your partner needs to completely eliminate vitamin K -- rather, once his Coumadin dose is determined, he should keep his level of vitamin K as constant as possible.

Other Coumadin-related advice includes checking with his doctor on other medications he might be taking. Aspirin, for example, affects blood clotting. Certain herbs can also interact with Coumadin (and blood clotting in general), so they should not be used without prior medical clearance. A list of suspect herbs would include ginseng, garlic, ginkgo, dan shen (salvia), devil's claw, dong quai, fenugreek, horse chestnut, papain (from papayas), chlorella and St. John's Wort.

You can download an extensive list of foods containing vitamin K at tinyurl.com/z92bfl7. This list comes from the coumadin.com website, which includes other pertinent information about the medication.

There are also a number of cookbooks that may help. One I am familiar with is appropriately named "The Coumadin Cookbook," now in its fourth edition. The author is a medical doctor who wrote the book after his wife was put on Coumadin, and they faced the same problems that you are now experiencing.

Your partner has been given the remarkable gift of a new heart valve -- something that would not have even been possible years earlier. If all that's needed to make it work is to watch the foods he eats, so be it! I wish you both good health and good luck.

Send questions to: "On Nutrition," Ed Blonz, c/o Universal Uclick, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.