Blood pressure with exercise

27. April 2007 William Davis (10)
Here's a frequently neglected cause for an increasing CT heart scan score: High blood pressure with exercise. Let me explain.

Paul's blood pressure at rest, sitting in the office or on arising in the morning, or at other relatively peaceful moments: 110/75 to 130/80--all in the conventional normal range.

We put Paul on the treadmill for a stress test. At 10 mets of effort (on the protocol used, this means 3.4 mph treadmill speed at 14 degree incline), Paul's blood pressure skyrockets to 220/105. That's really high.

Now, blood pressure is expected to increase with exercise. If it doesn't rise, that's abnormal and may, in fact, be a sign of danger. Normally, blood pressure should rise gradually in a stepwise fashion with increasing levels of exercise. But any blood pressure exceeding 170/90 is clearly too high with exercise. (Not to be confused with high blood pressures not involving exercise.) A handful of studies have suggested that a "breakpoint" of 170/90 also predicts heightened risk of heart attack over a long period.)

I see this phenomenon frequently--normal blood pressure at rest, high with exercise. This also suggests that when Paul is stressed, upset, in traffic congestion, under pressure at work, etc., his blood pressure is high during those periods, as well. I wouldn't be surprised to see other phenomena of underappreciated high blood pressure, like abnormally thick heart muscle (left ventricular hypertrophy), an enlarged thoracic aorta (visible on your heart scan), left atrium, perhaps even an abnormal EKG or abnormal kidney function (evidenced by an elevated creatinine on a standard blood panel).

Unfortunately, the treatments that reduce blood pressure are "stupid," i.e., they have no appreciation for what you are doing and they reduce blood pressure all the time, whether or not you're stressed, exercising, or sleeping.

Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

The message: Watch out for the blood pressures when you have a stress test. Or, if you have a friend who is adept at getting blood pressures, get a blood pressure immediately upon ceasing exercise. It should be no higher than 170/90.
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Comments (10) -

  • Anonymous

    11/7/2007 8:57:00 PM |

    Dr. Davis,
    Sorry, this isn't about high blood pressure and exercise.  Do you believe there is a connection between high blood pressure and tinnitus?  Also, do you think that there are any vitamins or minerals that could relieve tinnitus?

  • Dr. Davis

    11/7/2007 10:02:00 PM |

    I know very little about tinnitus. However, I have seen some people get relief with niacin (immediate-release).

  • Sara

    5/5/2009 11:02:00 PM |

    Dr. Davis:

    What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop, or a slight rise in systolic but a slight drop in diastolic, even with moderately vigorous exercise; my doctor doesn't think it's a concern (he's only worried about it being high, and I run 115/75 on average when just sitting around), and I haven't been able to find anything on my own. I'd like to know more about what conditions it can signal, and that I should therefore ask my doctor about specifically.

  • blood pressure medications

    8/19/2009 9:02:48 AM |

    What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop,High blood pressure cure supplement, natural herbal remedy to lower & control high blood pressure. Use Alistrol everyday to help maintain healthy circulation and support cardio-vascular health.

  • Anonymous

    6/20/2010 8:06:42 AM |

    Just chiming in on the enzyme called serrapeptase. I have the capsules and only use it when any of my dogs get bitten by a centipede. As soon as they come into the house squirming and licking the bitten paw, I give them one capsule and w/in a few minutes, they stop squirming and licking and fall asleep. So I think it works even if the stomach acid might destroy some of it. BTW, I used to take 1000 mgs of bromelain at night before bed and once when I was taking it regularly for about a week, I took a cholesterol lab test and my results came back showing a big decrease in my LDL and Total cholesterol numbers. The only change I could think of that might have caused the decrease was taking the bromelain.

  • Brian

    9/15/2010 10:26:52 AM |

    I have the same problem as Paul. Low/Good blood pressure while sitting around, but extremely high blood pressure after/during exercising, going up stairs, playing the trumpet, etc.

    Although I understand and agree with all of the natural remedies you listed for lowering blood pressure (exercise, lower carbs, etc), why do you recommend low saturated fat intake? Are there any sources/studies that indicate that saturated fat has a direct effect on BP, and if so, that it's a bad thing? And would these studies take into account other variables such as carbohydrates and trans fats?

    Any information you have would be GREATLY appreciated! Thanks.

    Brian

  • buy jeans

    11/3/2010 3:11:53 PM |

    Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

  • Brian

    11/3/2010 3:31:04 PM |

    I can understand the weight loss, exercise, and reduction of carbs (although not just processed, IMO) as well as magnesium and Vitamin D supplementation, but why the lower saturated fat? If you're trying to link lower sat fat intake to weight loss, I'd have to ask for a good source of information before I would believe you. In my practical experience in weight loss, I have lost tons of weight even though lots of my calories came from fat, and fat is needed for energy.

  • Mark "High Blood Pressure Causes " Lampson

    3/26/2011 4:27:59 AM |

    Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

  • Mark "High Blood Pressure Causes " Lampson

    3/26/2011 4:27:59 AM |

    Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

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A second chance

A second chance

29. September 2006 William Davis (1)
Stewart had a CT heart scan in 2004. Score: 475.

As always in the Track Your Plaque program, Stewart had his lipoproteins assessed. Among his patterns were LDL 157 mg/dl, severe small LDL, and the (post-prandial, or after-eating) IDL. Stewart was also "pre-diabetic" with a blood sugar of 123 mg/dl. Blood pressure was also a major issue. Although initially concerned, life and distractions got in the way, and Stewart's attentions drifted away.

Two years of a lackadaisical effort and Stewart's heart scan score was 600, a 26% increase. Not as bad as it could have been doing nothing (i.e., 30% per year), but still far from great. But, even with the increase in score, we still really didn't get Stewart's attention. He went about his business with a very lax dietary program, overindulging in breads, crackers, goodies, hot dogs, etc., and following a virtually non-existent exercise program except for playing golf once or twice a week.

Unfortunately, Stewart started having pains in his chest with very minimal efforts like climbing a single flight of stairs. His stress test proved abnormal. Stewart then received a stent in his left anterior descending coronary and another in his circumflex. His right coronary artery had a 40-50% blockage, close to requiring a stent.

I stressed to Stewart that this had been preventable. Should motivation remain unchanged, the next step would be bypass surgery.

I think I finally succeeded in getting Stewart's attention. He found the prospect of a bypass operation a lot more concrete than the idea of progression or regression of coronary plaque. So Stewart is being given a second chance. Unfortunately, we will no longer be able to track Stewart's plaque very effectively, since two of three arteries now contain stents, and only the right coronary remains scorable.

I hope Stewart succeeds. But I sure wish he had done this earlier. He had realistic hopes of never requiring stents or bypass surgery.

Learn from Stewart's mistakes. Attention to your program requires vigilance. You can't ignore the causes of your coronary plaque for any length of time without it catching up to you. But seize your first and best chance.
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Comments (1) -

  • Rick

    1/27/2009 4:56:00 AM |

    I hadn't realised that a stent prevented calcium scoring. Why is that?

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Heart disease is reversible

Heart disease is reversible

13. February 2008 William Davis (10)
In a previous post, Take this survey: I double-dare you, I posed a challenge:

Ask your doctor: Is heart disease reversible? Their answer:

1) No. Heart disease is definitely not reversible.

2) Yes, in rare instances, like lightning striking twice.

3) Yes, of course it is! Let's talk about how to do it!

I predicted that few readers of this blog would respond. I also predicted that the few who did would respond with the first answer, Heart disease is definitely not reversible. After all, in nearly all medical practices, the only parameters routinely followed to track risk for heart disease are LDL cholesterol and blood pressure. A measure of the disease itself (i.e., coronary atherosclerotic plaque) is not followed. So how can your doctor actually tell whether heart disease is reversed or not? When I engage in this conversation with colleagues, it goes no farther than rolled eyes or a snort. In my experience, talking about reversal of heart disease is a wasted effort.

To my great surprise, this simple survey received a total of 177 responses. Even more surprising, 122 (69%) of respondents chose number 3, claiming that their doctor said that heart disease is reversible.

Overall results:

1--31 responses (17.5%)

2--24 responses (13.5%)

3--122 responses (69%)


Now wait a minute: Where is the disconnect? Why are doctors saying that heart disease is reversible, yet not following this concept in practice? Contrary to the survey results, I have yet to meet a patient who said their doctor was trying to reverse their heart disease. Of course, this may be a skewed population, but I find it hard to believe that the prevailing view is that heart disease is reversible.

Anyway, this simple survey cannot settle the why or how, nor can it suggest just how prevalent this opinion is.

I am encouraged by these results. If true, it means that the message that heart disease is a reversible process is spreading. It may be make-believe heart disease reversal as preached by Dr. Dean Ornish or claimed by statin drug manufacturers. It may be the hocus-pocus of practices like chelation, or scams like nattokinase. But perhaps the seed of this notion has been planted in the minds of the medical community.

I'd be interested in hearing from the respondents who reported that their doctor said heart disease is reversible. How exactly are they going about achieving reversal?
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Comments (10) -

  • Anonymous

    2/13/2008 3:33:00 PM |

    "How I voted": After diet, exercise,Lowest Lipitor(1/2 a 10)and 1500 Niacin(high LP a)....my Cardio told me I was the only one of his patients able get to counts so low. And at that level he felt I would have "some chance for a little reversal". HDL70/LDL34/TR32/LPa30. I gave him a "2" because his tone of voice sounded forced to say "some chance" like he wasn't really convinced. Love your blog info....many thanks!

  • JJC

    2/13/2008 3:53:00 PM |

    Dr. Davis,

    I don't think there is a lot of inconsistency. I first got a scan because my Dr. was frustrated with me for not wanting to do the statin and niacin and lisinopril that he thought were needed. So he challenged me to get a heartscan. I'd never heard anything about them before. Once I came back motivated he was delighted. So, the only reason I got a scan was that I had a Dr. who already thought that heart disease was reversible, though to a more limited degree than you have documented.

    Before I got the scan I found your book and site and took your advice on EBT.

    When I talked to the cardiologists in the HMO, the first and supposedly the most flexible one told me that it was not reversible. The others were downhill from there. The primary care Dr's of 4 close friends that I keep bugging on this issue all either deny the usefulness of scans and/or maintain that niacin is useless if you are on a statin. (I guess they don't even read the NYtimes.)

    So, I think you got the responses you did because one way people come to this program is through Drs. that already know a bit more than the average Dr. about these issues. I find it very hard to motivate friends on these issues if their docs are not supportive, even if they have terrible scan scores.

    Best,
    Jim

  • vin

    2/13/2008 4:59:00 PM |

    May be the result is not such a surprise because the question is not answered by a random group.

    Most of the people who read this blog are already aware that heart disease is reversible. Majority with heart problems are not aware and are not told by their doctors that such a possiblity exists.

    It would be interseting to find out what course the "reversible" doctors take to achieve reversal: is it drugs to lower LDL and raise HDL or low fat diet or TYP.

  • Anonymous

    2/13/2008 5:12:00 PM |

    Hello Dr.Davis
    I responded heart disease is reversible because of data that I have read and personal experience on body's ability to heal.

    Also just a thought that your survey results might be weighted because people reading this blog would tend to be better informed. They also must think there are positive results in proactive (and preventive) health management to invest time in reading this blog, etc..

  • Anonymous

    2/13/2008 5:20:00 PM |

    One other thought - it seems that doctors do prescribe activities that they think reverses ( or at least halts) heart disease - such as quit smoking, lose weight, exercise, etc..
    But they aren't paid to educate - they are paid to treat disease (as you have pointed out so many times; there is no money in prevention).
    It seems like we need a new mandatory addition to the public education system.

  • Anonymous

    2/13/2008 9:03:00 PM |

    I am subscribed to the newsfeed of this blog, and try not to skip over anything you post. But perhaps I missed something, because you bashed nattokinase in a few of your recent posts.

    Isn't nattokinase also called natto, which is high in K2? Didn't you post about how it could be promising here:
    http://heartscanblog.blogspot.com/2007/12/food-sources-of-vitamin-k2.html

    Maybe I didn't understand the December post, or maybe you've changed your views on it.

    Well back to this posts theme: my parents dropped in from their motorhome-gypsy trip, and my father told me about his GP, who's a DO, that has him taking the supplements you recommend, as well as on a low-glycemic diet to control his newly diagnosed diabetes.

    His fasting sugars now range between 110-120s without pills or insulin, but he didn't know his cholesterol profile. I'll have to follow up with him via snail mail to ask him about that, now that I have their national forwarding address (it's difficult to finish a conversation with him with interruptions from my mother -- I asked my father his DO/GP's name, but instead I got my mother's doctor's name for her condition, sigh).

    I mentioned K2 to him, so now I'm wondering if I should tell him to forget it.

  • Anonymous

    2/14/2008 1:35:00 PM |

    Hi Doc:
    My cardiologist says that heart disease can be reversed by driving down LDL, pure and simple.  He has no interest in any other numbers.  To accomplish this he prescribes statins, and has not counseled me about any other lifestyle changes.

  • Anonymous

    2/14/2008 5:26:00 PM |

    I agree with what others have said.  The people who would take time to read your blog are better informed and probably seeking out better than average medical advice.  My doctor is very proactive on many things and not just a pill pusher.  In fact I would not continue to visit a doctor that is just pushing pills, surprisingly to me, there still seems to be a lot of people in the country that think that because their doctor has perscribed them something it is totally safe.

  • buy jeans

    11/3/2010 3:15:29 PM |

    Now wait a minute: Where is the disconnect? Why are doctors saying that heart disease is reversible, yet not following this concept in practice? Contrary to the survey results, I have yet to meet a patient who said their doctor was trying to reverse their heart disease. Of course, this may be a skewed population, but I find it hard to believe that the prevailing view is that heart disease is reversible.

  • johndouglas

    11/8/2010 7:54:20 PM |

    I appreciate the concern which is been rose.This is a wonderful opinion. The things mentioned are unanimous and needs to be appreciated by everyone.

    Well, it’s amazing. The miracle has been done. Hat’s off. Well done, as we know that “hard work always pays off”, after a long struggle with sincere effort it’s done.
    --------
    johndouglas

    Cycle Covers Motorhome Facts

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Can I stop my Coumadin?

Can I stop my Coumadin?

5. September 2010 William Davis (20)
Here I go again.

While I will try to keep this blog on topic, i.e., coronary heart disease prevention and reversal using nutritional and other natural strategies, I believe that a "critical mass" of frequently asked, though off topic, questions keep cropping up.

One such question revolves around Coumadin, or warfarin.

Somehow, my Nattokinase scam blog post draws traffic about Coumadin. I tried to make the point that a conventional blood thinning agent like Coumadin that undoubtedly has undesirable side-effects cannot be replaced by an agent that has an uncertain track record. In the case of nattokinase, no track record.

To illustrate how far wrong the "nattokinase as replacement for Coumadin" idea can go, here is a question from Anna:


I came across your blog while perusing.

I am a bit bummed because I have been on Coumadin (warfarin) for around 22 years since I was 6 years old. I have a mechanical heart valve (St. Jude's), as I have heart-related issues, including hypertrophic obstructive cardiomyopathy.

Well, it is just that the warfarin seems to interact with nearly everything. I feel like I can not get the nutrients my body requires. I desire to consume more raw foods and vegan foods, though I do not want anything to damage my heart valve or risk a stroke/heart attack or internal bleeding.

I have been underweight the majority of my life, malnourished , currently am still somewhat underweight, though enjoying food again, as I had what mimicked Crohn's Disease for several years (horrendous pain), from which I am in remission now. I was diagnosed with osteoporosis, which may or may not be caused from consuming warfarin.

Is it possible to get off of warfarin and effectively keep my blood thinned ? I currently take 1.5 mg to 2 mg dosage. Does the warfarin destroy Vitamin K and if so does that mean while on warfarin I never get the Vitamin K nutrients even if I did consume foods with it in it?

Thank you
Anna

No, sorry, Anna. Stopping Coumadin with your unique issues, i.e., a prosthetic mechanical heart valve (likely mitral, judging by your history of hypertrophic obstructive cardiomyopathy, in which the patterns of blood flow ejected from the heart disrupt the natural mitral valve function) and cardiomyopathy, can be fatal. Without blood thinning, the mechanical heart valve can trigger blood clot formation, since it is a foreign object implanted into the bloodstream.

There are no natural alternatives available with track records confident enough to bet your life on. Aspirin nor Plavix are blood thinners, but platelet inhibitors. These two agents, while they work for other forms of arterial (but not venous) blood clot inhibition, will not work for your unique situation.

Likewise, a purported oral lytic agent like nattokinase should not be substituted for Coumadin. Even if there was plausible science behind it, you should demand substantial evidence that it provides at least blood thinning equivalent to Coumadin. Should a blood clot, even a small one, form in or around the prosthetic valve, the valve can stop working within seconds. This can lead to death within minutes.

I believe it would be foolhardy to bet your life based on the marketing--let me repeat: MARKETING--of a "nutritional supplement" by supplement manufacturers eager to make a buck.

Nor are there any other nutritional supplements that can safely replace the Coumadin. I wish that were NOT true, as I am no stranger to the long-term dangers of Coumadin and I am a big believer, in general, in nutritional supplements. I am a BIGGER believer, however, in the truth. Weighing the options available to us today, there really is no rational choice but to remain on Coumadin.

By the way, I tell my patients to eat a substantial amount of green vegetables while they take Coumadin. I know that conventional advice is to reduce or eliminate green vegetables due to their content of Coumadin-antagonizing vitamin K. I think this is wrong, also. Green vegetables are the best foods on earth. They reduce risk for cancer, diabetes, bone disease, and coronary heart disease.

To obtain the benefits of green vegetables without mucking up your blood thinning (your "protime" or International Normalized Ratio, INR), I advise my patients who take Coumadin to eat green vegetables--but do so every day in relatively consistent quantities, so that the protime or INR is not disrupted and remains reasonably constant. It may mean that your total dose of Coumadin may be somewhat higher, e.g., 3 or 4 mg instead of 2 mg, but the dose is immaterial outside of blood thinning. That way, you obtain all the wonderful health benefits of green vegetables while maintaining fairly consistent blood thinning/protime/INR. Coumadin does not block all the health benefits of vegetables, only those related to vitamins K1 and K2.

With regards to protecting yourself from the osteoporosis promoting effects of Coumadin, I would be sure to follow a program of natural bone health, such as the one I discussed in Homegrown osteoporosis prevention and reversal. You will have to be extra careful, however, with the vitamin K2. Ideally, you have a doctor knowledgeable about vitamin K2 who can assist you in managing K2 intake while on Coumadin. This is something you can definitely NOT manage on your own. (I am a big believer in self-managed care, but this is way beyond the limit.)

Lastly, it is my belief that anyone with an inflammatory bowel condition, such as Crohn's disease or ulcerative colitis, should absolutely, positively, and meticulously AVOID WHEAT and all other gluten sources (such as rye, barley, and oats). Even if you test negative for celiac markers (e.g., anti-gliadin antibodies, emdomysium and transglutaminase antibodies), the enhanced intestinal permeability will allow wheat proteins, such as gluten, to gain ready entry into the bloodstream. Not to mention that wheat should have no place in the human diet anyway, in my view.
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Comments (20) -

  • Myron

    9/5/2010 7:09:35 AM |

    Coumadin is considered a Natural Medicine having been derived from mold acting on Sweet Clover.

    Most Pharmaceutical Drugs have a Natural Basis.

  • Anonymous

    9/5/2010 8:32:30 AM |

    What about using heparin derivatives as a replacement of Marevan / Coumarin?

  • Anonymous

    9/5/2010 8:38:52 AM |

    As mentioned in Wikipedia, low molecular weight heparin (LMWH) is used in pregnancy. It should be possible to change Marevan / Coumarin with LMWH.
    http://en.wikipedia.org/wiki/Marevan#Pregnancy

    Heparin can not be taken orally, so you have to get injections if you decide to change medication.

  • Dr. William Davis

    9/5/2010 9:54:16 AM |

    Yes, indeed.

    But anyone who has taken low-molecular weight heparin injections will tell you it's no picnic. The injections can be painful and leave a bruise. After a few weeks, you can feel like a pincushion and be riddled with bruises. Not a happy alternative.

  • Chris Masterjohn

    9/5/2010 4:56:00 PM |

    Hi Dr. Davis,

    Great, although somewhat depressing, post.

    What is the point of taking the K2 when K2 interferes with the therapy (as Vermeer's group showed) and the dose will have to be adjusted?  The drug interferes with the recycling of vitamin K so it should affect both forms equally.  Are you hoping it may shift the balance of residual vitamin K activity towards the bones and blood vessels?  That seems to make some sense if there is substantial residual vitamin K activity.

    Chris

  • Anonymous

    9/5/2010 6:13:38 PM |

    Chris, I think you are going down the right path with your thinking.  Some K2 survives warfarin therapy as evidenced here:


    "In conclusion, our study indicates that in a rat model
    arterial media calcification is prevented by a high dose of
    MK-4."

    http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224160&Ausgabe=229786&ArtikelNr=75344

    The question then becomes how high a dose is therapeutic in humans and can you get it from diet alone?

    I'm a prisoner of life long warfarin therapy and have consciously shifted my K intake to K2 by eating lots of eggs, cheese and grass fed/finished beef instead of green leafy vegetables because of the way warfarin hammers conversion of K1 to K2.  Sure green leafy vegetables have health properties but they won't help with warfarin driven arterial calcification and osteoporosis.  So far I have avoided taking a K2 supplement and adjusting warfarin dosage because I don't have confidence in the consistency of the K2 in a supplement form.  It becomes another wildcard.  But the bottom line is I really don't know if there is enough K2 to make a difference from food alone.

  • Anonymous

    9/5/2010 6:19:24 PM |

    Dr. Davis, do you have any thoughts on arginine supplementation as a driver of nitric oxide production for the purpose of blood vessel dilation?  I am showing signs of venous insufficiency from a blood clot in my leg suffered over a decade ago.  You mention aspirin and Plavix as platelet inhibitors that don't impact venous clotting.  Arginine also affects platelet activity and I can't find anything definitive about whether or not that is an issue with warfarin.  Arginine is also associated with mitigating atherosclerosis which would seem to make it a good choice for people on warfarin.

  • Anonymous

    9/5/2010 8:04:38 PM |

    Dr davis

    after reading your blog two things have stuck in my mind. one about the role of vaccines in development of disease. and two role of GM foods in destroying health.

    kindly shed light on it. im splitting my hair over it

    Smile

  • Anonymous

    9/5/2010 8:37:04 PM |

    This topic has to be of great interest to the many people on Warfarin for atrial fibrillation,  particularly the issue of warfarin-induced calcification and osteoporosis.  This article http://bloodjournal.hematologylibrary.org/cgi/content/full/109/8/3607 suggests that levels of 45mcg of K2 supplementation would be safe, but what is a therapeutic dose and how does it work with Warfarin? (One of the authors has ties with Natto Pharma, seller of K2; they also suggest it is a safe dose.) Until specific studies are done, we will not know how it works.

    Will one of the newer anticoagulants in the pipeline, such as Dabigatran, which I understand is not a vitamin K agonist, be approved soon and will it be effective?

  • Anonymous

    9/6/2010 3:16:19 PM |

    Dear Dr. Davis:

    This topic is really distressing.  My father has been on Warfarin for 10 years due to atrial fib. I can't help but wonder if his increasingly worsening calcium scores were due in part to Warfarin. It seems to be an extremely nasty - but necessary - drug.

    Over the past year he has been increasingly tired and two months ago had a triple bypass. He has been on a low carb diet, lost 25lbs and started taking fish oil and 5,000 i.u Vitamin D3. He is not taking any K2, but he does eat green vegetables every day. He recently started taking 10,000 i.u. of D3.  Should anyone taking larger D3 doses who is also on Warfarin be worried about arterial calcification? How does one find a doctor in Milw. or elsewhere who has knowledge about K2 and Warfarin? What else can Warfarin users do about their heart disease?

  • Dr. William Davis

    9/7/2010 1:45:50 AM |

    Sadly, there are no data--none, zero, zip--that address the end result of taking vit K2 in any dose or any form while on warfarin.

    No doubt: It will drive INR down, driving warfarin need up. But there are no data on what effects will result at the bone or artery level.

    I wish that weren't true, but we cannot invent data where it doesn't exist. It also cannot be extrapolated from existing data or experiences without incurring substantial risk.

    Sometimes, we just need the data.

  • Anand Srivastava

    9/7/2010 7:14:21 AM |

    How does Omega3 supplementation help?
    I have read that Omega6 is one of the agents that triggers blood clotting.
    Also I read that coumadin actually works by inhibiting action of K1/K2.
    So adding K1/K2 will actually be against the coumadin therapy.

    But since Omega6 is required for the signalling that causes blood clots. If you reduce the Omega6 and increase the Omega3 then the blood clots should not happen naturally.
    It will be like the Inuits.
    Their arteries are in a bad shape but they never get a heart problem, because they do not get blood clots in their blood.
    The only problem is that they don't get blood clots while bleeding also.
    So if you use excess Omega3 with very little Omega6 you will be doing the same. But the side effect is that you have to be careful about bleeds.
    I would think that the same problem will be there for coumadin

  • Anonymous

    9/7/2010 5:20:15 PM |

    Dear Dr. Davis:

    The FDA Advisory Council is meeting regarding Dabigatran on September 20th and word is that its approval is expected by the end of the year or early 2011. I have even seen Boehringer-Ingelheim ads on the online JACC to the effect of "Coming Soon - Pradaxa" (the brand name).

    Will this be the paradigm-shifting Warfarin alternative for AF patients?  As Dabigatran is not a Vitamin K agonist, will its users be able to also use food and supplemental sources of Vitamin K2?

    Apart from the supposed reduction in bleeding risk, will Dabigatran be a preferable anticoagulant for long-term Warfarin users?

  • Chris Masterjohn

    9/8/2010 7:07:28 PM |

    Dear Dr. Davis,

    Did you mean that there are no data on whether K2 will protect against the heart valve calcification that occurs on these drugs, or that there are no data showing its effect on INR?

    Vermeer's group compared vitamin K2 as MK-7 to K1 and showed that it is much more potent at driving down the INR value:

    http://bloodjournal.hematologylibrary.org/cgi/content/full/109/8/3279

    By the way, since you are a fan of K2, if you haven't already seen it, you might enjoy the large review I wrote on it back in 2007, which argued that it was the "Activator X" discovered by Weston Price:

    http://www.westonaprice.org/abcs-of-nutrition/175-x-factor-is-vitamin-k2.html

    Love your blog!

    Chris

  • Chris Masterjohn

    9/8/2010 7:12:27 PM |

    Anonymous, I have seen that study but I don't think it shows how much residual activity of K2 there is, or to what extent it can protect against calcification for someone on warfarin.

    The reason is that K2 potently interferes with these drugs.  In the study, they used a massive dose without cranking up the warfarin proportionately.  However, if you take K2 and you actually need to be on these drugs, your doctor will have to adjust the dose of the drug according to the dose of K2 you are taking.  So it is not very apparent that it is actually possible to obtain the beneficial effects of K2 while taking these drugs.

    (As a side point, the massive dose of K2 could provide enough K2 in these studies to allow each molecule to act once and then get converted to the epoxide form without being recycled, and actually exert a meaningful effect.  Off memory, I don't remember whether they did calculations to show whether there was residual reductase activity (i.e. activity of the enzyme that recycles vitamin K, which is the target of warfarin), but the principle that high dose K2 protects against calcification does not show that the dose of warfarin used allowed residual activity of the enzyme, necessariliy.)

    Chris

  • Anonymous

    9/8/2010 9:03:01 PM |

    Sounds as if AF patients should ask their physicians to change them to Dabigatran as soon as it comes out. Less bleeding risk, no constant monitoring and, importantly, the ability to avail oneself of good nutrition without worrying about INR's. The British Heart Foundation is campaigning for the drug to replace Warfarin.  

    Used widely to get rid of rat infestations in post-Katrina New Orleans, maybe Warfarin will soon be relegated to only killing rats.

  • Chris Masterjohn

    9/8/2010 10:10:20 PM |

    Anonymous,

    Good points -- warfarin was actually developed specifically as a rat poison, so if it came back into fashion post-Katrina, that's nothing new.

    Chris

  • Lacie

    9/10/2010 10:21:24 PM |

    I spent 18 unhappy months on Warfarin after a DVT/pulmonary embolism episode due to oral contraceptive use (I have Factor V leiden).  Happily, my physician took me off blood thinners last year after a doppler scan to confirm all of my clots were gone.

    If you really need a blood thinner (artificial heart valve, active blood clot, severe prolonged a-fib, homozygous Factor V leiden), there's just no good alternative to Warfarin at the moment.  Several alternatives have been tested and rejected due to severe side effects.

    A lower-risk propensity to blood clotting (hterozygous Factor V leiden, mild, short-duration a-fib, etc.) might respond to vitamin E.  I started taking it while on Warfarin and my INR readings shot up from 2 to 4.5.  See study by Harvard researcher Robert Glynn, published in September 25, 2007, issue of Circulation journal

  • Holistic health Blog

    6/29/2011 1:07:21 PM |

    Surely the answer is to take the nattokinase, keep a close watch on the INR & if it goes up significantly titrate the warfarin down.

  • Sal P

    5/15/2013 6:40:08 PM |

    Hello Doc,

    I have the same conflict as many here. I take Coumadin for my mechanical heart valve but I do eat green veggies such as broccoli, spinach, or a small salad everyday. I also take Omega 3 daily. My PT INR is usually around the required goal of 2.0. As long as I have this consistent INR reading, is it safe to continue to to have all the above mentioned in my body? I am hoping that my Coumadin dosage can be lowered with the same INR results.

    Please Advise

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