Diet for Heart Health

A study by Caldwell published by the NIH set out to show that plant-based nutrition helps prevent coronary artery disease in a large group of patients. 198 patients with CVD were followed and given counseling on how to convert from a regular diet to plant-based nutrition. Results showed that 89% adhered to the diet and in the group of adherent participants major cardiac events recurred at a rate of 0.6%. This was significantly less than reported in other similar studies where a smaller group was used. Of the non-adherent participants, 62% experienced adverse events. Caldwell concludes that patients with CVD respond to intense counseling and when on a sustained plant-based diet for a mean 3.7 years they experience a low rate of cardiac events. Plant-based nutrition has the potential for a large effect on the CVD epidemic.

Source: A Way to Reverse CAD?

Supporting Articles: Evidence listed by Coldwell to support a low-fat vegan diet:

Nattokinase as a Possible Treatment for Cardiovascular Disease

A 2018 review in the NCBI Biomarker Insights journal looks at nattokinase as a possible alternative in the prevention and treatment of cardiovascular disease. Nattokinase (NK), the most active ingredient of natto (cheese-like food made from fermented soybeans), possesses a variety of favorable cardiovascular effects. The review looks at the pharmacological effects and mechanisms of NK in terms of fibrinolytic/antithrombotic effects, anti-atherosclerotic and lipid-lowering effects, antihypertensive effects, antiplatelet/anticoagulant effects, and neuroprotective actions. The review also lists the few clinical studies that have been done with NK. NK is registered as a nutritional supplement and not a drug. In summary, compared with traditional antithrombotic and antihypertensive drugs, NK is characterized by high safety, low cost, simple production process, oral availability, and long in vivo half-life. As such, it is expected to become a new-generation drug for thrombotic disorders or CVDs.

Source: Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases

Food/Drug/Supplements that effect INR

Common drugs that can interact with warfarin include:

Aspirin or aspirin-containing products
Acetaminophen (Tylenol, others) or acetaminophen-containing products
Antacids or laxatives
Many antibiotics
Antifungal medications, such as fluconazole (Diflucan)
Cold or allergy medicines
Ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, Naprelan, others)
Medications that treat abnormal heart rhythms, such as amiodarone (Pacerone, Nexterone)

scan for more information on drug interaction:


drug interactions with Warfarin

www.ncbi.nlm.nih.gov/pmc/articles/PMC1942100/bin/18TT1.jpg
drugs that interact with warfarim

Common supplements that can interact with warfarin include:

Vitamin K
Vitamin K2 [2]
Vitamin C [3]
Probiotics [2]

Resveratrol (possibly safe, see [1])
Omega 3
Coenzyme Q10 (ubiquinone)
Dong quai
Garlic
Ginkgo biloba
Ginseng
Green tea
St. John’s wort
Vitamin E
Vitamin A
Senna leaves
Flavonoids – safe [4]
Nattokinase
Vitamin D3 – reduce vitamin K

Take Magnesium/Zinc/Iron at least two hours apart from Warfarin That should eliminate any possible interaction.

Common foods and drinks that might interact with warfarin include:

Food high in Vitamin K (green leafy vegetables)*

Cranberries or cranberry juice
Grapefruit
Alcohol
Garlic
Black licorice

It’s important to have a consistent amount of vitamin K in your diet (if on warfarin). If you have little vitamin K in your diet, a sudden spike can increase your risk of bleeding.

Resistance to oral anticoagulants has been associated with high vit K food intake.

Foods rich in vitamin K include:

beef liver, broccoli, Brussels sprouts, cabbage, collard greens, endive, kale, lettuce, mustard greens, parsley, soy beans, spinach, Swiss chard, turnip greens, watercress, and other green leafy vegetables.

Moderate to high levels of vitamin K: asparagus, avocados, dill pickles, green peas, green tea, canola oil, margarine, mayonnaise, olive oil, and soybean oil. Snack foods containing the fat substitute,

olestra, are fortified with 80 mcg of vitamin K per each one ounce serving

Consumption of large amounts of mango fruit has been associated with enhanced effects of warfarin. The exact mechanism of interaction is unknown but may be related to the vitamin A content, which may inhibit metabolism of warfarin.

Limited data also suggest a potential interaction between warfarin and cranberry juice resulting in changes in the INR and/or bleeding complications.

There have been several case reports in the medical literature of patients consuming grapefruit, grapefruit juice, or grapefruit seed extract who experienced increases in INR. R(+) warfarin…possibly safe

.. elevated INR due to pomegranate juice

Black currant juice and black currant seed oil may theoretically increase the risk of bleeding or bruising if used in combination with anticoagulants.

Soy protein in the form of soy milk was thought to be responsible for a case of possible warfarin antagonism in an elderly male stabilized on warfarin. The exact mechanism of interaction is unknown, as soy milk contains only trace amounts of vitamin K. Subtherapeutic INR values were observed approximately 4 weeks after the patient began consuming soy milk daily for the treatment of hypertriglyceridemia. No other changes in diet or medications were noted during this time. The patient’s INR returned to normal following discontinuation of the soy milk with no other intervention.

An interaction with chewing tobacco was suspected in a case of warfarin therapy failure in a young male who was treated with up to 25 to 30 mg/day for 4.5 years. The inability to achieve adequate INR values led to eventual discontinuation of the chewing tobacco, which resulted in an INR increase from 1.1 to 2.3 in six days. The authors attributed the interaction to the relatively high vitamin K content in smokeless tobacco.

Some experts recommend that continuous enteral nutrition should be interrupted for one hour before and one hour after administration of the anticoagulant dose and that enteral formulas containing soy protein should be avoided. Anticouglant users should consider limiting the consumption of cranberry juice or other cranberry formulas or pomegranate juice, black currant juice, and black currant seed oil.

<h2) Natural blood thinners</H2
Celery, galic, vit C
are does Warferin alternativesss,
need some postapocaliptiiic solution, assumin, only

Other blood thinning medication:

Plavix – avoid grapefruits, Celery
לתרופות החדשות למניעת קרישה (קסרלטו, אליקוויס ופרדקסה) כמעט שאין התנגשויות ידועות עם מזון.
avoid grapefruits, Celery, garlic

לבני ממליצה גם להיזהר ממזונות מדללי דם כמו סלרי ושום ולא לצרוך אותם בכמויות גדולות, למרות שכרגע אין מידע על אינטראקציות של מזונות אלה עם התרופות החדשות.

References:

www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/in-depth/warfarin-side-effects/art-20047592

[1] www.ncbi.nlm.nih.gov/pmc/articles/PMC5090816/

[2] 1.getmanaged.online/gut-bacteria-and-probiotics-that-lower-inr/

[3] Vitamin C
Vitamin C with Rose Hips (ascorbic acid)

Ascorbic acid has been implicated in causing warfarin resistance. However, controlled clinical trials have not demonstrated clinically important variations in prothrombin times. The possibility of an interaction may be considered if warfarin resistance is encountered in patients taking high doses of ascorbic acid.
References
Smith EC, Skalski RJ, Johnson GC, Rossi GV “Interaction of ascorbic acid and warfarin.” JAMA 221 (1972): 1166
Hume R, Johnstone JM, Weyers E “Interaction of ascorbic acid and warfarin.” JAMA 219 (1972): 1479
Rosenthal G “Interaction of ascorbic acid and warfarin.” JAMA 215 (1971): 1671
Weintraub M, Griner PF “Warfarin and ascorbic acid: lack of evidence for a drug interaction.” Toxicol Appl Pharmacol 28 (1974): 53-6
Feetam CL, Leach RH, Meynell MJ “Lack of a clinically important interaction between warfarin and ascorbic acid.” Toxicol Appl Pharmacol 31 (1975): 544-7

[4] = flavonoids, no interaction with Warfarin – www.ncbi.nlm.nih.gov/pubmed/28696372qqqq

****************

Guo LQ, Yamazoe Y “Inhibition of cytochrome P450 by furanocoumarins in grapefruit juice and herbal medicines.” Acta Pharmacol Sin 25 (2004): 129-36
Bodiford AB, Kessler FO, Fermo JD, Ragucci KR “Elevated international normalized ratio with the consumption of grapefruit and use of warfarin.” SAGE Open Med Case Rep 0 (2013): 1-3
Suvarna R, Pirmohamed M, Henderson L “Possible interaction between warfarin and cranberry juice.” BMJ 327 (2003): 1454
Beckey NP, Korman LB, Parra D “Effect of the moderate consumption of olestra in patients receiving long-term warfarin therapy.” Pharmacotherapy 19 (1999): 1075-9
Kempin SJ “Warfarin resistance caused by broccoli.” N Engl J Med 308 (1983): 1229-30
Sullivan DM, Ford MA, Boyden TW “Grapefruit juice and the response to warfarin.” Am J Health Syst Pharm 55 (1998): 1581-3
Westfall LK “An unrecognized cause of warfarin resistance.” Drug Intell Clin Pharm 15 (1981): 131
Harrell CC, Kline SS “Vitamin K-supplemented snacks containing olestra: Implication for patients taking warfarin.” Jama J Am Med Assn 282 (1999): 1133-4
Walker FB “Myocardial infarction after diet-induced warfarin resistance.” Arch Intern Med 144 (1984): 2089-90
Pedersen FM, Hamberg O, Hess K, Ovesen L “The effect of dietary vitamin K on warfarin-induced anticoagulation.” J Intern Med 229 (1991): 517-20
Grant P “Warfarin and cranberry juice: an interaction?” J Heart Valve Dis 13 (2004): 25-6
Griffith LD, Olvey SE, Triplett WC “Increasing prothrombin times in a warfarin-treated patient upon withdrawal of ensure plus.” Crit Care Med 10 (1982): 799-800
Ge B, Zhang Z, Zuo Z “Updates on the clinical evidenced herb-warfarin interactions.” Evid Based Complement Alternat Med 2014 (2014): 957362
Kazmier FJ, Spittell JA Jr “Coumarin drug interactions.” Mayo Clin Proc 45 (1970): 249-55
Wells PS, Holbrook AM, Crowther NR, Hirsh J “Interactions of warfarin with drugs and food.” Ann Intern Med 121 (1994): 676-83
Agencia Española de Medicamentos y Productos Sanitarios Healthcare “Centro de información online de medicamentos de la AEMPS – CIMA. Available from: URL: cima.aemps.es/cima/publico/home.html.” ([2018]):
Zallman JA, Lee DP, Jeffrey PL “Liquid nutrition as a cause of warfarin resistance.” Am J Hosp Pharm 38 (1981): 1174
Watson AJ, Pegg M, Green JR “Enteral feeds may antagonise warfarin.” Br Med J 288 (1984): 557
Monterrey-Rodriguez J “Interaction between warfarin and mango fruit.” Ann Pharmacother 36 (2002): 940-1
Roberts D, Flanagan P “Case report: Cranberry juice and warfarin.” Home Healthc Nurse 29 (2011): 92-7
Griffiths AP, Beddall A, Pegler S “Fatal haemopericardium and gastrointestinal haemorrhage due to possible interaction of cranberry juice with warfarin.” J R Soc Health 128 (2008): 324-6
Parr MD, Record KE, Griffith GL, et al “Effect of enteral nutrition on warfarin therapy.” Clin Pharm 1 (1982): 274-6
Chow WH, Chow TC, Tse TM, Tai YT, Lee WT “Anticoagulation instability with life-threatening complication after dietary modification.” Postgrad Med J 66 (1990): 855-7
Hamann GL, Campbell JD, George CM “Warfarin-cranberry juice interaction.” Ann Pharmacother 45 (2011): e17
Andersen P, Godal HC “Predictable reduction in anticoagulant activity of warfarin by small amounts of vitamin K.” Acta Med Scand 198 (1975): 269-70
Howard PA, Hannaman KN “Warfarin resistance linked to enteral nutrition products.” J Am Diet Assoc 85 (1985): 713-5
MacLeod SM, Sellers EM “Pharmacodynamic and pharmacokinetic drug interactions with coumarin anticoagulants.” Drugs 11 (1976): 461-70
Rindone JP, Murphy TW “Warfarin-cranberry juice interaction resulting in profound hypoprothrombinemia and bleeding.” Am J Ther 13 (2006): 283-4
Jarvis S, Li C, Bogle RG “Possible interaction between pomegranate juice and warfarin.” Emerg Med J 27 (2010): 74-5
Lee M, Schwartz RN, Sharifi R “Warfarin resistance and vitamin K.” Ann Intern Med 94 (1981): 140-1
Brandin H, Myrberg O, Rundlof T, Arvidsson AK, Brenning G “Adverse effects by artificial grapefruit seed extract products in patients on warfarin therapy.” Eur J Clin Pharmacol 63 (2007): 565-70
Kuykendall JR, Houle MD, Rhodes RS “Possible warfarin failure due to interaction with smokeless tobacco.” Ann Pharmacother 38 (2004): 595-7
Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT “Recommendations for the use of medications with continuous enteral nutrition.” Am J Health Syst Pharm 66 (2009): 1438-67
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Karlson B, Leijd B, Hellstrom K “On the influence of vitamin K-rich vegetables and wine on the effectiveness of warfarin treatment.” Acta Med Scand 220 (1986): 347-50
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Magnesium to prevent and reverse Aurtic stenosis and calcification in general

the SEM data show that the protein-protein cross-linking bonds are the starting sites of calcification. In addition, substitution of Ca2+ cations by Mg2+ cations leads to the formation of amorphous hydroxyapatite, preventing aortic valve stenosis, which suggests that treatment with magnesium salts may reduce stenosis of aortic valves…
iv.iiarjournals.org/content/28/1/91.full

We observed strong, favorable associations between higher self-reported total (dietary and supplemental) magnesium intake and lower calcification of the coronary arteries…
www.ncbi.nlm.nih.gov/pmc/articles/PMC3957229/

Studies showed that a calcium to magnesium intake ratio <2.8 is critical for optimal health, supporting a long-held but non–evidence-based recommendation that the calcium to magnesium ratio should be close to 2. Increasing calcium intakes in the United States since 1977 have resulted in a calcium to magnesium ratio >3.0 since 2000, coinciding with increasing rates of T2D and colorectal cancer. US studies assessing oral magnesium therapy or dietary magnesium intakes showed beneficial effects of dietary magnesium in CVD, T2D, and cancers, although similar studies in populations with lower calcium to magnesium ratios (≥1.7) reported the opposite…
www.ncbi.nlm.nih.gov/pmc/articles/PMC4717874/

 

Vitamin D

does vit D cause calcification of arteries?
according to one article, it could in some settings, not clear when, many other sources point out the benefits of vit d

Vitamin D in Vascular Calcification: A Double-Edged Sword?

#q
How much sun exposure is needed for vit D instead of supplements?

answer from https://www.healthline.com/nutrition/vitamin-d-from-sun#time-of-day

At noon, the sun is at its highest point, and its UVB rays are most intense. That means you need less time in the sun to make sufficient vitamin D (5Trusted Source).

Many studies also show that the body is most efficient at making vitamin D at noon (6Trusted Source7Trusted Source).

For example, in the UK, 13 minutes of midday sunlight exposure during summer three times per week is enough to maintain healthy levels among Caucasian adults (5Trusted Source).

Another study found that 30 minutes ttof midday summer sun exposure in Oslo, Norway was equivalent to consuming 10,000–20,000 IU of vitamin D (8Trusted Source).

The commonly recommended daily dose of vitamin D is 600 IU (15 mcg) (3).

Vitamin D is critical for brain health…