Holidays equal splurges – do you agree with me? And with all the treats lurking around, you may be wondering how not to completely fall off the vitamin K bandwagon and mess with your INR levels. But don't worry – in this article, we've got you covered with loads of practical tips (and recipes that will make you drool). And I guarantee that you will still find this article useful even if, like me, you don't celebrate Valentine's Day.
Can you eat out if you're taking Coumadin?
Definitely. But it goes without saying that your food selection matters. I know, that's probably a 'Duh!' moment for you but keep scrolling to see what I mean.
I suggest you avoid soups made entirely with vitamin K rich green leafy veggies such as kale or spinach unless you know exactly how much greens have been used to make the soup. Instead, why not try a small portion of soup made from beets, carrots, squash or sweet potato? You also want to be aware of any herbs that might have been added to the soup (see below).
If you take a look at the recipes linked to this article, you'll notice that none of them contain bread or any wheat-containing product. That's because one of the issues caused by the gluten and gliadin found in wheat products gradually damage our guts. This may lead to various autoimmune disorders since about 80% of our immune system lies in our gut.1, 2
But if bread dipped in oil is a must for you, request extra-virgin olive oil instead of industrial seed oils such as those of corn, canola, safflower, cottonseed or soybean. Wondering why? Well, besides increasing systemic inflammation, these industrial oils have also been found to make the gut more permeable and, as such, may lead to random but numerous food sensitivities.3
If you're ready to ditch the bread, here are some tasty suggestions:
- Veggie sticks with hummus
- Cucumber slices with guacamole
- Sweet potato fries with salsa
- Grilled eggplant with a little bit of garlic butter
- Roasted cabbage with feta cheese
So this year, instead of the traditional bread in oil dip, why not try:4
- Avocado (guacamole): 42.2µg per whole avocado
- Clarified butter (ghee): 1.0µg per tablespoon
- Extra virgin olive oil: 8.06µg per tablespoon
- Grass-fed butter: 1.0µg per tablespoon
- Virgin coconut oil: 0.1µg per tablespoon
- Feta cheese: 0.5µg per ounce
- Hummus: 0.4µg per tablespoon
- Peanut butter (free from sugar, vegetable oil and additives): 3.4µg per ounce
- Salsa: 0.75g per tablespoon
Salads consisting mostly of greens will usually be high in vitamin K. So if you're looking for a low-vitamin K option, look for a more colorful one. You could try:
- Grilled eggplant with full-fat Greek yogurt seasoned with cayenne pepper
- Sautéed zucchini noodles served with meat Bolognese
- Shrimps mixed with cucumber and cherry tomatoes
- Roasted butternut squash with chopped apples on a bed of iceberg lettuce
To give you an idea, here's how much vitamin K you can get per cup of the following veggies:4
- Acorn squash: 0.0µg
- Broccoli, raw: 92.5µg
- Brussels' sprouts, cooked: 29.5µg
- Butternut squash: 1.5µg
- Cauliflower: 17.2µg
- Cabbage, green: 67.6µg
- Cabbage, red, chopped: 34.0µg
- Cucumber, peeled and sliced: 8.6µg
- Eggplant: 2.9µg
- Garlic: 0.1µg per clove
- Iceberg lettuce, shredded: 17.4µg
- Kale, raw: 112.8µg
- Spaghetti squash: 1.5µg
- Spinach, raw: 188.7µg
- Zucchini: 0.0µg
In a nutshell, go for meats that look like meat. I mean if you look at a chicken nugget or breaded fish, unless you read the list of ingredients, you probably won't know what you're ingesting… Plus that way you're sure to get some real protein and some quality zinc which is known to be an aphrodisiac mineral.5 To get even more nutritional bang for your money, select wild fish, free-range chicken or grass-fed beef – this will be clearly written on the menu.
Here is the vitamin K content of a few healthy choices:4
- Beef sirloin steak: 0.4µg per ounce
- Chicken breast (skinless, boneless): 0.0µg
- Eggs: 0.15µg per large egg
- Filet mignon: 2.6µg per steak (about 164g or 5.8oz)
- Ground beef: 0.15µg per ounce
- Ground lamb: 1.02µg per ounce
- Lobster: 0.0µg
- Oyster, emu: 0.0µg
- Oyster, ostrich: 0.0µg
- Salmon, Atlantic: 0.0µg
- Salmon, pink: 0.1µg per ounce
- Salmon, sockeye: 0.03µg per ounce
- Scallops: 0.94µg per ounce
- Shrimps: 0.38µg per ounce
If you don't eat meat, you can get all the protein you need from legumes, beans and seeds. You'll notice that I didn't mention soy products here – that's because 90% of the soy in the US has been genetically modified and because of the way they are processed, soy products have been linked to numerous health issues.6
'Well, Asians eat lots of soy!' Hmm, no they don't – they use it as a condiment not as the main ingredient in their meals. Plus, the soy consumed traditionally by Asians used to be fermented prior to consumption – fermenting removes lots of anti-nutrients.6
This being said, you might want to know that the research surrounding soy have provided mixed results – if you're a soy fan, rest assured that it will not affect your INR levels.
Here is the vitamin K content of a few vegan protein sources:
Legumes & beans (per cup)4
- Adzuki beans, boiled: 0.0µg
- Black turtle beans, boiled: 6.1µg
- Cranberry beans: 0.0µg
- Chickpeas, boiled: 6.6µg
- Fava beans, boiled: 4.9µg
- Kidney beans, boiled: 0.0µg
- Lentils, boiled: 3.4µg
- Pinto beans, boiled: 6.0µg
- Split peas, boiled: 9.8µg
- Tofu, fried: 2.2µg per ounce
Nuts & Seeds (per ounce)4
- Almonds: 0.0µg
- Brazil nuts: 0.0µg
- Cashews: 9.7µg
- Chia seeds, dried: 0.0µg
- Macadamia nuts: 0.0µg
- Pecans: 1.0µg
- Pine nuts: 15.3µg
- Pistachio: 0.0µg
- Pumpkin and squash seeds: 2.1µg
- Walnuts: 0.8µg
A little note about herbs
Remember that the following herbs are loaded with vitamin K:4
- Basil, dried: 36µg per tablespoon
- Parsley: 62.3µg per tablespoon
- Thyme, dried: 46.3µg per tablespoon
- Sage: 34.3µg per tablespoon
So, here's what you can use instead:4
- Basil, fresh: 11.0µg per tablespoon
- Chives: 6.4µg per tablespoon
- Cilantro or coriander leaves: 12.4µg per tablespoon
- Marjoram, dried: 10.6µg per tablespoon
- Rosemary, dried or fresh: 0.0µg
- Scallion: 12.4µg per tablespoon
Desserts & Treats
Can you eat chocolate if you're taking Coumadin?
Let's start with some good news: dark and milk chocolate are low in vitamin K! As a guide, here's how much vitamin K is present in 1oz of various types of chocolate:4
- Milk chocolate: 2.6µg
- Dark chocolate (45 - 59% cacao solids): 2.3µg
- Dark chocolate (60 - 69% cacao solids): 2.0µg
- Dark chocolate (70 - 85% cacao solids): 2.1µg
This being said, chocolate in its raw form is healthy (yes, it contains the anti-nutrient phytic acid but a lot is destroyed when the beans are fermented and heat processed). What turns it into an unhealthy treat is the crazy amount of sugar, emulsifiers, preservatives, flavorings, soy lecithin and other unpronounceable junk that are added to it. I personally am not a fan of white chocolate – I don't like its taste plus it contains a substantial amount of sugar and only cocoa fat without the antioxidant cocoa solids. But if that's your thing, go for the high-quality stuff which comes with fewer additives (but pretty much the same sugar count as the bargain-basement junk).
Don't want to scrutinize food labels to spot nasty ingredients that might be lurking around? Then check out our healthily decadent dessert section for incredibly easy to make (and amazing to look at) ice-creams, mousse, sweethearts, fudges, truffles and many more. Bonus: we did all the *exciting* vitamin K calculations for you so that you can maximize the time spent with your loved ones instead of your calculator.
Take home message: Go for dark chocolate with at least 70 to 85% of cacao solids or unsweetened cocoa powder or baking chocolate.
What about fruits and ice-cream that are usually served as Valentines treats?
Most of the Valentines dessert recipes out there call for reddish or purplish fruits such as berries or pomegranate. Here's how much vitamin K is found in the following fruits:4
- Blackberries: 28.5µg per cup
- Blueberries: 28.6µg per cup
- Cranberries: 5.0µg per cup whole
- Medjool dates: 0.6µg per pitted date (about 24g)
- Pomegranate: 0.6µg per cup of arils or seeds (about 87g)
- Raspberries: 9.6µg per cup
- Strawberries: 3.2µg per cup
- Watermelon: 0. 2µg per cup
Although cranberries don't contain that much vitamin K, you might want to talk to your doctor before consuming it – these cute berries are rich in salicylic acid which thins the blood.
If you're having ice-cream, chocolate and vanilla ice-creams usually contain 0.2µg of vitamin K per half cup. Of course, that's only an average value – the exact amount of vitamin K in any product will depend on the other ingredients added.
And here's your guide to vitamin K per tablespoon of whipped cream:4
- Whipped cream, pressurized: 0.1µg
- Light whipping cream, fluid: 0.4µg
- Heavy whipping cream, fluid: 0.5µg
How about trying a healthy version of whipped cream this year? You can make it in a jiffy at home using this recipe – it's A-Mazing and the entire recipe contains NO vitamin K. The thing I like the best about this recipe is the 'Lazy Girl Version'.7
What about alcohol?
Surprisingly little published evidence-based data exists on the interaction of alcohol and warfarin. However, since the interaction is so complex and will vary between individuals, I usually advise my patients to avoid alcohol completely. The choice is yours and if you do decide to skip the booze this year, this doesn't mean that you have to settle with plain ol' water.
Here are a few fancy suggestions that will impress your other half:
Non-Alcoholic Drink Recipes
Foods at the Theater
There is something about movie theaters that just make you want to munch on something, right? Although it is common knowledge that the foods sold there aren't particularly healthy options, do they pose a threat to someone who is on warfarin therapy? Well, there's no scientific evidence that shows that these kinds of foods affect INR levels. And most of these foods don't contain much vitamin K:
- Hotdog, plain: 0.0µg
- Nachos with cheese: 5.5µg per ounce
- Popcorn: 0.0µg
- Popcorn, cheese flavor: 2.3µg per ounce
- Potato fries, commercial: 0.9µg per ounce
- Soft Drinks (Pepsi, Sprite, Mountain Dew etc): 0µg
If you plan on watching a movie this year for Valentine's Day, I want to remind you to move your feet around in circles every so often during the film. This will improve your circulation and help prevent blood clots.
Do non-food related activities affect INR levels?
Don't want to settle for the typical 'dinner-movie' date this holiday? That's an awesome decision! This being said, the following activities may not be totally devoid of risks if you're on warfarin therapy:
I couldn't find any research done on the effects of bubble bath on INR levels. However, according to the warfarin package, intense heat, humidity and temperature fluctuations can increase INR levels especially after prolonged exposure to such conditions7. And this occurs even in the most stable patients. So if you really feel like having a bubble bath with your loved one, it might not be a good idea to have a boiling hot bath. And to be on the safe side, keep a bottle of water nearby if you plan on taking a very long bath.
In one study, researchers concluded that while massage therapies are not risk free, the incidence of adverse events is unknown but probably low8. However, the authors warn against massage by non-professionals or forceful techniques such as shiatsu, urut and Rolfing which, quite often, lead to adverse events such as sensory dysfunction, nerve trauma, pulmonary embolus and swelling.
Note: Massage is usually discouraged when there is an existing clot since that clot could dislodge and cause serious health issues.
Although more research is warranted, scientists speculate that high altitudes can increase the risk of hypercoagulability which may have a negative effect on INR levels 9. There is however insufficient data to recommend a change in warfarin therapy. Any activity that can cause you to bruise easily or may lead to several minor cuts might not be the best idea.
Note: I am not a doctor so you might want to talk to your physician before trying a new activity or deciding to avoid it altogether.
Want to learn more about how to eat when you're taking coumadin?
Check out the The Definitive Coumadin Diet Guide for a unique insight on how to manage your INR levels. And if you need to find the vitamin K content of a specific food, try INRTracker's impressive, yet very easy and straightforward to use, vitamin K food database. We have also compiled a list of 50 holiday recipes with vitamin K levels of up to 50µg per serving.
Lots of love everyone,
Shari is a registered dietitian specializing in naturopathic medical nutrition for women and children. She is currently doing her MS in Nutrition & Health Promotion at Mississippi State University with the aim of helping others achieve optimal health with real foods. Her passion is to discover the root cause of disease instead of simply trying to mask the symptoms. Shari is the founder of NutriHeal, absolutely loves HIIT and regularly plays volleyball. LinkedIn
Citations (view all)
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- 2. Hollon, J., Puppa, E. L., Greenwald, B., Goldberg, E., Guerrerio, A., & Fasano, A. (2015). Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Nutrients, 7(3), 1565-1576.
- 3. Ghosh, S., Novak, E. M., & Innis, S. M. (2007). Cardiac proinflammatory pathways are altered with different dietary n-6 linoleic to n-3 α-linolenic acid ratios in normal, fat-fed pigs. American Journal of Physiology-Heart and Circulatory Physiology, 293(5), H2919-H2927.
- 4. USDA National Nutrient Database for Standard Reference Release 28
- 5. Dissanayake, D. M. A. B., Wijesinghe, P. S., Ratnasooriya, W. D., & Wimalasena, S. (2009). Effects of zinc supplementation on sexual behavior of male rats. Journal of human reproductive sciences, 2(2), 57.
- 6. Soy Alert! (2015) Weston A. Price Foundation. Retrieved from www.westonaprice.org/soy-alert/ on 08/02/2016.
- 7. Bristol-Myers Squibb Company. Medication Guide for Coumadin Tablets and Coumadin for Injection [Package Insert]. Princeton, NJ: Bristol-Myers Squibb Company. 2009. 15-16.
- 8. Ernst, E. (2003). The safety of massage therapy. Rheumatology, 42(9), 1101-1106.
- 9. Mortenson, D. (2011). Changes in coagulation factors at high altitude: A systematic review. (PDF)