How I Eat After a Blood Clot

How I eat after a blood clot

Before I was a VTE blogger, I was a health and fitness blogger. Before I started writing about my blood journey, I wrote about my weight-loss journey. Before I was diagnosed with a DVT and PE, I was diagnosed with insulin resistance as a pre-cursor to diabetes, which motivated me to make changes in my life related to nutrition and fitness. I started running half marathons and eating better – and I eventually reversed the damage being done to my body and came off insulin-sensitivity drugs. In the process, I became enamored with nutrition, fitness and running and continued training – and writing about it – up until that weekend in June of 2012 when un-relenting calf pain turned into a blood clot in my lung and I was out of the fitness game for the next three years.

During my recovery, I gained back all of the forty pounds I had previously worked so hard to lose – and then some. I stopped focusing on making good choices when I ate food and while I didn’t go overboard, my body reached its highest weight ever and I plateaued there. There was nothing I could do – or wanted to do – to change it at the time. My singular focus was on recovery from my blood clot including managing my pain, decreased lung function, leg swelling, a fluctuating INR, multiple doctor visits, physical setbacks, emotional trauma and the numerous lifestyle changes that come with all of the above. Still, in the back of my mind, I knew I had to get the weight off. Once physically recovered from my blood clot, I still felt horrible, lethargic, fatigued and out of control because of my weight. My self-esteem took yet another beating when I already didn’t have much self-esteem left. Eating – and the choices I was making about food – were wrecking havoc on my emotional health.

It’s hard to eat consciously on a regular day, let alone when you are managing an ongoing illness. Now, some of the most common questions I receive at BCRN are, “How do I eat healthy on a blood thinner and how do I lose weight after a blood clot?” While I am not a doctor, nor am I a nutritionist, I am sharing what as worked for me and some tips that I believe can help benefit anyone who is trying to lose weight or make better choices when it comes to food. Studies tend to show that in terms of weight loss, diet plays a much bigger role than exercise – and just because you are taking an anticoagulant does not mean you can’t eat for weight loss and/or optimal health. As a rule, it is important to discuss any dietary changes you want to make with your physician before you make those changes. I talked to three of my doctors – hematologist, endocrinologist and GP – before I made these changes.

Overview: Establish or find a nutrition plan.

Worst first, right? When talking about nutrition for weight loss, it is important to find a diet plan that works for you (here is the only place you will see me use the word “diet” in this context. I refer to the way I eat as a lifestyle, not a diet because it is how I prefer to eat and it is what makes me feel good). The internet, books, magazines, etc. are filled with an overwhelming amount of information about how to eat, when to eat, what to eat and what’s the right way to do things. The thing is, though, finding a plan is just as individual as the blood clot treatment plan you are on. There is no right way because each of us is different.

I have spent many years researching ways to eat and tried a multitude of the plans that are out there – Weight Watchers, Paleo, Whole 30, Low-fat, Autoimmune Protocols, Gluten-Free, Blood Type Diet, Low Calorie, High Calorie – all of them have their pros and their cons. Finding one that works is entirely up to you.

I have chosen to incorporate pieces and parts of these plans to make my own plan, with the guidance of my doctor. The basics of my plan include:

  • 1,500 calories a day (or about 500 calories a meal) – drastically cutting calories does not work for anyone.
  • A focus on eating macronutrients each day with a goal of not more than half of my daily intake of nutrients being carbohydrates, about 30 percent of my daily intake of nutrients being fat and about 30 percent of my daily intake of nutrients being protein.
  • I do not eat (or I limit) white grains (rice, pasta, bread), potatoes (all kinds), sugar (and alcohol), dairy (cheese, sour cream, milk, creams, etc.), soy, whey, protein powders.
  • I eat chicken, beef and fish (although I do limit my intake to a few times a week as a personal choice), beans, eggs, nut butters, vegetables (the list is large: peppers, onions, mushrooms, spinach, broccoli, green beans, tomatoes, squash, asparagus, etc.), sweet potatoes, whole grains (limited to once a day and is either whole grain rice or bread), fruit (apples, oranges, bananas, grapes), olive oil, coconut oil, butter (not margarine) and on occasion bacon fat or lard. I cook with almost every spice except rosemary and fennel.
  • I eat three meals a day and an afternoon snack, usually. I eat breakfast every single day (not an easy accomplishment) within one hour of waking up. A typical day for me is brown rice, spinach, and an egg fried in butter for breakfast; more spinach and beans or roast beef on a whole grain tortilla and spinach with mustard for lunch; chicken/steak and vegetables or a sweet potato with almond butter and vegetables for dinner. Snacks might be an apple with almond butter or Greek yogurt.
  • I do allow myself to have treats. I eat out about once a week with no restrictions, have a pinch of sugar and sometimes cream in my tea each morning and consume wine every now and then.
Fill up on good things – what works for you.

Finding out what makes you feel good – and is healthy –  is important. Once you do, eat those things in excess, even in spite of calories goals. I eat spinach every day because it makes me feel healthy, strong, energized and full. Eating protein makes me feel full. Eating nut butters, fruit and on occasion chocolate makes me feel happy. If I am hungry at the end of the day, I eat a sweet potato, popcorn or a even a piece of chicken, even if I am going over on my 1,500 calorie goal.

Cut out the bad things – what doesn’t work for you.

In the beginning, I read It Starts with Food by Dallas and Melissa Hartwig, which gave me a lot of insight into how poor nutrition might be affecting our overall health, including inflammation in the body. I did the Whole 30 Challenge where I eliminated grains, dairy, sugar and alcohol according to the plan for 30 days. At the end of the thirty days, I started adding things back into my diet that I previously loved to eat and was certain I couldn’t continue living without. Certain things made me feel horrible – and still do to this day. I avoid milk and white grains (rice, pasta and bread). On the other hand, I do love white rice – especially from Chinese take-out with a lot of hot sauce. I eat it once in awhile, but I am prepared to face massive joint swelling and pain the next day so my once in awhile is really only that – once in awhile.

I rarely eat anything that is not whole – meaning I eliminate processed foods or things that come out of a box, a bag, a container, etc.

Consistency is key.

When talking about nutrition – especially if you are taking medications that can be affected by food, like warfarin – it is important to talk about consistency. Consistency is more important than elimination, especially when discussing the foods that are healthy for you. I eat about the same amount of spinach everyday. I eat about the same amount of protein in a day. I eat about the same amount of carbs in a day. I eat about the same amount of calories in a day.

I also consistently cook at home, make two or three meals out of one (before it even goes on my plate I divide it up) and shop the perimeter of the grocery store (that’s where you find whole foods like vegetables, fruits, eggs and meat).

Write it down, somewhere, somehow.

In writing down what I eat everyday (as a means to keep track of calories), I realized two things: We as human beings consume entirely way too many calories without realizing it and we eat generally the same things each day without realizing it. Write down what you eat. I think you might find consistency is more present than you realize and you eat more than you realize. I use MyFitnessPal mobile app (or checkout the desktop version) to keep track of my calories and macronutrients. It’s free to download for iOS and Android. You can also use a paper or electronic journal.

Drink water.

I exclusively drink water – and black tea in the morning with sugar and sometimes cream. If you feel thirsty, you need to drink more water. I don’t really pay attention to cups or ounces, but I do drink to not be thirsty. If I go out, I order water. I don’t drink soda, juice or coffee very often, if at all. If I want flavor in my water, which I rarely do, I put my own sliced lemon or lime in it.

Treat yourself.

You cannot eat according to plan 100 percent of the time. It’s not healthy, either. What I refer to as treat (not cheat) meals are important to your mental attitude. I do this about once – maybe even twice – a week. I do not take a treat day, but I take a treat meal where I eat what I want (usually from a restaurant) and do not worry about calories, nutrients or goals. I may or may not write my treat meal down. I eat what tastes good and looks good to me (insert Chipotle here). Over time, I have found my desire to do this is less and less and I tend to have treats that are not really meals – a chocolate bar, a glass or two of wine, or French fries with my salad at dinner.

Don’t do weight loss alone.

Apps like MyFitnessPal have a community component where you can “Like” and “Comment,” just like Facebook. Find a group, an app, an online forum, a book, etc. – anything to make connections with other people who are on the same journey as you. Not only is it motivating, it also helps hold you accountable to your own goals.

Tips for eating well 3

To sum it up, this is what works for me – and might not work for you too. This is what I discussed with my doctor – your doctor might make different recommendations. All of that is okay.

Weight loss takes time, dedication and hard work. Changes can be slow – they should be slow, as should weight loss. With small changes, comes lasting progress. I take one day at a time. My today is not my yesterday or my tomorrow. By eating to feel good and fueling my body well, I have noticed I feel much better – and while I am losing weight slowly, the emotional benefits far outweigh the physical ones. I feel more confident, happy and secure in my decisions to take care of myself. For me, self-care extends far beyond my initial recovery to caring for my body and my mind from this point forward.

Reader Writes In: Are you trying to lose weight or eat healthy after a blood clot? What works for you? What is your favorite treat?

There is hope for healing and you are not alone,

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BCRN Awareness Matters
More information to share:

Get Your Recovery on Track with INRTracker

Get your recovery on track with INRTracker

Being diagnosed with a blood clot is scary. It’s confusing, it’s overwhelming and all too often, patients are discharged from the hospital with little to no support from their doctors and medical providers. While I had a doctor who was very supportive of me and my recovery, I did not have a positive experience with the physicians who treated me in the hospital. I was handed a paper detailing instructions that made little to no sense of me between all the confusion, pain and medications I was taking. I asked a lot of questions prior to discharge, but can’t remember or didn’t fully understand the answers. In addition, the doctors who discharged me where clearly irritated that I asked so many questions. I left feeling frustrated, confused and very much alone.

One of the things I found most complicated about my diagnosis and then treatment was first understanding and then managing my INR. For starters, I didn’t even know what an INR (or international normalized ratio) was or why it mattered what my numbers were. I soon found out that INR is a measure of how long it takes for blood to clot and it mattered because if my INR was too low, it could mean I had a tendency to clot again or if it was too high, I could run the risk of bleeding internally. From there, I wondered about things like vitamin k and diet consistency; when to take my medication and how much to take; what kind of risk I was facing for clotting again and what to do about things like exercise. Nothing was the same – and everything was an issue since my diagnosis. Nothing was simple, easy, clear-cut or obvious. It was like learning to live all over again.

Even just a few years ago, there were not as many resources about DVT and PE recovery as there are today. I like to think that as resources grow and become more readily available, it must also been we are raising awareness about blood clots. One of the resources more recently developed to help with blood clot recovery is INRTracker.com.

INRTracker.com is free and personal online app to help Warfarin patients manage their INR, medication dosages, vitamin K, doctor appointments, compression stockings and more. In fact, there are 13 different health variables you can manage with INRTracker.

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And, when everything else seems really complicated during recovery, the information at INRTracker is really straightforward to input.

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While it isn’t necessarily ideal for me to log in everyday and note whether or not I have taken my medication, INRTracker would be really helpful to note a medication adjustment, and so far, I have been using it to track my exercise, menstrual cycle, blood pressure and upcoming appointments. Once you start tracking information, you can view your information through concise, customizable charts, which is a feature that I really like. You can also generate your own reports to take to your doctor, a feature that is invaluable when you are trying to remember something or have a question.

Screen Shot 2015-05-18 at 4.58.52 PMINRTracker also has some other great tools that may be helpful during recovery and adjusting to living with the complications of DVT and PE. They are the INR Levels Tool, Vitamin K Food Database and DVT Calculator.

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The INR Levels Tool is designed to help you understand your desired INR value and read about the impact that INR level will have on your Warfarin treatment. And, for any patients who are taking warfarin, it is important to understand the impact of vitamin K on your medication. The Vitamin K Food Database is a comprehensive listing of over 4,500 and their vitamin K content to help ensure you are getting enough vitamin K in your diet. The DVT Calculator and PE Calculator are two tools I also find very useful, particular if you are concerned about another blood clot. While these calculators could help determine if you or someone you know is experiencing a DVT or PE with a specific set of doctor-recommended questions, it is also important to note medical attention should be sought in either case and especially in the case of a PE, which can be life-threatening. INRTracker also offers some very important articles to help educate you about blood clots, including medical terms, diagnosis and tests run by doctors.

What I love about INRTracker is it was created by people who have real-world knowledge of DVT and PE, it’s free, completely customizable and offers a wealth of information all in one, easy to navigate place. What I wish it had is a mobile component so that I could keep track of all of my information on the go (like when I am getting my INR results from the lab) and per the creators, a mobile app is in the development stages.

Connect with INTracker on Facebook and Twitter for more information and updates.

Reader Writes In: How do you manage your life after a blood clot? Have you used INRTracker? Will you give it a try? Have you found any other successful programs to keep you on track?

There is hope for healing and you are not alone,

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Warfarin and Vitamin K – Why You Need Both

Why you need warfarin and vit k

If you’ve been diagnosed with a blood clot, chances are you are taking a blood thinner, which is very commonly Coumadin or warfarin. If you’re like me and have been diagnosed with a clotting disorder or have a high chance of re-occurring blood clots, you might even be taking warfarin for the rest of your life. The prospect of having to monitor a potentially dangerous condition, let alone take medication forever, is overwhelming and worrisome for many, including myself. Warfarin can be difficult to manage, is not entirely safe for your liver over an extended period and has some pretty notable interactions with other vital nutrients, mainly vitamin K. In fact, you may have even been told by a medical professional to stop eating foods high in vitamin K. While warfarin and vitamin K do interact, the potential harm of completing eliminating vitamin K from your diet may be proven to be more dangerous than creating a consistent level of it in your blood.

Why Vitamin K Matters

Vitamin K is a naturally occurring vitamin most commonly found in green, leafy vegetables such as spinach, broccoli and lettuce (see an extensive list of foods here). Your body uses vitamin K from foods you eat and also bacteria in your intestines to produce some of the factors that help your blood to clot.

Why Warfarin Matters

Warfarin interferes with how your body uses vitamin K by preventing the production of vitamin K clotting factors in your liver. This can cause clotting to occur at a much slower rate and creates the potential for unwanted bleeding problems or additional clotting in your veins.

How Does Vitamin K Affect My INR?

Changes in the amount of vitamin K you consume through your diet can alter the liver’s ability to process warfarin and change the amount of blood thinning properties in your body. Your INR refers to a standardized way to measure how quickly your blood is clotting. The lower your INR, the more quickly the blood clots or the “thicker” the blood. If your INR is too low, you could be at risk for further clotting. The higher your INR, the longer it takes the blood to clot or the “thinner” the blood, putting you at risk for bleeding problems. With an increase in vitamin K your INR level may drop, creating the potential for unwanted clotting.  A decrease in vitamin K intake may increase your INR, creating the potential for unwanted bleeding.

What We’ve Been Told

Most of us have been told to avoid vitamin K like the plague.

Beyond the Blood Thinner – Why You Need Vitamin K

You may have seen this article posted on the internet or in a variety of forums you visit. I first found the article through Stop the Clot National Blood Clot Alliance. The headline screams, “Warfarin a potential heart-attack risk,” which immediately elicited concern from myself and I am sure many others. I started reading, expecting to find something about some horrible thing warfarin was doing to my heart (instead of my liver) and was shocked to read this instead, “Vitamin K deficiency caused by the long-term use of warfarin has a wider range of health implications than commonly known, including the calcification of organs that can lead to life-threatening problems like heart attack.” And then, “Warfarin is a commonly used medication in the prevention of blood clots but depletes vitamin K levels. However broader effects of the deficiency on various organs and functions are not well understood.”

We are taking warfarin, it’s depleting our body’s natural vitamin k stores – which are important for a variety of things, most notably the hardening of arteries in the heart, potentially creating serious health implications – and we are being told not to replace it.

Let that sink in.

In our need to manage a serious clotting condition, have we been creating potential problems for our hearts and maybe other organs? I’m not willing to take that chance.

A New Way of Thinking

It is not about eliminating vitamin K from your diet. Per Stop the Clot, “One good way to think about vitamin K and its importance while taking warfarin is that you need to maintain a balance between the amount of vitamin K in your body and the amount of warfarin prescribed by your health care provider.” You should aim to keep the amount of vitamin K in your diet consistent. For example, if you eat two servings of foods per day that are high in vitamin K, you should continue doing that. If you don’t eat foods rich in vitamin K at all, do not suddenly decide to eat large amounts of them. Clot Care also confirms, “It is a common misconception that people on warfarin should avoid vitamin K. Reducing your vitamin K intake can cause your INR to increase and may make it more difficult to control. Rather than avoiding vitamin K, you should maintain a consistent intake of vitamin K by maintaining a consistent diet. In other words, from week to week, you should eat the same types of foods.”

Nowhere does it say, never ingest vitamin K, you can never eat salad again or kiss that calming cup of green tea goodbye. It is about consistency and slowly reintroducing vitamin K foods into your diet if you desire to and have previously eliminated them.

Yes, You Can and Should Consume Vitamin K

You do not have to avoid foods or other products that are high in vitamin K; these foods have many other vitamins and minerals that are part of a healthy diet, particularly when it comes to your heart. The most important thing to remember about vitamin K intake is being consistent as much as possible and communicating any changes that may occur.

But that’s Not What My Doctor Said

Unfortunately, I think it is easier for doctors to tell you to avoid vitamin K (and all of the wonderful, nutritious, satisfying foods that go with it) because it is just plain easier. This way, doctors can build a baseline for your warfarin dosing without having to worry about vitamin K obtained from foods and nutrients affecting your INR. Chances are you were not consuming green leafy vegetables on a consistent enough basis to include a vitamin K allowance in your treatment planning. Sure, we all enjoy a salad now and again or eat broccoli once in a while with dinner, but how many of us (truly, honestly, let’s top kidding ourselves for one moment) could say without a doubt that we were eating three cups of spinach four days a week, a half a cup of broccoli or green beans two nights a week and scallions in our omelet every other Sunday? It’s difficult to say unless you are very conscious of it and most of us grossly underestimate the amount of greens we actually consume, even though we should be consuming them frequently.

Almost Everyone I know who takes Warfarin Avoids Vitamin K

Not anymore. I remember the first time I posted that I was taking a vitamin K supplement in an online forum. It was in regards to a forum member’s frustration over her inability to maintain a therapeutic INR level. I posted- “I am taking warfarin and also vitamin K, both prescribed and monitored by my doctor. I started taking vitamin K after being on Arixtra injections [blood thinners that are injected into the stomach daily] for over ten months, which was concerning to my doctor because Arixtra is non-reversible [you cannot be given an anecdote to stop bleeding if you are seriously injured, for example in an accident] and there is not a lot of research about adverse effects to the body [beyond a typical-length pregnancy in which women are often put on injections to reduce the risk of clotting]. In light of some successful research, my doctor decided to actually put me on a low dosage of vitamin K to create a balance of warfarin and vitamin K in my blood. Within a month or so, my INR stabilized for the first time since leaving the hospital and I have not been on injections since. I also posted this link to some of the research that I could find myself.

I remember the first comment my reply received, “Sara, you need to get a new doctor pronto because yours will certainly kill you if you are taking vitamin K.” More of the like ensued and no one backed me up, leading me to believe I was alone in my treatment and my treatment’s success.

I was horrified. Since the beginning, I had trusted my doctor – he had after all found the Antiphospholipid Antibodies when the Emergency Room Doctors were all too hasty to send me away with three month course of blood thinning therapy blaming my DVT and severe PE on birth control and birth control alone. My case was so severe that a specialist was called in, my now hematologist, who I credit with saving my life and providing me with the ongoing care I so desperately need and will need from here on out. He had not yet steered me wrong. He explained what happened, my treatment and what to expect in recovery when no one else had, not a single person.

There was no chance I doubted him on vitamin K. I kept up with my treatment. I ate greens about as consistently as I had – a few times a week and slowly increasing as I worked to get my diet and weight loss back on track. Through it all, I keep him informed of any major changes and continue to get my INR monitored at the least, bi-weekly.

What Should I Do?

Talk to your doctor. We need to be an advocate for our own health and we cannot let blood thinners determine how we choose to live our best lives.

Discuss incorporating vitamin K rich foods back into your diet with your doctor; taking a supplement or alternative treatments (i.e. Xarelto) that do not affect vitamin K. Also discuss the implications of the absence of vitamin K in your body.

In is also important to keep in mind that other things impact the body’s vitamin K production and warfarin’s ability to metabolize including, but not limited to vitamins, nutritional supplements, antibiotics, bacteria/viruses, illness and stress.

Resources

Share your Story. What are your thoughts on vitamin K and warfarin? Do you take or eat foods rich in vitamin K? Why or why not? What did your doctor tell you about vitamin K? Did you read the heart-healthy article? What are your thoughts on needing vitamin K?

There is hope for healing and you are not alone,

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