Supplements That Can Aid Warfarin Users By Reducing Abnormal Clotting and Bleeding Risks

In my previous article Widely Used Anticoagulation Drug Warfarin (Coumadin) More Dangerous Than Commonly Thought, I discussed some coagulation disorders in which the widely prescribed drug warfarin (Coumadin) is used and how it has some very bad long-term side effects. Warfarin fails to fully solve the problem of abnormal clotting particularly in patients who have been taking it for years in whom it may actually aggravate several processes which can increase abnormal blood clotting risk.

Abnormal clotting can show up as DVTs (deep vein thrombosis which typically present as a swelling and painful leg changing colors and feeling warmer than usual), heart attacks, pulmonary embolisms (which are often lethal and the symptoms of which may be confused with a heart attack), strokes, and a variety of less frequent but still dangerous conditions. Warfarin users in some ways are more likely to have these problems if for no other reason than the warfarin interacts with vitamin K levels in a way that can often be difficult to control without additional measures.

Warfarin probably is a reasonable stop-gap measure for treating people at elevated clotting risk, but I personally do not believe it should be used for more than a few weeks on its own without also introducing a variety of other measures designed to help prevent clots. Past experience of many patients using warfarin is that they are much more likely to experience abnormal bleeding and still have abnormal clotting even when taking warfarin precisely because it is highly sensitive to vitamin K in the diet and it only modifies two blood clotting factors, prothrombin (Factor II) and Factor VII, while doing nothing to a myriad other biochemical factors that influence clot development and progression.

For many patients using warfarin, even those with genetic risk factors such as Factor V Leiden, it should be possible over a period of a year or more to eliminate the drug and its dangerous side effects. Careful monitoring of test results, consistent use of supplements that reduce a wide range of clotting risk factors, and for many people some diet changes (particularly reducing carbohydrates) are all necessary for this to be safe and successful.

Unfortunately, not all warfarin patients are candidates for stopping the drug. Dr. William Davis, a cardiologist who often advises the use of supplements over prescription drugs, says that those with artificial heart valve replacements are likely to need to continue to take the drug because their clotting risk is so severe. Even for these people, however, supplements and diet changes are likely to make the anticoagulation effects safer and to reduce some of the side effects of warfarin.

Here I’m going to outline some of the best measures outside of medications that you should discuss with your doctor about how to reduce the risk of side effects from warfarin and possibly, over time, get off of it entirely. I must caution you that although getting off of warfarin is a definite possibility for many people, this is not something you want to do quickly because your body needs time (maybe even over a year) to lower its innate clotting risks affected by some combination of the supplements below before you should risk discontinuing warfarin entirely.

Making Warfarin’s Vitamin K Interaction More Consistent

Warfarin works by interfering with the biological activity of vitamin K. Although vitamin K is fat soluble and therefore should in theory persist longer in the body than many water soluble nutrients, the reality is that most people get too little vitamin K and they tend to eat a “bursty” diet of vitamin K foods. If you eat some tasty kale and a spinach salad one day and then only have a piece of iceberg lettuce on a burger for your greens the next, you are creating peaks and valleys in your circulatory vitamin K levels. What this means is that on the days you eat a lot of vitamin K, the warfarin won’t protect you against abnormal clotting as well. And on the days you eat much less, you are far more likely to see a rise in your INR (clotting time) measurement that means you are a higher risk for abnormal bleeding.

Abnormal bleeding can be just as lethal as abnormal clotting. If there was a way to maintain more consistent levels of vitamin K then warfarin would probably be a safer drug. One step would be to carefully calculate how much vitamin K you get in the foods you eats and to modify or time your diet to keep daily vitamin K intake steady. Unfortunately, this is really not so easy to do as you may not always know what is in the foods you are eating and with people’s busy schedules, a shift of a planned meal by a few hours could still leave you with peaks and valleys in vitamin K.

Fortunately there are practices using supplements that can help stabilize vitamin K. The first one is to get a supply of supplements containing vitamin K2 of both the forms MK4 and MK7 and to take them at a consistent time each day every day with a meal containing fats and apart from any fat-blockers such as fiber and Orlistat that would impede the vitamin K absorption.

MK7 lasts in the body about 24 to 72 hours. Vitamin K1 lasts around 8 hours. MK4 lasts even less time, often stated as “a few hours”, but is more rapidly absorbed by the body than the K1 form commonly found in foods and supplements.

Vitamin K2 MK7 supplementation at levels around 50 to 150 mcg (micrograms) per day is likely to create a much more stable level of vitamin K in your bloodstream while still allowing warfarin to reduce clotting activity. So when you eat that kale or spinach salad, instead of your vitamin K levels skyrocketing by hundreds of percent perhaps they will go up only 50%. The reverse applies, too, that on days when you don’t eat much vitamin K in your diet you will not see as big of a drop in your blood reserves. Overall, this means that the warfarin dosage you can take probably will need to be a little higher but it will often be more stable and less important to get frequent tests to track the changes.

You might time your vitamin K2 MK4 intake to correspond with a meal containing some fat that also contain the least natural vitamin K of your daily meals. Typical breakfast foods (cereals, milk, toast, eggs, etc.) often don’t have much vitamin K but do have some fat, so taking your vitamin K2 MK4 with this meal might be a good choice. It may be appropriate to take part of your warfarin dosage at the same time as a vitamin K supplement containing K1 or K2 MK4 forms in order to ensure the uptake of the extra vitamin K doesn’t cause an excessively large drop in anticoagulation effect.

You may have to argue with your doctor over the entire concept of vitamin K supplementation for warfarin patients. Many of them are under the mistaken belief that vitamin K supplements are dangerous for warfarin patients. That’s not quite right. What is probably most dangerous is that consuming widely inconsistent amounts of vitamin K which is precisely what is happening due to the varying diet of many or even most people taking warfarin.

If your doctor is not receptive to these ideas, you may want to look for an integrative health care practitioner who is familiar with combining medications and supplements to get a better effect than you are likely to obtain from medicines alone.

Calcium Control

Probably the worst long-term problem with warfarin is that by interfering with vitamin K biological activity, it causes calcium to leach out of your bones (raising your risk for osteoporosis) and into your blood. The calcium may attach at a higher than normal rate to the inside of your blood vessels, heart valves, and possibly other non-bone tissues with large enough blood flow volume to keep the calcium coming to the area. In short, this causes vastly increased rates of calcification which can damage heart values, organs with high circulatory volumes such as the liver and kidney, and most obviously all of your blood vessels. Calcification makes them more rigid and creates higher risk for high blood pressure. It’s not far off to say that warfarin causes people to “grow bones in their blood vessels”!

It’s important to keep a watch on your calcium levels in your blood if you are taking warfarin. The body is fairly good at keeping stable levels, but if you see the levels rising or falling much from previous tests it can be a warning sign that something is going wrong with your vitamin K and warfarin interaction.

The danger of aggravated calcification during long-term use of warfarin is so significant that patients should talk with their doctors about getting a CT heart scan with calcium scoring to establish a baseline measurement of calcification and then rechecking to see how the drug over a period of a year or more may be rapidly and measurably worsening the calcification.

It may be also worthwhile to get a bone density measurement, such as a DEXA scan, to monitor for how warfarin may be aggravating bone loss to the degree it triggers osteoporosis. As warfarin is often prescribed in senior citizens who are already at elevated risk for osteoporosis and life-threatening falls and fractures, it is especially important to monitor and reduce the loss of bone integrity caused by this drug.

Other health conditions can exacerbate the displacement of calcium from the bones into the bloodstream. The use of steroid drugs, for instance, can do this. High levels of cortisol, a condition often seen in people under high stress, can also result in numerous health problems including accelerated bone loss that may result in dangerously increased calcification of the cardiovascular system.

It may not be a great idea to take supplemental calcium for warfarin patients as you don’t want to boost the calcium levels too high and make any accelerated arterial calcification problems even worse. It is arguably safer to increase your dosage of vitamin D3 and magnesium, both of which in conjuction with vitamin K help your body to maintain safe levels of calcium and to avoid osteoporosis and arterial calcification. Then after you have some experience with how these and the other supplements below work, you might considering adding small quantities of calcium supplements.

In short, I believe that almost all warfarin patients should be put onto a consistent dose of vitamin D3 and magnesium that is enough to get their vitamin D blood levels up to something in the low end of the optimal range and keeps the calcium levels in the blood stable preferably in the bottom half of the reference range for the calcium test. The few exceptions would be the atypical person who already has adequate levels of both or the handful of people who suffer from illness that is aggravated by vitamin D, for instance very high calcium levels caused by some unusual calcium metabolism.

What are suitable dosages? Unfortunately they vary tremendously based upon diet and individual biology. Some people may attain good healthy vitamin D levels with as little as a couple thousand IU per day of vitamin D3. Many more will need more than 5000 IU per day. A few may need even more than 10,000 IU per day, even though that is regarded as the upper safe limit for vitamin D3 supplementation by the researchers who have studied dosages most carefully. You really need to get vitamin D blood testing to know how your vitamin D levels are and how vitamin D3 supplements work for you.

Magnesium dosages vary on a lot based upon the form of the supplement. Magnesium citrate is reputed to be more bioavailable than some other forms, for instance. Magnesium deficiency is fairly common, so unless you have test data that says otherwise I’d assume that you probably could benefit from at least 400 mg to 500 mg of magnesium supplements each day.

Controlling Blood Lipids, Inflammation, and Oxidation

High cholesterol is widely called a huge risk to people’s health. But why is this? It is not that cholesterol in and of itself is bad. Clearly, low cholesterol levels can lead to depression, suicidality, and hormonal abnormalities. This has been noticed in many patients taking statins to lower their cholesterol levels. Low cholesterol produced by the use of statin drugs also tends to produce low CoQ10 enzyme levels that endanger cardiac function and can cause chronic pain and muscle weakness.

Moreover, not all forms are cholesterol are equal. HDL cholesterol helps to transport fatty acids back to the liver, LDL helps to distribute them throughout the body. HDL is often called “good” cholesterol and LDL “bad” cholesterol. This is overly simplistic. You need both.

Even LDL cholesterol itself is complicated to evaluate. First of all, standard lipid blood tests only estimate LDL cholesterol and can be off substantially versus a direct measurement. Secondly, not all LDL cholesterol is the same. Some LDL cholesterol molecules are small and dense and others are big and fluffy. The small dense LDL variety is much more dangerous because it is likely to punch through endothelial linings in your blood vessels and trigger inflammation and repair processes that aggravate atherosclerosis.

Instead of focusing so much on cholesterol levels and INR test results as many doctors do in warfarin patients, I view it as more accurate to consider the overall viscosity and ease of flow of the blood in terms of how blood lipids and other factors such as oxidation and inflammation influence blood flow. If you have a lot of fats in your blood, the blood is likely to be more viscous and resistant to easy flow. If you have a lot of inflammatory cytokines in your blood, it likely the inflammation will affect the way your blood vessel operate both in terms of narrowing down the spaces through which blood flows and also making the endothelial linings of the blood vessels more subject to damage that will lead to atherosclerosis.

To have healthy blood vessels and blood flow, you need to keep blood viscous, keep inflammation levels low, and keep oxidative damage to your body low so that it doesn’t aggravate inflammation.

Thus for this class of concerns, I’d recommend supplementation with large dosage omega 3 fatty acids such as fish oil, carnitine supplements to help shuttle fatty acids into your mitochondria where they can be burned for an energy supply, and amla extracts to fight one of the major cardiovascular risk factors observed via the C Reactive Protein test.

Immediate release niacin (nicotinic acid which is a form of vitamin B3) is another good supplement for lowering LDL cholesterol and raising HDL cholesterol levels. If you take it with food, you are less likely to get the unpleasant but harmless red flushing and itching effect. Niacinamide and inositol hexanicotinate are two other common forms of vitamin B3, but they do not appear to have much if any effect on altering blood lipid levels. Extended release niacin in some people can cause liver damage, so I’d recommend trying the immediate release form first starting around 250 mg to 500 mg with each of the two biggest meals of the day. Watch your liver test results before greatly ramping up the dosages from there.

I do not recommend statins as a first option for anybody. If you have tried other means to lower your LDL cholesterol including those listed in this article and still the results are not good enough, consider trying red yeast rice supplements first. They include active ingredient basically the same as statins but are believed to be less likely to cause statin-induced muscle damage and abnormal hormone levels that can leave people so sick they are bedridden or may attempt suicide. If you try statins or red yeast rice, please add some CoQ10 to your supplementation program as both will reduce the amount of CoQ10 your body produces because they lower production of intermediate compounds on the way to both cholesterol and CoQ10.

Oxidation occurs all the time but particularly when your body is generating a supply of energy to be used by its cells. There is no way to completely stop oxidation. The key is to pump your body full of enough antioxidants that the free radicals are turned from dangerous reactive substances into more inert ones so that the body can repair the damage they cause at a more rapid rate than it accumulates. For this, I’d recommend high dosage vitamin E containing mixed tocopherols and tocotrienols, CoQ10 (preferably ubiquinol or a water soluble formula such as QGel), idebenone (a synthetic analogue of CoQ10 that is an even better antioxidant than CoQ10 itself), and a good solid dose of multivitamins containing vitamins A (preferably in beta carotene form that doesn’t interfere with vitamin D), B complex vitamins, and vitamin C. I’d also recommend supplementation with N-acetylcysteine as it helps the body build up strong levels of glutathione which is a very important antioxidant. Greet tea extracts, particularly those with high levels of EGCG, are also a good option.

Reducing Excess Clotting Proteins

People who have high levels of the clotting protein fibrinogen are more likely to experience abnormal clots. Lowering your levels of fibrinogen can be accomplished with a variety of proteolytics such as bromelain and nattokinase. Other proteolytics such as serrapeptase may also help, but nattokinase is much better studied for managing clotting problems.

Two variants of pine bark extracts known as Pycnogenol and Enzogenol have scientific evidence backing up their ability to lower fibrinogen levels significantly. One person I know tried proteolytics including nattokinase, serrapeptase, and bromelain for a few years with mixed success as indicated by no more clots (even after discontinuing warfarin) but still higher than optimal fibrinogen levels. Upon trying supplements that included Pycnogenol, this person noticed a very strong and obvious effect that resulted in significantly lower fibrinogen levels. Enzogenol has been studied for lowering C Reactive Protein and fibrinogen in smokers and is believed to work similarly to Pycnogenol even though the source is a different species of pine bark. There’s reason to believe it should work well in non-smokers, too.

Lowering Homocysteine

Homocysteine is a toxic byproduct of various reactions in the body. High levels of homocysteine are correlated with worse cardiovascular health. As it is believed much of this is due to damage to the endothelial linings of blood vessels, it is likely high homocysteine could contribute to elevated clotting risk. For those attempting to lower homocysteine, often the supplements TMG (trimethylglycine), vitamin B12, vitamin B6, and folate are highly advised.

I’d recommend the methylcobalamin fom of of vitamin B12 as the body has an easier time utilizing it than the cyanocobalamin form common in most multivitamins. Cyanocobalamin may also leave behind traces of cyanide that you would not get from methylcobalamin. Some people cannot convert cyanocobalamin into the biologically active methylcobalamin form, so that’s another reason to pick methylcobalamin.

P5P (pyridoxal 5 phosphate) is a better form of vitamin B6 than the usual pyrixodine that also has anti-glycating properties that help to reduce the damaging crosslinking of sugar molecules with proteins. High dosages of pyridoxine over longer periods can cause neuropathic pain, but this hasn’t been observed with P5P or another vitamin B6 variant known as pyridoxamine which is common on poulty. Unfortunately, the FDA in its corrupt zeal to pump up big pharmaceutical company profits at the expense of citizen’s health banned the sale of pyridoxamine to benefit a company that wants to use it a new drug for diabetics because it works so well at prevent glycation.

Folic acid is the most common form of folate in supplements, but methylfolate is a superior form. The concerns about poor conversion of folic acid to active methylfolate are similar to those about cynanocobalamin to methylcobalamin. Methylfolate is also called 5-MTHF or 5-methyltetrahydrofolate.

Vitamin B2 (riboflavin) and magnesium are also important for helping the body to convert unhealthy homocysteine to beneficial biochemicals. You can probably get enough vitamin B2 from a quality multivitamin, but are likely to get more in a B complex vitamin than a general multivitamin. The magnesium needed is more than you’d get from a general multivitamin so it is likely best to supplement with dedicated magnesium supplements such as magnesium citrate as discussed above with regards for controlling the body’s calcium usage.

Low levels of the amino acid taurine are also tied to high levels of homocysteine. So it might be worthwhile to add 500 mg to 1000 mg of taurine to your supplementation program if you have homocysteine levels above the upper limit of the optimal range which is around 8 umol/L.

Finally, the nutrient choline can be converted into TMG by the body. Choline is regarded as a promising natural supplement for helping both brain and liver health, so it may be worth adding more of this into your diet or supplementation program, too.

Improving Circulatory Health

The supplements pomegranate and GliSODin both help widen up blood vessels and improve the health of endothelial linings. Thus they are likely to be beneficial for people at high risk of clotting or most people taking warfarin because bigger blood vessel openings are less likely to get plugged up by the typical small clots forming in your body.

Other Supplements

Pretty much any other supplement that has scientific evidence of being an antioxidant or anti-inflammatory is going to be somewhat beneficial for reducing clotting risk. Curcumin, lycopene, Nexrutine, nettle leaf and stinging nettle extracts, 5-LOXIN and boswellia, and many more are likely to help some. However, I think for cost and benefit reasons you should start with the supplements I mentioned earlier in this article. Many of the other supplements have other properties that are extremely helpful for other conditions such as opposing the development of Alzheimer’s Disease and prostate cancer or fighting chronic joint pain, so if those are concerns for you then I’d suggest investigating the supplements mentioned in this paragraph further.

Exercise and Weight Loss

Finally, although this is very hard for many people, boosting your exercise levels and eating less fats and carbohydrates is a consistently good suggestion for how to lose weight, lower inflammation, and improve your blood flow. I believe that for most people this is going to take some long-term commitment and effort to achieve, therefore the supplementation program I outlined above is probably more practical to get some substantial effect within the first few months.

Bleeding vs. Clotting Risk Tradeoff

Your doctor and many supplement labels may warn you that even very common supplements such as vitamin E and CoQ10 may increase bleeding risk. For most supplements, that’s overly alarmist especially if you introduce the supplements at the low of their dosage ranges one or two at a time, tell your doctor and warfarin clinic what you are doing, and monitor your INR tests as usual watching for any changes and adjusting the warfarin dosage as needed.

Which is the bigger risk, bleeding or clotting? For people on warfarin, clotting is probably the bigger risk otherwise what would be the point of taking the medication? This is why I say that the “may increase bleeding risks” warnings are probably on the alarmist side.

I don’t believe that any of the supplements I listed above taken in normal dosages by themselves or in conjuction with low dosages of warfarin are likely to cause unusually high bleeding risks. However, if you are foolish enough to down 60 veggie caps of high-potency nattokinase at once, don’t be surprised if you end up with some unusual bleeding. Supplements of often work by tweaking biochemical processes one way or another, but you can turn the tweak into an overly strong push when dosages are way too high.

If you start with the labelled dosages and try to spread out your supplements throughout the day, it’s quite unlikely you will significantly elevate the risk of bleeding to the point that it will be bumping up your INR test results by more than what your warfarin dosage itself is doing. I say this based upon observations that a person who is taking a heavy dosage of the supplements I listed above but is not taking any warfarin at all often sees a high-normal (i.e., upper end of reference range or just above) INR test result but does not notice unusual bleeding or bruising.

INR for patients not on anticoagulation therapy (warfarin, heparin, etc.) is supposed to be between 0.8 to 1.2. Somebody taking a lot of the supplements above but no anticoagulation medications may tend to see INR tests more like 1.1 to 1.3, right around the “high normal” range.

Patients taking warfarin are virtually always going to be told to aim for INR test results above 2.0. Those with very high clotting risks are often guided to INR ranges above 3.0 sometimes even up to around 4.5. Very few will be advised to aim for levels higher than that as most doctors would conclude the risk of abnormal bleeding at that test range would be higher than the risk for abnormal clotting.

What people with high normal INR (i.e., around 1.2) may notice is that their blood seems to flow from cuts or a prick a little more than most people’s blood does. Blood droplets from puncture wounds, such as from a blood glucose test prick, may look “thinner” in the way the blood droplet forms into shape.

These small changes are probably helpful even in people who do not have a high risk of clotting. For somebody who has a history of abnormal clotting the changes are particularly beneficial under typical circumstances. But in the event of a very severe cut or impact injuries, such changes can tip the risk profile to that of excessive bleeding. So to be on the cautious side, you might add a note to your medical documents in your wallet or purse to list the supplements that you take which may have an anticoagulation effect and suggest that emergency medical personnel should consider that they may need to test your INR to determine what to do if your bleeding seems unusual.

Initially when you start supplementation, particularly with vitamin K, you may find that your INR drops some. This may mean you need to take more warfarin for a time.

As you add in more of the supplements discussed above, you may see your INR go up somewhat and if so then it’s likely you’ll need a reduction in your warfarin dosage.

The combination of a more stable INR plus some of the increase in INR being from a mix of supplements rather than from just warfarin alone may lead to reduced risk from both abnormal clotting and bleeding.

It is important to talk with your doctor and warfarin clinic about what you are doing and to introduce the supplements listed above one or two at a time so you and they can understand what the supplements are doing. If you do this, it is unlikely that you will put yourself at high risk of bleeding.

When a well-designed supplement protocol is taken consistently in reasonable dosages and combined with the usual INR monitoring and warfarin dosages adjustment, I think you and your doctor will find that you will improve your control over your risk of abnormal clotting and abnormal bleeding over what you were able to do with conventional use of warfarin and the typical “bursty” low to moderate vitamin K diet that most warfarin patients consume. And you’ll be doing this while also simultaneously lowering your long-term risk of the cardiovascular disease and osteoporosis that long-term warfarin users are likely to suffer if they rely on the drug alone for their coagulation control.

Further Reading

Widely Used Anticoagulation Drug Warfarin (Coumadin) More Dangerous Than Commonly Thought

Lowering CT Heart Scan Calcium Score and Heart Attack Risk Via Diet and Supplement Changes

Increased Vitamin K Consumption May Slow Progression of Insulin Resistance and Lower Diabetes Risk

Vitamin K & Warfarin: Stabilizing Anticoagulant Therapy While Protecting Cardiovascular and Bone Health

Blood Clot Prevention

Doctors Are Afraid to Change: Coumadin and Aspirin

Amla and Pycnogenol May Powerfully Lower Dangerous C Reactive Protein and Fibrinogen Levels

L-Carnitine Helps Reduce LDL Cholesterol, Triglycerides, Blood Glucose, and Insulin in Fatty Liver Disease and Diabetes Patients

Adjusting Your Vitamin D Intake to Optimal Levels

Homocysteine Reduction

Red Yeast Rice for Lowering Cholesterol

Idebenone, a Better CoQ10

Subclinical hypercortisolism among outpatients referred for osteoporosis


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Comments

Supplements That Can Aid Warfarin Users By Reducing Abnormal Clotting and Bleeding Risks — 13 Comments

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  4. Dear Alison,

    Atrial fibrillation is the reason I’m taking warfarin. I’m due for a pulmonary vein isolation ablation in a month and the clotting risks are high. My paroxysmal fibrillation episodes got worse than usual and lasted longer over the previous month. I’d increased my dose of MK7 from 100mcg to 200mcg some few weeks before that. In my research to see what interaction this MK7 might have with warfarin, I found this rather alarming site:

    http://www.inspire.com/groups/national-osteoporosis-foundation/discussion/vit-k2-7-heart-arrhythmias-and-palpitations/

    There are twelve pages total of people’s personal stories of MK7 seemingly causing arrhythmias and palpitations. My history seems congruent with theirs. Of course, I’m predisposed with my history of paroxysmal AF.
    These are all lay people comparing notes so, of course, I looked for the science. I couldn’t find any. Do you know anything about this? If there’s anything to it, your recommendation of up to 150mcg of MK7 would not be good for the likes of me! (I stopped all MK7 after reading the above link.)
    If there’s anything to it, then what do I do for healthy calcium handling – avoiding osteoporosis and vascular calcification?

    Please let me know your thoughts.
    Thanks,
    Jeff Patten

  5. Jeff,

    I have to take a more careful look at this before writing a more complete answer. However I wanted to get back to you right away with some other angles which I think are worth investigating because they might be of help at reducing clotting risk without being completely dependent upon using warfarin and thereby enable you to use vitamin K2.

    There is a lot of debate on MK4 vs. MK7. Those favoring MK7 say it lasts longer in the blood. Those favoring MK4 say it is rapidly absorbed and used by tissues that need it. I do not think the science is well enough understood yet to say what the right position is on this.

    I am not aware of any good answer to what you can do about calcification risk if you cannot use vitamin K2 forms because of using a vitamin K blocking drug. Based upon current science, it strongly appears you must have the osteocalcin and MGP to control calcification risk. So far as I am aware, today there is no option on how to get these other than the consumption of adequate vitamin K2 thus allowing your body to make osteocalcin and MGP. Maybe some option to take MGP and osteocalcin via injection might exist at some point, but I am not aware of such an option at the moment.

    There are a lot of things that can cause abnormal heart function. Mitochondrial dysfunction such as low ATP production, low CoQ10, low mitochondrial counts, neurotransmitter imbalances, and more can all cause heart irregularities. That is nowhere near a complete list.

    As I understand it, paroxysmal fibrillation problems seem to be thought of as being mostly related to problems with the electrical control of the heart. It appears warfarin is mostly used in such conditions to reduce the clotting risk, not to solve the fibrillation problem itself.

    In my opinion, anybody with elevated clotting risk needs to address several risk areas and not just depend upon a single drug such as warfarin to prevent clots. Clots can get started from inflammation, platelet clumping, or other conditions besides the blood clotting factors that warfarin blocks. Even people taking warfarin can get abnormal clots, particularly if they miss a dose or eat too much vitamin K or develop some other condition (such as an infection or injury) that triggers clotting.

    Recently I have been doing some reading on MTHFR methylation genetic defects and their possible ties to blood clots and other conditions. Statistics are that possibly around 1/3 or more of the population has some kind of MTHFR defect that impairs the production of 5MTHF form of folate which is necessary to many biological processes. Methylation problems like these seem to explain a huge variety of illnesses of widely varying symptoms.

    Methylation defects are definitely tied to high homocysteine levels and high homocysteine is often connected to increased cardiovascular disease risk, including clots.

    There are conflicting studies on the MTHFR tie to atrial fibrillation. Here are a couple:

    Hyperhomocysteinemia and vitamin B6 deficiency: new risk markers for nonvalvular atrial fibrillation?

    Role of C677T and A1298C MTHFR, A2756G MTR and -786 C/T eNOS Gene Polymorphisms in Atrial Fibrillation Susceptibility

    While doing this reading, I noticed a lot of discussion of Factor V Leiden (FVL is another common condition, affecting maybe 5% to 10% of the population) combined with MTHFR causing higher rates of thrombosis, pulmonary embolism, and miscarriages. One doctor, Ben Lynch, has noted that it seems common in his experience for people with blood clotting disorders such as FVL to also have MTHFR defects and if so, it seems beneficial to treat the MTHFR defects with nutritional supplements to improve outcomes.

    MTHFR and other methylation pathway defects are really complicated to understand because there are dozens of identified interrelating genetic mutations that cause cause widely varying results.

    In general, folic acid (even the modest amounts in fortified foods) causes problems for a lot of these people. Rather than taking folic acid which needs to undergo biochemical reactions that are impaired to turn it into the active form, these people benefit from taking pre-activated L-5-methyltetrahydrofolate such as you would find in Quatrafolic, Metfolin, Metanx (which is a prescription drug often used in psychiatry and for diabetics that is basically just the active forms of vitamins B9, B12, and B6), and many other products. In general, they should also be taking vitamin B12 methylcobalamin and vitamin B6 P5P (pyridoxal 5 phosphate) supplements to keep their methylation pathways running smoothly.

    The full picture is really complicated, more than I can cover in a reply here right now.

    To understand if any of this applies to you, you would need to get some genetic tests and blood chemistry tests. You probably have had some of these tests already, but likely not all of them.

    Many of the people most interested in understanding and treating methylation defects are suffering from chronic fatigue and pain and immune conditions such as fibromylagia, ME/CFS, MS, IBS, PCOS, MCS, and others. It seems that getting genetic testing via 23andme.com and then getting some help to interpret the results is one of the most cost effective ways to get some answers because that test can detect several hundred of the most common genetic mutations for around $300.

    Here’s a presentation about 90 minutes long that discusses a lot of this material.

    Methylation and MTHFR Defects presented by Benjamin Lynch, ND

    Given how much dysfunction that MTHFR and other methylation defects can cause and how confusing the symptoms are, plus there being other genetic risk factors for clotting, it seems to me like anybody with an elevated clotting condition should consider getting the 23andme genetic tests and examining the results to see if mutations are found that might explain some of their observed symptoms and medication side effects.

    What I’m trying to say in short is that you may be able to benefit from attacking the clotting risk from many different angles and then still be able to take some amount of vitamin K2.

    It may be that for you and others with AF, vitamin K2 MK4 taking around the time you take a lot of anti-coagulation supplements may work better than MK7. My thinking here is that MK4 is reputed to be rapidly absorbed and used and therefore does not stay circulating in the blood for long compared to MK7. It is kind of like the immediate release niacin versus time-release niacin argument. Time-release niacin is far more likely to cause liver damage precisely because it leaves niacin levels in the blood higher for a nearly continuous period. MK7 does the same, and therefore this might mean reports you are seeing could be tied to MK7 staying high in the blood while the anti-coagulation drugs decay to a lower level before the next dose.

    I would also suggest you look into anti-coagulation drugs that do not depend upon blocking vitamin K action. I would ask your doctors about dabigatran (brand name Pradaxa) and any other alternatives that do not depend upon interfering with vitamin K activity. Switching from warfarin to such a drug plus the approach of attacking the clotting risk from other angles may enable you to safely take vitamin K2 to reduce calcification risks. I mentioned this possible option in another article Widely Used Anticoagulation Drug Warfarin (Coumadin) More Dangerous Than Commonly Thought.

    I will try to get back to you in the next week or so with some additional thoughts.

    Alison

  6. Well, thank you for the prompt reply.

    My plan is to have the ablation in a month. There is a pretty decent success rate at my hospital. So, if the plan works out I won’t have the fibrillation and I’ll be off warfarin a couple of months later. Total time on warfarin: four months. Dabigatran results in more clots and more bleeds if used leading up to the procedure than does warfarin, so that’s out.
    http://content.onlinejacc.org/article.aspx?articleid=1206384
    If I had to be on warfarin indefinitely I’d be really concerned. I just have to get through these weeks with minimal harm done.

    I guess my refined question would be what’s the minimum MK7 or MK4 that would have the desired vessel clearing (or maintenance) effect?
    Perhaps a bit of both? I ask for minimums over concern about the purported arrhythmia effect. I certainly wouldn’t want to cause myself fibrillations after having been cured of them by trying to address the vascular calcification issue. Seems like a classic catch 22!

    You mentioned in your article that MK7 keeps the INRs from fluctuating. That seems desirable to me. But then, the MK4 supposedly has fewer side effects. More 22?

    BTW, I take 5000IU D3, 750mg mixed magnesium, Trace of cobalt, fish oil, gamma tocopherol E, ordinary B6 and ordinary folate. Just so you know. 🙂

    Thanks for your interest. It helps to have smart concerned people on your side.

    Jeff

    • If you can keep the warfarin usage down to just four months as you plan, then you can add the vitamin K2 later. Use the time to bump up other supplements and dietary changes that should reduce the risk of clots but which won’t interact with the warfarin.

      I agree that the study you cited does suggest dabigitran used around ablation for atrial fibrillation may have some elevated risks versus warfarin. If you were not getting surgery and longer-term anti-coagulation therapy was needed, then possibly dabigitran would be better than warfarin despite these risks because it does not interfere with vitamin K activity.

      Uncontrolled bleeding and clotting are not certainties, they are risks. By contrast, systematic blocking of virtually all vitamin K activity via the use of warfarin virtually ensures (i.e., approaching 100% risk) that you will suffer aggravated health problems such as osteoporosis, tissue calcification, atherosclerosis.

      To my knowledge, there is no official recommendation on vitamin K2 consumption per day. The official recommendations regard vitamin K1, under the assumption that vitamin K is mostly important for blood clotting. The scientific understanding of vitamin K2 seems to be far ahead of official guidelines on nutrition given how vitamin K2 is not even mentioned in many official government nutritional guidelines.

      The smallest doses of K2 commonly sold are 45 mcg per softgel or capsule using the MK7 variant of K2. Possibly you could take two per day with meals containing fat, one with breakfast and one with dinner, to help keep the blood level even more level than you would get with one per day. Discuss with your doctor the idea of taking your warfarin in two doses per day around the same time as the vitamin K2 to help maintain even anti-coagulation effect. You might consider asking a pharmacist about the timing as they often have better knowledge of pharmacokinetics and pharmacodynamics than doctors do.

      Vitamin K2 MK4 is usually sold in much larger dosages than K2 MK7. Three doses of K2 MK4 at 15mg per dose is often prescribed for treating osteoporosis in Japan. This is far beyond the typical dietary intake of K2 MK4 with no apparent toxic effects. Because of packaging considerations, it may be a lot easier to try small doses of K2 MK7 than K2 MK4. Be sure to have your INR monitored carefully as you introduce the vitamin K2 supplements, and be sure your doctor and/or warfarin clinic staff are aware of what you are doing.

      This link Daily Low-dose Vitamin K Supplementation Stabilizes INRs contains some links to studies on vitamin K in anti-coagulation patients. But it appears these are all regarding vitamin K1, not K2 forms.

      Living With Warfarin contains the following text which suggests that supplementation with small doses of vitamin K2 will not have much impact on warfarin anti-coagulation because K2 does not much participate in production of coagulation factors but does help improve bone and cardiovascular health:

      Dutch researchers have observed that vitamin K1 tends to accumulate in the liver where it is used in the synthesis of coagulation factors, whereas K2 preferentially accumulates in the artery walls where it participates in the production of MGP which, in turn, inhibits arterial calcification. Unfortunately, warfarin inhibits the intestinal conversion of K1 to K2, thus explaining why warfarin promotes arterial calcification. The researchers also
      observed that menaquinone, but not phylloquinone supplementation prevented warfarin-induced arterial calcification in rats.[31]

      Another group of researchers from Maastricht University in the Netherlands has reported that a high intake of menaquinone (vitamin K2), but not phylloquinone (vitamin K1) is associated with a significantly reduced risk of arterial (aortic) calcification and coronary heart disease (CHD). The epidemiological study included 4800 participants in the Rotterdam Study. The researchers found that the average daily intake of vitamin K1 was 250 micrograms, while that of vitamin K2 was only about 29 micrograms. Study participants with a vitamin K2 intake of more than 32.7 micrograms/day had a 41% reduced risk of CHD, a 57% reduced risk of dying from CHD, and a 26% reduction in overall mortality when compared to those with an intake below 21.6 micrograms/day. Participants with a high menaquinone intake also had a 52% reduced risk of severe arterial calcification. Phylloquinone intake was not associated with decreased risk of CHD, CHD mortality, overall mortality or arterial
      calcification.[35]

      University of Wisconsin researchers have found that, while warfarin is highly effective in blocking the recycling of vitamin K1, it has little effect on the activity of vitamin K2.[36] Considering the above findings it is tempting to conclude that daily supplementation with menaquinone (vitamin K2) would be highly beneficial in reducing arterial calcification (whether warfarin-induced or not), CHD, and overall mortality without impacting on warfarin’s role in reducing the level of coagulation factors. In other words, supplementing with moderate amounts of vitamin K2 should not affect INR levels. Clinical trials, of course, should and hopefully will be carried out to substantiate or negate this hypothesis.

      On that same website, I also noticed a report of an atrial fibrillation patient who claims to have gotten his atrial fibrillation under control via nutrition using magnesium supplements, magnesium IV, and detoxification of high mercury levels.

      Dr. Sarah Myhill of the UK suspects that many cases of atrial fibrillation may involve mercury toxicity. She states that Dr. Paul Cheney (noted for his work on understanding and treating ME/CFS, a condition which he has sometimes characterized as having similarity with cardiomyopathy) has stated that mercury may concentrate in the heart at levels 10,000 times those in the blood.

      Generally speaking, the supplements you mention taking sound to be useful for reducing the risk of clots and for helping maintain bone and cardiovascular health.

      Active forms of vitamins B6, B9, and B12 are a lot more likely to help with processes such as mercury detoxification than the common inactive forms you are using. Many people with health problems tied to toxic metals like mercury are noted to have methylation impairments such as the 677TT and A1298C mutations that prevent folic acid conversion to active 5-methyltetrahydrofolate (5-MTHF). In these people, folic acid supplementation can be toxic whereas 5-MTHF (active folate) supplementation is often very helpful.

      How much fish oil are you taking? Recommendations for this vary all over the place. People who take a lot of fish oil often have blood that is obviously less viscous. See Beneficial effect of fish oil on blood viscosity in peripheral vascular disease for some more discussion on this. Elsewhere there is some mention of lower viscosity blood possibly helping reduce thrombosis and arrythmia risks.

      You can find a lot more on fish oil and blood viscosity in an interview of Gary Gordon, M.D. that was conducted by Richard Passwater, Ph.D. This interview mentions that drugs like warfarin do little to nothing about lowering blood viscosity.

      But you can also find doctors mentioning that high dosage fish oil users may get excessive bleeding such as frequent nose bleeds. Then again, you see frequent nose bleeds in some warfarin patients, too.

      Possibly the more important factor in bleeding episodes is how long does it take for the bleeding to stop. It is my observation that a person taking warfarin may bleed for much longer than the same person no longer taking warfarin who has instead switched to using high dosage fish oil in the range of a few to several grams per day as part of a set of nutritional supplements with anti-coagulation effect. On warfarin, the patient might have nose bleeds that are very hard to control and last tens of minutes but with high dosage fish oil (and no warfarin) they may stop in less than a minute.

      Both thrombosis and hemorrhage are serious risks, but if you had to pick between elevated hemorrhage risk with quick clotting (high dosage fish oil) versus elevated hemorrhage risk with slow clotting (warfarin) then it seems like the quick clotting response would be preferable because this would reduce the chances of serious injury from downstream blood flow interruption due to the abnormal bleeding.

  7. Thank you, Alison. I can see that you put in a good deal of research on this. Forgive me for not responding sooner. I just now checked after a few days.

    I started taking that minimum 45 mcg dose of MK-7 when I started the Coumadin. Coumadin was Dr’s orders; restarting MK-7 was my idea.

    I started MK-7 100 mcg a couple of years ago. Then, according to an article I read suggesting that doubling that dose would be good, I did – the beginning of this October. Then, as I described above, I read http://www.inspire.com/groups/national-osteoporosis-foundation/discussion/vit-k2-7-heart-arrhythmias-and-palpitations/ (Did you check it out?) I looked at my record. My several years hiatus from Afib ended with a few moderate and short-lived episodes a couple of years ago. The episodes increased in frequency, duration and symptoms through the month of October. Duh. That’s when I quit MK-7. The episodes abated. A perfect correspondence.

    It’s hard not to draw the conclusion that MK-7 is my culprit. Is it a coincidence that I got poor again, then worse, and then fine, all according to my MK-7 dose?

    Having started again on this reduced dose, I’ve been doing well. I wouldn’t want to increase it at this point.

    I’m hoping when the Afib cause is gone after the ablation that I can resume a fairly normal life, which would include things like an optimal daily dose of MK-7 – among others.

    I’m going to look into the possibility of switching to dabigatran once the ablation is over. I’m supposed to be on anticoagulants three months following.

    I found a fascinating interview of Dr. Cees Vermeer, one of the Dutch researchers in question. He sounded like a straight-arrow scientist. He’s so convinced of the benefits of MK-7 that he takes 360 mcg per day! Arrhythmia isn’t mentioned.
    http://www.youtube.com/watch?v=WTm95J8SNGo

    Sometimes it’s hard not to think that it’s all in my head.

    You’ve presented some interesting ideas about the B’s here. I’ll have to check it all out.

    About six years ago, at great expense, I had all my amalgam fillings out eliminating one possible source of mercury.

    I take two 1 gram gel-caps of fish oil morning and evening. My little family has at least three servings of wild salmon per week and other cold-water sea creatures for variety.
    This article is very interesting:
    http://www.nlm.nih.gov/medlineplus/news/fullstory_130821.html
    I know that not all research papers are perfect representatives of the real world. What do you think?

    Jeff

  8. I don’t think you are going to find a definitive answer on your questions about MK-7 affecting Afib. The problem as I see it is that no nutrient, vitamkin K2 MK-4 and MK-7 forms included, acts alone in the body. And this means that there is going to be variation between people that might appear to be due to the MK-4 or MK-7 but in fact is due to some other nutritional variation.

    Some recent research is showing that vitamin K2 can great improve mitochondrial activity in fruit flies. Fruits flies that cannot fly due to poor mitochondrial health can fly after vitamin K2 supplementation. Since mitochondria are the power-generating mechanisms for cells, you can imagine that making them work better could affect a lot of things in the body.

    But consider what happens if you improve mitochondrial health without addressing some other latent problems in the body.

    Say your mitochondrial health is improved somewhat by the K2 MK-7 supplementation, and this allows stronger electrical signalling from the brain to the heart by increasing the energy availability due to better functioning mitochondria. But your heart might have a buildup of conductive metals due to other health problems, meaning that “normal” strength electrical signalling might cause abnormal results such as Afib. So you might end up with Afib or some other heart arrythmia from what should be a supplement that should improve health based upon how it seems to affect mitochondria in fruit flies.

    As to why this might happen with MK-7 but not with MK-4, recall that MK-7 persists in the bloodstream much longer than MK-4. MK-4 is rapidly absorbed from the bloodstream by cells that use it extensively such as the salivary glands, osteoblasts, and other cells types that are involved in bone maintenance. That leaves little MK-4 in circulation where it might affect the mitochondria in cells spanning the nervous system connection between the brain and heart. But when you use MK-7, perhaps the bone maintenance cells do not remove it from the blood so rapidly and this leaves more to affect the mitochondria throughout the body.

    This is one possible hypothesis of what is happening to you. Whether it is accurate or not, I don’t think anybody could say for sure at the moment based upon published research.

    You could easily make up similiar but not identical hypotheses involving low magnesium, high calcium, conductive heavy metal toxicity, etc. all that might have the effect of making the brain to heart signalling become overly sensitive and triggering arrythmias.

    You mentioned taking magnesium supplements. What kind? In writings on treating ME/CFS patients, many mention injection magnesium is better at raising magnesium levels in the body versus supplements. Also, not all magnesium supplements are reputed to be able to get into the brain. Magnesium L-Threonate has been studied as being much more effective for raising neural magnesium than more ordinary supplements such as magnesium citrate, despite those being regarded as more effective than forms such as magnesium oxide. Epsom salt baths are also sometimes advised for raising magnesium levels as magnesium in them can be absorbed into the body. So it is possible you could be taking magnesium supplements but still not have enough magnesium somewhere in your body that is affecting your heart.

    Another data point is that other substances that mess with mitochondrial function appear to be capable of causing arrythmias. I recall a man in his 70s who was having PVCs, thousands per day. I suggested to a relative of his that they should look into the possibility that the statins he was taking might be related to the PVCs. When he stopped taking the statin medication, the PVCs stopped. Statins suppress CoQ10 production, and low CoQ10 will impair mitochondrial function. So maybe that left him with degraded signals to the heart that caused PVCs? I have read other anecdotal reports like this one, too, which is where I got the idea of a possible connection.

    Given how you are using warfarin, another point to note is that at least some of the literature on vitamin K2 vs. K1 suggests that K1 affects coagulation significantly but K2 does not. The study Effects of vitamin K2 (menatetrenone) on atherosclerosis and blood coagulation in hypercholesterolemic rabbits found that even very high dosages of K2 MK4 (100 mg / kg body weight per day) for 10 weeks did not increase coagulation. But of course these were rabbits not on warfarin, not humans on warfarin.

    From what I’ve learned so far, it appears there are no obvious conversion mechanisms from K2 to K1 in the human body. If that is so, then you should be able to supplement with K2 MK-4 without much affect on coagulation versus what you would get with the same amount of vitamin K1. Of course, vitamin K2 research is still pretty immature so there could be some mechanism for producing K1 from K2 that is not yet known.

    You could try an experiment with supplementing with vitamin K2 MK-4 at low dosages, monitoring your INR to see if it changes, and then see if the INR stays relatively stable even while you are ramping up your MK-4 dosage. Also watch for what you are describing at Afib producing side effects of the MK-7 to see if they also happen with MK-4.

    One problem with trying this might be finding a low dosage MK-4 supplement. Most of the low dosage supplements are MK-7, and many MK-4 supplements are using 1000 mcg or even up to 15mg per dose. You might be able to use a liquid K2 supplement such as Thorne Research Vitamin K2 Liquid
    that features 1 mg of K2 MK-4 per drop with some dilution into a fatty liquid (lecithin or olive oil?) to get smaller dosages around 50 to 200 mcg more like what you find in MK-7 supplements. The whole container has just 80 doses of 15 drops each, meaning they are aiming for 15mg of vitamin K2 MK-4 per dose which is much like what Japanese osteoporosis treatement uses.

    If you can take a little more vitamin D3 (which is probably the case), then the product Vitamin D / K2 Liquid offers 500 IU of vitamin D3 plus 100 mcg of vitamin K2 MK-4 per drop. That might be the easiest way to experiment if you want to give it a try. On Amazon it is about $22 for a bottle of the Vitamin D / K2 liquid that looks like it has 1200 drops, so this would last you quite a long time even if you find you can take two or three drops per day.

    By the way, this also looks like it would be a great product to try on kids who don’t like swallowing vitamin D3 pills and/or who don’t get enough K2 in their diet, particularly if they have tooth decay problems as the vitamin K2 will help remineralize tooth surfaces. Simply put drops of it into some milk, broth, or other liquid they like that contains some fat.

    It is great that you had your dental amalgams removed and replaced with safer fillings. However mercury can still persist in the body for a long time. Since mercury is a conductive metal, it could have something to do with electrical signalling problems in Afib and other arrythmias.

    NAC with vitamin C, selenium, and molybdenum can help detox mercury and also help fight pretty much any condition involving high levels of oxidation, such as a flu. There is a lot of research on using high dosage NAC for disorders such as trichotillomania and OCD with dosages around 2000 mg to 3000 mg per day, so I think most people would be quite safe using 600 mg to 1200 mg per day long-term along with maybe 500 mg to 1000 mg of vitamin C plus selenium (perhaps 100 to 200 mcg per day — be careful because long-term selenium supplementation much beyond this can cause toxicity) plus some molybdenum (maybe around 100 mcg — hard to say as the dosing of many trace minerals is poorly understood) so long as they don’t have any counterindications such as high levels of cysteine or kidney stones. When taking NAC, one should also take some vitamin B6, preferably P5P form, maybe around 25 to 50 mg per day, plus 5-MTHF (methylfolate) around 400 mcg or more per day plus methylcobalamin (vitamin B12 in active form) around 500 mcg or more per day because they are needed to support conversion cycles involving cysteine, homocysteine, methionine, and SAMe. People with methylation defects may need a lot more 5-MTHF, methylcobalamin, and P5P.

    If NAC detox is not enough, then EDTA or other more severe chelation therapies might be more helpful. You have to be careful with them and supplement with desired minerals (calcium, magnesium, zinc, copper, potassium, manganese, molybdenum, etc.) because some of those will be chelated out of the body along with the heavy metals. You can find more discussion on EDTA therapy along with concerns about removing needed minerals in a interiew with Dr. Garry Gordon. It looks like oral EDTA therapy would run less than $10 per month with inexpensive EDTA products such as Bestvite EDTA plus a multi-mineral supplement. EDTA should be used hours apart from other supplements to avoid wasting the effect by chelating the minerals in the supplements rather than from the body.

    I agree with you that many studies are questionable. The same goes for anecdotal evidence. I’d assume that any one or two or even ten studies could be wrong because of something that nobody considered. When you get to the level of thousands of studies showing something with good biochemical explanations that match up, that may seem like absolute truth but even then you can sometimes find unusual situations that don’t match the studies. A genetic difference, some other comorbid condition, or even diet and supplementation variations that are not common could mean the study does not apply.

    Keep an open mind, consider lots of possibilities, and try to develop some ideas you can test on yourself to see if they might help or not. Don’t try many things at once and introduce them slowly (waiting at least 3 days or maybe week between changes) to see if there are any acute effects. But even if you exercised the utmost caution and introduced a change just once per month, it is possible that several months into whatever you are doing things will improve and it may not be from the latest change but from one you made months ago finally reaching a level of effect that is obvious. Or maybe it took three or more things working together to get the obvious effect, and dropping any one of them will make the whole package change results. And then you might falsely think it was just the one thing you changed most recently.

    Listen to your doctors, but don’t assume they are really that concerned about you or that they are experts. Medical research is moving way too fast for any one person to keep up with it. Sometimes experts get stuck in old ways that later turn out to be shown to be really bad courses of treatment yet they continue using them because it has become a habit. Ultimately, you are the person who must decide what is good or bad for you, not your doctor or some health blogger or nutritionist or anybody else. You know your body in a way that nobody else can know it, and you have a more vested interest in your good health than anybody else does.

    If I was in your shoes, I would be trying to avoid the ablation procedure with some more aggressive nutritional changes such as further boosting magnesium and oral chelation therapy. The other concerns about the clotting are secondary to the arrythmia, because if you didn’t have the Afib then you would not be as worried about the coagulation risk. I would still try to address the coagulation risk, however, such as with the high dosage fish oil and proteolytics that break down excess fibrin and approaches like those that don’t involved inactivating your vitamin K.

    As I understand it, ablation is believed to work by using scar tissue to disrupt the arrythmia. It sounds to me like a “quick fix surgery” approach to a problem that probably took years of something being wrong to start the arrythmia. Unfortunately, sometimes the “quick fix” has some unintended effects later on and nobody notices what they are until decades later. Just like carpenter might view a hammer as a tool for any problem, a surgeon is likely to view a scapel or other surgical instrument as a tool for any problem. With the financial incentives doctors and hospitals have from surgeries being so expensive and therefore lucrative and experts who often have a mindset that surgery is a great option, I would expect them to push the surgery option strongly. But even a “safe” surgery has its risks.

  9. Alison,

    You certainly are up to the challenges I throw at you!

    With respect to MK7 or MK4, I’ve already experimented. I’ve been taking the reduced 45mcg dose of MK7 since I started the Coumadin. No ill effects with that dose. Eleven days ago I added 5 mg MK4 per day. It took the first seven days of that period of time for my INR to drop from a stable 2.8 to 1.3. I then quit the MK4 and four days later I was back to an INR of 2.4. The only change I made was the MK4. The Coumadin dose and my diet stayed the same.

    Now that’s a much better experiment than the one I did on myself earlier. As I told you, I had quit the 200 mcg dose of MK7 when I read of the possible arrhythmia connection. I also examined myself to see if I could find anything else that might have been responsible for the increased Afib. I’d been drinking more decaf coffee during that period. (Yeah, there’s still some caffeine!) I’m a martyr to chocolate also. I dropped both along with the MK7. I’ve reintroduced one cup of decaf a day recently with no bad result. The much reduced dose of MK7 is OK. That leaves chocolate. Or something else.

    No one in Establishment Medicine pretends to understand why and how the aberrant electrical signals get established. They all, however, are pleased to explain in detail how they can physically locate these signal sources. My sort of paroxysmal Afib usually originates in the musculature of the pulmonary vein walls. Again, they don’t know why. They create a ring of scarring by freezing the tissue where each of the veins enters the left atrium thereby blocking the electrical signal. It seems a bit crude, but it’s the best that’s available now. There are researchers applying photosensitive nanoparticle technology to the problem. They can destroy targeted cardiac tissue down to the cellular level. This they do in a dish. It’ll be tens of years before this is done in anyone’s heart, making current ablation look even more crude.

    My ablation is on December 4, just nine days away, so I won’t be doing any further experimenting till that’s well over.
    Yes I’m going to do it. You’ve made strong arguments against it, and I’ll examine them carefully and apply them as prophylaxis against the possible post ablation return of afib. You see, the many articles I’ve read all refer to Afib as a progressive disease and I’ve seen it in myself no matter what I’ve done to try to avoid it, just as I saw it in my father. He died of a massive stroke after a few years of arrhythmia at the age of seventy five. That was in the early ’70s when there was no ablation, no antiarrhythmia meds, and the only option was life-time Coumadin. I’ve got seven years before I’m his age when he died. Genetics. Just gotta deal.

    Coumadin strikes me as being primitive. It’s dangerous. You must give yourself bleeding mini-stabs regularly to check on how erratic your blood clotting is depending on how little nutritious green vegetable you can get away with – all while endangering your bones and arteries. It’s better than stroke! Nonetheless, that doesn’t mean that QOL – or even lifespan – doesn’t suffer.
    Speaking of surgeons plying procedures for profit, how about the whole infrastructure built up around INR testing?
    What do you think of the new alternatives dabigatran and rivaroxaban? No INR testing for these! What about that infrastructure?? No compromise of any form of K either! Yeah, they’re new with little clinical history to go on, but they seem attractive to me in my position. (Apixaban won’t get the FDA nod till March.)

    I’d been using “Jigsaw” magnesium as dimagnesium malate. It’s time-release and is therefore supposed to avoid diarrhea. Well, it’s a nice theory. About the middle of October during my bad Afib period I switched to magnesium taurate. It would seem that I absorb that better, since there’s no loosening side-effect. It didn’t seem to change anything else. Perhaps it takes time?
    Magnesium L-Threonate is a new one on me. I’ll have to see about that.

    The amalgams were removed in early 2007. Still a possible mercury issue?

    Thanks. I’ll keep you posted.

  10. Jeffrey,

    Thanks for the details on your MK4 experiment. 5 mg is a lot of MK4 compared to what most people get in their diets. This might be too much MK4 for somebody taking warfarin. From what you found, it certainly does affect the INR despite reports that say that K1 is the more important form of vitamin K so far as coagulation is concerned. INR 1.3 is barely above reference range for many labs.

    Did you try the Carlson Labs product that offers this amount of MK4?

    I generally feel more concerned about mainstream medical’s tendency to pursue irreversible procedures (the ablation procedure you describe, joint replacement surgeries, etc.) than alternative medicine’s approach of using supplements that they often don’t understand completely but which almost always can be reversed simply by stopping them and waiting some time.

    Good luck with your surgery. Given what happened to your father, I can better understand your decision to proceed with it.

    The newer anti-clotting drugs don’t have enough track record to know how much better they will be long-term. Simply because they get rid of the vitamin K interaction, they are worth serious consideration. The vitamin K sensitivity and interaction of warfarin ends up causing a lot of abnormal bleeding and clotting episodes that could be avoided, and its interference with vitamin K is in my view so severely dangerous that this drug should be regarded as the rat poison it is.

    I am not sure the INR testing infrastructure is that much of a profit center for clinics that they will be loathe to change to a better drug. INR tests are not expensive, and with the move towards providing patients with testing machines they can use in their homes the potential profit has been moved somewhat from the clinics and hospitals to the test equipment manufacturers.

    I suspect the newer anticoagulants will rapidly become popular in the next five years because they are so much more profitable for big pharma than warfarin and because doctors who understand warfarin do not like it much. largely because of the diet sensitivity problems and how this makes it difficult to keep patients in target INR ranges.

    The newer anticoagulants will be vastly more profitable because they can cost many thousands of dollars per year versus under $100 per year for warfarin. Big pharma loves to tweak products to create new patents for drugs little different than existing drugs. But in this case, the action of the newer drugs is radically different than warfarin. It is not just some minor more or less clinically useless tweak to an antidepressent or statin that they dish out like candy to tens of millions of patients.

    Long-term, I think the approach of using a single pharmaceutical agent to try to control clotting risk is the wrong approach. There are so many things that can trigger clots. Furthermore, sometimes you want those clots to happen to prevent damage from excessive loss of bloodflow or blood due to uncontrolled bleeding. But the anticoagulation medications do not differentiate between inhibiting bad clots versus good clots. I think a safer approach is likely to address many inflammation, clotting factor, and nutritional issues to keep the cardiovascular system clear of debris and clogs (atherosclerotic plaque, calcification of tissues, etc.) while holding down high levels of systemic inflammation factors that are common in many people starting in their 30s. This is what I have tried to describe in my articles on warfarin.

    If you spent the $3000 some per year you might spend on a new anticoagulant on a broad spectrum of nutritional supplements, it is my guess you would get adequate clot control while overall improving your health more than from the expensive drug. This could be tested scientifically, but with the current medical system it will never be tested because the deep pockets (big pharma) have no interest in testing cheap unpatentable supplements that would take market share away from very lucrative patented drugs. This is a very serious flaw in the US medical system that is in my view one of the main reasons why medical costs are so high and outcomes, particularly those involving chronic conditions, are so poor in the US.

    The inability to quickly reverse newer anticoagulants is also a problem. Somebody who gets into a serious car crash or other accident could end up being at high risk of uncontrollable bleeding that cannot be quickly reversed with a vitamin K shot like warfarin can be reversed.

    Magnesium malate is one of the better forms of magnesium supplements. I’ve used it myself. Chelated magnesiums like the taurate forms are also good options. To my knowledge, the only form that is well-demonstrated to get through the blood-brain barrier is the chelated L-threonate form. The developers patented it so it is expensive, unfortunately. But it is still far cheaper than most drugs.

    Amalgams are a major source of mercury in the body, but they are not the only source. Certain foods and even certain geographic areas (downwind of a coal fired power plant with poor pollution control systems) may also elevate your mercury levels a lot. It is also not clear how long it takes for the body to clear accumulated mercury. It could be years, decades, or never unless special measures are taken such as chelation therapy.

    I don’t know that you can easily rule of mercury because there is evidence the body dumps it into tissues such as fat (and there is a lot of fat in the brain) to keep it out of general circulation. So from what I’ve read, it is my impression you could have acceptable mercury levels in the blood but still have high mercury somewhere in the body. It appears the brain and fat stores around the body would be the most likely places for mercury to be hidden away, but other toxins (such as fluoride) preferentially accumulate in bones.

    Also, I wanted to mention the EDTA (which I mentioned previously) or other chelation therapy is not something I would recommend for just anybody to try for general health. Some in the alternative health community have pushed EDTA heavily for general purpose use, but the results are not compelling for general purpose use especially when you consider it can chelate essential minerals, too, not just heavy metals.

    There’s a recent long-term study on EDTA IV therapy that suggests small benefits for cardiovascular health, but I noticed they were also using a number of other supplements in the IVs including high-dosage vitamin C (7 grams), B vitamins, electrolytes, and heparin. It could easily be the benefits were from something other than the EDTA, but I suspect this will be spun by some as being from EDTA.

    Overall, medicine is still a really primitive practice that is often based more upon superstitions and profit motives than any real scientific understanding or honest opinions about what would be best for the patients. This is why you should also investigate any treatment thoroughly yourself before consenting to it.

    Alison

  11. In World War 2, autopsies were done on random 18 year old soldiers killed in action. Evidence was seen that their arteries were in the initial stages of calcification. The individual can get away for several decades on the typical USA diet before symptoms are noticed, especially if the person never runs (shortness of breath indicates obstructed arteries).

    The arteries must be taken care of so they can take care of you. That means minimizing sugar intake and especially avoiding soft drinks. The healthiest beverage to routinely use would be fresh squeezed orange juice at normal strength, with a tablespoon of fresh lemon juice added. The lemon will add tartness but the mixture overall will remain pleasant. If used regularly from an early age, it’s unlikely arterial disease will be the cause of the individual’s demise. The simple ingredients are quite potent. The ascorbic acid is obvious, as is the potassium with lesser amounts of magnesium. The real power is however, the citric acid content in the lemon juice. This mixture should not be allowed to remain on the teeth after finishing a glass.

    Lemon juice will adversely affect tooth enamel if allowed to remain beyond five minutes without plain water rinse. This should not inhibit its use, because what it will do to enamel if allowed to remain should suggest how beneficial it is withing the circulatory system—no calcium build up, because citric acid solufies calcium. This additionally means no kidney or bladder stones, and no strokes. Google “Living To Enjoy My Silver” for my personal experience with the most powerful plant I ever found—lemons.

  12. Hi,
    I just came across your article and wanted to thank you for it. The information answered a great many questions for me. I do have a problem I could use some advice on however. I am 57 years old and have a thyroid problem that has caused an enormous gain in weight. About a year ago I had a blood clot in my leg that caused six to ten blood clots in my lungs. Along with that I had a UTI that caused sepsis. All in all, I nearly died and spent two months in the hospital and rehab. When I finally got out, they put me on Coumadin. I am still recovering from that. Now I am having severe pain in my ribs. I went in for an X+Ray and was told I had Osteopenia. I want to start something called Bonexin in hopes it will stop the pain as it is a bone supplement. The ingredients list is at their website. I tried to post the address but the spam checker blocked the message. Just put Bonexin in the search engine. They have the ingredients listed like an advertisement so I can’t just copy and paste them here…I apologize.
    I was wondering what you thought of taking this with the coumadin? The doctor is iffy about it but I must do something about this pain and if it is the osteopenia causing it, this may help. It has many of the things you have written about. I also have Pseudotumor Cerebri and a shunt but still am in pain daily from that. The addition of the pain in the ribs is nearly too much to stand. Please give me some direction.
    Thank you,
    Celeste

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