Dear Dr. Roach: I am looking forward to having my 90-year-old father-in-law come to live with us later this year, but we have a difference of opinion about his diet. He maintains that because he is taking warfarin, he can have only occasional salads and limited green vegetables. It is my understanding that as long as his consumption of these foods is relatively consistent, they would be fine additions to his diet 鈥� and would be especially helpful in alleviating his persistent constipation issues. Can you discuss this subject and possibly resolve our disagreement?
J.E.
Warfarin (Coumadin) blocks the action of vitamin K, preventing the formation of active clotting factors. Vitamin K is found especially in leafy green vegetables, so it鈥檚 the balance of warfarin and vitamin K intake that determines how much of the active clotting factors are made.
So, you are both right. He shouldn鈥檛 suddenly increase his intake of salads and other greens, as his INR (the international normalized ratio, the standard test for determining clotting time and effectiveness of warfarin) will decrease and possibly put him at risk for blood clots, based on whatever risk factor he is taking warfarin for, such as atrial fibrillation or history of blood clot.
However, by adjusting his dose, he can eat reasonable amounts of healthy green vegetables and get the multitude of health benefits that go with them, including improving constipation for many people. However, he will have to do so in a controlled fashion, with the help of his doctor to manage the warfarin.
You are quite right that consistency is the key to maintaining an INR that is effective at preventing clots and not so high that it puts him at risk of excessive bleeding.
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Dear Dr. Roach: I am a 65-year-old woman who had bilateral partial knee replacements last September. I had frequent episodes of restless leg syndrome before surgery, but it has been taken to a whole new level. This is severely impacting my life, as it happens off and on all day. I can鈥檛 sit down to watch TV, read the paper or work on my computer. It makes car travel miserable, but what I鈥檓 really worried about is a planned trip overseas that requires a 12-hour flight. I had a gastric bypass and take a 325-milligram iron tablet, as I was found to be anemic. I take Requip for the restless legs at bedtime. I get a couple of hours of sleep and take a sleeping pill, which allows me another couple hours of sleep. I wake up early. I鈥檓 exhausted, frustrated and depressed. Is there anything else I can do?
A.H.
Restless leg syndrome (Willis-Ekbom disease) is more common than once thought (between five and 10 per cent of adults have it). It鈥檚 characterized by odd sensations in the legs and an almost irrepressible urge to move them. You have mentioned two conditions that can exacerbate RLS: knee surgery and iron deficiency. Knee surgery can cause RLS symptoms even in people who haven鈥檛 had it before, but that usually lasts for only a few weeks to months.
RLS occurs in 30 to 40 per cent of people with iron deficiency anemia. Given your gastric bypass surgery, which can interfere with iron absorption, I would worry that 325 mg of iron is not enough. The next time you see your doctor, it might be wise to get your iron retested. Vitamin C helps iron absorption.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
