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In the USA, you can’t turn on your TV without being bombarded with ads for prescription blood thinners. But there’s a list of natural blood thinners (and natural substances that interfere with them) you need to know about if you take them.

On American TV, there is an amazing amount of advertising about prescription blood thinners. You can see an ad featuring a sixty-something woman backpacking through the woods who tells you Eliquis helps you “go for your best.” You could have seen the late golfer extraordinaire Arnold Palmer celebrating his ability to eat a salad since he started Xarelto. Or you could see the Brilinta commercial narrated by the grandpa who survived a heart attack so he could have a birthday party with his family and take a day at the beach.

All of these new additions to the prescription blood thinners list and more have some advantages over old-style treatment with Coumadin (warfarin). But what the manufacturers of these anticoagulant wonders only tell you in the fine print, if at all, is the list of natural blood thinners, and the list of natural “anti-anticoagulants,” you need to know for them to work well.

Let’s take a look at this list of blood thinners in alphabetical order

Aspirin is an old work horse, serving as an over the counter blood thinner. If you can’t afford anything else, you almost certainly can afford aspirin. Not everybody can take aspirin. Some people are allergic to it. Some people get digestive upset. But nobody has to worry about how it affects liver enzymes that process other medications, or how certain foods might interfere with the action of aspirin. That’s not true of the prescription blood thinners.

Brilinta (ticagrelor) is a blood thinner that is used to prevent future heart attacks. When it first came out, it was wildly popular and patients were told not to take any aspirin if they took the drug. Now it’s seen more as a specialty drug, for people who don’t need coronary intervention yet, and it’s considered safe with up to a baby aspirin (up to 100 mg of aspirin) every day [1].

The liver breaks down Brilinta and regulates the amount of Brilinta in your system with the CYP3A4 enzyme [2]. Statin drugs for lowering cholesterol interfere with this enzyme, so you will have more Brilinta in your system and more of a risk for bleeding. Grapefruit juice also interferes with this enzyme with the same results [3]. However, it isn’t just grapefruit that can pose a problem. Brilinta is unpredictably more potent if you eat celery, peanuts, persimmons, or tomatoes, and if you drink more than one or two coffees, teas, or glasses of red wine daily [4].

Coumadin (warfarin) has been around for decades. It used to be the only drug you could get to prevent clots after surgery or a heart attack. It’s an inexpensive drug, although it doesn’t start working right away, and it’s hard to regulate so you get protection from clots but don’t “spring a leak” with unexplained bleeding.

You’re sure to be told that you need to limit your consumption of leafy greens and certain vegetables while you’re on Coumadin. They contain vitamin K1, and the way the drug works is by interfering with the way the body uses vitamin K1. However, you aren’t likely to be warned that you also need to avoid basil, thyme, parsley, coriander, kale, amaranth leaves, collards, oregano, dandelion greens, turnip greens, potato chips, Swiss chard, and green onions. Potato chips, especially if they are pressed out of dehydrated potatoes, like Pringles, are very high in vitamin K1.

It’s also only in the last few years come to the attention of doctors that the way your body processes Coumadin depends on the action of a liver enzyme called CYP2C9 [5]. It turns out that grapefruit juice can “concentrate” Coumadin in your body, too, but so can celery, onions (especially red or purple onions), apples (especially the peels), Hungarian wax peppers, buckwheat, cranberries, lingonberries, and black-eyed peas. When you are already taking Coumadin, you should consider all of these plant foods as a kind of natural blood thinners list. These foods are all unusually rich sources of the quercetin that interferes with the enzyme [6].

And it’s also only fairly recently come to light that retinol (a form of vitamin A) also interferes with the body’s recycling of Coumadin. Some doctors report that just a tiny serving of mango or mango juice can interfere with Coumadin [7]. There could be similar problems with cod liver oil, papaya, and butter. Combining them with Coumadin makes them natural blood thinners.

Effient (prasugrel) is a relatively new anticoagulant that works by binding to a receptor site that platelets have to use to “stick” to each other. Combined with low-dose aspirin as a two-part anticoagulant drug, it prevents clotting that increases the risk of “NSTEMI” heart attacks (heart attacks in which the EKG doesn’t show an elevated ST segment) and unstable angina, in which the pain isn’t predictable. It works the same way as the older drugs Plavix (clopidogrel) and Ticlid (ticlopidine), except Effient doesn’t have to be activated by a liver enzyme called CYP2A19. Some people just don’t respond to Plavix or Ticilid because their livers don’t make CYP2C19. If the doctor simply gives them Effient, that’s not a problem.

Researchers have investigated interactions of grapefruit juice with Effient. Grapefruit juice slows down the speed at which Effient builds up to an effective concentration, but won’t interfere with the action of Effient if you have been taking it (12 hours or more) before you drink the grapefruit juice. [8] To be on the safe side, just avoid grapefruit, grapefruit juice, and Earl Grey Tea (because it contains bergamot, which is chemically similar to grapefruit) if you are taking Effient.

Eliquis (apixaban) reduces blood clotting in yet another way, but interfering with the action of clotting Factor X (more specifically, clotting Factor Xa). With this drug, the problem isn’t so much taking it with a specific food, but making sure you don’t take it with a high-calorie or high-fat meal [9]. Xarelto (rivaroxaban) works the same way Eliquis does to stop clots, but with this medication the main consideration is to make sure to take it with food [10].

Pradaxa (dabigatran) is a blood thinning medication that works through yet another mechanism, interfering with the action of thrombin. It’s particularly useful if there is a serious possibility of needing to stop the blood thinning action of the drug. That’s done with another drug called Praxbind (idarucizumab). There are no known food interactions with Pradaxa, but there are too many drug interactions to list here [11]. Be sure you doctor and your pharmacist know all the medications you are taking if you take Pradaxa.

 

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