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Is your blood too thin?

Helen is in her 80s and has been taking prednisone for years for her arthritis. It takes away some of the pain, but leaves her with very thin skin. Recently, she bumped her leg, and it began to bleed. Her blood was so thin it wouldn't clot. Hours later, when the cut wouldn't stop bleeding, she had to go to the hospital emergency room to have it dressed.

Helen wasn't taking Coumadin or any other blood thinning medications, but she did take a baby aspirin every morning. In addition, she had increased her vitamin E to protect her heart, and was taking ginkgo for better memory.

While all of these have their benefits, they are all blood thinners!

Helen had thinned her blood too much. It cost her a trip to the hospital, where she ended up getting an infection in her leg. This was unfortunate, but not surprising, since hospitals are notorious breeding grounds for bacteria. When her infection refused to heal, even with oral antibiotics, she was admitted to the hospital and given intravenous antibiotics. Taking too many blood thinners almost cost Helen her life. It was months before she was back to normal.

In an effort to prevent blood clots that can lead to stroke or heart attacks, or for their patients who have had a stroke, heart disease, or phlebitis, many doctors are recommending taking a baby aspirin each day. If you've already had a problem associated with clotting, you may be taking a blood thinner like Coumadin in addition to aspirin. And if you're health-conscious, you may be creating very thin blood by taking nutrients that do the very same thing. Doctors rarely look at blood-thinning substances other than medications. In fact few doctors are aware of the many nutrients that thin the blood. The more you take, the thinner your blood is likely to be, and the more you are likely to have bleeding problems. Especially with any surgery -- including dental surgery.

Blood thinning nutrients

The American Association of Nurse Anesthetists (AANA) are very concerned. They published a study in the February 2000 issue of the AANA Journal evaluating the interactions of various nutrients with anesthetics. They caution that people who take blood-thinning nutrients can dramatically increase the time it takes for their blood to clot.

The nutrients they mentioned that may prolong coagulation time include: alfalfa, chamomile, garlic, ginkgo biloba, kava kava, licorice root, vitamin E, and fish oils. But there are more. An article in a German journal, Perfusion, talks about a host of herbs that increase the effect of medicinal anticoagulants. In large doses (300 mg), the natural hormone DHEA was found to increase clotting time. We don't know how little you can take without getting this effect. Individually, these nutrients may not thin your blood too much. But in combination, you, like Helen, may experience problems.

What if Helen had been in surgery? Her uncontrollable bleeding could have ended her life. I think it's vital to talk with several people in your health-care team: your pharmacist, physician, and any practitioners of complementary medicine, to look carefully at the actions and interactions of everything you're taking. Ask them to make sure you're not thinning your blood too much. You or they can also consult the new Physicians' Desk Reference for Nutritional Supplements, an excellent up-to-date reference on the actions and adverse reactions of hundreds of nutrients.

Fish oil supplements are good for the heart in part because they decrease blood clotting. Fish oils contain several fatty acids, but it appears to be the EPA (eicosapentaenoic acid) that has this anti-thrombotic effect. EPA also reduces blood pressure. If you're taking supplements high in EPA, you may want to stop taking them two weeks before surgery. Check with your anesthetist to determine whether or not a fish dinner is advisable the night before any surgery.

Vitamin E reduces platelet adhesion and aggregation. Simply put, it thins your blood. If you're taking as much as 400 IU of this vitamin a day, you may want to stop taking it before surgery. If your multi contains 400 IU, ask the anesthetist or your doctor if this amount is safe for you to continue right up until surgery. The PDR for Nutritional Supplements suggests that people on blood thinning medications should not take much more than 100 IU/day. To me, this indicates that more than 100 IU of vitamin E a day has measurable blood thinning capabilities. If you're taking blood thinning medication, be monitored by your doctor to make sure the amount of vitamin E you're taking is consistent (so the meds thin your blood at the same rate each day) and does not cause unsafe interactions.

Garlic is used by people with atherosclerosis to help prevent their platelets from sticking. This can increase bleeding. There have been reports of garlic extracts that increased the effect of blood thinning medications like Coumadin. The World Health Organization (WHO) has stated that, "Patients on warfarin (Coumadin) therapy should be warned that garlic supplements may increase bleeding times. Blood clotting times have been reported to double in patients taking warfarin and garlic supplements." Eating a clove of garlic a day, or adding it to your food, should not be a problem.

Ginkgo biloba is used to increase the memory. It does this in part by increasing blood flow to the brain and by increasing the tone of blood vessels. Blood flow is increased when the blood is thinner. Individual cases of excessive bleeding with the combination of ginkgo and aspirin have been seen. One patient who took just 40 mg a day of a standardized 50:1 ginkgo extract, along with aspirin, had bleeding from the iris. I think ginkgo is a valuable herb, but for now I have enough reasons to be cautious about who uses it, in which amounts, and with what other nutrients and medications. I don't think it's as safe, across the board, as people think.

Other nutrients that could affect clotting include alfalfa, chamomile, feverfew, echinacea, dong quai, willow bark (natural aspirin), goldenseal, and horse chestnut. This doesn't mean you shouldn't use them. It means you should talk with your doctor and pharmacist about your supplements so that any doctors associated with a scheduled or unscheduled surgery are aware of your blood's clotting abilities. Perhaps you'll decide to use some herbs with anticoagulant properties on an as-needed basis, instead of daily -- such as echinacea and golden seal. Or you may find that you don't need aspirin if you're taking a number of nutrients with a similar activity.

Blood thinners and your diet

If your doctor has put you on Coumadin or another blood thinning medication, you may have been told to reduce your dietary intake of vitamin K. Vitamin K causes blood to clot and is found in abundance in dark green vegetables and vegetable oils. These foods are contraindicated for people taking blood-thinners, but not for the rest of us. If you're taking nutrients with anti-coagulant properties, eat plenty of veggies to increase your vitamin K and reduce your risk for bleeding. A balance of diet and nutrients is always important, but in this case it can be a life saver.

Before any surgery

To be very safe, two weeks before any surgery, including dental surgery, stop taking all blood thinners except for those given by your physician. Talk with your doctor to see if it would be wise and safe to stop any prescribed blood thinners prior to surgery. Never make this decision on your own. For more information both for you and your doctor, contact the American Association of Nurse Anesthetists (AANA) at 847-692-7050 or

Blumenthal, Mark. Herbal Medicine: Expanded Commission, E Monographs, American Botanical Council, 2000.

Blumenthal, Mark. "Interactions between herbs and conventional drugs: Introductory considerations," Herbalgram, No. 49, 2000.

Ernst, E. "Possible interactions between synthetic and herbal medicinal products, Part 1: a systematic review of the indirect evidence," Perfusion, January 2000.

Lininger, Schuyler W., DC, et al. HealthNotes, A-Z Guide to Drug-Herb-Vitamin Interactions, Prima Health, 1999.

Norred, Carol L., CRNA, MHS, et al. "Use of complementary and alternative medicines by surgical patients," AANA Journal February 2000, vol 68, no. 1.

PDR for Nutritional Supplements, Medical Economics, 2001.

Sahelian, Ray, MD. DHEA: A Practical Guide, Avery Publishing Group, 1996.
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Author:Fuchs, Nan Kathryn
Publication:Women's Health Letter
Geographic Code:1USA
Date:Nov 1, 2001
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