Brianna Ballard

DIE 3213- Nutrition Therapy 1

Professor Dray
September 29th, 2016

Questions:

1. What is the Dietary Reference Intake (DRI) for Vitamin K? (1 point) What is the Daily
Value (DV)for Vitamin K as listed on food and supplement labels? (1 point)

- According to the U.S. Department of Health and Human Services, the recommended intake for
females over the age of 19 is 90 mcg.1 The FDA does not require Vitamin K to be posted on food and
supplement labels. If indeed is posted, the Daily Value is based off of 80 mcg for adults and children
over the age of 4. Foods that contain over 16 mcg (20% of DV) of Vitamin K are considered be a
high Vitamin K source.

2. Identify sources of Vitamin K, both from diet and synthesis in the body. (2 points)

- Vitamin K is found highest in Natto (fermented soy), collards, and turnip greens. It is commonly
found in avocados, cranberry juice, and leafy greens. We synthesize Vitamin K in our own bodies
through intestinal microbiota.2 This type of Vitamin K is called Vitamin K 2 or menaquinones.

3. Look up Vitamin K levels of the following sample foods in a food composition table or database: 1
cup of cooked kale, 1 cup turnip greens, 1 cup raw romaine lettuce, 1 cup raw peeled cucumber, 1
cup cooked turnips. How do the Vitamin K levels of these foods compare to the DRI and DV? (3
points)

1 cup cook kale3 1062.1 ug, 1328% DV

1 cup turnip greens 138.05 ug, 173% DV

1 cup raw romaine lettuce 48.18 ug, 60% DV

1cup raw peeled cucumber 8.57 ug, 11% DV

1 cup cooked turnips .23 ug, .29% DV

The kale and turnip greens both fulfill and exceed the DRI of 90 mcg. The romaine lettuce,
cucumber, and turnips do not meet either the DRI or the DV. However, the 1 cup of romaine lettuce is
considered to be a high nutrient source of Vitamin K because it is over 20% of the DV.

4. What is the recommended adjustment in Vitamin K intake in patients on warfarin? (1

point) What
foods should they avoid or limit? (1 point)

- It is recommended that consumers should stay consistent with their Vitamin K intake. They should
neither increase nor decrease their intake but keep the same. It is important to be aware of what type
of foods are high in Vitamin K so the intake can remain consistent. These foods include leafy greens,
broccoli, cabbage, prunes, avocado, tuna, and peas. However, some foods do not contain consistent
amounts of vitamin k such as avocados, margarine, and mayonnaise 4. It is also recommended to not
eat or drink grapefruit juice.

5. Is it advisable for her to take a multivitamin? (1 point) How much vitamin K is in a standard
once daily multivitamin? (2 points)

- Vitamin K is commonly present in most multivitamin supplements. Typically 75% of the DV or

60mcg are found in the multivitamins. 1 The client had reported she takes a multivitamin occasionally.
I would advise her to choose to take it, however, if she cannot remember to take it everyday, I would
encourage her to not take it at all. Its all or nothing in order to keep consistent levels of Vitamin K in
her system.

6. How would her periodic use of antibiotics affect her INR? (3 points)

- Vitamin K is synthesized by the gut bacteria in the intestine. Antibiotics have the potential to
destroy these bacteria possibly causing a low vitamin K status. 1 By inhibiting the bodys natural way
in producing its own Vitamin K, levels cannot remain consistent affecting her INR.

7. Describe the effects of herbal supplements such as St. Johns wort on medication action. (3
points)

- Much is still not known about herbal supplements and further research needs to be completed.
Currently, the British Pharmacological Society has done research between St. Johns wort and
warfarin and has recognized a relationship. The conclusion is that the St. Johns wort reduces the
effect of the medicine. This is due to the induction of cytochrome P450 isoenzymes. 5

8. Name other food medication interactions for which she is at risk. (3 points)

- The client also takes Simvastatin which helps lower LDL cholesterol. It works by reducing the
synthesis of LDL made by the liver. When taking any medications, alcohol is not advised. The client
reported she has a glass of wine once or twice weekly. Grapefruit juice and St. John wort is also not
recommended when taking simvastatin.6 Warfarin can also be affected by vitamin A, E, and C. 4

9. Write a PES statement. (2 points) What is your intervention? (2 points)

- Food-medication interaction related to the intake of Vitamin K and Warfarin as evidenced by an

INR of 4.0 seconds.
- E, Nutrition Education would be provided as an intervention. Priority modifications would be
recommended such as stop drinking alcohol and grapefruit juice. Take a multivitamin daily or
none at all. Consume consistent intake of spinach, collard greens, asparagus, and romaine lettuce.
Do not take St. Johns wort. I would also provide a list of foods high in Vitamin K so she can
watch her intake of Vitamin K.

10. Name a specific intervention(s) that would address her nutrition diagnosis, and specify how you
would monitor their effectiveness. In addition to diet and fluid status, what other parameter might
you monitor in a HF patient?. (5 points)

- Consuming a consistent intake of Vitamin K would help the food-medication interaction. I

would monitor the effectiveness of the intervention by using labs to test her INR. It was reported
that her INR levels before were not stable. Testing the INR at different times would identify if
the intervention was effective or not. It would also be helpful to monitor her blood pressure,
cholesterol, and triglyceride levels as being a HF patient. It is very important to have balanced
blood so that clotting nor excessive bleeding occurs. If blood becomes imbalanced, consuming
omega-3 fatty acids could help and further assessment would be needed.

References
1. Vitamin K Health Professional Fact Sheet. U.S National Library of Medicine.
https://ods.od.nih.gov/factsheets/vitamink-healthprofessional/#en3. Published
February 11, 2016. Accessed September 28, 2016.
2. Booth S, ed. Vitamin K. Micronutrient Information Center.
http://lpi.oregonstate.edu/mic/vitamins/vitamin-k. Published August 2014.
Accessed September 28, 2016.
3. Vitamin K In Kale (Cooked, Boiled, Drained, Without Salt) | INRTracker. INR Tracker.
http://inrtracker.com/nutrients/vitamin-k-in-kale-cooked-boiled-drainedwithout-salt. Accessed September 28, 2016.
4. Warfarin (Coumadin) Interactions with Food. IHTC Warfarin Coumadin Interactions
with Food Comments. http://www.ihtc.org/payors/conditions-we-treat/clottingdisorders/coumadin-interactions-with-food/. Accessed September 28, 2016.
5. Henderson L, Yue QY, Bergquist C, Gerden B, Arlett P. St Johns wort (Hypericum
perforatum): drug interactions and clinical outcomes. British Journal of Clinical
Pharmacology. 2002;54(4):349-356. doi:10.1046/j.1365-2125.2002.01683.x.
6. Pronsky Z. Food Medication Interactions . Food-Medication Interactions