The holidays are a time to enjoy fun, festivities and food…lots of food. Yet, for those with heart conditions, some foods + supplements + medications can lead to not-so-fun interactions.

Many heart patients take medications daily to control risk factors such as cholesterol, blood pressure, diabetes as well as those to address certain conditions such as heart failure, rhythm problems and the like.

With so many medications and conditions to balance, it’s important to remember that certain foods and beverages as well as select herbal and dietary supplements may interact with or impact the concentration of certain medications. Some can even interfere with lab tests and lead to a missed diagnosis in the event of a heart attack.

That’s why it’s so important to communicate regularly with your cardiologist and your pharmacist. While you should have these important discussions on a regular basis, here are some specific considerations for cardiovascular patients as it relates to potential interactions.

Leafy greens:

Greens like spinach and kale are high in Vitamin K. While Vitamin K has many great health benefits, it can affect your INR (International Normalized Ratio). Your INR is the measurement of how long it takes your blood to clot. For patients taking blood thinners (ie. Coumadin or warfarin), leafy greens can lower your INR. The good news is that patients on these medications are monitored regularly to check their INR, so you can absolutely continue to eat leafy greens (they are great for your heart!), but it’s best to keep your intake of them consistent. Whether you prefer to eat them once a day or several times a week, just try to eat about the same amount each week. This will allow your cardiologist and pharmacist to keep you on a consistent dosage. So, please consistently, eat your greens.

Grapefruit/Grapefruit juice:

Medication interactions with grapefruit and grapefruit juice are common across a wide range of drugs. For heart patients, the most common are cholesterol-reducing drugs (statins such as Crestor/Lipitor) and those that treat high cholesterol, but there are numerous other specific drugs that treat problems such as heart failure, and certain rhythm and/or vascular problems, as well as many non-cardiovascular drugs such as those designed to treat anxiety, pain, cough/allergy, erectile dysfunction, among others.

Caffeine:

While caffeine doesn’t cause drug interactions, per se, it can increase your heart rate. This may negate or counter the effects of certain medications, such as those designed to lower your blood pressure. In these cases, it can cause an opposing effect to the medication. While some caffeine is fine for most, you may want to talk with your cardiologist or pharmacist about the appropriate amount based on your individual disease state.

Alcohol:

Alcohol is naturally a blood thinner and can cause damage to the liver – which means for patients taking blood thinners or statins (or any medication that can cause liver damage), it’s important to talk to your doctor or pharmacist about alcohol intake and what’s safe for you.

Herbal & Dietary Supplements

While many herbal and dietary supplements offer health benefits, there’s a common misconception that they can’t cause medication interactions or side effects. This simply isn’t true – they can cause dangerous side effects just like medications, so it’s important for heart patients to consult with their cardiologist before starting any new supplements. Here are a few specific examples to be aware of.

Garlic, ginger, ginseng, ginkgo:

These supplements can increase the risk of bleeding in patients who take blood thinners. That’s because each of these products also thin the blood, so the combination can be dangerous for certain patients.

St. John’s Wort:

Often taken as a supplement to help improve mood or symptoms of depression, this supplement brings a wide range of potential interactions. Specifically, it can affect the concentration of medications such as blood thinners and statins, reducing their efficacy.

Vitamin E:

While vitamin E offers some positive antioxidant benefits, it can interact with both blood thinners and anti-platelet drugs, as well as statins. For patients on a blood-thinner or anti-platelet medication, using vitamin E can increase the risk of bleeding. Taking vitamin E with statins or niacin may reduce the medication’s effects.

Biotin/Vitamin B7:

Often used in beauty products to improve hair and nail growth, biotin can also be found in smaller amounts in multi-vitamins and prenatal vitamins, and may be used in high doses to treat certain patients with multiple sclerosis. In extremely high doses, biotin can interfere with certain lab tests designed to check troponin levels. Troponin is a cardiac marker that is used to determine whether a patient is having or has recently suffered from a heart attack. In some cases, biotin can cause falsely low results, which could lead to a missed diagnosis and the avoidance of critical treatment needed in the event of a heart attack. It’s important to note that these complications are typically reported in patients who take a mega-dose (100 to 300 mg), or amounts that far exceed the recommended daily intake of biotin.

Janna Beavers, PharmD, BCPS-AQ Cardiology, BCCP, a WakeMed cardiology clinical pharmacist, reminds heart patients to keep an accurate list of all current medications and supplements to ensure you don’t forget anything when consulting with your cardiologist or physician. “Oftentimes, patients forget to tell us about herbal or dietary supplements they’re taking – thinking that they’re completely harmless.”