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Ask Dr. Mike: Readjusting Blood Pressure Medication & Taking Vitamin K2 while on Coumadin

Here you'll find the answers to a wealth of health and wellness questions posed by Healthy Talk fans. Listen in because what you know helps ensure healthy choices you can live with. Today on Healthy Talk, you wanted to know:

I'm being treated with three medications for blood pressure. I'm also taking a thyroid medication. My blood pressure is still really high, my top number 135-160 and bottom number 60-70. I try to exercise and walk, however, I just don't have the energy and my legs hurt and ache. Please help if you can!

First, Dr. Mike wants to see that top number decrease to 110. Since you're also feeling tired even though you're on thyroid medication and other blood pressure medications, maybe you need to ask your doctor to readjust one of your medications. Dr. Mike also suggests getting rid of one of your blood pressure medications that are known to cause extra fatigue.

You may want to consider replacing your medication with nutrients such as pomegranate, olive leaf extract, or grape seed extract.

Can I take Viatmin K2 if I am on coumadin? If so, what dose?

Coumadin prevents your blood from clotting together, which can cause a heart attack, stroke, and other clotting in your arteries.

As long as your coumadin numbers are being monitored, you can take vitamin K2. However, you should talk to your doctor before taking it and discuss proper dosage.

If you have a health question or concern, Dr. Mike encourages you to write him at This email address is being protected from spambots. You need JavaScript enabled to view it. or call in, toll-free, to the LIVE radio show (1.844.305.7800) so he can provide you with support and helpful advice.

RadioMD Presents:Healthy Talk | Original Air Date: March 23, 2015
Host: Michael Smith, MD

RadioMD. It's time to Ask Dr. Mike. Do you have a question about your health? Dr. Mike can answer your questions. Just email: This email address is being protected from spambots. You need JavaScript enabled to view it. or call now: 877-711-5211. The lines are open.

DR. MIKE: So, in case you want to call in today, I have a different number. I have 844-305-7800 that is 844-305-7800.

I would love to talk to you on air but, of course, you can always just send me your email questions as well.

So, this one came from Virginia Ross. She says, "I'm being treated with three medications for blood pressure: Lisinopril 200 mg twice a day, Lopressor 500 mg twice a day, and Norvasc--that's a calcium channel blocker--at 5 mg a day." And then, she also added that she is also taking thyroid medication. "My blood pressure still high, the top number ranges up to 130 to 155 the bottom number is okay. I try to exercise and walk; however, I just don't have the energy, plus my legs hurt and ache. So, please help if you can."

Well, I think there are two issues here. I think your bottom number, Virginia, you know that 60-70 range that is good. The top number, though, that is high. I would like to see that more around 110. I know your doctor probably says 120. I think that's still a little too high. I think that optimal blood pressure is 110/70. I think when I was in medical school we learned 120/80 was kind of the target, but I think that's a little too high. I think that needs come down. And remember, out of the 17 heart disease risk factors, next to smoking, I put blood pressure right at the top the list. So, I do want to see those top numbers come down.

Now before I answer the question--because I think I'm going to need just to make some supplements suggestions that you could add to the medications. Of course, talk to your own doctor. I'm just giving suggestions here. I'm not your doctor. I will say something, though, about the not being able to walk or exercise too much because you don't have energy.

Well, first of all, you're on thyroid medication, so if I were your doctor I would want to know if you're being properly medicated for your low thyroid condition? So, you wrote down here that you're on Synthroid.

I don't know the dose so and I don't know where your thyroid profile is. I think that's really important because we want you to exercise. We know that it's incredibly important for the cardiovascular system, but if you can't do it because your thyroid is not being properly replaced--your thyroid hormone--you know that's going to make it difficult. And then, Virginia, add into this the fact that you know you have a couple medications here. The Lopressor and the Norvasc--they're kind of known for wiping energy out. So here you have a thyroid condition that may or may not be treated properly and you're on medications--a beta blocker and a calcium channel blocker that are known to cause low-energy.

So, yes, I don't blame you. I really believe you that you're trying to walk but you just don't have energy. I get it. So I think you're on it here's the good news. We're not talking about anything major here we're just talking about maybe 10 more points or so, maybe 15 or 20 more points from your top number. So, I think you're a perfect candidate to really talk to your doctor about maybe getting rid of one of the medications, either Lopressor or the Norvasc. I would keep the Lisinopril. Get rid of one of those medications that are known to cause fatigue. Check your thyroid to make sure you're being treated properly and, if that's the case, and your thyroid numbers look okay, I would then add something like maybe pomegranate 100-200 mg a day. You could do milk peptides. That's when you take whey and you break it up into smaller pieces and when you take it, that can act as a blood pressure medication.

It's a supplement, but it acts in the same way as some of the medications we have. You could also do olive leaf extract that's another good suggestion. Grape seed extract is another good suggestion. So, there are things you can do. What your goal would be is to maybe take away one of the medications possibly causing some fatigue and replace it with a couple of those nutrients. I would personally do pomegranate and olive leaf extract and see if we can get a drop in that top number a little bit. Plus, you're going to have a little more energy because we took out one of those medications and now you're going to want to exercise more which is going have benefit towards blood pressure down the line as well. I've got to tell you though, a lot of this hinges on the thyroid, though. We've got to make sure your thyroid's being treated properly, so get that checked as well.

That's my suggestion for Virginia. Go ahead and talk to your doctor about getting rid of one of the medications, either the Lopressor or the Norvasc, and adding pomegranate and olive leaf extract. I hope that helps, Virginia.

Okay next question: "Can I take Vitamin K2 if I am on Coumadin? What dose should I take if I can take it?"

So, Coumadin is a blood thinner, although there's really no such thing as a blood thinner. What usually people mean by that is you are preventing a clot from forming and so you bleed. So, maybe that's where the idea of blood thinner came from. You bleed more easily. People who have had strokes, heart attacks, deep venous thrombosis--stuff like that--are put on the medication Coumadin. There are other ones out there that I think are a little bit better. They don't require as much monitoring, but this person here is on Coumadin, so that's fine.

How does Coumadin work? Well, in order to form a clot, the first thing that happens is platelets will form over the injury, the injured vessel, and then on top of the platelets what is called "thrombin". Eventually, fibrin will form over the platelets as the clot. In order for that to happen, you have to have vitamin K. Vitamin K is required to activate some of the proteins involved in forming a clot. Coumadin is a vitamin K antagonist. It blocks vitamin K from doing its thing and helping you to clot.

Now, vitamin K comes in two forms. It comes and K1 and it comes in K2. Vitamin K1 is the form of the vitamin involved in clot formation, so Coumadin is a vitamin K1 antagonist. So that means, to answer the question "Can you take vitamin K2," as long as your numbers are being followed and that you know your Coumadin numbers, you should be okay doing a vitamin K2. Now, vitamin K1 and K2, some doctors believe that they should be thought of as totally different vitamins. Vitamin K1, as I said, is in clot formation. Vitamin K2 is in calcium management and helps to put calcium into the bones. There are some doctors who just believe that they're two totally different vitamins. That's not totally true.

Vitamin K2 does have some effect on blood clotting, but for the most part, if somebody is on Coumadin, the vitamin K1 antagonist, they should be able to do some vitamin K2 which is extremely important for the cardiovascular system. You should be okay. Of course, talk to your doctor and make sure that's okay. By the way, if any my listeners are taking the drug Coumadin, also called Warfarin and your doctor has said don't take any vitamin K1 or don't eat leafy green vegetables--that kind of stuff--more and more research has shown that that's not true. To tell somebody not to eat leafy greens is just crazy. That's almost malpractice. I think what we've found is that if you're on Coumadin, you don't want to take a vitamin K1 supplement.

You still want to eat your leafy greens. You still want to get vitamin K1 from your diet. As a matter of fact, that helps Coumadin work better. That's the latest research. As far as dose goes, if you take vitamin K2, it comes in two forms MK-4 and MK-7. MK-4 is a thousand micrograms, which is 1 mg, and MK-7 is about 200 micrograms a day. That would be the dose range of the vitamin K2 and you want to see both of those on a label, MK-4 and MK-7.

So, yes, it should be okay. Talk to your doctor and there you go. That's vitamin K2.

This is healthy talk on RadioMD. I'm Dr. Mike. Stay well.