Quick Answers
Some vegetables that may need to be limited or avoided when taking the blood thinner Eliquis (apixaban) include:
- Leafy greens like kale, spinach, and collard greens – high in vitamin K which can interfere with Eliquis
- Broccoli and brussels sprouts – moderately high in vitamin K
- Green beans – can be high in vitamin K depending on preparation
- Avocados – can be moderately high in vitamin K
- Celery, cucumbers, zucchini, and asparagus – contain lower amounts of vitamin K
You don’t necessarily have to avoid these vegetables completely, but limiting intake and keeping serving sizes consistent can help manage your vitamin K intake. Work closely with your healthcare provider for guidance on your specific diet.
Eliquis (apixaban) is a commonly prescribed anticoagulant or “blood thinner” that helps prevent blood clots from forming or growing larger. It works by blocking Factor Xa, a protein involved in blood clotting.
While anticoagulants like Eliquis provide important protection against strokes, blood clots, and other medical emergencies, they also come with a risk of excessive bleeding if an injury or accident occurs. For this reason, it’s important to understand how different foods can interact with these medications.
One dietary component that plays a particularly important role is vitamin K. Vitamin K helps activate clotting factors and supports healthy blood coagulation. Eating large amounts of foods high in vitamin K can counteract the effects of anticoagulants like Eliquis.
However, completely avoiding vitamin K is not necessary or recommended. A balanced approach can help manage vitamin K intake while still getting nutrients from a varied diet.
How Does Vitamin K Interact with Eliquis?
To understand which vegetables may need to be limited or avoided with Eliquis treatment, it helps to first understand how vitamin K interacts with anticoagulant medications.
Vitamin K is essential for the functioning of proteins involved in blood clot formation. Specifically, it’s a required component in the carboxylation process that activates clotting factors II, VII, IX, and X as well as proteins C and S.
However, anticoagulants like warfarin and Eliquis block the action of some of these clotting factors. When the factors are inactive, clots are less likely to form.
So eating high amounts of vitamin K-rich foods can potentially override the anticoagulant effect of Eliquis. The high vitamin K content helps activate clotting factors that the drug is trying to inactivate.
Does this mean you need to completely avoid vitamin K when taking Eliquis? Not necessarily. The key is to try to keep your vitamin K intake consistent from day to day rather than eliminating it altogether.
Sudden large increases or decreases in dietary vitamin K can make anticoagulant dosing challenging. But a steady intake at a lower to moderate level can often be accommodated.
Vitamin K Content of Different Foods
The foods highest in vitamin K are generally leafy greens, certain oils, and some herbs and spices. But the amount can vary significantly based on factors like:
- Growing conditions
- Harvest time
- Storage length
- Cooking method
- Portion size
For example, 1 cup of raw spinach contains 145 mcg of vitamin K but 1 cup of boiled spinach only contains 839 mcg. Cooking can significantly reduce vitamin K content.
Here’s an overview of some common dietary sources of vitamin K:
Leafy Greens
Leafy greens like spinach, kale, lettuce, collard greens, and cabbage are among the highest sources of vitamin K. For example:
- 1 cup raw spinach: 145 mcg
- 1 cup raw kale: 1062 mcg
- 1 cup raw collard greens: 1452 mcg
- 1 cup raw broccoli: 220 mcg
Leafy green vegetables, especially when raw, are concentrated sources of vitamin K. Portion size is an important factor.
Certain Oils
Some plant oils are also high in vitamin K. These include:
- 1 tablespoon canola oil: 127 mcg
- 1 tablespoon soybean oil: 128 mcg
- 1 tablespoon olive oil: 60 mcg
Oils used in cooking, dressings, and sauces can contribute significant vitamin K, so amounts may need to be limited.
Fruits & Vegetables
Amounts of vitamin K vary among different fruits and vegetables based on type, serving size, and preparation method. For example:
- 1/2 cup broccoli, boiled: 220 mcg
- 1/2 cup green beans, boiled: 33 mcg
- 1 medium avocado: 35 mcg
- 1 cup celery, raw: 13 mcg
- 1 medium cucumber: 10 mcg
Green beans, celery, cucumbers and zucchini tend to be lower in vitamin K, while broccoli, Brussels sprouts, asparagus and avocados are higher.
Herbs & Spices
Herbs and spices often provide concentrated amounts of vitamin K. For instance:
- 1 tablespoon dried basil: 80 mcg
- 1 tablespoon dried parsley: 153 mcg
- 1 tablespoon dried oregano: 32 mcg
- 1 tablespoon dried thyme: 45 mcg
Spices and herbs like parsley, basil, oregano and thyme can be high in vitamin K, so use sparingly if taking Eliquis.
Vegetables Highest in Vitamin K
Based on their typically high vitamin K content, these vegetables may be most important to limit or consume cautiously when taking Eliquis:
Leafy Greens
- Kale
- Spinach
- Collard greens
- Swiss chard
- Lettuce, especially darker varieties like romaine
- Cabbage
- Broccoli and broccoli rabe
These greens are healthy when eaten in moderation but provide concentrated amounts of vitamin K. Avoid sudden large increases in intake.
Brussels Sprouts
1 cup of cooked Brussels sprouts contains about 250 mcg of vitamin K. Portion size is key when preparing these vitamin-rich vegetables.
Asparagus
6 spears of asparagus provide about 56 mcg of vitamin K. Eat only occasional, moderate portions.
Avocados
1 medium avocado has approximately 35 mcg vitamin K. Like other fruits and vegetables, avocado intake needs consistency.
Green Beans
When boiled, green beans contain about 33 mcg of vitamin K per 1/2 cup. However, intake needs consistency as amounts can vary.
Vegetables Lower in Vitamin K
These vegetables contain relatively lower amounts of vitamin K and may be safer options when taking Eliquis:
- Carrots
- Corn
- Mushrooms
- Eggplant
- Tomatoes
- Zucchini
- Celery
- Cucumbers
- Onions
- Peppers
- Potatoes
When preparing these vegetables, go easy on high-vitamin K oils, herbs and seasonings.
Can You Eat Salads When Taking Eliquis?
Salads offer a crunchy, refreshing way to enjoy vegetables as part of a balanced diet. However, the vitamin K content of salads can vary tremendously based on ingredients. Some tips for eating salad while taking Eliquis:
- Choose lighter lettuces like iceberg or romaine over darker greens like spinach and kale
- Top with vegetables lower in vitamin K like cucumbers, carrots, tomatoes and peppers
- Use creamy dressings sparingly
- Avoid salads with avocados, broccoli, cabbage or heavy oily dressings
- Keep portions consistent from day to day
Using caution with salad ingredients and portions can help keep vitamin K intake steady.
Tips for Managing Vitamin K with Eliquis
Here are some additional tips for balancing vitamin K in your diet while taking Eliquis:
- Monitor your intake. Keeping a food log can help you identify the main vitamin K sources in your diet.
- Opt for frozen or canned. Frozen and canned greens contain much less vitamin K than their raw counterparts.
- Go easy on oils. Oils are concentrated sources of vitamin K, so use sparingly.
- Limit herbs and seasonings. Dried herbs like parsley and basil are very high in vitamin K.
- Steam vegetables. Steaming reduces vitamin K content more than boiling.
- Avoid sudden large increases. Dramatic short-term increases in vitamin K foods can impact anticoagulant therapy.
- Read labels. Check packaged food labels as supplements and shakes may contain added vitamin K.
Being consistent and mindful with servings of vitamin K foods at meals and snacks can help you safely balance this important nutrient.
Sample Meal Plan
Here is a sample 1-day meal plan with Eliquis management in mind:
Breakfast
- 1 cup oatmeal made with water or almond milk
- 1 sliced banana
- 1 cup blueberries
Lunch
- Tuna salad sandwich made with 2 slices whole wheat bread, 1 can tuna, 1 tbsp mayo, chopped celery, pepper
- Carrot sticks
- 1 medium orange
Dinner
- 3 ounces chicken breast
- 1/2 cup boiled carrots
- 1 small baked potato
- 1 cup iceberg lettuce salad with 1 tbsp oil-based dressing
Snacks
- 1 ounce almonds
- 1 cup sliced cucumber
- 1 cup cottage cheese
This provides a variety of vitamin K-free and lower-vitamin K foods. Portion sizes and vitamin K intake are kept consistent throughout the day.
Should You Take a Vitamin K Supplement?
In certain cases, your healthcare provider may recommend a low-dose vitamin K supplement to stabilize your levels. But the decision depends on many individual factors, including:
- Why you are taking anticoagulants
- Your risk of bleeding versus clotting
- Your ability to maintain a steady vitamin K intake
- Other supplements or medications you take
- Blood work to monitor anticoagulation levels
Don’t start taking vitamin K supplements on your own while being treated with Eliquis. Always consult your doctor first to avoid unsafe interactions.
Foods to Avoid Completely
While you don’t necessarily have to cut vitamin K foods completely out of your diet, there are certain foods, beverages and supplements that should always be avoided with Eliquis:
- Alcohol – Alcohol interacts negatively with Eliquis and can increase bleeding risk.
- Grapefruit – Grapefruit inhibits the CYP3A4 enzyme used to metabolize Eliquis.
- St. John’s Wort – This herbal supplement also inhibits CYP3A4 enzymes.
- Other anticoagulants – Taking Eliquis with other blood thinners raises bleeding risks.
- NSAIDs – Drugs like aspirin, ibuprofen, and naproxen increase chances of bleeding.
Always check with your pharmacist or doctor when using any new medications, supplements or herbal products alongside Eliquis.
When to See Your Doctor
Consult your healthcare provider if you experience any unusual or prolonged bleeding while taking Eliquis, including:
- Nosebleeds lasting over 10 minutes
- Bleeding gums when brushing teeth
- Heavy menstrual bleeding
- Blood in urine or stools
- Unusually heavy bruising
- Coughing up blood
- Vomit containing blood or a coffee-ground material
Report any hits to the head, falls or other trauma. Seek emergency help for serious injuries, accidents or bleeding that won’t stop. Don’t discontinue Eliquis unless told to do so by your doctor.
The Takeaway
Monitoring your vitamin K intake from foods like leafy greens, vegetables, oils and herbs is important when taking the anticoagulant Eliquis. Avoiding sudden large changes in intake can provide balance.
Work closely with your healthcare provider for guidance on allowable vitamin K foods and appropriate portion sizes. Consistency is key for keeping anticoagulation levels regulated, so you can reduce clotting risks while staying nourished.
